Hypersomnia in children: what is this childhood sleep disorder?

Getting a good night's rest is very important in childhood, and hypersomnia alters the quality of sleep.

Hypersomnia in children is a sleep disturbance that can occur early in that can occur in early stages of development. As its name suggests, it consists of an excess of sleep that can significantly affect the person's daily activities. It is the opposite of insomnia.

Although it may be temporary, hypersomnia often causes a lot of discomfort and can also be an indicator or precursor to the development of long-term sleep disorders, so it is important to address this disorder in a timely manner.

In this article we will see what is hypersomnia in children, what are its characteristics and causes, and finally some of the most recommended treatments.

What is hypersomnia in children?

Hypersomnia (or primary hypersomnia) is a Non-Organic Sleep Disorder, also known as non-organic hypersomnia, according to the ICD (International Classification of Diseases, WHO).

This sleep disorder can be developed by both adults and children. In general terms, infantile hypersomnia is characterized by the presence of excessive daytime sleepiness, i.e. the inability of children to stay awake..

Some indicators may be, for example, if the child falls asleep at school, appears drowsy, or finds it difficult to pay attention to daily activities that require an age-appropriate pace.

Related to the above, some difficulties associated with hypersomnia in children are poor school performance, the presence of mood disorders, and alterations of the immune system, the endocrine system or the metabolic system.

When hypersomnia occurs towards adolescence, it can even lead to the consumption of stimulants (such as caffeine) or depressants (such as alcohol), because they are used as tools to maintain wakefulness or to stimulate sleep.

WHO symptoms and diagnostic criteria.

It is estimated that, on average, a newborn sleeps 16 hours. An infant sleeps 12 to 14 hours; a child aged 3 to 5 years sleeps 11 hours; and between 9 and 10 years of age, the child sleeps about 10 hours.

From adolescence and into adulthood, it is estimated that a person sleeps 7 to 8 hours a day. Because of this progressive decrease in the hours of rest, late childhood is considered as the stage where our sleep has the best quality..

However, it may happen that the hours of sleep that the child has, do not seem to be enough for him to reach adequate rest and maintain the corresponding activities in wakefulness.

If this also occurs for a prolonged period of time, we can suspect hypersomnia. For its diagnosis, the WHO considers the following criteria:

• Excessive sleepiness or daytime sleep attacks, which appear after an adequate night's sleep.
• Very prolonged period of transition from sleep to wakefulnessi.e., pronounced and long-lasting difficulty in awakening.
• Occurs daily for a month or more, and causes severe discomfort or significantly interferes with the child's daily activities.
• There are no other symptoms that together can be diagnosed as narcolepsy or sleep apnea.
• There is no neurological or medical alteration that explains the drowsiness.

In the absence of organic factors or medical illnesses to explain the sleepiness, the presence of hypersomnia may be indicative of a more global psychological disturbance. For example, hypersomnia is often associated with the development of affective or depressive disorders.

Possible causes

The causes of sleep disorders vary according to the age of the person. Some may be physiological, some causes may be psychological, and some may be related to sleep habits. and others may be related to the habits of the child himself and his family.

1. Changes in brain activity

The brain functions under three fundamental periods: wakefulness, REM (rapid eye movement) sleep and non-REM sleep. During each period, the brain remains active and responds to external stimuli in different ways.

The periods that regulate activity during sleep are REM sleep and non-REM sleep, which alternate in different phases every 80-100 minutes. REM sleep, which is regulated by activation of the noradrenergic system, and its phases increase in duration as dawn approaches.

One of the causes of hypersomnia and other sleep disorders may be natural changes in the physiology of the brain. For example, as development and chronological age increase, the depth and continuity of sleep changes considerably; waking states are longerand some of the phases of REM and non-REM sleep decrease.

Psychological and social factors

Many times sleep disorders in children are related to stressful events that have not been adequately managed, but it also has to do with more specific issues such as how caregivers direct the activities that occur before and after sleep.

For example, sleep disturbances in children under 2 years of age may be related to parenting styles. may be related to parenting styles and parental responses to the child's sleep-related behaviors. An even more specific example is the way in which parents are involved in the child's sleep and wakefulness (at bedtime).

At school age, which is usually from the age of 3 years onwards, sleep disorders are often related to the way bedtime limits are set. They are also related to previous habits that stimulate children in different ways, for example, watching TV, tablet, or reading stories can have different consequences on rest.

Likewise, hypersomnia and other sleep disorders may be related to emotional exhaustion. emotional exhaustion and chronic medical conditions that cause nighttime awakenings. that cause nighttime awakenings.

How to evaluate and what is the treatment?

For hypersomnia evaluation in childhood it is necessary to know the child's sleep history, that is, to have access to a detailed description of the frequency, cycles and circumstances or habits associated with rest, and periods of activity and inactivity.

It is also necessary to know the possible medical illnesses, trauma or infections; and the activities carried out during the day (for example, their feeding schedules).

This is important because it allows detecting if the sleep has been modified from an early age or if it is related to a specific event. The most effective technique to know this is by means of an interview to the caregivers and educators, and even to the child himself, depending on age.and even to the child himself, depending on the age.

For treatment it is important to consider that sleep is regulated by internal synchronizers (such as melatonin, body temperature or cortisol), and by external synchronizers (such as light and darkness, sounds, habits or stressful events).

The latter are the ones that largely determine the functioning of the former, and are also the easiest to modify. Therefore, one of the ways to treat hypersomnia in children is to modify the external synchronizers, which will ultimately have an impact onwhich will eventually have an impact on the internal synchronizers.

Bibliographic references

• Pérez, H. (2016). Sleep throughout life. In Martínez, J. and Lozano, J. (Coords). Insomnia. Guidelines for action and follow-up. IMC: Madrid
• Amaro, F. (2007). Sleep disorders in childhood and adolescence. Retrieved May 09, 2018. Available at http://www.paidopsiquiatria.cat/files/trastornos_del_sueno.pdf.
• Montañés, F. and Taracena, L. (2003). Treatment of insomnia and hypersomnia. Medicine, 8(102): 5488-5496.