Dr. Henry Paul, MD

Psychiatrist, Author and Educator

Tag Archives: sleep disorders in kids

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.

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.

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.

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.