CHAPTER 20
Sleep Disorders
Sleep problems are relevant to child and adolescent mental health pro-
fessionals because there is a complex relationship between sleep disorders
and psychiatric disorders:
Psychiatric disorders can cause sleep problems. For example, difficul-
ties getting to sleep or staying asleep are common in anxiety and
depressive disorders, while nightmares can be a prominent feature of
post-traumatic stress disorder.
Conversely, sleep disorders may cause, mimic or aggravate psychiatric
disorders. For instance, sleep deprivation in a 6-year-old may result in
over-activity, poor concentration, impulsiveness and irritability, that is,
features that are normally part of ADHD and disruptive behavioural
disorders.
It may be hard to distinguish between sleep disorders and psychiatric
disorders, for example, nocturnal panic attacks can be mistaken for
nightmares or night terrors, or vice versa.
Psychotropic medication (or its withdrawal) may induce sleep problems,
for example, difficulty getting to sleep when taking methylphenidate, or
nightmares following the abrupt withdrawal of antidepressants.
A single risk factor may predispose a child to both sleep problems and
psychiatric difficulties. For example, children growing up in chaotic
household without routines or consistently enforced rules are more
likely to develop both disruptive behavioural problems and difficulties
getting a regular night’s sleep.Normal sleep
The structure of a normal night’s sleep is shown schematically in Box 20.1,
along with accompanying notes. Daytime sleepiness tends to peak in the
afternoon – different cultures have different expectations as to when (if
ever) children should cease having an afternoon nap/siesta. The pineal
hormone, melatonin, helps coordinate the sleep–wake cycle with the
24 hour dark–light cycle. Just as good and bad hygiene alter the risks
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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