Excessive Daytime Sleepiness in Children

Causes and Impact on Learning and Behavior

Excessive sleepiness in children can be caused by a variety of health problems and sleep disorders, but regardless of the specific cause the impact of sleepiness on learning and behavior is significant.  Many adolescents and adults in our society are chronically sleepy, but sleep experts also emphasize the importance of identifying daytime sleepiness in children as well.  

Manifestations of sleepiness in children are sometimes different compared with adults.  Mild sleepiness is accompanied by subtle behavioral changes that are not immediately obvious to the casual observer.  For example, drowsy children experience lapses in attention and concentration, difficulty staying on task, fidgety or hyperactive behavior, or irritability.  With the transition into more obvious sleepiness, children exhibit droopy eyelids and loss of facial expression.  Severe sleepiness is identified by recurrent lapses into obvious sleep, with loss of postural tone and diminished responsiveness.  Because children may be embarrassed by sleepiness or disciplined for falling asleep, they sometimes develop ways of hiding their sleepiness or they deny feeling sleepy if asked.  

The identification of chronic daytime sleepiness in a child should initiate a discussion with the child’s parents to discover any obvious contributors such as inadequate night time sleep or medication-related sleepiness.  A variety of medical problems are associated with chronic sleepiness, including respiratory disturbance during sleep (obstructive sleep apnea), narcolepsy (a neurologically based sleep disorder that causes severe chronic sleepiness regardless of the amount of night time sleep), restless legs syndrome, and insomnia.  Insomnia sometimes occurs in association with depression or anxiety, and in some situations a mental health evaluation is a valuable part of the diagnostic work-up. 

Consultation with the child’s physician begins the process of identifying the cause of the sleepiness, and in some cases, referral to a sleep medicine specialist is warranted.  When respiratory disturbances during sleep or narcolepsy are suspected, the diagnostic evaluation often includes an overnight sleep study and possibly a daytime study to characterize the nature and severity of daytime sleepiness.  It is important to distinguish between sleepiness and fatigue, which is characterized by a feeling of tiredness or loss of energy but not overt sleepiness.  Chronic fatigue may be associated with a different group of health problems, including depression, anxiety, and medical problems such as chronic infection, hypothyroidism, autoimmune and neurological problems.

Full alertness across the day is a requirement for efficient learning and academic success.   Teachers and parents are ideally positioned to observe signs of chronic sleepiness in children.  Recognition of chronic sleepiness represents the important first step in identifying the underlying cause and developing a plan for intervention.

The Methodist Healthcare Sleep Disorders Center is an award-winning sleep facility accredited by the American Academy of Sleep Medicine.  The Sleep Center specializes in sleep disorders affecting patients of any age.  For more information, please contact the Sleep Center at (901) 683-0044.

Merrill S. Wise, M.D.
Pediatric Sleep Medicine Specialist
Methodist Healthcare Sleep Disorders Center