Sleep and Its Disorders in Children

Timothy F. Hoban, MD


Semin Neurol. 2004;24(3) 

In This Article

Insomnia in Older Children and Adolescents

Subjectively reported sleep problems remain common during the school-age and adolescent years. In one large survey studying sleep problems affecting 5- to 12-year-old children, bedtime resistance was reported in 27%, sleep-onset delays in 11.3%, and excessive night waking in 6.5%.[39] The high frequency of insomnia in older children and adolescents is accompanied by concerningly high prevalence of daytime somnolence as well. Several surveys of school-age children have reported excessive sleepiness in 17% to 21% of subjects.[39,40] In a survey of 10- to 13-year-old early adolescents, 13% reported actually falling asleep in school at least once in the present school year.[35]

Although sleep problems such as cosleeping, night waking, and sleep-onset association disorder become less frequent in older children and adolescents, bedtime resistance remains common and insomnia becomes common as children grow older. Several important developmental influences have a direct bearing on these phenomena. First is the fact that children typically gain increasing autonomy in setting their bedtime as they grow older. This often results in later bedtimes, irregular sleep schedules, and suboptimal sleep hygiene, which often disrupt sleep onset or sleep quality. In addition, the physiological tendency toward delayed circadian phase that develops during later childhood may make it difficult for the older child or adolescent to fall asleep at the time necessary to permit sufficient sleep on school nights, with resultant complaints of nighttime insomnia and daytime tiredness.

Delayed sleep phase syndrome (DSPS) is the most common circadian disorder in adolescents,[41,42] and most adults with the condition report onset of symptoms during childhood or adolescence.[26] DSPS may be diagnosed when delayed circadian phase is sufficient to cause sustained and clinically significant impairment of daytime function in the form of oversleeping, somnolence, or disrupted sleep schedule. Youngsters with DSPS typically present with complaints of insomnia and substantially delayed sleep onset accompanied by difficulty or inability to wake at an appropriate time the following morning. DSPS is often accompanied by daytime napping, which further retards timely sleep onset at night, and by late waking on non-school days, which may act to reinforce the abnormally delayed circadian phase.[37] DSPS can be mimicked or worsened by comorbid problems such as school avoidance or voluntary participation in stimulating late-night activities.

Psychophysiological insomnia is observed less commonly in older children and adolescents than in adults. When present, the patient's insomnia is usually accompanied by identifiable rumination or performance anxiety regarding sleep. This emotional state attains sufficient duration and intensity that wakefulness is maintained for long periods following bedtime, resulting in negative sleep associations. Insufficient nighttime sleep in older children can be the result of other identifiable sleep disorders or occur as a primary problem when insufficient time is allotted for nighttime sleep. Only limited data are presently available regarding the neurobehavioral effects of insufficient sleep. Modest reductions of nighttime sleep from baseline, averaging only 30 minutes for 3 nights, was accompanied by significant declines in objective measures of neurobehavioral function in one group of elementary school children. Among a group of older adolescents, restricting sleep to 5 hours nightly for 1 week was accompanied by progressive and substantial decreases in mean sleep latency, suggesting that consistently insufficient sleep may cause a cumulative impairment of daytime alertness that may not plateau over time.[38]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: