Insomnia in children: babies, children even in puberty. Solve it with drugs, teas?

What is sleep?

Sleep is the opposite of wakefulness. It is an altered state of consciousness and motor inhibition. During sleep, heart rate, breathing, metabolism and reactivity to external stimuli slow down.

Paradoxically, in the dreaming phase (REM phase), just before awakening, these physiological functions increase.

Sleep is a periodic process of mental and physical rest and an active process of brain activity, the real reason for which is unknown even to scientists. But everyone knows that without sleep, life is impossible.

Sleep phases - circadian rhythm

Sleep consists of several phases. These phases differ from each other. They build on each other and repeat several times during the night. This process is called circadian rhythm.

Sleep phases:

1. The wakefulness phase
2. Theta sleep (5%)
3. Sigma sleep (20%)
4. Delta sleep (50%)
5. REM phase (25%)

Tip: For more on the stages of sleep and the causes of insomnia, see our article.

Sleep and sleep phases vary according to age. The phases themselves are the same, but their duration during the night varies according to age. This means that the need for sleep and the time it takes to start varies between ages.

Differences in the sleep process in children

Age affects sleep and its stages in several aspects. Differences in sleep in children are reflected in the initiation of sleep, the duration of sleep, the duration of each stage, and the frequency of waking.

The most obvious differences in sleep duration are in newborn babies. Every mother knows that babies sleep for most of this period. With age, these differences between adults and children become more uniform.

The process of sleep in babies during intrauterine development

In the fetus, the wakefulness phase is at a minimum. It sleeps most of its time in the womb. According to the latest sleep research, certain behaviors have been demonstrated as early as the beginning of the third trimester of pregnancy.

The first condition that appears during this period is active REM sleep. Outwardly, this is manifested in the fetus by multiple, subtle movements and twitches.

Resting non-REM sleep is manifested by a discontinuous EEG curve with gaps. It is an activity that persists until about the 6th week of pregnancy. After that it disappears. At about the 3rd month of pregnancy, the different sleep phases can be distinguished.

The sleep process in the neonatal period

In the neonatal period, sleep disorders are very rare, they almost do not occur.

The newborn sleeps up to 20 hours a day, is awake for 4 hours. He wakes up more often. He stays awake for a maximum of 10 minutes and falls asleep again.

Active sleep (REM phase) prevails over resting sleep (non-REM phase). In percentage terms, about 65 % of active sleep and 35 % of passive sleep. Circadian rhythm cannot yet be observed.

Sleep process in infants

During the infant period, a day and night rhythm begins to form.

The baby sleeps almost all night, with a peak between midnight and 5 a.m. Since the rhythm is not yet fully established, more frequent wakings are not uncommon, especially in the first months.

In contrast to the neonatal period, the active phase of sleep declines sharply, especially in the first three months of life. However, it is still not equal to the ratio of active to passive phases in the adult.

The sleep process in toddlers

In this period, the day and night routines are established. The baby wakes up rather sporadically at night.

The reason for waking may be illness, hunger or a wet nappy. If he is content, he sleeps through the night.

The ratio of active to passive sleep begins to stabilise and resembles that of an adult. Active sleep gradually decreases between the second and fifth year of life and eventually reaches only about 20%.

The sleep process in the preschool period

In the preschool years, the ratio of active to passive sleep is the same as in adults.

However, the active and passive phases can be accompanied by nightmares (night terrors), which are quite common during this period. This causes frequent waking and subsequent problems falling asleep.

The child finds it harder to fall asleep, forces the presence of a parent and wakes up about 3 hours after falling asleep because of bad dreams, pale, frightened, sweaty and crying. He/she is scared. Falling asleep again may take longer.

Specifics of sleep during puberty

Sleep stages are not markedly different between puberty and adulthood. However, adolescence brings with it major changes in terms of socialization.

This results in frequent bedwetting and a shift in the sleeping phase. Bedwetting causes fatigue, frequent sleeping during the day and associated concentration disorders.

Considering all the aspects of this period, it is the most problematic period of human development and sleep disorders are only part of the whole. However, its lack can cause a multiplication of behavioural disorders.

Indicative table with an approximate overview of sleep duration by age

When do you know your child has insomnia?

Unlike adults, babies, especially smaller ones, sleep deeply but with a high arousal threshold. This means that despite adequate sleep depth, all it takes is a little shuffle and there's that pitiful cry from the crib.

As can be seen from the specifics of sleep by developmental period (table above), the need for sleep and its duration decreases as age progresses. It temporarily increases again at puberty. These facts must be taken into account when diagnosing insomnia.

Insomnia in children - definition and manifestations

Insomnia is the subjective perception of inadequate sleep, either qualitatively or quantitatively, or the objective measurement of inadequate sleep with consequent difficulties during the day. A child's occasional awakenings during the night, or even prolonged falling asleep, cannot be considered insomnia.

Manifestations of insomnia:

• difficulty in initiating sleep
• frequent night waking
• abnormal nocturnal states (walking, talking, emotional instability, bedwetting)
• abnormal breathing (snoring, sleep apnoea)
• sleep paralysis
• sleepwalking
• nightmares at an atypical age
• excessive daytime sleepiness
• sleep irregularities

Comorbidities caused by insomnia:

• reduced physical activity
• exhaustion, fatigue, daytime sleepiness
• disturbances in concentration, memory and learning
• reduced reaction time and decision-making
• nervousness, irritability
• restlessness, tearfulness, anxiety, emotional instability
• increased impulsivity
• aggressiveness, other behavioural disorders
• signs of bipolar disorder
• paradoxically, hyperactivity in children
• eating disorders, weight loss
• pallor in the face, circles under the eyes

A baby who cannot yet speak expresses all his needs by restlessness and crying. Being tearful does not necessarily mean a big problem. Crying is an expression of hunger, pain, a medical condition, a feeling of discomfort (cold, heat, pressure, wet diaper, uncomfortable place, alarm that he wants to be held, etc.).

Later in life, he tries to achieve his goal by crying and protesting, even if he has no objective difficulties. This is merely a targeted manipulation of the parents.

Children often cry during periods of separation anxiety. This is a developmental period of the child and forms a separate chapter.

The main causes and solutions to your baby's insomnia

Insomnia in children and adolescents is not uncommon. The prevalence of this sleep disorder is about 30% of the total pediatric population. Some studies even reveal much higher numbers, up to 50%.

The thorny road to undisturbed sleep: will sleeping pills alone really help?

The correct diagnosis of a sleep disorder, with the cooperation of the family, is a positive prerequisite for the successful management and subsequent treatment of insomnia in the child. No complex procedures are required for diagnosis. A history and observation over a period of time are usually sufficient. An electroencephalogram is only indicated for serious and chronic conditions that cause serious problems for the baby during waking hours.

Addressing the causes of waking in children:

1. Parental education - Often the problem is the anxious and overprotective parent and not the child.
2. Learned associations and good habits - A baby may wake up if, for example, he is used to falling asleep on his hands and is currently in the crib. Also, the habit of falling asleep with the parent may be the cause of long periods of falling asleep and waking up.
3. Proper nutrition - Children are often woken up by hunger or, on the contrary, overeating, poor burping.
4. Proper climate - Overdressed baby, underdressed baby.
5. Proper hygiene habits - A common problem is a full diaper.
6. Good health - Insomnia causes pain or illness.
7. Family stability, emotional background - An unstable and disrupted family affects the baby's emotional development, where insomnia may not be the ultimate problem.
8. Elimination of distractions - Sounds, lights, vibrations, etc.

Addressing insomnia in children:

1. Eliminating the cause of insomnia (pain, climate, fear).
2. Removing the organic cause of insomnia
3. elimination of the developing psychological illness
4. the right and loving attitude of the parents (patience plays a big role in solving the problem in the long term)
5. psychotherapeutic procedures (regime adjustment, sleep hygiene)
6. hypnotics (preferred in adults, almost never used in children)

Important: Non-pharmacological methods of dealing with insomnia are preferable to drug therapy, preferably in younger children, but also in adults! Hypnotics are used only minimally and for short periods of time. This is usually due to other serious illnesses that cause insomnia.