Hypersomnia in children: What is this childhood sleep disorder?
Hypersomnia in children is a sleep disorder that can occur in the early stages of development. As the name suggests, it consists of excessive sleep that can significantly affect a person’s daily activities. It is the sleep disturbance opposite to insomnia.
Although it may be temporary, hypersomnia often causes a great deal of discomfort and can also be an indicator or precursor to the development of long-term sleep disorders.
In this article we will see what is hypersomnia in children, what are its characteristics and causes, and finally some of the most recommended treatments .
Related article: “Hypersomnia: Types, symptoms, causes and treatments”
What is hypersomnia in children?
Hypersomnia (or primary hypersomnia) is a Non-Organic Sleep Disorder, also known as non-organic hypersomnia, according to the ICD (International Classification of Diseases, WHO).
This sleep disorder can be developed by both adults and children. Generally speaking, childhood hypersomnia is characterised by the presence of excessive daytime sleepiness, i.e. the inability of children to stay awake .
Some indicators may be, for example, if the child falls asleep at school, seems sleepy, or has difficulty paying attention to daily activities that require a pace appropriate for his or her age.
Related to the above, some difficulties associated with hypersomnia in children are poor school performance, the presence of mood disorders, and alterations of the immune system, endocrine system or metabolic system.
When hypersomnia occurs towards adolescence, can even lead to the use of stimulants (such as caffeine) or depressants (such as alcohol), because they are used as tools to maintain wakefulness or to stimulate sleep.
Symptoms and WHO diagnostic criteria
It is estimated that, on average, a newborn baby sleeps 16 hours. An infant sleeps 12 to 14 hours; a child who is 3 to 5 years old sleeps 11 hours; and between the ages of 9 and 10, a child sleeps about 10 hours.
From adolescence and into adulthood, it is estimated that the person sleeps 7 to 8 hours a day. Because of this progressive decrease in the hours of rest, late childhood is considered to be the stage where our sleep has the best quality .
However, it may happen that the hours of sleep the child has, seem to be not enough for him/her to achieve adequate rest and keep the corresponding activities in vigil.
If this also occurs for a long time, we can suspect hypersomnia. The WHO considers the following criteria for diagnosis:
- Excessive sleepiness or daytime sleep attacks, which appear after adequate nighttime sleep.
- Very long transition period from sleep to wakefulness , that is, pronounced and lasting difficulty in waking up.
- It occurs daily for a month or more, and causes intense discomfort or significantly interferes with the child’s daily activities.
- There are no other symptoms that together can be diagnosed as narcolepsy or sleep apnea.
- There is no neurological or medical disorder that explains the drowsiness.
As there are no organic factors or medical diseases that explain sleepiness, the presence of hypersomnia may be an indicator of a more global psychological disorder. For example, hypersomnia is often associated with the development of affective or depressive disorders.
The causes of sleep disorders vary according to a person’s age. Some may be physiological, other causes may be psychological and others may be related to the habits of the child and his/her family.
1. Changes in brain activity
The brain functions under three fundamental periods: wakefulness, REM (rapid eye movement) sleep, and non-REM sleep. During each period, the brain remains active and responds to external stimuli in different ways.
The periods that regulate activity during sleep are REM and non-REM sleep, which alternate in different phases every 80-100 minutes. REM sleep, which is regulated by the activation of the noradrenergic system, and its phases increase in length as the sun rises.
One of the causes of hypersomnia and other sleep disorders may be natural changes in the physiology of the brain. For example, as development and chronological age increase, the depth and continuity of sleep is significantly modified; waking states are increased , and some of the phases of REM and non-REM sleep decrease.
2. Psychological and social factors
Many times sleep disorders in children are related to stressful events that have not been properly managed, but it also has to do with more specific issues such as how caregivers manage activities that occur before and after sleep.
For example, sleep disorders in children under the age of 2 may be related to parenting styles and parental responses to sleep-related child behaviors. An even more specific example is the way parents are involved in their child’s sleep and wakefulness (bedtime).
At school age, which is usually from 3 years onwards, sleep disorders are often related to the way in which limits are set at bedtime. They are also related to previous habits that stimulate children in different ways, for example, watching TV, tablet, or reading stories can have different consequences on rest.
Also, hypersomnia and other sleep disorders may be related to emotional exhaustion and chronic medical conditions that cause nighttime awakenings.
How to evaluate and what is the treatment?
For hypersomnia evaluation in childhood, it is necessary to know the child’s sleep history, that is, to have access to a detailed description of the frequency, cycles and circumstances or habits associated with rest, and periods of activity and inactivity.
It is also necessary to know the possible medical illnesses, traumas or infections; and the activities you carry out during the day (for example, your feeding schedules).
This is important because it allows us to detect whether sleep has been modified from an early age or whether it is related to a specific event. The most effective technique to know this is by means of an interview with caregivers and educators , and even to the child himself depending on his age.
For treatment it is important to consider that sleep is regulated by internal synchronizers (such as melatonin, body temperature or cortisol), and by external synchronizers (such as light and dark, sounds, habits or stressful events).
The latter largely determine the operation of the former, and are also the easiest to modify. Therefore, one of the ways to treat hypersomnia in children is to modify the external synchronizers , which will eventually affect the internal synchronizers.
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