WHEN ARE SLEEP MEDICATIONS NECESSARY FOR CHILDREN?

March 14th, 2014

Recent studies show a striking rise in the prescription of sleeping pills for children by pediatricians and child psychiatrists. These doctors worry about the effects of disrupted sleep on children and mostly prescribe for this reason. This is alarming to me and many others in the field. Medications have side effects, and some could even lead to a habit forming situation. In general, I rarely prescribe a sleeping agent for children and teens. The few times that I do consider it necessary is when:

• The situation continues moderately to severely despite all other remedies.

• It is caused by another medication, which is necessary.

• It is part of a mental disorder, and the treatment does not affect the insomnia.

Most sleeping problems pass. As I mentioned in my earlier blogs, you need to try sleep hygiene techniques first. They almost always work! Other things that work include parent counseling and various behavioral interventions. Oh, and remember that too much technology, over-scheduling, and caffeine could all play a part. I can’t stress enough that medication should always be the last resort.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

OTHER SLEEP DISORDERS IN CHILDREN AND TEENS – NIGHT TERROR DISORDER

March 11th, 2014

In my last couple of blogs, I have been discussing a group of sleep disorders in children called Parasomnias. I have addressed two of the four parasomnias in children; nightmares and sleepwalking. Today I will discuss night terror.

Night terror disorder is quite frightening for parents or to anyone who witnesses it. Typically the child bolts upright from sleep with eyes wide open (although often not able to recognize family members), appears frightened often to the point of panic, and is screaming, confused, and inconsolable. The heart rate is elevated; there is shortness of breath, and he might be sweating, as well. There is what appears to be acute terrifying distress. The child usually cannot be awakened. The episode usually occurs in the first third of the night, and he falls right back to sleep. There is amnesia for the event the next morning.

Although this is a dramatic event, it is not particularly serious in the long term. It occurs rarely and usually disappears by teenage years. Some hypothesized causes are fatigue, new environments, fever, obstructive sleep apnea, and stress of some sort. As with nightmares the way to handle this is to be reassuring and comforting and for you not to panic. Practicing good sleep hygiene is a parent’s best bet. If these night terror attacks become frequent and/or disrupt family life, the use of benzodiazepines for a short amount of time has been found helpful. Some parents have reported that 1-5 hydoxytryptophan, which is sold over the counter and metabolized to become serotonin in the body, has allayed these terror attacks.

Our next blog is bedwetting and it will conclude this short blog series on parasomnias.

SLEEP DISORDERS IN CHILDREN AND TEENS – SLEEPWALKING

March 6th, 2014

In the last blog, we discussed nightmares. Now, we are going to look at sleepwalking. This parasomnia is characterized by a child getting up and walking around. Eyes are open, but responsiveness is either absent or inappropriate. Walking around can vary from quiet walking to agitated running. There is usually a glassy dazed stare. Sometimes the child can go to the bathroom or engage in other activities. Rarely there is violence. There is amnesia for the event. After the episode, the child can be found sleeping somewhere in the house.

There appears to be a genetic contribution to causation. Additionally, sleep deprivation, a chaotic environment, stress, some sleeping pills, and antipsychotic drugs, stimulants, or antihistamines might cause these episodes. It is also associated with PTSD, panic disorder and possibly dissociative identity disorder. Some medical conditions including gastroesophageal reflux, fever, asthma, and obstructive sleep apnea are present.

As in other parasomnias, treatment becomes necessary if there is resultant family disturbance or increased frequency. Since children can hurt themselves by accidents such as falling down stairs or getting outside the house, safety measures have to be taken such as trying to make the first floor of a house the sleeping location, locking doors and windows, clearing obstructions, putting heavy drapes over glass windows, and possibly setting an alarm which will sound if the child gets out of bed. Treatment consists of clearing up any associated medical conditions and rarely the use of medication including the short term benzodiapine Klonopin or Trazadone.

OTHER SLEEP DISORDERS IN CHILDREN AND TEENS — NIGHTMARES

March 5th, 2014

Sandy has been scaring us. She seems to wake up screaming, terrified, and agitated. She bolts up. After a few minutes she goes back to sleep. It not only scares us but she doesn’t even remember the whole thing the next morning.

There is a group of sleep disorders called Parasomnias. These syndromes present as unusual behaviors or movements that occur during sleep. They occur mostly in children and are rarely serious. They usually are gone by adolescence and the most effective interventions are parent education and counseling. Medication is rarely needed for most cases. They are rarely associated with major mental disorders. The most common ones encountered in practice are Nightmares, Night Terrors, Sleepwalking, and Bedwetting.

I will discuss all four in my next few blogs, but we’ll start with nightmares today. Nightmares or bad dreams are quite common in young people. These are dreams in which the child experiences himself in danger, vulnerable, frightened, and helpless. There is great distress, sometimes even panic and horror. Common themes often involve being chased, drowning, and other frightening losses of control. These dreams usually happen in the second part of the night, and the child often wakes up scared and remembers the dream content.

The child is often quite anxious, possibly believing that the dream was reality. He has a fast heart rate and might be perspiring, as well. Children usually need soothing and reassurance. Sometimes from the content of the nightmare the parent will be able to figure out what might be causing a passing stress or anxiety and might be able to help. Of course, there might be causes for repetitive nightmares such as chronic stress/anxiety. Some physiological causes might be the administration of certain antidepressants or stimulant medication for ADHD and post-traumatic stress disorder. If nightmares have become disruptive to the point of interfering with functioning then treatment to decrease stress, a fitness program, relaxation therapy, yoga, and even meditation have all been reported to help. In the most severe cases, such as those following a severe stressor, medication has been used with success and includes the antidepressants Trazadone or Serzone, some mood stabilizer, and possibly a Benzodiazepine anti-anxiety drug for the short term (a week or so).

Dr. Henry Paul, MD

Psychiatrist, Author and Educator