Hours of sleep: 10 to 11 hours per 24 hours.

School-age children may not obtain sufficient sleep, which can lead to behavioral and learning problems. The child may be misdiagnosed with attention-deficit disorder or learning disabilities, particularly in classroom subjects that require complex problem solving or sustained attention (2).

Some of the more common nonrespiratory sleep disorders in the school-age child are as follows:

Disorders of arousal parasomnias are more frequent in childhood than in adolescence. Estimates of sleep terrors range from 1% to 6%, sleepwalking up to 17% with a peak at 8 to 12 years, and confusional arousals up to 17.3% (1). School-age children with chronic sleep deprivation rarely articulate the need to nap or rest because they don’t know what it feels to be adequately rested.

Bruxism is a movement-type sleep disorder characterized by repetitive grinding or clenching of the teeth during sleep. It is accompanied by scraping and clicking sounds. Bruxism has two distinct patterns, diurnal and nocturnal. Although bruxism is closely related to stress, the two etiologies appear to be different (1). Allergies, cerebral palsy, intellectual disability, alcohol, stimulant medications, and seizure can contribute to bruxism. Adult-type bruxism usually begins in childhood or adolescence; however, most cases of bruxism are self-limiting and may even disappear with the eruption of secondary teeth. Diagnosis rarely involves a sleep study. Bruxism can lead to excessive wear of the teeth, periodontal tissue damage, jaw pain, and headache. Dental appliances, sleeping position, pharmacotherapy, or psychological treatment may be used to alleviate the symptoms (2).

Inadequate sleep hygiene is caused by activities that increase arousal, like caffeinated soda, stimulating television, and play. Napping during the day, nighttime awakenings from periodic limb movements (PLMs), loud noises, and bright lights lead to disorganized and often insufficient sleep for the youngster.

Hours of sleep: 9 to 9.5 hours needed but 7 to 7.25 hours obtained.

Sleep disorders seen in this age group include the following:

Around puberty, hormonal changes cause a daily delay in melatonin secretion. This delay results in a delayed sleep onset of approximately 2 hours. Despite the circadian rhythm delay, the adolescent still needs 9 to 9.25 hours of sleep. With early school start times, extracurricular activities, more independence, part-time jobs, and increasing socialization, adolescents manage an average of 7 to 7.5 hours of sleep, causing them to be chronically sleep deprived. Insomnia may be caused by new social pressures, academic pressures, increased responsibilities, or a bedtime too early for the adolescent’s circadian rhythm (3). Parents and adolescents may attribute the symptoms of RLS or PLMD to growing pains or sports injuries. A polysomnogram is useful in identifying the movements and the extent of related arousals.

Chronic sleep restriction can cause mood disturbances, depression, poor academic performance, attention or memory deficits, risk-taking behavior, and increased involvement in traffic accidents (3). All the previously listed sleep disorders lead to excessive daytime sleepiness. However, narcolepsy has more complex symptomatology.

Narcolepsy is caused by impaired sleep-wake regulation of the central nervous system (CNS). The patient complains of excessive daytime sleepiness, cataplexy (the abrupt loss of muscle tone provoked by strong emotion), hypnagogic hallucinations (vivid auditory or visual “dreams” often frightening), and sleep paralysis (inability to move or speak for a few seconds at sleep onset or offset). Although narcolepsy is reported for all age groups, it is most often reported by teenagers and young adults (4).

Kleine-Levin syndrome (5), or recurrent hypersomnia, is characterized by acute episodes of excessive sleepiness, hyperphagia, and hypersexuality lasting up to several weeks at a time. Kleine-Levin syndrome usually occurs during adolescence and is more common in males. Sleep and behavior are normal between episodes (5).

Bedtime in the sleep center should be identical to the bedtime in the child’s home, and the nighttime routine should approximate the routine at home as closely as possible. Obviously, the environment is different, but the parent should nevertheless be encouraged to attempt to simulate the environment and bedtime routine. Have the child bring his or her favorite blanket, pillow, pajamas, bedtime snack, and snuggle toy. Document the bedtime routine, use of a night light, bedtime stalling, and the interaction between the parent(s) and the child at or around sleep onset. Some of the most common sleep disorders in this age group are sleep-onset association disorders in which the child’s innate self-quieting skills are replaced by a need for the physical presence of the parent and/or some parental bedtime behavior in order to initiate sleep. The best course in documentation is to describe an observed activity quoting the dialogue between parent and child. The technologist should not write an opinion or make any judgment regarding the activity or event.