Sleep Disorders in Children: When to Worry and What to Do

Most children's sleep problems are behavioral—bad habits, inconsistent routines, or developmental phases that pass with time. But sometimes sleep difficulties signal an actual sleep disorder that needs medical attention. Knowing the difference helps you get your child appropriate help.

Sleep disorders in children are more common than many parents realize, and many go undiagnosed. An untreated sleep disorder can significantly impact your child's development, behavior, learning, and quality of life. AAP

When Sleep Problems Aren't Just Habits

Normal sleep challenges:

• Resisting bedtime (behavioral)
• Waking for comfort (developmental)
• Early waking (schedule issue)
• Nightmares (developmental)
• Difficulty falling asleep (often sleep hygiene)

Signs of possible sleep disorder:

• Symptoms persist despite good sleep habits
• Physical symptoms (snoring, gasping, leg movements)
• Excessive daytime sleepiness despite adequate sleep time
• Unusual behaviors during sleep
• Symptoms significantly impact daily functioning

Common Sleep Disorders in Children

Obstructive Sleep Apnea (OSA): AAP
The most common medically significant sleep disorder in children.

*What it is:* Partial or complete blockage of airway during sleep, causing breathing pauses.

*Signs:*

• Snoring (loud, regular)
• Breathing pauses observed
• Gasping or choking sounds
• Mouth breathing
• Restless sleep
• Unusual sleep positions (neck extended)
• Bedwetting (in previously dry child)
• Behavior problems and attention issues

*Who's at risk:*

• Enlarged tonsils/adenoids (most common cause)
• Obesity
• Down syndrome
• Craniofacial differences
• Neuromuscular conditions

*Why it matters:*

• Affects behavior, learning, and growth
• Can cause heart problems if untreated
• Often mistaken for ADHD

Restless Legs Syndrome (RLS): NSF
Often overlooked in children.

*What it is:* Uncomfortable sensations in legs with urge to move them, worse at rest and at night.

*Signs:*

• "Creepy crawly" or uncomfortable leg feelings
• Can't sit still at bedtime
• Kicks legs in bed
• Difficulty falling asleep
• May describe as "growing pains"

*Who's at risk:*

• Family history
• Low iron levels
• ADHD (high co-occurrence)

*Why it matters:*

• Causes significant sleep loss
• Often treatable

Periodic Limb Movement Disorder (PLMD):
*What it is:* Repetitive jerking movements of legs (and sometimes arms) during sleep.

*Signs:*

• Leg jerks every 20-40 seconds during sleep
• Restless, disrupted sleep
• Tired despite seeming to sleep enough
• May not be aware of movements

*Difference from RLS:*

• RLS is awake sensation urging movement
• PLMD is movements during sleep (often together)

Parasomnias: AAP
Unusual behaviors during sleep.

*Night terrors:*

• Screaming, thrashing, appearing terrified
• Happens during deep sleep (usually 1-3 hours after falling asleep)
• Child is not actually awake
• No memory in morning
• Usually outgrown

*Sleepwalking:*

• Walking or other complex behaviors while asleep
• Usually during deep sleep
• May run in families
• Usually outgrown
• Safety is the main concern

*Confusional arousals:*

• Disoriented, confused behavior when waking
• May seem awake but isn't responding normally
• Usually outgrown

Narcolepsy:
Rare in children but can occur.

*Signs:*

• Excessive daytime sleepiness
• Suddenly falling asleep
• Muscle weakness with strong emotions (cataplexy)
• Sleep paralysis
• Vivid dreams at sleep onset

Delayed Sleep Phase Disorder: NSF
Common in teens.

*What it is:* Circadian rhythm shifted significantly late.

*Signs:*

• Cannot fall asleep until very late (1 AM+)
• Sleeps well once asleep
• Extreme difficulty waking for school
• Functions normally on late schedule

*Note:* Some degree of this is normal in adolescence.

When to See a Doctor

Contact your pediatrician if your child: AAP

Has physical symptoms:

• Snores regularly (not just with colds)
• Stops breathing or gasps during sleep
• Has restless legs at bedtime
• Jerks or moves excessively during sleep

Has unexplained daytime symptoms:

• Very sleepy despite adequate sleep time
• Behavior problems that don't improve with better sleep
• Attention/learning issues
• Morning headaches

Has unusual sleep behaviors:

• Night terrors that are very frequent or happen later at night
• Sleepwalking that's dangerous or frequent
• Any behavior that concerns you

Doesn't improve:

• Sleep problems persist despite good sleep habits
• Problems significantly impact functioning
• Your gut says something is wrong

What to Expect at the Doctor

Initial evaluation:

• Sleep history (patterns, behaviors, environment)
• Medical history
• Physical exam (especially throat/tonsils)
• Discussion of symptoms

Possible referrals:

• Sleep specialist (for evaluation and possible sleep study)
• ENT (if enlarged tonsils/adenoids suspected)
• Neurologist (for some conditions)

Sleep study (polysomnography):

• Overnight study monitoring sleep
• Records breathing, oxygen levels, brain waves, movements
• Child may sleep at a lab or use home equipment
• Required to diagnose sleep apnea and some other disorders

Treatment Options

For sleep apnea:

• Tonsillectomy/adenoidectomy (most common treatment in children)
• Weight management if obesity is a factor
• CPAP in some cases
• Dental devices for older children

For restless legs:

• Iron supplementation (if levels low)
• Sleep hygiene optimization
• Massage, stretching
• Medication in severe cases

For parasomnias:

• Usually observation and safety measures
• Addressing sleep deprivation (which can trigger them)
• Treating underlying conditions if present
• Rarely, medication

What Other Parents Ask

Q: My child snores sometimes. Should I worry?
A: Occasional snoring with colds is normal. Persistent, regular snoring—especially if loud—warrants evaluation. Snoring with breathing pauses or gasping definitely needs attention. AAP

Q: My child talks in their sleep. Is that a disorder?
A: Sleep talking is extremely common and usually not concerning. It doesn't require treatment unless accompanied by other symptoms.

Q: Could ADHD actually be a sleep disorder?
A: Sometimes. Sleep disorders can cause symptoms identical to ADHD (inattention, hyperactivity, impulsivity). Any child being evaluated for ADHD should also be screened for sleep problems. NSF

Q: My teenager can't fall asleep until 2 AM. Is that a disorder?
A: It might be delayed sleep phase disorder, or it might be lifestyle factors (screens, caffeine, irregular schedule). Try improving sleep hygiene first. If it persists despite good habits, seek evaluation.

The Bottom Line

While most childhood sleep problems are behavioral and manageable at home, true sleep disorders exist and often go undiagnosed. Physical symptoms (snoring, breathing issues, leg movements), excessive daytime sleepiness despite adequate sleep time, and unusual sleep behaviors warrant medical evaluation.

Key points:

• Sleep disorders are different from behavioral sleep problems
• Sleep apnea is common and often treatable
• Restless legs syndrome is underdiagnosed in children
• Parasomnias are usually developmental and resolve
• Persistent symptoms need professional evaluation
• Sleep disorders impact behavior, learning, and development
• Treatment is often highly effective

Clara is here to help you understand when your child's sleep problems need medical attention.