GPAtlas🧭 When to suspect
Suspect a sleep disorder when parents report persistent difficulty with a child's sleep that causes significant distress to the child or family. Roughly 20–30% of children are reported to have sleep problems, and the great majority are behavioural – difficulty settling, frequent night-waking, or an inability to self-settle – rather than a primary medical disorder.
The central skill in primary care is twofold: separate common behavioural insomnia from the minority with an underlying medical, respiratory or neurological cause, and treat any reversible contributor first. Chronic insomnia is conventionally defined as difficulty falling or staying asleep on ≥ 3 nights a week for ≥ 3 months; a normal sleep-onset latency (time to fall asleep) is under 30 minutes.
| Category | Recognising features |
|---|---|
| Behavioural insomnia (commonest) | Two patterns – sleep-onset association (needs a parent, feed or rocking to fall asleep, so wakes and cannot self-settle) and limit-setting (bedtime resistance and stalling). Normal sleep architecture; responds to behavioural measures. |
| Parasomnias | Night terrors / sleepwalking (early night, child not fully roused, no memory) versus nightmares (later night, child wakes and recalls). Usually benign and outgrown. |
| Sleep-disordered breathing (OSA) | Loud snoring with witnessed pauses or gasping, restless sleep, mouth-breathing; daytime behaviour and concentration problems. Often adenotonsillar hypertrophy. |
| Restless legs syndrome / periodic limb movements | An urge to move the legs at rest, worse in the evening, relieved by movement; bedtime resistance and fragmented sleep. Check ferritin. |
| Circadian rhythm disorder (delayed sleep phase) | Especially adolescents – a physiological shift to a later clock, cannot fall asleep early, very hard to wake for school, but sleeps normally if allowed to choose their own times. |
| Narcolepsy / hypersomnia (rare) | Excessive daytime sleepiness despite adequate night sleep, ± sudden loss of muscle tone (cataplexy). Needs specialist assessment. |
|
🧠 Clinical pearl In children, chronic sleep deprivation often presents as hyperactivity, irritability and poor concentration rather than the obvious daytime sleepiness seen in tired adults – the mirror image. A "hyperactive" or inattentive child may simply be under-slept, so always take a sleep history before attributing daytime behaviour to ADHD. |
Source: BMJ 2018
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