MHM Magazine

10 | MENTAL HEALTH MATTERS | 2022 | Issue 5 MHM When do sleep difficulties become a problem? Sleep difficulties might become a problem if a child continues to struggle to 1. fall asleep, 2. stay asleep, 3. sleep enough hours, or 4. have good quality sleep, even though there is enough opportunity and circumstances for sleep, leading to the child not being able to do important day-time tasks (such us concentrating in class – to learn new things -, and playing and interacting with friends). What are some sleep problems encountered in children? • Bedtime resistance When a child refuses to get ready for bed, refuses to remain in bed or requires a parent to be present at bedtime. These are often called limit setting sleep disorders, which are often the result of parental difficulties in setting limits and managing the child’s behaviour. In such cases receiving parental guidance from a professional might be helpful. • Sleep onset difficulties When a child has difficulty with falling asleep (within 20 minutes after going to bed). Reasons that may contribute to sleep onset difficulties include psychiatric conditions (e.g., mood disorders), poor sleep hygiene, or objective sleep disorders (e.g., restless legs syndrome – when a child has an uncomfortable feeling within their legs and needs to move them to make this feeling go away*). Consulting a professional (psychologist or psychiatrist) might be needed when a child suffers from a mood disorder or restless legs syndrome. • Night awakenings This is when a child wakes up at night and requires parental help to return to sleep: e.g., prolonged night awakenings may occur when a child gets used to falling sleep in circumstances that are not readily available during the night, such as having a parent present. • Difficulties with morning awakenings Behaviours such as a child refusing to wake up by himself or difficulties getting out of bed in the morning. They may be the consequence of inadequate sleep or the result of parental difficulties in setting limits and managing behaviour. Parental guidance might be needed. • Daytime sleepiness It’s reflected in persistent tiredness and lack of energy, with a tendency to fall asleep during the day. Causes of daytime sleepiness include: • Not enough sleep at night. • Underlying conditions that disrupt sleep (e.g., sleep apnoea*, and restless legs syndrome*). • Psychiatric disorders (e.g., mood disorders). • Post-traumatic excessive sleeping. • Excessive daytime sleepiness with an irresistible urge to fall asleep is the hallmark of narcolepsy – it often includes the muscles of the body relaxing without being able to control it. A professional might need to be contacted for these occurrences, especially if excessive sleeping after a traumatic event continues for longer than one month. • Sleep disordered breathing Most commonly known as snoring and sleep apnoea – breathing that stops and starts while a child is sleeping*. Removal of adenoids and/or tonsils might be needed. • Restless sleep Sleep characterised by excessive movements of some parts or the whole body. • Parasomnias Parasomnias are unwanted physical events or experiences that happen while falling asleep, while sleeping, or during awakening from sleep. They include: 1. Sleepwalking: Intense need to walk while asleep with no memory of this when child has woken. 2. Sleep terrors: When a child experiences intense fear while sleeping and struggles to wake up – they are different from nightmares. Don't awaken a child during a night terror — this just prolongs the episode. 3. Nightmares or bad dreams. Reassuring a child that these types of dreams are normal . 4. Nocturnal enuresis: Bed wetting after a child has been successfully potty trained. Most children tend to grow out of these experiences as they become older and don’t require treatment. If necessary, safety measures need to be considered as the first line approach (especially when it comes to sleepwalking) as well as scheduled awakenings (waking your child half an hour before the time they usually have an episode) and naps (sleep terrors, for example, are often associated with children not getting enough sleep). Psychology and sleeping – lifting the veil In the end it’s important to remember that parents’ lives, family histories and relationships are the framework within which they bring up families. Sleep problems may punctuate uncertainties between parents and children and bring out doubts in parents about their parenting abilities. These are some of the prevalent underlying troubles a parents face. When, for example, a parent has experienced separation in their own lives as unbearable, it may make the small separation of a child going to bed unbearable as well. Sometimes, it’s also important to look at how parents experienced their own upbringing, and how bedtime and sleep were managed when they were children. Sometimes parents rigidly cling to practices of how they were brought up or become determined to act differently from their own parents. When linked with bedtime, parents may re-enact traumas in their past, coming in the way of being able to notice and respond to their child in a manner that the child need most.