Kerstin Malmberg

Kerstin Malmberg is head physician at the neuropsychiatric unit at Astrid Lindgren´s children´s hospital in Solna.

Questions and anwers regarding sleeping problems among children

What is important to start with when diagnosing a sleep problem?
– We start by taking in the family history (history of diseases) and make a diagnosis regarding what kind of sleep disorder it is.

What should you think about regarding sleep and sleep medicine in cases of obstructive sleep apnea (when something obstructs the way of the air) in children?
– Treat the sleep problems with a referral to ear / nose / throat specialist for an assessment of removal of tonsils and / or adenoid (polyps behind the nose). Sleep medicine is forbidden in cases of obstructive sleep apnea.

What kind of sleep disorders are there in children?
– Difficulties falling asleep, obstructive sleep apnea (snores a lot at night and breathes through the mouth), delayed sleep phase (falling asleep late and waking up late).

What is the most common sleep disorder in children and what does it mean?
– Insomnia is the most common sleep disorder in children and involves:

  • Difficulties falling asleep
  • Nightly awakening
  • Too early awakening
  • Poor sleep quality

What is hypersomnia?
– Expresses itself as daytime sleepiness or generally increased need for sleep. Can´t be explained by too short or too poor night sleep. Common among young people with depression (but insomnia is the most common). Occurs in the aftermath of a trauma, such as a brain injury. The discovery of daytime sleepiness in children is complicated by the fact that children with sleep disorders often react with irritability or overactivity, rather than typical sleepiness.

Can you give sleep medicine for respiratory sleep disorders?
– No, respiratory sleep disturbances can be contraindicated with sleep medicine, ie, increase the risk.

How is sleep difficulty primarily treated?
Insomnia disorders are primarily treated with sleep hygiene and weighted blankets.

Why can weighted blankets improve sleep?
– The weighted blankets reduce the time it takes to fall asleep and releases the feel-good hormone, which causes anxiety to decrease. There are occupational therapists who have the right to prescribe and try out the weighted blankets.

What does sleep hygiene mean?
– Sleep hygiene is a routine for bedtime; settle down, no computer, phone or TV one hour before bedtime. You may also have an evening snack and a drink.

What do you do if sleep hygiene or weight loss is not enough?
– You can add cardiac melatonin 1 mg, which can be filtered as needed.

What common drug interaction is there with melatonin?
– Contraceptives increase melatonin concentration so that the dose may need to be corrected.

Insomnia difficulties are a common side effect of central stimulant treatment. How should these be handled?
– You can switch to another central stimulant with a shorter duration (the time a drug has an effect).

What is the difference between Circadin and cardiac melatonin?
– Circadin contains melatonin, but is built as a 1 mg release preparation that acts immediately and 1 mg with delayed effect. It’s good for those who wake up in the middle of the night.

What are the most common side effects on melatonin?
– The most common side effects are headache, stomach ache, palpitation, nausea, morning fatigue, morning irritation, unusually clear dreams or nightmares.

How can you increase body melatonin?
– You can increase melatonin in your body by being out in the open-air in the daylight. It affects the body´s own production of melatonin.

What is melatonin?
– Melatonin is a bodily hormone produced in the pancreas which is believed to be important for sleep regulation.

Is there any therapy for sleep disorders?
– CBS can work against sleep disorders and involves exercising at home before bedtime.

Can you measure sleep at a laboratory?
– Yes, sleep can be measured with EEG, polysomnography and eye movements.

What problems can sleep failure give?
– Impairment of physical health and cognitive functions. Decreased parent-child relationship. One´s mood is adversely affected. Impaired impulse control and maintenance of mental health.