General Evaluation of Childhood Sleep-Wake Disorders

Parental concerns about sleep are common, even though youngsters may not complain themselves. Young children never seem tired and typically resist going to bed. Adolescents, in contrast, can sleep anywhere, anytime. Many become difficult to arouse on school mornings and sleep excessively on weekends. Rarely do either children or adolescents seek treatment for these behaviors. Thus, distinguishing among genuine sleep disorders, transient sleep problems, behavior problems associated with poor sleep hygiene, and parental concerns about sleep may be difficult, especially in children whose daytime functioning is minimally or not at all impaired by sleepiness.

It is important to obtain a careful sleep history when evaluating children whose parents describe sleep problems. In addition to assessing sleep, the clinician in his or her evaluation needs to determine the degree of impairment of the child's daytime functioning and the degree of general family distress caused by the sleep disturbance. However, because sleep symptoms may not be prominent, it is equally important to inquire about sleep hygiene in children who present with behavior problems. Important areas about which to inquire in an evaluation of sleep are presented in Table 17-8.

The sleep-wake history can be divided into several domains:

General

• Does the child's schedule conform to the family's schedule in a socially appropriate way?
  
• How regular are the child's sleep habits?
  
• What are the sleeping arrangements? With whom does the child share a room or bed?
  
• Are bedtime routines present?
  
• Whom do the child's symptoms disturb most?

Sleep Organization

• How many hours does the child sleep in each 24-hour day?
  
• Does the amount of sleep meet the child's developmental needs?
  
• Is the sleep-wake cycle structured in an age-appropriate way? That is, do bedtimes and rise times occur at customary clock times?

Sleep Disorder

Questions should focus on specific categories of dyssomnia or parasomnia such as difficulties in falling asleep or maintaining sleep, or disruptions and intrusions into sleep.

• Are there breathing difficulties manifested by snoring, noisy breathing, or mouth breathing during sleep?
  
• What was the child's age at onset of the symptom or problem?