They may snooze in class but . . .
People tend to think of sleep problems as adult problems, connected to trouble with weight, diet, stress or depression. But more and more children are having trouble sleeping -- and more often than not, a new study finds, treatment comes in the form of a pill.
The trend is concerning, the study authors say, because sleep deprivation can lead to headaches, irritability, impaired concentration and even behavior akin to attention-deficit hyperactivity disorder.
In addition, little is known about the consequences of the prescriptions children are being given to deal with their sleep disturbances. Neither their safety nor effectiveness has yet been studied in young people.
In the report, published in the Aug. 1 issue of the journal Sleep, researchers at Ohio State University in Columbus analyzed 18.6 million cases of sleep disorders in patients ages 17 and younger. They found that 81% of the cases resulted in a drug prescription to treat the problem. Only 7% of patients received dietary counseling, and only 22% were given behavioral therapies such as psychotherapy or stress management counseling.
The data, collected from 1993 to 2004 as part of the National Ambulatory Medical Care Survey, consisted of nationwide records of visits to doctors within all areas of medical practice.
The high rates of sleep disorder prescriptions are supported by industry figures. According to a drug trend report published by Medco, a company that processes prescription-drug claims, sedative or hypnotic drug prescriptions grew at a rate of 14.6% in 2006, faster than any other class of medications. Medco also reported large increases in sleep aid prescriptions made to children ages 10 to 19, an 80% increase for girls and a 64% increase for boys from 2001 to 2006.
Often, the drugs were not ones specifically designed to aid sleep. Antihistamines (such as Atarax) and alpha-2-agonist drugs (such as Catapres or Tenex) have sedative effects secondary to their intended use. Drugs such as non-benzodiazepines, specifically designed to aid sleep, were given less often.
Many factors that impair sleep in adults such as obesity are at work in kids, says study senior author Milap Nahata, an Ohio State University professor of medicine. Changed habits may be playing their part as well. The National Sleep Foundation reported in 2006 that only 20% of adolescents get the recommended nine hours of sleep; distractions such as computers or video games in kids’ bedrooms may lessen sleep quality.
Sleep issues in children aren’t always easy to recognize. “Children with sleep disorders don’t necessarily look sleepy,” says Dr. Ronald Chervin, director of the University of Michigan Sleep Disorder Center. “Some [sleepy] children look hyperactive -- they fidget, they jump up and down.”
He adds that it’s very reasonable for doctors to prescribe a sleep aid for a short time while behavioral changes, which can be quite effective, are made. Only 19% of cases in the study received medication in concert with behavior therapy.
Chervin adds that in some cases, such as when a child is developmentally impaired, behavioral approaches may not be appropriate. In other cases, pediatricians may be too busy to try behavioral approaches, or they may be influenced by parents.
Many doctors lack understanding of sleep disorders, says Dr. William Kohler, medical director of the Florida Sleep Institute. Medical schools spend only a few hours on the topic. A 2001 survey of 626 pediatricians reported that only 25% felt confident treating such disorders.
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