General aspects

A particularly neglected problem

Anders et al. (1978) took doctors to task for not paying more attention to excessive sleepiness in children: ‘The sleepy child has been ignored by physicians attracting medical attention only after daytime sleepiness had seriously impaired their education.’ As mentioned earlier, this reproach has still not been heeded and the problem remains neglected, despite the evidence that it is common and the reasons for supposing that it is linked with various difficulties and dangers comparable to those described in sleepy adults (reduced work performance, accidents including car crashes, impaired social relationships and even major disasters) (Mitler, 1996).

There are a number of explanations why childhood sleepiness has not received the attention that it merits.

• Compared with the other main sleep problems of sleeplessness and the parasomnias, sleepiness is less obvious and also less troublesome. It may not be recognized as a problem until the child goes to school and has difficulty with school work or other activities.

• Even when the problem is acknowledged, the sleepy child may not come immediately to professional attention because the sleepiness is often not viewed as a medical problem by parents, teachers or children themselves. The symptoms are easily misinterpreted as laziness, awkwardness, boredom or poor motivation.

• If a professional opinion is sought, similar mistaken conclusions may be reached, or the sleepy behaviour viewed as a sign of depression or limited intelligence. Such mistakes seem particularly common in narcolepsy in which long delays in making the correct diagnosis often occur, as will be discussed later.