Which clinical history findings are characteristic of pediatric sleep disorders related to another mental disorder?

Updated: Oct 09, 2018
  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Insomnia related to another mental disorder is common (35–50%) among individuals who present to sleep disorder facilities for evaluation of chronic insomnia. In young children, separation anxiety, stress, and trauma may result in nighttime awakening, nightmares, or resistance to going to bed. Sleep disruption is usually part of the diagnostic criteria for a psychiatric disorder.

Patients who have major depressive disorder or dysthymic disorder often report difficulty in falling asleep or staying asleep or early morning awakening with inability to return to sleep. Hypersomnia can be a feature of depression, especially major depression with atypical features. Children and adolescents with major depressive disorder generally present with less subjective sleep disturbance and fewer PSG changes than do older adults with a similar degree of depression.

Prepubertal children with depression are more likely to experience insomnia (75%) than hypersomnia (25%); after puberty, hypersomnia predominates. Hypersomnia is a common feature of depressive disorders in adolescents and young adults. Insomnia is more common in older adults.

Individuals with generalized anxiety disorder and posttraumatic stress disorder report difficulty in falling asleep and may awaken with anxious thoughts in the middle of the night. Panic attacks can arouse patients and cause insomnia. Significant insomnia is observed during exacerbations of schizophrenia and other psychotic disorders but rarely is a predominant symptom. Children with psychotic symptoms may be too afraid to get out of bed to use the bathroom and therefore present with secondary enuresis. Other mental disorders that may be related to insomnia include adjustment disorders, somatoform disorders, and personality disorders.

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