Behavioral Causes of Insomnia in Children

Insomnia is the inability to fall or stay asleep or experiencing sleep that is not restorative. The causes of insomnia in children may overlap with those for insomnia in adults, but there are also some unique conditions that may predispose your child to difficulty sleeping.

Sleep issues are one of the most common frustrations of new parents. Taking preventive measures focused on sleep routines and the sleep environment can be very helpful. Many books have been written about this, the most famous probably Dr. Ferber's Solve Your Child's Sleep Problems.

Perhaps the most common and frustrating of the causes of insomnia are difficulties related to your child’s behavior. Babies and toddlers may enjoy being comforted as they transition to sleep, but if they awaken and you are not there, this can be a source of great distress. This may result in frequent tearful tantrums in the middle of the night. This sleep-onset behavioral insomnia can be remedied by letting your child fall asleep alone.

Another potential problem is toddlers and young children who refuse to go to bed. They will insist on a litany of needs prior to going to sleep: a drink of water, a trip to the bathroom, another bedtime story, a few more minutes with the light on, and the list goes on. This limit-setting insomnia is overcome by setting appropriate boundaries and asserting parental authority.

Moreover, children need to have a set of healthy sleep habits and a bedtime routine that will ensure a smooth transition to sleep. This includes appropriate sleep hygiene, which eliminates disruptions to sleep and makes the period of time just prior to falling asleep a time of relaxation. In addition, many distractions should be eliminated from the bedroom to ensure an appropriate sleep environment.

There are a number of medical problems—including neurologic and psychiatric conditions—that may lead to insomnia in children. In general, these are rare disorders and other signs would exist beyond insomnia. Some of these possible disorders include:

• Depression
• Post-traumatic stress disorder (PTSD)
• Attention deficit hyperactivity disorder (ADHD)
• Autism
• Asperger syndrome

In addition, some children (especially teenagers) may have circadian rhythm disorders such as delayed sleep phase syndrome that result in insomnia. These conditions lead to difficulties falling asleep at night and a desire to oversleep in the morning. This occurs because the desired sleep phase is shifted later than is standard. This may interfere with school performance and some school districts are actually shifting the start times to allow teens to sleep in. The use of phototherapy and melatonin may also help to shift these troublesome sleep patterns.

Aside from the causes described above, there are a few other possible situations that may result in insomnia in children. Some children may experience insomnia as the result of medication use, especially the use of stimulants in ADHD. Finally, precocious children (those who are intellectually gifted) often have insomnia.

If your child is having difficulty falling asleep, and simple changes to address behavioral causes are ineffective, you may want to speak to your pediatrician about exploring other possibilities to improve your child’s sleep.