Children's Sleep Disorders Tied To Psychiatric Disorders

Growing recognition over the past two decades that primary sleep disorders may harm children's neurocognitive, behavioral, and affective development has fostered the emergence of pediatric sleep medicine as a distinct clinical specialty, Anna Ivanenko, M.D., Ph.D., told Psychiatric News.

About one-quarter of parents of 4- to 12-year-olds report that their children have clinically significant difficulty sleeping, said Ivanenko, who directs the pediatric sleep program at Central DuPage Hospital in Chicago. She is an assistant professor of clinical psychiatry and behavioral sciences at Northwestern University School of Medicine (see Questionnaire Helps Identify Children's Sleep Disorders).

Parents describe problems such as bedtime resistance, bedtime anxiety, delayed sleep onset, nighttime awakenings, nightmares, night terrors, sleepwalking, snoring, enuresis, early morning awakenings, and excessive daytime sleepiness.

Sleep disorders may mimic or worsen psychiatric disorders, Ivanenko noted. Irritability, apathy, and other symptoms suggesting a mood disorder in an adolescent, for example, may reflect chronic sleep deprivation associated with early school start times. What appears to be attention deficit/hyperactivity disorder or learning difficulty in an elementary school child may result from a sleep-related breathing disorder. Successful treatment of the sleep disorder may ease or end psychiatric symptoms.

Ivanenko is the editor of the new book Sleep and Psychiatric Disorders in Children and Adolescents (Informa Healthcare), which explores such issues in depth. Topics covered in the book's 28 chapters by 57 contributors include current pharmacological and nonpharmacological treatment for sleep disorders in children, assessment of sleep problems in schools or private practice, sleep problems in children with mood and anxiety disorders, and sleep and substance abuse in adolescents.

“It is important for child psychiatrists to assess sleep in every child,” she said, “and to watch for possible adverse effects of psychiatric medications on sleep and daytime alertness.”