Insomnia and anxiety are ubiquitous in young people

If you have difficulty falling asleep, staying asleep, and waking up very early in the morning, you may have insomnia.  It is not enough to close your eyes, and count sheep and hope you will eventually enter the world of snooze.

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Most people have occasional sleeplessness, irrespective of their age. You will experience it due to changes in your sleep schedules (e.g. during travel) or stressful circumstances, to name a few. 

However, when it starts happening frequently and becomes long-term, it can cause problems in your daily schedule.  You may feel sleepy putting you and others at increased risk of injury if you drive a vehicle or operate machinery.

According to the Harvard Medical School, you have an increased risk for many chronic health problems, including obesity, diabetes, and heart disease. 

 You may also have trouble concentrating and experience problems with your memory.  When you are not getting enough sleep due to insomnia, little stressors can feel like a mammoth amount of pressure, blowing everything out of all proportion and interrupting your thoughts and decision making.


At this point, your coping skills deteriorate fast, and you may become confused, irritable and then angry.  Eventually, your relationships with your family, friends, or co-workers will suffer as well.

To complicate matters, people with insomnia are often anxious or have an anxiety disorder.  Confounding this further, if you have both anxiety and depression, your insomnia will be worse.

So why do anxiety and insomnia often co-exist in individuals?

First, let’s discuss how insomnia can cause anxiety.  If you are having trouble sleeping, this may lead you to stress about many different things.  

You might start worrying about how you will function the next day on so little sleep, and how you will ever make it through the entire day.  

As you think about this and watch the numbers on the clock slowly advance, you become more anxious, making it hard to fall asleep.

On the other hand, when your anxiety is causing insomnia, your concern makes it difficult to shut off those thoughts in your head.  You may be feeling worried or fearful about perceived or real issues. 

 For example, a new parent may have experienced sleep deprivation with a new-born baby who sleeps very poorly at night.

For example, a new parent may have experienced sleep deprivation with a new-born baby who sleeps very poorly at night. 

It may feel like every time you begin to fall asleep; the baby wakes up.  In someone prone to anxiety, this may translate into anxious thoughts. 


That little voice in your head, telling you “The baby is going to wake up just as I start to fall asleep,” when you go to bed.  Thus, resulting in the inability to fall asleep in the first place.

In the case of a child with separation anxiety, that results in insomnia. However, alternative connections may revolve around the child’s fear of the dark (phobia) or when a child can’t go to sleep without a bottle of milk or being alone and away from their parents. 

Because anxiety and insomnia are so prevalent in children and teens today, it is a topic worthy of discussion on its own.  Anxiety disorders in adults are the most commonly experienced mental illnesses in the United States, and young people are no exception. Roughly one in eight children may have an anxiety disorder.

Is insomnia in children and teens similar to adults?

Yes, children can also have insomnia.  The American Academy of Pediatrics estimates that sleep problems affect 25 to 50 per cent of children and 40 per cent of adolescents. Sleep is an essential building block for your child’s mental and physical health.

However, how much sleep do you need?

The following table was deemed appropriate by the sleep foundation to be within a healthy range and age-appropriate.

Acute insomnia may last for only a few days (due to sickness), or it can become more frequent and long-term (chronic).  

As every parent knows, a child that’s short on sleep can swing between being grumpy and hyperactive, with effects that can mimic anxiety, depression, or other medical problems, so you should always make sure to have your child evaluated by a physician. 

If a sleep problem is suspected, your doctor will look at their overall health and sleep habits. In addition to doing a physical examination, take your medical history by asking you about any concerns and symptoms: your past health, your family’s health, medications, allergies or other issues you deem important and relevant.

Although visiting the doctor can also raise further concerns when the child was scared or upset during a previous visit.  A host of syndromes to contend with include  stranger anxiety and bad memories of being sick or vaccinated (needle phobia) and finally, white coat syndrome. could add to the young person anxiety.

Obviously, children and teens may have different reasons for their insomnia when compared to adults.  For example, it is usual for a young person to feel scared or worried about going to bed at night.

They might be concerned about having bad dreams or afraid of the dark. Children may be scared of the monsters they think exist in their closets or under their beds.

How can I soothe my child’s bedtime fears?

Further advice can be found under the parent talk website.

Sleep terrors are episodes of screaming, intense fear and swinging arms and legs while still asleep. Is also known as night terrors, are paired with sleepwalking.

Most sleepwalkers are teenagers and it may run in families, usually when a person is sick, has a fever, is not getting enough sleep, or is feeling stressed. Any unusual movements or unusual behaviours during sleep are called parasomnias.

Moreover, people with high ADHD-traits were more vulnerable to sleep deprivation and showed more significant impairment than those with low ADHD-traits.  There are some interesting new studies concerning the gut-brain-axis in ADHD possibly leading to novel therapeutic strategies in the future. 

Teens may also be stressed out by exams or bullying at school.  Some new reach has suggested that bullying should be considered as a form of personal trauma and treated accordingly.

 In many cases, there is a component of anxiety that would generally co-exist with insomnia. 

According to the National Institute of Mental Health, nearly 1 in 3  of all adolescents between 13- to 18-years of age, will have an anxiety disorder and just under 6% have a severe anxiety disorder.

It is an understatement to say, we are living in some uncertain times at the moment. When mental health experts, advocacy groups and public health organisations describe the incidence of anxiety and depression among college students and college-age young adults as an epidemic.   That is why it is essential to try to get to the root cause of insomnia whenever possible.

We know that young people are getting much less sleep than they did just ten years ago.

Delayed sleep-wake phase disorder (DSWPD) is a disorder in which a young person’s sleep is delayed by two or more hours beyond the socially acceptable or conventional bedtime.

They suffer from a standard shift that occurs in one’s internal clock or sleep-wake cycle during puberty. Children and adolescents with DSWPD may experience depression and other psychiatric difficulties, including behavioural issues resulting from daytime tiredness and absenteeism.

Some would describe themselves as “night owls”, but daytime drowsiness can also lead to a lowered academic performance from missed classes or tardiness and inattention.

The signs and symptoms of insomnia in children and teens can include:

  • Sleepiness during the day
  • Poor performance in school
  • Irritability
  • Anxiety
  • Decreased focus and concentration
  • Mood swings
  • Being worried about things
  • Hyperactivity
  • Forgetfulness and reduced memory for things
  • Increased behavioural issues such as fighting and not getting along with others
  • Increased impulsiveness

Alternative list Suitable for 2-18 years (Follow the link)

Understanding and helping the the sleep of 12-20-year-olds by Dorothy Bruck PDF download link.

Here are some ways to help a child or teen with insomnia:

For example, if you learn that your child is stressed by trying to keep up with school and homework and out-of-school extracurricular activities, you will need to address this before insomnia can go away.  This can be quite a common stressor for children and teens, as they tend to be overscheduled.

Once you determine the cause, try to eliminate the stressor

In the example above, if the child feels stressed by an overly busy schedule, you will need to make adjustments to the program.  It may involve talking to the teacher and setting realistic expectations for homework.  

Perhaps you will learn that your child is not using their time effectively at school and home, and needs more guidance on doing this. 

Many children and teens have time management skills, and they will need your help in this area.  To do this, you may need to set limits on using technology such as video games, for example.  It may also be helpful to sit down and help your child determine how to prioritise tasks.

School Environment

A recent study has suggested that anxiety levels among young teenagers have dropped during the coronavirus pandemic.  Within this survey, pupils who felt least connected to their school before the lockdown saw a considerable decrease in the anxiety.

This vehemently questions how the school environment affects young peoples mental well-being. The current survey results, only highlight that the school may not be a happy, or friendly experience for many young people.

Has the lockdown allowed children and adolescents with anxiety disorders, now have an avenue to avoid the focal point of their tension?  Besides, most of them find it quite challenging to practice social distancing.

Children and adolescents find it quite tough to make sense of what’s happening in the world, and they have their inherent suggestibility to follow the rumours/myths being forwarded in social media and on news channels.

Jill Walsh, a Boston University sociologist who studies technology use among adolescents, finds that having fewer in-person interactions has left many teenagers feeling “incredibly uncertain about their friendships.”

Current debate concerning schools opening during the pandemic and its effects on young peoples’ mental health is a “hot potato”.  Research shows that obtaining precise information about a potential threat helps people feel better, but ambiguous information does nothing to reduce anxiety or the urge to seek reassurance. Remind them not to rely on rumours or unreliable sources.

Consider, America and how they approached the previous school shootings with safety drills. Simple adding more to a long list they have, will depend upon their geographic location to include everything from tornadoes and earthquakes to chemical spills and terrorist attacks.  At which point is fostering a warm and nurturing learning environment, actually promoting fear instead?

Establish and follow a bedtime routine

Just like younger children do well with a set routine every night, so do older children (and even adults).  It gets your mind and body prepared for sleep.  When you have a set way, it also keeps things predictable and allows you to better manage your time. 

It would be best if you taught children and teens that they need time to unwind and relax before actually going to sleep.  This means no television, video games, social media, and so forth for one to two hours before going to bed. 

These blue light from your devices can also interfere with melatonin production in your body, just before bedtime, delaying your sleep cycle. This hormone helps tell your body that it is time to sleep.

Instead, teach them that they can do something relaxing, such as reading a book before turning off the light, if they are old enough.  Invest in special lightbulbs that do not emit blue light. 

Red lightbulbs are also an option, and you can find them online. For younger children, you can set up a specific routine of having a bedtime snack, then brushing, teeth, you can read them a book, and then tuck them into bed with a hug and kiss. 

It may also help to provide your child with a back rub or some extra cuddling time.  You have to determine what works best for your own children.

Limit your child’s or teen’s access to the news

Unfortunately, the news media portrays a lot of violent and terrible things happening in the world – from terrorist activities to inclement weather such as tornadoes and floods.  For an already-anxious child, this can severely contribute to insomnia.

Do not discuss anxiety-provoking or stressful situations before bedtime

Before your child goes to bed, it is not the time to discuss your disappointment in your child’s grades or that he forgot to do his chores again. 

Teach your older child stress management and anxiety-reducing techniques

Children with insomnia can benefit from many of the same stress and anxiety reduction techniques that adults use

- progressive muscle relaxation, visual imagery, yoga, deep diaphragmatic breathing.  

Learning these methods and using them before bed, can help treat insomnia as they start to relax, via the parasympathetic  route of your nervous system. 

Teach and use suitable sleep hygiene methods

These methods include waking up and going to bed simultaneously, avoiding napping, and avoiding caffeinated beverages and foods six hours before bedtime. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down.

Many people also experience heartburn, a backflow of acid and food from the stomach into the oesophagus after eating, which may keep you awake.

Ensure the bed is only used for sleep, and that it is not the place where the child watches television or does other activities during the day. 

Besides, do not exercise two hours before bedtime.  However, do keep in mind that exercise is vital in helping with quality sleep, ensuring you promote movement. 

The best kinds of activities can be those where you spend time with your child going for a walk, riding a bike, or going to the park. 

Also teach your older child that instead of tossing and turning for too long, it is better to get out of bed, put a light on low (preferably a red lightbulb), and do something quiet such as reading for 15 minutes, and then go back to bed and attempt to sleep.  

If sleep does not occur soon after returning to bed, he can get up again, and repeat the process until sleep finally comes.

Set up the bedroom for relaxation

This means sleeping in a room that is not overly hot.  It is recommended that you keep the space between 68 and 70 degrees Fahrenheit (20 – 21 degrees Celsius).  It depends on the child’s age and if/what types of pyjamas the child wears to bed. 

Have drapes in place to keep the room dark during sleeping, but you can have a small discreet nightlight (with a red lightbulb) in the corner of the room, if necessary to lessen anxiety.  If your child tends to stare at the alarm clock numbers, it is best to turn it around to make sure that it cannot be viewed. 

Remove technology devices from the bedroom

Remove any temptation to check the time, text messages, emails, or social media for the latest updates.  This can increase anxiety, especially if anything is unsettling that your child reads or views just before going to sleep.  The blue light emitted from these devices also suppresses melatonin – the sleep hormone – production, thereby delaying sleep. 

In children with anxiety, removal of the devices during the day can also be helpful.  Initially, it may cause more stress due to the fear of not being accessible by others and no longer “being in the loop” at all times. 

This FOMO, or Fear of Missing Out, can be anxiety-provoking.  However, you can teach your children that being “on-call” all the time or knowing every little thing about other people’s lives (through social media), can cause them more anxiety which further contributes to sleep problems. 

Spend extra time with your children and teens

When you spend time talking and doing fun things together (i.e. family board game night), your children and teens feel closer to you, will trust you more, and will open up to you more. 

This allows you to understand better what they are experiencing in their lives and how it may contribute to their insomnia and anxiety.  You can often help reduce insomnia by assisting them in dealing with or solving the problems they are facing. 

You have to remember that children and teens do not have the life experience and knowledge of dealing with situations like you do.  By merely providing them with this guidance and teaching, you can help reduce the anxiety too. 

Also, you want to remember that you want to teach them methods of dealing with stressors when you are not there.  You may wish to do role-playing to give them the confidence to deal with situations that arise when you cannot be present. 

Consult a physician or naturopathic doctor

Sometimes, more help is needed.  Medications are not generally prescribed for children with insomnia.  However, alternative treatment options may include cognitive-behavioural therapy.  The physician or paediatrician can make a referral to a therapist or psychologist trained in this. 

A naturopathic doctor may also be able to provide natural suggestions for improving sleep too.

In any case, it is always essential for the healthcare professional to try to determine if there is a physical or psychological cause to insomnia.

Conclusion

Insomnia is a problem for adults, children, and teens.  Anxiety often co-exists in individuals with insomnia, and it becomes vital to identify the source of the concern if insomnia is to be treated successfully.  

Many methods can be used to help a child with insomnia, which has been previously outlined above.

Referencing / Further Reading page

Types of Parasomnia Dr. Anis Rehman

https://www.sleepfoundation.org/parasomnias

Parasomnias By Richard J. Schwab , MD.

https://www.msdmanuals.com/en-gb/home/brain,-spinal-cord,-and-nerve-disorders/sleep-disorders/parasomnias?query=parasomnia

Recommendations for appropriate sleep durations. The report recommends wider appropriate sleep ranges for most age groups.

The results are published in Sleep Health: The Journal of the National Sleep Foundation

https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times

People with ADHD tendencies are more sensitive to insomnia, severe functional impairments.

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging reports.

https://www.news-medical.net/news/20201217/People-with-ADHD-tendencies-are-more-sensitive-to-insomnia-severe-functional-impairments.aspx

Mothers who report increased insomnia symptoms have higher levels of acute COVID-19 anxiety

https://www.news-medical.net/news/20201012/Mothers-who-report-increased-insomnia-symptoms-have-higher-levels-of-acute-COVID-19-anxiety.aspx

Delayed Sleep-Wake Phase Disorder (DSWPD) in Children and Adolescents

https://my.clevelandclinic.org/health/diseases/14295-delayed-sleep-phase-syndrome-dsps-in-children-and-adolescents


Latest
| news

Increased level of teenage anxiety and depression as teenage experience changes over time

https://www.nuffieldfoundation.org/news/increased-levels-of-anxiety-and-depression-as-teenage-experience-changes-over-time

Anxiety For teenagers

https://stem4.org.uk/anxiety/anxiety-for-teenagers/

Sleep timing and quality can influence dietary behaviours of school-aged children

https://www.news-medical.net/news/20180807/Sleep-timing-and-quality-can-influence-dietary-behaviors-of-school-aged-children.aspx?utm_source=news_medical_newsletter&utm_medium=email&utm_campaign=nutrition_newsletter_8_august_2018

Children and sleep

https://www.sleepfoundation.org/children-and-sleep

Diagnosis: A Syndrome That's Got Legs

Restless legs syndrome can keep you up at night and raise the risk of heart disease.

Psychology today,  Greg Isaacson published November 1, 2007 - last reviewed on June 9, 2016

https://www.psychologytoday.com/gb/articles/200711/diagnosis-syndrome-thats-got-legs

If you’re worried about a child’s safety, call NSPCC on 0808 800 5000. If you’re concerned about a child’s health, call 111. In an emergency, call 999.

Tony

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