Sleep in Children and Adolescents

Problems related to inadequate sleep in children and adolescents are fairly common. Studies have shown that inadequate or irregular sleep usually results in some variation of daytime sleepiness, but may also result in behavior problems, difficulties with alertness, concentration, attentiveness, problem solving, memory, school problems, and other daytime behavior problems. Adolescents health may also be compromised by poor sleep/wake habits, with increased irritability... 

Emslie, G.J., Armitage, R., Weinberg, W.A., Rush, A.J., Mayes, T.L., and Hoffmann, R.E (2001) Sleep polysomnography as a predictor of recurrence in children and adolescents with major depressive disorder. Int J Neuropsychopharmacol 4 159-168. 

If at the end of the continuation phase it is decided that the antidepressants should be discontinued, this should be done gradually (e.g., over 6 weeks) to avoid withdrawal effects such as sleep disturbance, irritability, or gastrointestinal symptoms, which may lead the clinician to misinterpret the need for continued medication treatment. Clinical practice has suggested that rapid discontinuation of antidepressants may precipitate a relapse or recurrence of depression. In children and adolescents, it is recommended that treatment be discontinued while they are on extended vacations, rather than during the school year. 

The TCAs appear to reduce symptoms of reexperiencing and depression related to PTSD. In children and adolescents, imipramine may be an effective agent for ASD symptoms, especially traumatic experiences or flashbacks related to sleep onset and sleep maintenance (Robert et al., 1999). Because of their safety and side effect profile and the apparent lack of effectiveness in childhood depression, the TCAs have been supplanted by the SSRIs as first-line pharmacotherapy in the treatment of depression and anxiety in childhood. As such, these agents should be reserved for second- or third-line treatment in pediatric PTSD. 

A similar pattern of sleep disturbance is observed in children and adolescents as in adults. In a study of children and adolescents an increase in WASO, with both an increased number of awakenings and increased duration of awakenings, more frequent daytime napping, and elevated evening sleepiness, was reported in HIV+ patients relative to control subjects (213). 

Similarly, persistent sleep problems have also been associated with learning difficulties throughout the elementary-high-school years (116). Studies of excessive sleepiness in children and adolescents due to DSPS, narcolepsy, or sleep apnea have also reported negative effects on learning, school performance, and behavior (117-119). Students who get more sleep and maintain more consistent school/weekend sleep schedules may obtain better grades because of their ability to remain alert and to pay greater attention in class and on homework. 

The results from the studies described above indicate that the MSLT provides a robust measure of sleepiness that is sensitive to sleep restriction in children and adolescents (112). Patterns of sleep latency from repeated naps during constant routine protocols or forced desynchrony protocols in older children and adolescents also illustrate the influences of both homeostatic and circadian processes on sleepiness/alertness and provide evidence for the hypothesis that... 

A number of other important research and clinical issues and questions have not been addressed for children and adolescents. How much napping occurs in school and out of bed What are the effects of sleep loss on metabolic processes, the immune system, and health outcomes in children and adolescents How do light exposure patterns affect sleep patterns and processes in children and adolescents How much and when do parents sleep and what role does a family s schedule of activities play in children s and adolescents sleep patterns What outcome measures have not been studied that are particularly important to parents and children What does sleep look like in underprivileged children and adolescents The list is long. 

Acebo C, Sadeh A, Seifer R, Tzischinsky O, Wolfson AR, Hafer A, Carskadon M A. Estimating sleep patterns with activity monitoring in children and adolescents how many nights are necessary for reliable measures Sleep 1999 22( 1 ) 95—103. 

Fallone G, Owens JA, Deane J. Sleepiness in children and adolescents clinical implications. Sleep Med Rev 2002 6 287-306. 

Clinical pharmacology of sleep disturbances in children and adolescents... 

Mindell J, Owens J (2003) Sleep in the Pediatric Practice. In J Mindell, J Owens A Clinical Guide to Pediatric Sleep Diagnosis and Management of Sleep Problems in Children and Adolescents. Lippincott Williams and Wilkins Philadelphia, PA... 

Stores G, Wiggs L (2003) Sleep disturbance in children and adolescents with disorders of development it s significance and management. Cambridge University Press, New York... 

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