Is Your Child Tossing and Turning? This Could Be to Blame

Most children have a restless night’s sleep from time to time. But if it happens frequently and causes behavior or mood changes, it may be a sign of a condition called restless sleep disorder.

“We’ve observed children experiencing restless sleep and next-day fatigue for many years,” says Sally Ibrahim, MD, a pediatric sleep medicine specialist at University Hospitals Rainbow Babies & Children’s. “Now those symptoms are recognized as a sleep disorder with a range of causes that we can treat to help children get better quality sleep.”

Following the Clues, from Iron to Apnea

Restless sleep disorder is diagnosed when a child experiences both frequent nighttime movements – five or more movements per hour – and next-day impairment. The disorder is often characterized by parents as a child sleeping “wildly” or frequently kicking off the covers. The child may wake up feeling unrefreshed and experience daytime sleepiness, behavior problems, inattention or hyperactivity throughout the day.

Restless sleep can have many causes, from nutrition to underlying health issues. Some children may have a genetic predisposition, such as a family history of restless legs syndrome. Other causes may include large tonsils or adenoids, breathing disturbances, acid reflux, iron deficiency or restlessness caused by itchiness from skin conditions like eczema.

“When we suspect restless sleep disorder, our job is to rule out potential causes so we can find the right treatment, which means taking all systems of the body into account,” says Dr. Ibrahim. The first step is to take a medical history that includes family history, lifestyle factors and medication history, and to run certain laboratory blood tests.

“Low iron is a frequent, treatable cause for this disorder, so we typically check it before moving on to a sleep study in cases that are unclear,” says Dr. Ibrahim.

Maintaining Healthy Sleep Habits

If parents suspect their children may have a sleep problem causing frequent sleep interruptions and daytime behavior problems, Dr. Ibrahim recommends taking an “inventory” of sleep habits. This inventory should include nutrition considerations such as eliminating caffeine before bed – even small amounts in drinks such as chocolate milk – and better sleep habits, including:

• Reset hourly expectations. A common misconception is that everyone, regardless of age, needs eight hours of sleep. In fact, a school-age child needs 9 – 11 hours of sleep and toddlers consistently need over 10 hours of sleep per night.
• Keep to a schedule. Once a bedtime is established, Dr. Ibrahim recommends sticking to it as much as possible – even on weekends. “Letting the schedule go on weekends could result in disrupted sleep that mimics restlessness, as your child may not be able to settle down at the expected time,” she says.
  As a guideline, a shift of one sleep cycle – approximately one or two hours later – for bedtime and waketime on weekends is common and reasonable for most children, says clinical psychologist Carolyn Ievers-Landis, PhD, a pediatric psychologist and behavioral sleep medicine specialist at University Hospitals Rainbow Babies & Children’s. Beyond these one to two hours, however, children may develop “social jet lag” as their clock shifts, making sleep more challenging on school nights.
• Limit light. Room-darkening shades can help keep the light out of the room at key times of the night, while allowing more light in the early morning. Electronics should ideally be kept out of the bedroom entirely where possible. If complete elimination is not practical, they should be put away one hour before bedtime.
• Find your child’s sleep window. “If a young child goes to bed too late, they may get overtired and have trouble settling down,” explains Dr. Ievers-Landis. “On the other hand, an adolescent who goes to bed too early will have trouble overcoming alerting signals that keep them awake. The key is to find the right sleep window for your child that takes into consideration their opportunity for sleep and their biological, age-appropriate need for sleep.”

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The Pediatric Sleep Medicine team at UH Rainbow Babies & Children’s specializes in treating a wide range of childhood sleep disorders, with evidence-based methods to help children achieve quality sleep.