Sleep problems are becoming more prevalent in the pediatric population. Disorders of hyperactivity, anxiety, depression, poor school performance, obsessive–compulsive disorder and school refusal are often the symptoms manifested as a result of an underlying, undiagnosed sleep disorder. While children may complain of poor sleep and parents may acknowledge difficulty getting them up in the morning; the significance of these symptoms remains unnoticed and untreated. Hyperactivity seen during the day is often addressed as ADHD as opposed to considering and evaluating for a sleep disorder. The use of stimulant medication paradoxically tends to help these children stay awake in the classroom; reducing the hyperactivity that can result from daytime sleepiness. The result is a cyclical spiral that becomes more difficult to tease apart as time passes.

Daytime sleepiness in children can result in the following symptoms:

  • Increased moodiness and emotional lability
  • Aggressiveness and irritability
  • Deepened emotionality, increased emotional fragility
  • Depression, fatigue, loss of energy and motivation
  • Increased weight gain and inability to lose weight
  • Hyperactivity
  • Poor impulse control
  • Deficits in attention, sustained attention, increased distractibility, decreased focus and thinking speed
  • Deficits in short-term memory
  • Disruption in the family due to the child’s behavior (children may become even more hyperactive at night, falling asleep exhausted and unable to get up the next morning)
  • Overall difficulties in various aspects of life at home, with peer relationships and in school

Young children who have daytime sleepiness appear as overactive or hyperactive; especially in a confined area such as the classroom. In order to stay awake, they move continuously, bother the students next to them, talk to themselves and play with various objects at their disposal; anything to amuse themselves and to remain awake.

Any sleep disorder resulting in poor sleep can result in daytime sleepiness. Thus it becomes important to rule out the following typically seen disorders:

  • Poor Sleep Hygiene
  • Insomnia
  • Bedtime difficulties
  • Anything causing sleep disruption: Nightmares, night terrors, parasomnias
  • Restless Legs/Growing Pains
  • Periodic Movement in Sleep
  • Obstructive Sleep Apnea, Upper Airway Resistance Syndrome
  • Additional medical diagnosis such as epilepsy