Restless Sleep — When to Be Concerned

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Fairfax Neonatal Associates

By Dr. Melody Hawkins, Pediatric & Adolescent Sleep Center

Restless sleep is a frequently reported symptom that may involve tossing and turning before sleep onset, frequent awakenings, feeling that you are not sleeping deeply, or frequent movements during sleep that can cause awakenings. In addition, restless sleep often causes symptoms the next day with increased sleepiness, adverse changes in behavior, and trouble focusing.

There are many causes of restless sleep ranging from poor sleep habits to sleep disorders to medical disorders. Sleep patterns vary with age; therefore, what is considered normal prior to sleep onset and during sleep is age-dependent. Restless sleep can present differently for infants, school-age children, and teenagers.

Some things that cause restless sleep include:

The environment can cause restless sleep if it is too hot or cold, the mattress/pillow is uncomfortable, or there are external noises or too much light. The bedroom should be clean and uncluttered.

Problems with grief, anxiety, depression, or even mind racing can cause trouble falling asleep and restless sleep.

Stimulant medications (sometimes used for ADHD) and caffeine can cause problems falling asleep.

Kids and adults alike suffer from a few common sleep disorders that cause restless sleep, including:

• Obstructive Sleep Apnea, which is often associated with restless sleep as it causes sleep disruption and awakenings.
• Parasomnia events (including sleepwalking and sleep terrors), which can be associated with increased movements during sleep.
• Restless Sleep Disorder, which was first described in 2020 for children 6- to 18-years-old and can be diagnosed by a sleep study.
• Restless Leg Syndrome, a clinical diagnosis often associated with restless sleep.
• Changes in circadian rhythm (often a shift back in sleep schedule for teenagers), which can cause restlessness prior to sleep onset due to problems falling asleep at night.
• Insomnia — children with Insomnia often report restless sleep or have been observed sleeping restlessly.

Addressing restless sleep usually involves trying to find the underlying cause, including:

• Minimizing environmental disruptions, such as using a fan or sound machine to drown out outside noises for light sleepers.
• Making the room dark and cool.
• Participating in calming activities or relaxation techniques, which can be helpful for anxiety surrounding falling asleep.
• Taking steps to minimize pain, which can often cause restless sleep.
• Making sure your child is not accidentally taking in late afternoon caffeine or other sources of caffeine, such as chocolate.

To reduce restless sleep, there are a few sleep habit improvements to try first, including:

• Establishing a consistent sleep schedule with daytime light exposure.
• Being active during the day, while voiding vigorous exercise before bed.
• Only using the bed for sleep.
• Establishing a good bedtime routine while setting aside time in the evening to wind down without electronics.
• Keeping a sleep journal, which can be helpful to establish any associations that cause worsening of sleep quality. This can be especially helpful for teenagers trying to establish a more consistent bedtime and wake time.

If restless sleep is frequent, worsening, or not responsive to attempts to improve sleep habits, then speaking to your doctor is recommended.

As the only American Academy of Sleep Medicine accredited sleep center in Northern Virginia, the specialists at Fairfax Neonatal Associates’ Pediatric & Adolescent Sleep Center evaluate and treat sleep-related problems specific to pediatrics and adolescents. Patients, ages 20 and younger, are seen by board-certified Pediatric Pulmonologists who are dedicated to fully treating a wide range of sleep disorders, including Restless Leg Syndrome, Narcolepsy, Sudden Infant Death Syndrome, and more.

Learn more about Dr. Melody Hawkins, this post’s author here, and all of Fairfax Neonatal Associates’ providers here. Connect with their Pediatric & Adolescent Sleep Center online or by calling (703) 226-2290.