Sleep and the Back-to-School Middle Schooler: What They Need and Why

The middle school years bring a whirlwind of change — new friends, tougher classes, bigger responsibilities, and a growing sense of independence. But one thing often gets overlooked during this transition: sleep. For 11- to 14-year-olds, getting enough high-quality rest isn’t just a nice idea — it’s essential for learning, mood regulation, and healthy development.

As summer fades and the school year begins, schedules shift earlier, homework piles up, and extracurricular activities kick in. Without careful planning, sleep can become the first casualty of the busy school routine. Understanding what middle schoolers need and how to help them get it can make the difference between a year of thriving and one of dragging.

How Much Sleep Do Middle Schoolers Need?

The American Academy of Sleep Medicine recommends 9–12 hours of sleep per night for children aged 6–12, and 8–10 hours for teens 13–18. That means most middle schoolers should be getting somewhere between 9 and 10 hours nightly.

But research shows many don’t. A CDC survey found that fewer than half of middle school students regularly get enough sleep on school nights. Late bedtimes, early alarms, and the lure of screens all contribute to the problem.

Why Sleep Is So Important in Middle School

Sleep affects middle schoolers in ways that are both immediate and long-term:

• Cognitive performance: Sleep helps consolidate memories, process new information, and support creative problem-solving. Well-rested students pay better attention in class and remember more of what they learn.

• Emotional regulation: Hormonal changes in early adolescence can amplify emotions. Adequate sleep makes it easier to handle stress, avoid conflicts, and recover from disappointments.

• Physical health: Sleep strengthens the immune system, supports growth, and helps regulate appetite and metabolism.

• Safety: Sleep-deprived students are more likely to make impulsive choices and have slower reaction times, which can be risky during sports, biking, or crossing streets.

The Middle School Sleep Challenge

Several factors make it harder for middle schoolers to get the rest they need:

1. Shift in circadian rhythm
   As children enter puberty, their natural “sleep phase” shifts later. Melatonin — the hormone that signals bedtime — is released later at night, making it harder to feel sleepy early.

2. Earlier school start times
   Many middle schools start before 8:00 a.m., which can require a wake-up time around 6:30 or earlier — out of sync with a teen’s biological clock.

3. Increased homework and activities
   Sports, music, clubs, and other commitments can push dinner, homework, and bedtime later.

4. Screen time
   Phones, tablets, and gaming consoles not only tempt kids to stay up later but also emit blue light that delays melatonin release even more.

Preparing for the Back-to-School Sleep Shift

If your middle schooler has been staying up and sleeping in during the summer, shifting back to a school schedule in one night will be a shock to the system. Start adjusting 1–2 weeks before school starts:

• Move bedtime earlier by 15 minutes every few nights.

• Wake them earlier in the morning to match the school-day schedule.

• Keep the schedule consistent on weekends to reinforce the body clock.

Building a Sleep-Friendly Evening Routine

A consistent wind-down routine can help counteract late-night energy and screen distractions. Consider a 30–45 minute bedtime ritual that might include:

1. Wrapping up homework and organizing the backpack for the next day.

2. Turning off all electronics at least 30–60 minutes before bed.

3. Taking a warm shower or bath.

4. Reading a book or listening to calming music.

Parents can help by setting a clear “screens off” time and charging devices outside the bedroom.

Creating the Right Sleep Environment

Middle schoolers may not think their bedroom setup affects their sleep — but it does. Encourage:

• Darkness: Blackout curtains or a sleep mask can help.

• Cool temperature: Around 65–70°F (18–21°C) is ideal.

• Quiet: White noise machines can mask household sounds.

• Comfortable bedding: A supportive pillow and breathable sheets make a difference.

Balancing Activities and Rest

Middle schoolers often want to “do it all,” but overscheduling can push sleep to the bottom of the priority list. Help your child balance commitments by:

• Limiting late-evening practices or events on school nights.

• Encouraging them to choose a manageable number of extracurriculars.

• Scheduling downtime after school before jumping into homework.

Watching for Signs of Sleep Deprivation

Even a shortfall of 30–60 minutes per night can add up over a week. Look for:

• Difficulty waking up in the morning

• Irritability or mood swings

• Trouble concentrating

• Frequent yawning or daydreaming

• Dozing off in the car or on the couch after school

If you see these signs, reevaluate bedtime and daily schedule.

Setting a Good Example

Kids this age notice when adults burn the candle at both ends. Modeling good sleep habits — such as sticking to a regular bedtime and limiting screens late at night — reinforces the message that rest matters.

The Takeaway for Families

Middle school is a period of rapid growth and increasing demands. Without enough high-quality sleep, students risk falling behind academically, feeling overwhelmed emotionally, and struggling physically. But with consistent schedules, mindful routines, and supportive boundaries, parents can help ensure their child gets the rest they need to thrive.

As the school year begins, remember: academic success starts the night before — with lights out, a quiet room, and the steady breathing of a child who’s truly recharging for the day ahead.

This article was created using OpenAI’s ChatGPT on August 15, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

Helping a New Kindergartener Adjust Their Sleep Routine

Starting kindergarten is a big milestone — not just for the child, but for the whole family. The excitement, new schedule, and increased demands on attention and energy all mean one thing: sleep becomes more important than ever. Unfortunately, getting a young child to bed on time (and helping them stay rested) can be a challenge, especially if they’ve been on a looser summer schedule.

The good news is that with some planning and consistency, you can help your kindergartener adjust to their new sleep routine without too many tears — yours or theirs.

Why Sleep Matters More Than Ever

Five- and six-year-olds need 10–13 hours of sleep in every 24-hour period, according to the American Academy of Sleep Medicine. That means if your child needs to wake up at 7:00 a.m. for school, their bedtime should ideally be somewhere between 6:30 and 8:00 p.m.

Adequate sleep at this age is linked to:

• Better mood regulation (fewer meltdowns)

• Improved attention and memory

• Stronger immune function

• Better coordination and motor skills

• More resilience in handling new challenges

The first weeks of kindergarten can be especially tiring. Your child is learning routines, meeting new people, and processing a huge amount of new information. Sleep is when their brains and bodies recharge — and without enough of it, their ability to adjust and thrive can suffer.

Step 1: Start the Adjustment Early

If your child has been going to bed later during the summer, don’t wait until the night before school starts to make changes. Begin adjusting bedtime and wake-up time about 2–3 weeks before the first day of kindergarten.

Move bedtime earlier by 10–15 minutes every few nights, and wake them up earlier in the morning by the same increment. Gradually shifting helps their body clock adjust without a huge shock.

Step 2: Create a Predictable Bedtime Routine

Young children thrive on structure, and a predictable bedtime routine signals to their body and brain that it’s time to wind down. Aim for a 30–45 minute routine that might look like this:

1. Bath or shower — warm water helps lower body temperature afterward, which can promote sleepiness.

2. Pajamas and tooth brushing — keep it consistent every night.

3. Quiet time — reading a book together or listening to calm music.

4. Lights out — ideally in a dim, quiet room.

Avoid high-energy activities and bright lights in the hour before bedtime. That means no roughhousing, TV shows, or tablets right before sleep. The blue light from screens can delay melatonin production, making it harder for kids to fall asleep.

Step 3: Make the Bedroom Sleep-Friendly

Kindergarteners, like adults, sleep better in an environment that’s comfortable and free from distractions.

• Keep it cool: A room temperature between 65–70°F (18–21°C) is ideal.

• Dim the lights: Darkness signals the brain to release melatonin. A small nightlight is fine if your child prefers it.

• Limit noise: White noise machines can help block out household or street sounds.

• Choose comfortable bedding: Involve your child in picking sheets or a blanket they love — it makes bedtime more inviting.

Step 4: Watch the Afternoon Schedule

Once school starts, you may notice your child is more tired than usual in the afternoons. Some kindergarteners still need a short nap, especially during the early weeks. However, a late afternoon nap can push bedtime later, so try to limit naps to before 3:00 p.m.

If they’re not napping, build in quiet time after school — reading, drawing, or playing calmly in their room — to give them a mental and physical break before the rest of the day.

Step 5: Be Consistent on Weekends

It’s tempting to let bedtime slide on Friday or Saturday nights, but big swings in schedule can make Monday mornings much harder. Try to keep bedtime and wake-up time within an hour of the weekday schedule, even on weekends.

Step 6: Handle Bedtime Resistance Gently but Firmly

Some kids may resist the earlier bedtime, especially if they’re used to staying up later. Stay calm, stay consistent, and remember that part of your job is to set boundaries that protect their health.

• Acknowledge feelings: “I know you don’t feel tired yet, but your body needs rest so you can have fun at school tomorrow.”

• Offer choices within structure: “Do you want to read one book or two before lights out?”

• Stick to the routine: Consistency builds habits faster than constant negotiation.

Step 7: Watch for Signs of Sleep Deprivation

Even with a good plan, some children may struggle to get enough sleep at first. Watch for signs such as:

• Morning irritability or crying

• Difficulty waking up

• Meltdowns over small frustrations

• Clumsiness or more frequent accidents

• Trouble focusing during play or homework

If you notice these signs regularly, try moving bedtime even earlier. It’s not unusual for some kindergarteners to need a 7:00 p.m. bedtime, especially in the first few months of school.

Step 8: Stay Flexible and Supportive

Every child is different. Some adjust within a week, while others may take a month or more to settle into a new sleep pattern. Life events, growth spurts, and illness can all cause temporary setbacks.

The key is to treat sleep as a non-negotiable priority, while also giving your child space to adapt at their own pace. Celebrate small wins — like falling asleep without calling for you — and keep reinforcing the idea that sleep helps them be their best.

The Long-Term Payoff

Helping your kindergartener adjust to a healthy sleep routine is one of the best back-to-school gifts you can give them. Not only will it make their days happier and more productive, but it will also lay the foundation for lifelong sleep habits that support health, learning, and emotional well-being.

A well-rested child is better equipped to meet the exciting challenges of school — from making new friends to learning to read — with energy and joy. And as a parent, you’ll have more peace of mind knowing you’ve set them up for success, one bedtime story at a time.

This article was created using OpenAI’s ChatGPT on August 15, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

What Is a Night Terror?

A night terror, also known as a sleep terror, is a type of sleep disturbance that falls under the category of parasomnias—unusual behaviors or experiences that occur during sleep. Night terrors are characterized by sudden arousals from deep sleep accompanied by intense fear, screaming, flailing, or other signs of distress. Unlike nightmares, which occur during rapid eye movement (REM) sleep and are typically remembered the next morning, night terrors occur during non-REM (NREM) sleep, particularly in stage 3, the deepest phase of sleep.

What sets night terrors apart is the intensity of the reaction and the fact that the person experiencing one usually has no memory of the event. These episodes are most common in children, particularly between the ages of 3 and 8, though adults can experience them as well, often as a result of stress, trauma, or other sleep disruptions.

Characteristics of a Night Terror

A night terror usually begins with a sudden awakening from deep sleep, often within the first one to two hours of falling asleep. The person may sit upright in bed, eyes wide open, breathing heavily, sweating, and possibly screaming or crying. They may thrash about or appear panicked, and although their eyes are open, they are not fully awake. In fact, they may be unresponsive to attempts to console or wake them.

The episode may last anywhere from a few seconds to a multiple minutes. Afterward, the person often settles back into sleep without fully waking up. In the morning, they may have little or no recollection of what happened. This lack of memory distinguishes night terrors from nightmares, which people can usually recall in vivid detail.

Night Terrors vs. Nightmares

It’s common to confuse night terrors with nightmares, but they are quite different in several key ways:

• Timing: Night terrors occur during non-REM sleep, usually early in the night. Nightmares occur during REM sleep, often in the later stages of sleep.

• Awareness and Memory: People experiencing night terrors are usually not fully awake and do not remember the episode. Those who have nightmares typically wake up and remember the dream clearly.

• Physical Reactions: Night terrors involve intense physical reactions such as screaming, flailing, and signs of panic. Nightmares may cause a person to wake up feeling scared or anxious, but usually without extreme physical responses.

• Duration: Night terrors tend to be short and intense, while nightmares may feel longer due to their vivid, narrative-like structure.

Causes and Triggers

The exact cause of night terrors is not completely understood, but they are believed to result from abnormal arousals during deep sleep. Instead of transitioning smoothly through the stages of sleep, the brain becomes suddenly and partially awake. This can create a state where the body reacts strongly, but the mind remains disconnected from full consciousness.

Several factors can trigger or increase the likelihood of night terrors:

• Sleep deprivation or irregular sleep schedules

• Stress, anxiety, or emotional tension

• Illness or fever (especially in children)

• Sleeping in a new or unfamiliar environment

• Certain medications that affect the central nervous system

• Underlying sleep disorders, such as sleep apnea or restless legs syndrome

• Family history: There may be a genetic component, as night terrors often run in families

In adults, night terrors can sometimes be linked to mental health issues, post-traumatic stress disorder (PTSD), or substance use. In rare cases, they may be a symptom of a neurological condition that disrupts normal sleep patterns.

Who Experiences Night Terrors?

Night terrors are most frequently seen in children, particularly during early childhood. Many children outgrow them by adolescence. The developing brain, along with changes in sleep cycles, makes children more susceptible to this type of sleep disruption.

Although less common in adults, night terrors do occur and are often more complex when they do. Adult episodes may involve behaviors such as jumping out of bed, running, or attempting to escape perceived danger. These actions can sometimes lead to injury and may require medical evaluation, especially if they occur frequently.

Diagnosis and When to Seek Help

A single night terror episode is usually not cause for concern, particularly in children. However, if night terrors are frequent, disrupt sleep regularly, or lead to dangerous behaviors, it may be necessary to consult a doctor or sleep specialist.

Diagnosis is typically made based on a description of the symptoms and sleep history. In some cases, a sleep study (polysomnography) may be recommended to rule out other conditions such as sleep apnea or seizures.

Treatment and Management

There is no specific medication needed for night terrors in most cases, and treatment often involves non-pharmacological strategies aimed at improving overall sleep quality:

• Establish a consistent bedtime routine to promote restful sleep

• Ensure adequate sleep to prevent overtiredness, which can trigger night terrors

• Reduce stress and anxiety through calming activities before bed, such as reading or gentle music

• Create a safe sleep environment, especially for those who might get out of bed during an episode

• Avoid caffeine or stimulating activities close to bedtime

In adults, if night terrors are linked to psychological stress or trauma, therapy or counseling may be helpful. In rare and severe cases, medications such as low-dose benzodiazepines (i.e., clonazepam) or antidepressants may be considered under medical supervision.

Conclusion

A night terror is a dramatic and frightening event, often involving intense fear, physical movement, and confusion—but it is fundamentally different from a nightmare. Rooted in the deepest stages of non-REM sleep, night terrors can feel as alarming for observers as they are bewildering for those who experience them.

Although they can be distressing, especially when frequent, night terrors are usually not harmful and often diminish over time—especially in children. Understanding what night terrors are, how they differ from other sleep disturbances, and what triggers them can help families and individuals manage them with greater confidence and peace of mind.

This article was created using OpenAI’s ChatGPT on May 16, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

How Do Large Tonsils Affect the Sleep of Children?

Tonsils are lymphoid tissues located at the back of the throat and play an essential role in the immune system by helping to protect the body from infections. However, in some children, the tonsils can become enlarged, leading to a range of health issues, particularly with regard to their sleep. Large tonsils can significantly affect a child's ability to breathe and sleep properly, contributing to a variety of sleep disturbances that can have long-term effects on their overall health and development.

In this article, we will explore the impact of large tonsils on children's sleep, the conditions they can cause, and the potential treatment options available for managing these sleep disturbances.

Causes of Enlarged Tonsils in Children

Tonsil enlargement, also known as tonsillar hypertrophy, can occur for a variety of reasons. In children, the tonsils are more prone to becoming enlarged due to frequent infections like strep throat, viral upper respiratory infections, or even allergies. These infections cause inflammation of the tonsils, leading them to swell. In some cases, the tonsils may remain enlarged even after the infection subsides, a condition known as chronic tonsillar hypertrophy.

The enlargement of the tonsils can also be caused by other factors, including genetic predisposition. Some children naturally have larger tonsils than others. Additionally, recurrent tonsillitis, which is the inflammation of the tonsils, can lead to the gradual enlargement of the tonsils over time.

The Impact of Large Tonsils on Children's Sleep

Large tonsils can obstruct the airway in various ways, leading to significant disturbances in sleep. The primary way enlarged tonsils affect sleep is through obstructive sleep apnea (OSA), a condition in which the upper airway becomes partially or fully blocked during sleep, causing breathing interruptions. Children with large tonsils are at higher risk for developing OSA because the enlarged tonsils may physically obstruct the flow of air through the nose and throat during sleep.

1. Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is one of the most common and serious conditions associated with enlarged tonsils in children. During sleep, the muscles in the throat relax, and if the tonsils are large, they can collapse inward and block the airway. This leads to periods of paused breathing, often lasting for a few seconds to minutes. These apneas (breathing pauses) can occur multiple times throughout the night, disrupting the child’s sleep cycle and reducing the quality of their sleep.

The most common signs of obstructive sleep apnea in children with large tonsils include:

• Snoring: One of the hallmark symptoms of OSA is loud and frequent snoring. Children with enlarged tonsils are more likely to snore due to the obstruction in the airway.

• Choking or gasping during sleep: Children may make choking, gasping, or snorting sounds as their body attempts to restart breathing after an apnea episode.

• Restlessness: Frequent tossing and turning during the night, and even sweating in sleep, can be another sign of disturbed sleep due to interrupted breathing.

• Difficulty waking up: Children with OSA may have trouble waking up in the morning, feeling tired, or even irritable throughout the day.

• Excessive daytime sleepiness: A child who is unable to get restful sleep due to apnea may show signs of excessive tiredness during the day. This can lead to difficulty concentrating at school or at play. It may be associated with attention problems or hyperactivity.

2. Sleep Fragmentation and Poor Sleep Quality

Even without full-blown obstructive sleep apnea, enlarged tonsils can lead to disrupted and fragmented sleep. When the tonsils block the airway, the child may wake up frequently throughout the night to adjust their position, clear their throat, or take a breath. These nighttime awakenings, though brief, can disrupt the natural sleep cycle, preventing the child from reaching deeper, restorative stages of sleep. Over time, this can lead to sleep deprivation. The loss of deep or slow-wave sleep has a negative impact on growth.

Sleep fragmentation can have a significant impact on a child’s mood, behavior, and cognitive functioning. Children who are not getting adequate, uninterrupted sleep may experience irritability, mood swings, difficulty focusing, and decreased academic performance.

3. Mouth Breathing and Dryness

When large tonsils (and more often associated adenoids) obstruct the nasal passage connection to the throat, children may have difficulty breathing through their nose, forcing them to breathe through their mouth during sleep. Mouth breathing can lead to several issues, including dry mouth, which can increase the risk of dental problems such as cavities and gum disease. Additionally, mouth breathing may contribute to a higher likelihood of upper respiratory infections, as the nose is no longer filtering out bacteria and allergens effectively. These are drawn directly to the throat, causing the tonsils to swell further.

Breathing through the mouth during sleep can also disrupt the natural flow of saliva, leading to a dry throat and increased irritation. This can exacerbate sleep disturbances and lead to symptoms like sore throat, difficulty swallowing, or frequent throat clearing.

4. Night Sweats and Discomfort

Children with enlarged tonsils may experience discomfort while sleeping, particularly if the tonsils are swollen or inflamed due to infection. This discomfort can cause them to wake up frequently, leading to poor sleep quality. Additionally, obstructed breathing can trigger the body’s stress response, resulting in increased heart rate and elevated body temperature. As a result, children may experience night sweats, which can further disrupt their sleep.

5. Potential for Developmental and Behavioral Issues

Sleep disruptions caused by large tonsils can lead to a cascade of other problems in children. Chronic sleep deprivation due to obstructive sleep apnea or fragmented sleep can affect a child’s emotional, cognitive, and physical development. Some of the long-term effects of poor sleep include:

• Behavioral problems: Children with disrupted sleep patterns often display more behavioral issues, such as irritability, hyperactivity, impulsivity, and difficulty following instructions.

• Academic difficulties: Sleep deprivation can impair a child’s ability to concentrate, leading to challenges with learning and lower academic performance.

• Growth and development: Growth hormone is primarily released during deep sleep, so inadequate sleep can impact a child’s physical growth and development. Poor sleep quality may also affect immune function, making the child more susceptible to illness.

• Increased risk for mood disorders: Long-term sleep disruption has been linked to an increased risk of mood disorders such as anxiety and depression in children.

Treatment for Sleep Issues Due to Enlarged Tonsils

The treatment of sleep disturbances caused by enlarged tonsils depends on the severity of the condition and the underlying cause of the enlargement. There are several approaches that may be used to address the issues associated with large tonsils and improve the child’s sleep.

1. Tonsillectomy (Surgical Removal of Tonsils)

One of the most common treatments for large tonsils that are causing sleep disturbances, such as obstructive sleep apnea, is a tonsillectomy. This is a surgical procedure in which the tonsils are removed. Tonsillectomy can be highly effective in improving sleep quality, reducing snoring, and eliminating the apneas associated with obstructive sleep apnea. It is approximately 80% effective in resolving sleep apnea.

This procedure is typically recommended when the child has significant symptoms of OSA that are not improving with other interventions, or when the tonsils are repeatedly infected and causing chronic issues.

2. Adenoidectomy (Removal of Adenoids)

The adenoids are another set of lymphoid tissues located in the upper throat, near the nasal passages. In some children, enlarged adenoids can contribute to airway obstruction and sleep disturbances, often in combination with enlarged tonsils. In such cases, an adenoidectomy may be recommended, where the adenoids are surgically removed. Adenoidectomy may be performed in conjunction with tonsillectomy for a more comprehensive solution.

3. Continuous Positive Airway Pressure (CPAP)

For children with obstructive sleep apnea who cannot undergo surgery or for those who do not wish to pursue surgical options, CPAP therapy may be an alternative. A CPAP machine delivers a constant flow of air through a mask, which helps to keep the airway open during sleep. While CPAP is more commonly used in adults, it may be an effective treatment for children with persistent sleep apnea caused by enlarged tonsils.

4. Medications and Lifestyle Changes

In some cases, medications or lifestyle changes may be used to help manage the symptoms of enlarged tonsils. For example, nasal corticosteroids or antihistamines may be prescribed to reduce inflammation and congestion in the nasal passages, which can help improve breathing during sleep. Allergy treatments may also be recommended for children whose sleep issues are exacerbated by allergic reactions.

Additionally, teaching children to adopt good sleep hygiene practices, such as establishing a regular bedtime routine and creating a calm sleep environment, can help improve their sleep quality.

Conclusion

Large tonsils can significantly affect a child's ability to sleep well, with consequences that go beyond just poor sleep. From obstructive sleep apnea to mouth breathing and disrupted sleep patterns, the effects of enlarged tonsils on sleep can lead to a variety of physical, emotional, and behavioral issues. Early diagnosis and intervention are essential to preventing the long-term effects of sleep disturbances. Treatments such as tonsillectomy, adenoidectomy, CPAP therapy, and allergy medications can be highly effective in improving sleep quality and addressing the underlying issues caused by enlarged tonsils, ultimately enhancing a child's health, well-being, and development. If a child exhibits signs of sleep disturbances, it is important for parents to seek medical advice to determine the best course of action for improving their sleep.

This article was created using OpenAI’s ChatGPT on February 23, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

What Causes Insomnia in Children?

By Brandon Peters, MD

Children are often the perfect sleepers, but when they are not, what causes insomnia in children? Insomnia is the inability to fall or stay asleep or sleep that is not restorative. The causes of insomnia in children may overlap with adults, but there are also some unique conditions that may predispose your child to difficulty sleeping.

How Behavioral Problems Result in Insomnia

Perhaps the most common and frustrating of the causes of insomnia are difficulties related to your child’s behavior. Babies and toddlers may enjoy being comforted as they transition to sleep, but if they awaken and you are not there, this can be a source of great distress. This may result in frequent tearful tantrums in the middle of the night. This sleep-onset behavioral insomnia is remedied by letting your child fall asleep alone.

Another potential problem is toddlers and young children who refuse to go to bed. They will insist on a litany of needs prior to going to sleep: a drink of water, a trip to the bathroom, another bedtime story, a few more minutes with the light on, and the list goes on. This limit-setting insomnia is overcome by setting appropriate boundaries and asserting parental authority.

Moreover, children need to have a set of healthy sleep habits and a bedtime routine that will ensure a smooth transition to sleep. This includes appropriate sleep hygiene, which eliminates disruptions to sleep and makes the period of time just prior to falling asleep a time of relaxation. In addition, many distractions should be eliminated from the bedroom to ensure an appropriate sleep environment.

The Role of Medical Problems

There are a number of medical problems -- including neurologic and psychiatric conditions -- that may lead to insomnia in children. In general, these are rare disorders and other signs would exist beyond insomnia. Some of the possibilities include:

• Depression

• Post-traumatic stress disorder (PTSD)

• Attention deficit hyperactivity disorder (ADHD)

• Autism

• Asperger syndrome

In addition, some children (especially teenagers) may have circadian rhythm disorders such as delayed sleep phase syndrome that result in insomnia. These conditions lead to difficulties falling asleep at night and a desire to oversleep in the morning. This occurs because the desired sleep phase is shifted later than is standard. This may interfere with school performance and some school districts are actually shifting the start times to allow teens to sleep in. The use of phototherapy and melatonin may also help to shift these troublesome sleep patterns.

Other Causes of Insomnia in Children

Aside from the causes described above, there are a few other possible situations that may result in insomnia in children. Some children may experience insomnia as the result of medication use, especially the use of stimulants in ADHD. Finally, precocious children (those who are intellectually gifted) often have insomnia.

If your child is having difficulty falling asleep, and simple changes to address behavioral causes are ineffective, you may want to speak to your pediatrician about exploring other possibilities to improve your child’s sleep.

Brandon Peters, MD, is the author of Sleep Through Insomnia, a neurology-trained sleep medicine specialist at Virginia Mason Medical Center in Seattle, and former adjunct lecturer at the Stanford Center for Sleep Sciences and Medicine.