The Science of Sleep: Problems and Warning Signs

Let’s look at medical reasons for sleep problems in children and adults and warning signs to help identify them in children!


Most, if not all, medical conditions, chronic or acute, go paired with altered sleep. The simple explanation for this is that a person’s sleep need increases with poor health. During sleep, the body’s immune system is more active than during wakefulness, and even more so when one’s health is compromised. Without adequate sleep, the body lacks the required regulation of disease-fighting processes to overcome illness. Due to the bidirectional relationship between medical conditions and sleep problems, where many medical conditions are indicative of a sleep problem or vice versa, sleep health professionals have resorted to detecting sudden changes in sleep characteristics or chronic sleep problems as warning flags for adverse health.

In this document, we mention how to recognize sleep problems in children with a helpful tool, and we list some of the most common medical conditions in children and adults that may explain some of these sleep problems.

How to recognize sleep problems in children using the BEARS tool.

This sleep identification tool is ideally suited and directed to parents and non-sleep specialists (for example family members, babysitters, etc.).

BEARS is a user-friendly screening tool to help identify sleep problems in children.  Ask yourself these questions:

B – Bedtime

  • Does my child have trouble going to bed?
  • Does my child have trouble falling asleep?


E – Excessive Daytime Sleepiness

  • Is it increasingly difficult to wake my child in the morning?
  • Does my child seem excessively tired during the day?
  • Is my child more moody or hyperactive during the day?


A – Awakening During the Night

  • Does my child awaken during the night and have trouble going back to sleep?
  • Has anything happened socially or within the family that may have contributed to my child’s sleep disruption?


R – Regularity and duration of sleep

  • Is my child getting the recommended sleep duration for his/her age? School aged children (6-13 years olds) are recommended to sleep 9 to 11 hours per night.
  • What time does my child go to bed and get up on weekdays?
  • And on weekend days?
  • Does this allow my child to get enough sleep every day?


S – Snoring

  • Does my child snore? Loudly? Every Night?
  • Does my child stop breathing, gasp, or choke during sleep?


If you answered “yes” to any of these questions, your child may have a sleep problem that should be discussed with your pediatrician or pediatric sleep specialist.

What are the most common medical conditions that may explain sleep problems in children?

Children (school aged children 6 – 13 years of age)


Obstructive sleep apnea syndrome

Sleep apnea syndrome is characterized by pauses or complete stops is breathing during sleep. It is one of the most common sleep disorders in adults, but is also common in children. Obstructive sleep apnea in children is often caused by enlarged tonsils or adenoids that prevents the child from getting adequate oxygen during the sleep. Parents can take note of snoring and heavy breathing and/or restlessness during sleep. Children with obstructive sleep apnea would also experience daytime sleepiness and lack of energy, which, in children,  may also present as hyperactivity.


Kidney disease

Sleep disturbances are common in children with chronic kidney disease. The most common ones are those associated with restless legs syndrome, sleep-disordered breathing, behavioural insomnia and abnormal behaviour during sleep (parasomnias, such as sleepwalking). These sleep disturbances often manifest as excessive daytime sleepiness.



As with adults, asthma in children may interfere with sleep, especially during an asthma attack. Asthmatic sleep-related symptoms are nighttime wheezing, difficulty falling and staying asleep.



Apart from chronic anemia, where the body does not produce enough red blood-cells, anemia can also be caused by iron deficiencies or hemolysis as a result of other diseases and infections. Sleep-related symptoms may include difficulty staying asleep and daytime sleepiness.



Children who are difficult to wake from sleep and those that experiences sleepiness may suffer from Diabetes. These symptoms occur particularly in response to ketoacidosis and hypoglycemia.


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What are the most common medical conditions that may explain sleep problems in adults?

Adults (18 – 65 years of age)

Psychiatric conditions

Sleep is regulated by the brain and psychiatric conditions occur in the brain. It is therefore not surprising that many psychiatric conditions, including depression, dementia, generalized anxiety disorders and schizophrenia, go hand in hand with sleep problems. If you experience difficulties falling asleep, have early morning awakenings with the inability to fall back asleep or experience excessive daytime sleepiness, you may have or be prone to having a psychiatric condition. Note that these symptoms are also common in those with acute stress, and usually fade away as stress levels decrease.


Obstructive sleep apnea syndrome

In adults, symptoms of obstructive sleep apnea include snoring, waking up out of breath, having a dry mouth or headaches upon awakening and excessive daytime sleepiness. If the individual has a bed partner, he or she may also notice pauses in breathing and gasping for air.


Heart disease

Some heart disease including coronary artery disease and congestive heart failure can cause difficulties maintaining sleep. Another sleep-related symptom of heart disease is feeling fatigued during the day.



Diabetes, specifically ketoacidosis and hypoglycemia, can make it difficult to stay asleep at night. Other sleep-related symptoms to look out for are night sweats and a frequent need to pass urine at night. Diabetes may also damage nerves in the arm or legs (peripheral neuropathy) which can cause nighttime limb movements, pain or discomfort.


Gastric acid reflux disease (GERD)

The upward flow of stomach acid in GERD, and the resulting coughing or choking may disrupt sleep. Common symptoms are heartburn, a sore throat and waking up with acid in your mouth.


Kidney disease

Sleep disturbances are a common sign of chronic kidney disease. Difficulties maintaining sleep, restless legs syndrome, periodic leg movements and obstructive sleep apnea are among the most mentioned sleep disturbances of chronic kidney disease patients. Sleep disorders have a higher negative impact on people with chronic kidney disease than on those without chronic kidney disease.


Chronic Obstructive pulmonary disease (COPD) and asthma

Many individuals with COPD report symptoms of insomnia, which seem to be related with the severity of the symptoms of COPD. The majority of individuals with COPD also suffer from obstructive sleep apnea. Sleep problems in those with asthma relate to the occurrence of an asthma attack during sleep. Other sleep complaints include symptoms of insomnia and its association with excessive daytime sleepiness.


Thyroid disorders

Individuals with thyroid disorders are more likely to have restless legs syndrome than those in a general population. Individuals with hypothyroidism are also at an increased risk for obstructive sleep apnea.  Sleep dissatisfaction, and the resulting excessive daytime sleepiness are also common among those with hypothyroidism, even in those not suffering from restless legs syndrome or obstructive sleep apnea.



People with anemia are more likely to suffer from restless legs syndrome than those who are not. Intravenous iron treatment in those with anemia resolves restless legs syndrome in most patients. Restless legs syndrome can cause difficulty falling asleep and difficulties staying asleep.


By Rob Henst and Paula Pienaar – Sleep Scientists from SSISA Sleep Science, in collaboration with MySleep.


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