Sleep Disorders in Childhood


There are a number of theories regarding the purpose of sleep.  “Sleep may provide a period of restoration in which deficits in somatic and central nervous system tissues are repaired.”  (Netherton, Holmes, & Walker, 1999, p. 415)  What I question is… wouldn’t we be able to detect that process (cellular creation/division)?

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It has been suggested that sleep facilitates information processing and memory consolidation.  This, too, seems plausible given the effects of sleep deprivation.  “Fatigue, excessive sleepiness, decreased attention, decline in perceptual, cognitive, and psychomotor capabilities and performance, regressive behavior, and disoriented though may result from prolonged sleep deprivation.  (Netherton et al., 1999, p. 415)

The “cycle of sleep” is a concept I found helpful to be able to conceptualize the process that takes place during sleep.

“While psychopathology is often comorbid with sleep disorders in adults, it is rarely so in children.”  (Netherton et al., 1999, p. 420)  NHW throws this out as a fact, but they don’t really give a reason why that is the case?

With regard to assessment, I very much approve of the use of sleep diaries as an effective way to document the course of events in a sleep-wake cycle.  We currently employ this tool with a couple clients of mine with a great deal of success.  One individual, in particular, had to take “the long way around” (which was particularly hard for the night staff I might add) but eventually we got them on a schedule that was amiable for all.

“Treatment of sleep disorders is designed to address both the symptoms and the causal factors of the disturbance; therefore, it is essential to cast a broad net in assessment to identify the likely etiology of a sleep disruption.”  (Netherton et al., 1999, p. 420)  I’m not sure it can be said better than that, great piece of writing in my opinion.

With insomnia, you sleep too little… with hypersomnia, you sleep too much.  Just FYI.

With regard to treatment, it would appear that the first and most important step is to regulate sleep hygiene.  This means we set and enforce a bedtime routine, and we foster the development of an environment that is conducive to sleep.  Eating and drinking (especially liquids that contain caffeine) should be limited close to bedtime.  (Netherton et al., 1999, p. 428)  We should assess all medications and determine if any possess stimulant qualities.  A “bedtime ritual” should be established and adhered to, including grooming and personal hygiene, flossing and brushing teeth, and using the bathroom.  Although this may be the case for some people, I personally disagree with the concept that bathing is a stimulant.  Personally, I have difficulty sleeping if I don’t bathe at night… it’s relaxing.  Matter of fact, sitting in the hot tub on a cold winter night is the sure fire way to make sure I get a great night of sleep.

I was also particularly interested in the relaxation training suggestion.  One method in particular that I was taught as a child, and that I endorse, is conceptualizing first that your lower extremities (starting with your feet) are “falling asleep.”  I progressively work my way “up” until I reach my head.  Usually, but the time I get to my arms, I am out like a light.  Mileage may vary, but it is one relaxation technique that worked for me as a kid.

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Reference

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

4 thoughts on “Sleep Disorders in Childhood

  1. delayed2sleep

    Thanks for the book review. As to “While psychopathology is often comorbid with sleep disorders in adults, it is rarely so in children,” I have my wonders. Children are depressed and children have ADHD; might many of these diagnoses disappear for individuals if their sleep disorders were properly addressed? I think so (and so does my sleep specialist).

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  2. Kent Brooks Post author

    I think they are more addressing prevalence over the entire population… my concerns were more over the lack of a citation or “proof” than anything else. I believe your absolutely right d2s… in cases where sleep disorders are comorbid with other Axis I disorders, most behaviorists would likely begin by addressing the behavior (not the underlying cause). Personally, I wouldn’t underestimate the possibility of the comorbid sleep disorders being bidirectional in nature. If you talk to a sleep specialist, he cite evidence that lack of sleep can cause depression. If you talk to a clinical counselor, they can cite evidence that depression can cause lack of sleep. I am more holistic in my approach… I am less concerned with the direction of the cause than I am solving the problem. While I certainly wouldn’t neglect to implement some of the sleep hygiene suggestions (which are certainly behaviorist in their positioning) I would also look “deeper” into the unconscious and identify residual issues that are causing issues with the entire sleep system. For example, if we were to identify a history of sexual abuse or trauma, and we identify that as the source of depression… the bedtime ritual may actually be reinforcing the nightmares (if, for example, the event happened shortly after the bedtime ritual… and the bedtime ritual is subjectively associated with the period immediately preceding the trauma). Especially in children, there is an increasing body of evidence that suggests that young children”generalize” ideas. (they may come to associate danger any number of harmless objects… like a toothbrush) As we grow we may not be able to rationalize the association between the object or ritual and a specific traumatic event in our past, but a sleep specialist of behaviorist bent (like the one described above in NHW) is probably ill equipped to deal with a sleep problem seated in childhood associations (for example).

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  3. delayed2sleep

    Thanks for response and interesting thoughts! I agree with “Personally, I wouldn’t underestimate the possibility of the comorbid sleep disorders being bidirectional in nature,” and I think that this attitude is gaining. The British Association for Psychopharmacology and others have recently started referring to comorbid sleep disorders, rather than secondary sleep disorders. And the disorders can be quite physical, also in children, such as apnea and circadian rhythm disorders, where sleep hygiene is of little help. Inadequate sleep may cause depression and tiredness in children, but is probably more likely to cause ADHD-like symptoms.

    Reply
  4. Kent Brooks Post author

    Absolutely, thank you for visiting the site. I really appreciate your commentary on the sleep aspect… I will admit wholeheartedly… you are certainly qualified to call yourself a “sleep specialist” based on the quality of the articles you are producing on http://delayed2sleep.wordpress.com/ I am no sleep specialist, but I have to acknowledge that sleep is a very real issue that too often compounds and amplifies other mental disorders. Your contributions are both timely and welcome.

    The recent elevation of sleep disorders from syndromes to disorders speaks to the attention sleep DESERVES.

    The Western Medical Model has gone to great lengths to differentiate the mind from the body, but I am of the belief the demarcation between mind and body is much more difficult to differentiate that they would have us believe.

    Do you have any insight to add on this?

    http://try-therapy.com/2010/09/20/sleep/

    Reply

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