Assessing and managing chronic insomnia in the healthy pre-adolescent child

Abstract

Insomnia (difficulty falling asleep or staying asleep) is reported by parents of 20-30% of children in the developed world [1,2,3,4]. Reliable data from developing countries is lacking, but adult data suggests that insomnia is a global phenomenon [5]. Children born in the new millennium are likely to have around 70 minutes less total sleep time than generations born 100 years ago [6]. This is a public health concern as short sleep is associated with multiple adverse outcomes [7-18] (Figure 1) and sleep problems in early childhood may constrain brain development. In a population based prospective cohort study, parent report of sleep problems after 2 years of age predicted reduced grey matter volume at 7 years in 720 Dutch children [19]. Importantly, childhood insomnia can have an erosive effect on parents. Only one week of sleep disruption produces measurable changes in mood, emotional regulation and decision making in adults [20,21]. Many parents experience months or years of sleep loss before seeking help.

Despite the importance of sleep to children, general practitioners rarely ask about sleep [22], perhaps reflecting limited undergraduate education in sleep medicine [23]. Presenting sleep problems could be caused by over 50 different sleep disorders in six recognised categories as defined by the International Classification of Sleep Disorders [24]. Text box 1. This article offers a toolkit for the generalist to manage the commonest childhood sleep disorder, chronic insomnia.

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Identifiers

ORCID for Catherine Hill: orcid.org/0000-0003-2372-5904

ORCID for Hazel Everitt: orcid.org/0000-0001-7362-8403

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