Sleep disorders are a common problem during child growth.They are considered as behavioral and developmental variations.About 20-30% of chidren experience sleep problems at some point in the first four years of life.Sleep disturbances in children canbe frightening for the parents but canbe managed at home with parents' support and guidance.In severe sleep problems a psychologist or psychiatrist and physician shouldbe consulted.

 Sleep disorders fall into two cattegories viz:

• Parasomnias
• Dyssomnias

Parasomnias refer to abnormalities of arousal,partial arousal and changes between stages of sleep.They include night terrors(nightmares),sleep walking and sleep talking.

Dyssomnia refer to problems with initiating sleep and maintaining it.They include problems with going to sleep and nightwaking.

Nightterrors and sleepwalking:

Nightterrors are often assosicated with sleepwalking.Almost 3% of children experience nightterrors.They commonly happen within 2hours after a child falls asleep.During a nightterror children getup screaming and start breathing rapidly.Their body sweatens and heart beats fastly.But nightterrors are not painful so the parents should not interfere with the course of episode.Once the episode is over,child goes back to sleep and don't remember the event next day.A nightterror may last up to half an hour.

Nightterrors canbe managed with the support of parents given to the child.Treatment maybe necessary.Usually nightterrors are a result of emotional and psychological stress.Finishing of the soure can help prevent nightterrors.

Secondly,sleepwalking may result in injury to the child,the parents should watchout when the attack occurs usually and wake the child up before 15minutes of that time.The child may get back to sleep five minutes later.This approach may end up nightterrors to happen within a week and walking is dicontinued in this way.

Imipramine(25-50mg) maybe useful at bed time but shouldbe used with doctors advice.

Nightmares:

Nightmares affect 25-50% of children.They usually occur in the latter part of night.Commonly children between 3-5 years of age are affected.Nightmares are frightening dreams.Children woken up from a nightmare have difficulty going back to sleep and cann't remember the frightening images next day.

Nightmares are often associated with frightening daytime events or some kinds of stresses.

Parents may need to reassure the child that he or she is safe to go back to sleep if the child is frightened off to sleep.

Nightmares go away by their own,are self-limited and need little treatment.

Many factors can result in dyssomnias.They canbe simply a result of sleeping of baby with the parents or feeding time at night.Many children can sleep all night after six months of age without being breast fed at night.Also, they canbe due to child's temperament or a child having had perinatal difficulties suchas intracranial hemmorhage or hayline disease or a result of psychological stressors.

Nightwaking:

Nightawakening occurs in 40-60% of children.It shouldbe noticed that if a child does not cry upon waking,it's not a sleep disturbance.

Sleep patterns change as the child grows up.A one week old baby sleeps for 16hrs a day (sleeping  6hrs in daytime) while a 2 year old child sleeps for 13hrs a day(only one hour during the day).Sleep disorders usually develop when the parents try to sleep the child before he or she is biologically ready to sleep.

As sleep is related inversly with daytime sleep so if a child sleeps more while daytime willbe sleepless at night.

Children who can not sleep earlier at night but can sleep later is also an annoying behavior.Some approaches maybe useful to change such behavior:(1)parents may stop paying attention to the wakeful child.(2)Gradually parents may wake the child up earlier moving the bedtime to an earlier hour.

Finally,it becomes important for the physician and the parents to recognize normal sleep patterns for the treatment of children who have difficulties going back to sleep or who awaken during the night and start disturbing others.