DESCRIPTION

• Sufficient sleep is essential for mental and physical health and development.
• Symptoms of inadequate sleep:
  • Daytime sleepiness
  • Irritability
  • Behavior problems
  • Learning difficulty, poor academic performance
• Interventions can improve sleep and cognitive functioning.

EPIDEMIOLOGY

• Prevalence: up to 1 in 2 children experience a sleep problem; significant in 20–30% of children
• Common in children with medical, neurodevelopmental, or psychiatric disorders

PATHOPHYSIOLOGY

• Non–rapid eye movement (REM) sleep predominates during first 1/3 of night; potential disorders include sleep walking, sleep/night terrors, and confusional arousals.
• REM sleep is notable for a marked decrease in muscle tone and REMs. Potential manifestations or disorders of REM sleep phenomenon include nightmares, REM sleep behavior disorder, sleep paralysis, and narcolepsy.
• When patients present with excessive daytime sleepiness, potential etiologies include the following:
  • Insufficient sleep
    • Insomnia
    • Inadequate sleep hygiene
    • Circadian rhythm disorders (delayed sleep phase syndrome, non-24 hour sleep–wake schedule, sleep entrainment difficulties)
  • Fragmented sleep
    • Sleep-onset association disorder
    • Respiratory related disorders
    • Movement disorders (periodic limb movement disorder, restless leg syndrome [RLS])
    • Parasomnias (disorders of arousal)
    • Other medical etiologies (asthma, gastroesophageal reflux disease [GERD], pain, seizures)
    • Environmental noise, light, cosleeping
  • Increased need for sleep:
    • Narcolepsy
    • Idiopathic hypersomnia
    • Hypothalamic lesions
    • Depression
    • Klein-Levine syndrome: hypersomnia, hyperphagia, hypersexuality, typically in adolescent males (70% of cases); cyclical symptoms with spontaneous remission
    • Head injury

RISK FACTORS

For some parasomnias, familial history increases risk.

GENERAL PREVENTION

• Regular sleep–wake routines
• Application of good sleep hygiene practices