Insomnia

Insomnia is when a person has trouble falling asleep or staying asleep, this includes waking too early in the morning. It is one of the most common sleep complaints made by adults, but is much less common in children and adolescents. Insomnia can be a short-term problem, usually because of a stressful event, or it can be long-lasting (chronic).

Many times, insomnia is a symptom of another sleep disorder. Just like pain can be a symptom of many things, problems with falling asleep or staying asleep may be the result of another sleep disorder or other problem (like anxiety). When the insomnia is not related to another sleep trouble, a psychiatric or medical problem, it is called primary insomnia.

Primary insomnia is almost always caused by (a) poor sleep habits, such as spending too much time in bed, napping during the day, or not going to bed and waking up at the same time every day and (b) negative thoughts about sleep, such as “I’ll never be able to fall asleep tonight.”

A child or adolescent with insomnia may have these symptoms:

• Sleep problems. A child or adolescent with insomnia has difficulty falling asleep or staying asleep, or may wake too early in the morning.
• Behaviors that interfere with sleep. These may include worrying during the day about falling asleep at night and trying too hard to fall asleep. (Adolescents with insomnia usually can fall asleep at other times, such as while watching television).
• Tension about sleep. A child or adolescent with insomnia is usually tense about going to bed and about being able to sleep.
• Daytime problems. A child or adolescent with insomnia may complain about having difficulty functioning during the day, is often tired, and may be moody or irritable.

There is no definitive test for insomnia, so a diagnosis is made based on the description of symptoms. A medical history should also be done to exclude other problems, such as another sleep disorder, a medical problem, or a psychiatric problem.

Treatment of insomnia, because it is a learned habit, requires effort and patience. Treatment can involve:

• Sleep hygiene. Good sleep habits are essential for children and adolescents with insomnia. These habits should include a regular sleep schedule that involves going to bed and waking up at the same time every day; avoiding caffeine, tobacco and other drugs; sleeping in a room that is cool, quiet and comfortable. Establish a bedtime routine that is calm and sleep inducing; and avoid all stimulating activities at or close to bedtime, such as computer games, television and cell phones.
• Relaxation. Teaching a child or adolescent relaxation strategies, such as deep breathing, positive imagery (like being on a beach), or meditation, can help them relax at bedtime. It will also give them something pleasant to think about while lying in bed.
• Change thoughts about sleep. Since most children or adolescents with insomnia have negative thoughts about sleep, such thoughts should be replaced by positive ones. For example, rather than saying “I won’t be able to sleep tonight,” it is better to think, “Tonight I’ll just relax and rest at bedtime.”
• Don’t be a clock watcher. Remove any clocks from the bedroom, as watching a clock during the night may feed your child’s anxiety, making it harder for them to fall asleep.
• Restrict the time in bed. Set bedtime so that the time in bed is equal to the usual amount of sleep each night, such as 7 or 8 hours. Being extra sleepy will help a child or adolescent to fall asleep right away and stay asleep. Once that happens, bedtime can be moved earlier by 15 minutes every few nights until the desired bedtime is reached.
• Get out of bed. Rather than lying in bed tossing and turning, it’s better to get out of bed and do another activity, which will help prevent the bedroom from being associated with sleeplessness. After 20 minutes of trying to fall asleep, get out of bed for 20 minutes and do something relaxing (such as reading, not watching television!). Then try again, repeating the 20 minutes in bed, 20 minutes out of bed cycle.
• Medicines. Medicines are usually not recommended for the treatment of insomnia in children and adolescents.
• Cognitive Behavioral Therapy for Insomnia or CBT-I. CBT-I is a process of slowly changing your thoughts and behavior patterns around sleep. It’s done through a series of visits about 2 weeks apart along with careful tracking of sleep. It has been shown to be very helpful for children older than 10 years old. One-on-one CBT-I is offered at Seattle Children’s sleep clinic, as well as by many counselors or therapists in the community. There are also apps that can be downloaded that will help take you or your child through the general process.