Dyssomnias are
sleep disorders associated with complaints of
insomnia or
hypersomnia. The
daytime sleepiness of
narcolepsy is treated by a combination of planned daytime
naps, regular exercise medications such as
modafinil, or
salts of
methylphenidate, or
amphetamine.
Cataplexy that accompanies
narcolepsy is treated with
anticholinergic agents,
selective serotonin reuptake inhibitors, or
sodium oxybate. Children with neurodevelopmental disabilities such as
autism have sleep initiation and maintenance difficulties on a multifactorial basis, with favorable response to
melatonin in some patients. Childhood onset
restless legs syndrome is often familial, associated with systemic
iron deficiency, and responsive to
iron supplementation and
gabapentin.
Parasomnias are episodic phenomena events which occur at the sleep -- wake transition or by intrusion on to sleep. Arousal
parasomnias such as
confusional arousals and
sleep walking can sometimes be confused with
seizures. A scheme for differentiating arousal
parasomnias from nocturnal
seizures is provided. Since arousal
parasomnias are often triggered by
sleep apnea,
restless legs syndrome, or
acid reflux, treatment measures directed specifically at these disorders often helps in resolution.
Clonazepam provided in a low dose at bedtime can also alleviate
sleep walking and
confusional arousals.
Obstructive sleep apnea affects about 2 percent of children. Adeno-tonsillar
hypertrophy, cranio-facial anomalies, and
obesity are common predisposing factors. Mild
obstructive sleep apnea can be treated using a combination of nasal
corticosteroids and a
leukotriene antagonist. Moderate to severe
obstructive sleep apnea are treated with adeno-
tonsillectomy, positive airway pressure breathing devices, or
weight reduction as indicated. This paper provides an overview of the topic, with an emphasis on management steps. Where possible, the level of evidence for treatment recommendations is indicated.