Sleep disorders

By the psychological counsellor Nermeen Al-Taweel. Sleep disorders mean the difficulties and obstacles that lead to a lack of sleep in children or to a disturbance in its pattern, and they either appear at the start of sleep or during it. The most important sleep disorders in childhood and adolescence are: 1. Insomnia: insomnia is one of the most common sleep disorders and may take one of three forms: either difficulty in falling asleep, or difficulty in remaining asleep or continuing to sleep, as when the child sleeps for a period then wakes and goes back to sleep again, or staying up late and waking early. It appears in the child's unwillingness to sleep at night and his remaining active and awake and resisting going to bed unless his mother sits beside him. Children suffering from insomnia show rapid irritability and quick temper, clear anxiety, intense tension, difficulty concentrating and frequent crying. 2. Excessive sleep: this means an increase in the number of hours of sleep above the normal rate for the child, and consists of a prevailing complaint of excessive sleep for at least a month. Excessive sleep is not properly assessed during periods of insomnia and does not occur on its own during another sleep disorder such as narcolepsy, daytime sleeping, breathing-related sleep disorder, sleep rhythm disorder or parasomnia. 3. Narcolepsy and daytime sleeping: this is a bout of sleep that comes over the patient suddenly and which he cannot resist, and it happens at any time, particularly in circumstances conducive to sleep such as quiet. It may occur at the most awkward moments, such as while eating or while riding a bicycle or in a car, and this state continues for a few seconds and may extend to a minute or a few minutes, after which the patient comes round. 4. Nightmares: the child wakes frightened and terrified because of a frightening and disturbing dream in which he feels helpless and weak and feels he is about to suffocate, which leads to waking and the interruption of sleep when the fear reaches its peak, with an increase in heartbeat and rapid breathing. On waking from the disturbing dream, the person becomes alert and oriented quickly, and the nightmare leads to difficulty in sleeping and waking. 5. Night terrors: repeated episodes of sudden waking from sleep, usually occurring during the first third of the night, beginning with a terrified scream and acute fear and signs of spontaneous arousal accompanied by a rapid heartbeat, rapid breathing and sweating. The child cannot recall any details of the dream and loses the memory. The difference between a nightmare and a night terror: A nightmare is a frightening experience during sleep, after which the child wakes and regains correct orientation and clear awareness, whereas a night terror is a frightening experience occurring between sleep and waking, after which the child does not wake fully. In a nightmare, waking is preceded by slight sounds and defensive movements, whereas in a night terror the child's features become distorted, his eyes widen, he rises from his bed and jumps from it in a state of agitation, or runs in terror. In a nightmare the child is fully awake, and once he has calmed down he can recount the dream he saw, whereas in a night terror the child is asleep and so is unable to give an explanation of his state and the parents fail to calm him. In a nightmare the child recognises everyone around him, whereas in a night terror he does not recognise those around him but reckons them part of what he saw in the dream. In a nightmare hallucinations never occur, whereas in a night terror the child sees the frightening things from the dream present before him in the room. A nightmare episode does not last more than a minute or two, whereas a night terror continues for a period of 15 to 20 minutes. 6. Sleepwalking: this sleep disorder consists in rising from sleep while asleep and walking, and it usually occurs during the first third of the night. While walking in his sleep the child is in a state of mental blankness and does not remember anything of what happened after he wakes. Causes of sleep disorders: a. Sleep disorders may be due to physical causes such as hunger, excessive fullness, pain caused by certain foods, the pain of illness, and wet bedding and clothes. b. Sleep disorders may be due to the parents' mistakes with the child in sleep situations: • Making sleep a punishment for the child for a mistake he has committed. • Telling frightening stories or reading them to the child, or watching disturbing films. • Allowing the child to sleep in his parents' bed. • The child imitating adults staying up late, so that he believes staying up is what adults do, and so he stays up at night, resists sleep and refuses to go to bed. • Frightening the child before sleep with ghosts, demons and animals, so that the child goes to sleep afraid. c. Sleep disorders may be due to the parents' mistakes in raising the child: • Excessive pampering, which makes the child attached to his mother and unable to bear being away from her. • The parents' excessive ambitions for the child and their demand that he obtain top marks in exams, so that he feels frustration and worry, which keeps him awake and leads to a sleep disorder. • Excessive harshness from parents or teachers makes the child feel rejected and insecure, which makes him worried, anxious and tense, so his sleep is disturbed and he suffers insomnia, nightmares and night terrors. • The parents' excessive compliance with the demands the child makes of them in order to attract their attention, which causes him insomnia. • Disagreement between the parents and constant quarrels between them in front of the child, which makes the child anxious, apprehensive and fearful for his parents or for one of them. d. Sleep disorders may be due to psychological and social pressures the child is exposed to, such as failure in exams, watching frightening programmes on television, hearing a disturbing story, the death of a loved one, the parents' separation, one of them going into hospital, the arrival of a new sibling, or the loss of something the child loves. e. Sleep disorders may be due to emotional disturbances and psychological illnesses. Psychological treatment of sleep disorders: treatment relies first on giving the child insight into his problem and its causes, resolving his conflicts, facing his fears by direct methods, and making him feel contentment and acceptance. Helping the child to release his feelings by using the technique of emotional release. Using behavioural treatment by means of reward and reinforcement when the child succeeds in sleeping properly. Family treatment: this includes improving the parents' relationship with the child and improving the ways they treat the child in sleep situations, giving them insight into the appropriate methods and how to apply them in treating their child's problems. They must also be given insight into the ways of developing sound sleep habits for the child: • The child should have a regular bedtime. • Not using sleep as a punishment. • Organising the child's time by setting an ordered programme for hours of sleep and waking. • Not using sleep as a punishment for the child, and providing conditions conducive to sleep, such as quiet and dim light.