Behavioural insomnia and circadian rhythm disorders

Overview & Definition

Two very different families sit at the exhausted end of most sleep referrals, and the examiner wants them separated at once. The toddler who cannot fall asleep without being rocked, and wakes the household four times a night, has behavioural insomnia of childhood: a learned problem of settling and staying asleep. The teenager who lies awake until two in the morning and cannot be roused for school has a circadian rhythm disorder: a body clock set to the wrong time. [1] [8]

The unifying definition of behavioural insomnia of childhood is difficulty initiating or maintaining sleep that arises from behaviour and learning, occurs despite an adequate opportunity to sleep, and produces daytime consequences for the child or the family. The circadian rhythm sleep-wake disorders, by contrast, are a persistent mismatch between the internal clock and the schedule the child needs to keep. Both are common, both are treatable, and both are frequently mismanaged with a hypnotic instead of the right behavioural or circadian plan. [1] [8]

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8. [8]Auger RR; Burgess HJ; Emens JS; Deriy LV; Thomas SM; Sharkey KM Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med, 2015.PMID 26414986
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