May Week 2: Common Sleep Problems

Bhargava, Sumit. Diagnosis and Management of Common Sleep Problems in Children. Pediatrics in Review. March 2011

Case 1
You see a 3 yr old girl for her well child check, and mom reports that pt has difficulty falling asleep. She has no bedtime, insists on sleeping with the parents and she sometimes sleeps in parents’ bed. She has been very hyperactive, and moody during the day. 

What questions would you ask the parents?
What are your recommendations for the parents? 
How much sleep is appropriate for this patient? Mom is exasperated, sleep deprived, and asks if this is normal. How would you answer her?

Case 2
Your 16 year old patient is complaining about his parents. He argues with his mother in the mornings because he cannot wake in time for school, regularly oversleeps on the weekends. He says that he is a night owl, and he stays up late because he can’t fall asleep.

What type of sleep disorder does this patient have?
What would you recommend? 
What are the other behavioral issues associated with this problem?

Case 3
A mom of a 6 year old boy is concerned about frequent nighttime waking. She says that he wakes up screaming and appears “scared to death” .

How would you distinguish between Night Terror vs. Nightmares? 
What are the age groups affected by these Parasomnias? 
How do you manage this patient?