Childhood Insomnia from A to Zzzzzzz

Roughly one third of Americans suffer from insomnia, or trouble falling or staying asleep. But what has been largely viewed as an adult problem is also showing up in children and can cause behavioral problems such as irritability and difficulty concentrating in school. Stress, screen time, over scheduling, past trauma, lack of exercise, and diet are all contributing factors, and there are many lifestyle changes and therapies to consider before resorting to prescription or over-the-counter medications.

Screen Time

Dr. Jennifer Lachman, a pediatrician with Central Oregon Pediatric Associates, sees electronic use as the biggest factor in the rise of childhood insomnia. Unlike in previous generations, today’s kids have technological devices as a daily part of their lives from a very young age.

“The wavelength of light that comes out of screens can be very stimulating for some people’s brains,” Lachman said. “Even though the activity itself can be technically quiet, it can be very hard for [children’s] brains to fall asleep.”

She has worked with many kids who claim that playing on their phones or tablets helps them relax and fall asleep, but most research shows the opposite it true. According to a review by Lauren Hale, Ph.D., of Stony Brook University, out of 67 studies published between 1999 and 2014, 90 percent of those studies show that screen time is adversely associated with sleep outcomes, primarily shortened duration and trouble falling asleep.

Lachman recommends zero screen time an hour or two before bedtime, and asks some parents to consider removing electronic devices from their children’s room at night because she’s talked to many kids who fall asleep, but then wake up in the middle of the night and hop on their phone or computer, without alerting their parents.

Of course, given that most parents are also tethered to technology, implementing these strategies may be a family affair. Setting the example for your kids by winding down after dinner with a good book as opposed to watching TV or perusing your own tablet or phone will help establish healthy habits that benefit the family as a whole.

Diet & Exercise

Dr. Joshua Phillips, a Naturopathic Physician at Hawthorn Healing Arts in Bend has seen a wide array of factors contributing to insomnia in children and believes it is very different for every kid and involves a unique combination of temperaments, as well as emotional, psychological, physiological and medical factors.

“Insomnia can definitely be related to internal stressors and poor diet,” Phillips said. “Allergies to dairy and wheat can stimulate the immune and nervous system, and if we can get the gut healthy that will help kids to sleep.”

While there is a wide range of food allergies, gluten and dairy are two of the most common sensitivities, partially due to the fact that they are difficult to digest and may get through the intestinal wall, where they are then identified by the immune system as foreign bodies. This triggers inflammation, which may present symptoms like depression, anxiety and insomnia. Because the body may take one to three weeks to present symptoms, food allergies often go untreated. There are tests available for food allergies, and Phillips believes that learning how the body reacts to certain foods can be a very empowering step toward a healthy night’s sleep.

“Even if allergies are not involved, sugar and high carbohydrate foods cause blood-sugar levels to fluctuate, affecting hormones that can disturb sleep,” Phillips noted. “I definitely recommend cutting out chocolate and caffeine before bed to prepare the body for rest.”

Randy Wild, a Licensed Professional Counselor and owner of Bend Counseling & Biofeedback in downtown Bend, notes that exercise in the early evening hours can also promote a good night’s rest. While it may be counter-intuitive, as the body cools down after a hot work out it will produce adenosine, a neuromodulator that makes us feel drowsy. This same logic is applied to an evening bath, where the benefits derive from cooling off after the bath, rather than the relaxing warmth of the bath itself.

Emotional Stress

Kids who live in households where there is fighting, substance abuse, or physical/emotional abuse may be trapped in a hypervigilant state, which means their sympathetic nervous system is in high gear, excreting stress hormones like adrenaline, noradrenalin and cortisol, all chemicals that trigger alertness and a fight or flight state, explained Wild. It is nearly impossible to fall asleep in this revved up state, and the result can be symptoms that may present like ADD — difficulty concentrating and hyperactivity — but often are really a result of sleep deprivation. Kids also may be dealing with past traumas, emotional or physical, and if this is the case, treatments specifically for sleep maybe palliative at best, Phillips pointed out, noting that he often refer families to counselors/psychologists to work in concert with naturopathic therapies when emotional disturbances may be the underlying cause of childhood insomnia.

Even milder household tensions such as stress about money or occasional marital disputes can be absorbed by children, so if the whole family is going through a difficult time, it’s important to remember that kids feel it too and it might be the root cause of their insomnia.

The rise of social media and the creation of an unsupervised and unmitigated landscape where kids interact with their peers without the emotional consequences of face-to-face conversations has also put a lot of stress on kids, along with the pressure to constantly interpret and respond to messages.

“Today’s kids are isolating more and are exposed to more and more information than ever before, and it’s not always good information,” said Wild. “The creators of media know we are hard-wired for danger, even the old newspapers knew this — ‘if it bleeds, it leads’ — so there is this inundation, and that creates stress, and we can’t separate sleep disorders from stress.”

Wild and his colleagues use a number of cutting-edge techniques to help children overcome insomnia. Non-sleepers have an excess of beta waves in their brains when they go to bed, along with muscle tension and an increased heart rate, both symptoms of the “fight or flight” state. Wild uses a technique called biofeedback, which trains patients how to voluntarily control functions of their body that are usually automatic. For insomnia, one approach that is very effective is teaching people to heat up their hand, which has the end result of cooling off the body’s core and producing adenosine, which makes us feel tired.

Wild also embraces a number of cognitive behavioral therapies such as helping children change the things they think about when they are trying to fall asleep

“Often sleeplessness is caused by an emotional state, focusing on something negative,” Wild said. “But we have a choice not to focus on that and instead think about things we are grateful for, that make us happy, and feel good.”

Herbal Remedies & Aromatherapy

The use of aromas, especially essential oils at bedtime, can be extremely effective when treating insomnia in children. From a neurobiological standpoint, smells have a huge influence over our emotions because they are processed by the hypothalamus in the limbic system of the brain, where emotions and memories are formed. This explains why a familiar scent can suddenly move us back in time to a thought of a loved one, a special place or a resonant moment in our lives.

Try creating a warm bath for your child with lavender essential oil and epsom salts (which also contain magnesium, a necessary nutrient for relaxation). Or create a blend of lavender, Roman chamomile and marjoram to rub on your child’s feet, spine and neck, or dilute with fractionated coconut oil and use for a backrub.

Phillips also recommends herbal remedies such as chamomile and passionflower tea, and even oatmeal at bedtime. Oats digest slowly and also stimulate the production of serotonin, which decreases stress levels, and also helps with the natural production of melatonin, the hormone that regulates sleep and wake cycles.

Melatonin

You may be surprised to find that most doctors, naturopaths and psychologists won’t recommend melatonin supplements for kids, at least not for any length of time, or as a permanent solution. Melatonin is a hormone secreted by the pineal gland that helps with natural rhythms, but because it is a hormone it also affects multiple physiological functions including the cardiovascular, immune and metabolic systems, as well as growth and sexual development. A quick fix for jet lag? Perhaps. A long-term solution for chronic insomnia? Definitely not.

“I don’t recommend melatonin at all for kids,” Phillips said. “I would much rather concentrate on helping kids aid their bodies in making their own melatonin. The light from blue screens on our phones and computers interrupts the production of melatonin, so shutting these things down by eight would be a good place to start.”

Pharmaceuticals & Over-the-Counter Medications

According to a 2007 study in Sleep Journal that explored trends in medications prescribed to kids for sleep problems over a 10 year period, 81 percent of doctor visits for childhood sleep problems resulted in a prescription of medication, many of which lacked FDA-approved labeling for children. There are currently no prescription drugs approved in the U.S. to treat childhood insomnia, however children are still given antihistamines such as Nytol and Benadryl, alpha-2 agonists including Clonidine, benzodiazepines such as Valium and Xanax, and antidepressants including Trazadone.

What this means for parents of children struggling with insomnia is that while it may be easy to obtain these sleep aids from doctors, it should probably be considered a last resort.

Lachman does not prescribe sleep aids for her patients, but notes very occasionally her patients try antihistamines on a temporary basis.

“I personally don’t believe in that,” she said. “Our society sees medication as an easy fix, but we shouldn’t try living in a way that compromises our health, but instead find ways to have healthy habits that support our body in a good night’s sleep.”

Sleep Hygiene

Phillips believes the first step in addressing sleep concerns is creating a wind-down period for kids an hour before bedtime. Taking a bath, journaling, doodling or drawing, and playing relaxing music are all things that work so well that kids may not need any other interventions.

“It can be super empowering for kids (and adults) to realize how they can calm down and relax their minds and bodies for sleep [with a few simple lifestyle changes],” Phillips said.

Removing electronics from the bedroom, making sure the room temperature is below 70 degrees, and that the room is as dark as possible are all simple steps that can help kids sleep. For younger children, creating a consistent bedtime with a comforting bedtime routine has also been known to help kids relax.

Overall, today’s kids are increasingly suffering from insomnia, as their lives become more complex and overscheduled, and their diets less conducive to falling asleep. Sleep is so important for learning and an overall sense of well-being and restoration, and vital for a child’s long-term emotional development. Taking the time to teach your child healthy habits for a better night’s sleep could have a lasting impact on the rest of their lives.

This story originally appeard in the May 2017 edition of U Magazine. To view the entire edition, click here.

“Often sleeplessness is caused by an emotional state, focusing on something negative. But we have a choice not to focus on that and instead think about things we are grateful for, 
that make us happy, and feel good.” — Randy Wild, licensed professional counselor and 
owner of Bend Counseling & Biofeedback