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Insomnia

Summary

Insomnia is a common sleep disorder that affects the ability to fall asleep, stay asleep, or get restful sleep. It can cause daytime fatigue, irritability, difficulty concentrating, and mood changes.

Children and adolescents may struggle with insomnia due to stress, anxiety, irregular sleep routines, or underlying medical conditions. Identifying the cause is essential for effective management. 

Diagnosis and When to Seek Help

Insomnia is typically diagnosed through a detailed discussion of sleep habits, routines, and any difficulties falling or staying asleep. A sleep diary or wearable sleep tracker may help assess sleep patterns.

Parents should consult a doctor if their child:

  • Struggles to fall asleep or wakes frequently at night for more than three nights a week.
  • Feels tired, irritable, or has difficulty focusing during the day.
  • Experiences anxiety, depression, or behavioral issues linked to poor sleep.
  • Has a known medical condition (e.g., asthma, ADHD) that might affect sleep. 

Management

Treatment depends on the cause and severity of insomnia. The first-line approach is improving sleep habits and using behavioral techniques:

  • Establish a Consistent Sleep Routine: Encourage a regular bedtime and wake-up time, even on weekends.
  • Limit Screen Time Before Bed: Blue light from screens can interfere with melatonin production, making it harder to fall asleep.
  • Create a Calm Sleep Environment: Ensure a quiet, dark, and comfortable room. Avoid caffeine and heavy meals before bedtime.
  • Encourage Relaxation Techniques: Reading, deep breathing, or guided meditation can help ease anxiety before bed.

For chronic or severe insomnia, cognitive behavioral therapy for insomnia (CBT-I) is the most effective treatment. In some cases, melatonin supplements or medication may be considered under medical supervision. 

Follow-Up and Monitoring

  • Keep a sleep diary to track progress.
  • Reassess sleep routines regularly and adjust as needed.
  • Seek professional help if insomnia persists despite lifestyle changes.

With proper management, most children and adolescents can overcome insomnia and develop healthy sleep habits. 

History and Exam

Key diagnostic factor

  • Presence of risk factors
  • Sleep partner complaints
  • Delayed sleep onset
  • Multiple or long awakenings

Other diagnostic factors

  • Impairment of functioning
  • Accidents
  • Decreased sleep time
  • Daytime napping

Risk factors

  • Female sex
  • Advanced age
  • Chronic medical conditions
  • Chronic pain

Diagnostic Investigations

1st investigations to order

  • Sleep diary
  • Pittsburgh sleep quality index (PSBI)
  • Insomnia severity index (ISI)
  • Standford sleepiness scale (SSS)

Investigations to consider

  • Polysomnography (PSG)
  • Actigraphy
  • Thyroid-stimulating hormone (TSH)
  • FBC and iron studies

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    Other Related Conditions

    Obstructive Sleep Apnoea

    Parasomnia (night terrors)

    Narcolepsy

    Delayed Sleep Phase

    Restless leg syndrome

    Behavioural sleep conditions

    Rhythmic movement disorder

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      1 Reason for referral *

      2 Parent Surname *

      3 Patient First Name *

      4 Email *

      5 Patient Surname *

      6 Phone *

      7 Child’s date of birth *

      8 ADDRESS