Insomnia | Diagnosis and Treatment

How is insomnia diagnosed?

If your child seems to be suffering from insomnia, a sleep specialist can evaluate the problem using the following techniques:

  • Taking a detailed history of your child's symptoms, including any medical, mental health or developmental issues.
  • Doing a complete physical examination.
  • A sleep log kept by parents, caregivers or the child (if he or she is old enough) for several weeks. Filling out the log helps track your child's sleep patterns and amounts of sleep over an extended period of time.
  • Tracking your child's sleep patterns over two to three weeks using a wristwatch-like validated device called an actigraph.
  • In rare cases, an overnight sleep study, if the sleep specialist suspects additional problems such as sleep apnea or excessive movements during sleep. (Sleep studies are unnecessary in the vast majority of patients with insomnia.)

What are the treatments for insomnia?

The good news is that insomnia is treatable, especially when it is behavioral in nature. For example, some children have become dependent on special conditions to fall asleep, like being rocked or fed or just having a parent present. When they awaken at night (as all children normally do), a caregiver then has to help them fall back asleep. In other cases, the problem may be bedtime resistance by toddlers testing their limits, lack of a relaxing bedtime routine or an inappropriate or irregular sleep schedule. Changing these habits and behaviors can lead to better sleep for everyone. A sleep specialist can help.

In older children and adolescents with insomnia, behavioral strategies usually include the active involvement of the patient in developing and carrying out the treatment plan. This may include a program developed specifically for insomnia called cognitive behavioral therapy for insomnia or CBT-I.

Can medications help treat insomnia?

On rare occasions, treatment with sleep medications in conjunction with behavioral treatment may be appropriate for children with insomnia. This is more often the case in children who have more complex medical, mental health or developmental issues. Providers at Boston Children's Hospital's Sleep Center work with families to select the safest and most effective medications in these situations.

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