Paediatric Sleep Disorders: Insomnia & Parasomnias

In the recently revised Sleep Medicine Textbook 2nd Edition, the topic of paediatric sleep disorders is addressed in its own dedicated section. In part 1 of a 3-part series, we’ll feature the textbook summaries of two paediatric sleep disorders: insomnia and parasomnias. 

Insomnia in Children 

“Insomnia in children is highly prevalent, can compromise the quality of life of children and families, and is associated with poorer developmental outcomes, being overweight and behavioural disturbances. Assessment of paediatric insomnia should follow a medical approach and examine primary and secondary contributing factors, and maladaptive behaviours related to sleep.  

Clinicians should incorporate questions about sleep into their routine health assessments of children, examining the sleep/wake schedule, abnormal behaviour during sleep, and daytime consequences of sleep deprivation. Sleeping environment and bedtime routines should be examined to identify behavioural issues related to sleep. Diagnosis is based on clinical history, and polysomnography is not routinely indicated for children with insomnia, but actigraphy can give an estimation of objective sleep parameters.  

Without appropriate treatment, insomnia can become chronic and last for many years. There are no approved sleep medications by the United States Food and Drug Administration or by the European Medical Agency for paediatric insomnia, and most medications are prescribed off label. Recently, one medication (paediatric prolonged-release melatonin) has been approved for insomnia in children with neurodevelopmental disabilities by the European Medical Agency.  

The authors highlight and summarize the most common treatment for paediatric insomnia, including sleep hygiene, behavioural strategies and pharmacological treatment. The choice of treatment should be individualized on the basis of multiple factors, including severity and type of sleep problem, genetic and environmental factors. For pharmacological treatment, generic recommendations have been formulated for different compounds. In addition, suggestions on the use of supplements might help in the correct treatment approach.” 

Summary by:
Oliviero Bruni (2021). I. Paediatric Sleep Disorders 1. Chronic Insomnia. In Bassetti, C., McNicholas, W., Paunio, T., & Peigneux, P. (Eds.). Sleep Medicine Textbook (2nd ed., pp. 647-663). Regensburg: European Sleep Research Society.   

Specific features of Parasomnias 

“Non-rapid eye movement parasomnias (especially disorder of arousals) represent a frequent sleep disorder in children. They are usually considered benign phenomena that disappear during adulthood. A strong familial occurrence has often been reported, and disorder of arousals seems to be more frequent in children with epilepsy, attention-deficit hyperactivity disorder, and neurodevelopmental disorders.  

Disorder of arousals can be triggered by sleep deprivation and other sleep disorders, especially sleep apnoea. The diagnosis of disorder of arousals in children is mainly clinical. Video-polysomnography is recommended in atypical cases, or in case of suspicion for sleep-disordered breathing or periodic limb movement disorder.  

Rapid eye movement sleep behaviour disorder is a very infrequent phenomenon in children, usually secondary to other sleep or neuropsychiatry disorders, or represents a side effect of pharmacological agents. In particular, rapid eye movement sleep behaviour disorder in children can represent a manifestation of narcolepsy, and it has been hypothesized to be related to a hypocretin loss.  

Amongst “other parasomnia,” primary sleep enuresis represents the most common disorder in children, with a strong familial occurrence. It can be related to a decreased nocturnal bladder storage ability, an excess urine production during the night and an inability to wake up.” 

Summary by:
Paola Proserpio (2021). I. Paediatric Sleep Disorders 2. Specific features of parasomnias. In Bassetti, C., McNicholas, W., Paunio, T., & Peigneux, P. (Eds.). Sleep Medicine Textbook (2nd ed., pp. 665-671). Regensburg: European Sleep Research Society. 

To dive even further into this topic, we invite you to purchase your very own copy of the Sleep Medicine Textbook 2nd Edition, now available in print and digital versions.