“The initial response (and second and even third) to the question “Should I give my child (should my teenager take) something to help her sleep?” is NO (no, no). There are lots of very good reasons not to, chief among them is that there are no prescription or over-the-counter medications that have been approved for use in the United States for children or adolescents who have difficulty falling asleep or staying asleep. Which basically means that the federal government agencies-that-be (such as the FDA) have concluded that we don’t have enough information about either the benefits or the risks of any sleep medications in children to make them a safe bet. And the majority of the time, medication is not the best (or even the second or third best) treatment choice.”
—Judy Owens, MD, M.P.H. Take Charge of Your Child’s Sleep. The All-in-One Resource for Solving Sleep Problems in Kids and Teens
The Sleep Guy’s Take: It is important to remember that insomnia is a symptom.
Insomnia may best be viewed as a “symptom” rather than a disease process. Often, it accompanies another cause or disorder. Kryger, Principles and Practice of Sleep Medicine.
Parallel Point: Fever is a symptom. People don’t have a fever disorder, rather they have a fever for a reason such as influenza or an infected tooth abscess… and those are treated in a different manner. Tylenol may allow for comfort during the fever, but to give it daily with the expectation that it will treat the underlying infection is not a reasonable expectation.
It is important to look for the identity of source of insomnia. There are times that sleep studies are indicated to make sure that there is not a sleep apnea, periodic leg movement disorder, or narcolepsy (examples) as the cause of the symptom of difficulty sleeping through the night.
Many times we find that the cause of the symptom of insomnia is a hypervigilant mind.
Neurological research suggests that brain “hyperarousal” is associated with insomnia. (Sleep in America; 1995. Princeton, NJ: The Gallup Organization, 1995) The way I like to explain this is by comparing “brain rhythms” with heart rates. That is, just as we have a heart rate, we also have brain rhythms that influence brain arousal. As we rest, our heart rate generally slows, as does our brain rhythms as we get drowsy. Emotions such as fear, anger, and anxiety cause your heart rate to speed up. And likewise, those same emotions (anxiety, hyperactivity, agitation) increase the level of our brain arousal.
Most common causes of a hypervigilant mind is ADHD and Anxiety, both can lead to Agitation. This goes back to my theory of Caveman Insomnia.
Note: That is not to say there is no room for medications. However appropriate medical therapy can be geared towards the underlying medical etiology. For example, medical treatment of symptoms of anxiety, hyperactivity, or aggression through FDA approved medications can help reduce either the state of hyperarousal that contributes to sleep avoiding behavior. But it should not be viewed as a “sleep med” as that is not what they are approved for.
In younger kids and children with special needs this can lead to Sleep Avoiding Behavior and Behavioral Insomnia of Childhood.
In teenagers and high achieving younger kids this can lead to early Psychophysiological Insomnia. Here it is important to learn that calming the heart calms the mind. I have found mindfulness (and other forms of Relaxation Therapy) to be especially helpful for this group.
In particularly Anxious children I’ve found Progressive Muscle Relaxation and Neurofeedback to be especially helpful.
Whereas an Adult may benefit from Cognitive Behavioral Therapy for Insomnia (CBT-I), this is not as well studied in children. Adults benefit from concepts of Sleep Hygiene, Sleep Restriction, and Stimulus Control in Nonpharmacologic / Behavioral approaches to insomnia.
Children benefit from concepts of Behavior therapy applied to parent training for Behavioral Insomnia of Childhood of Sleep Onset Association and/or Limit-Setting Types in Nonpharmacologic / Behavioral approaches to insomnia. (Beh Sleep Med. 2010 8:172-189)
Additionally, Children need to learn Self-Regulation skills equally as they need to learn Limit Setting and Consequences.
To cultivate the Self-Regulation skills consider Play Therapy through a registered therapist from the Association for Play Therapy (A4PT) or through Clinical Self-Hypnosis through a registered professional through National Pediatric Hypnosis Training Institute (NPHTI) or the American Society of Clinical Hypnosis (ASCH).
To learn about Limit Setting and Consequences I would advise an evaluation by a licensed child psychologist. Younger children and special needs kids may additionally need Applied Behavioral Analysis (ABA) Therapy.
For self-help through books:
A book/method that I’ve found parents to find easy to follow is 1-2-3 Magic by Dr. Thomas Phelan Ph.D www.parentmagic.com for non-medication approach to behavior modification and parental limit setting.
A book that is sleep specific that is comprehensive with many suggestions Take Charge of Your Child’s Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and Teens. By Judith Owens M.D., MPH
A future post on Self-Regulation in Children is to come! Nutrition also plays a HUGE role in sleep. A future post on sleep and nutrition is also yet to come. So stay tuned to Paradise Sleep!