General aspects

Definition of the problem

When parents say that they have a problem with their child's sleep it is essential to establish from the start the precise details of the problem as they see it. Doing so sometimes reveals that the child's sleep is actually within normal limits and that his parents (uncertain about children's sleep requirements including individual differences) are worried unnecessarily about possible harmful effects on their child of not getting enough sleep. In the circumstances, simple explanation and reassurance may be very therapeutic.

Assuming that the child's sleeplessness is ‘real’ rather than ‘imaginary’ in this sense, the following types of sleeplessness need to be distinguished from each other:

• bedtime difficulties (either reluctance to go to bed or difficulty getting to sleep);

• waking up at night and not being able to go to sleep again;

• waking early in the morning, not going back to sleep and causing a commotion.

The term ‘sleeplessness’ may also be used by parents to mean that their child's sleep is very restless or disturbed by frequent nightmares or other episodic events.

These problems may occur singly or combined. They need to be distinguished from each other because the factors causing or maintaining them can be different and may require different types of treatment.

Apart from its nature, sleeplessness can be defined in terms of its severity.