Sleep in Special Populations and Pediatric Sleep Medicine
Children and adolescents
Children have high sleep needs that decline with age. Behavioral insomnia of childhood includes sleep-onset association and limit-setting types. Obstructive sleep apnea in children often presents with snoring, mouth breathing, and adenotonsillar hypertrophy; adenotonsillectomy is often curative. Adolescents commonly have delayed sleep phase and insufficient sleep; screen for this before diagnosing insomnia. Parasomnias are common and usually benign.
Pregnancy
Pregnancy increases insomnia, RLS, and sleep-disordered breathing risk, especially in the third trimester. OSA should be treated; CPAP is considered safe. Supine sleep in late pregnancy is discouraged.
Older adults
Sleep becomes lighter and more fragmented; advanced sleep phase is common. Medications and comorbidities contribute. Falls and cognitive impairment warrant caution with sedatives.
Traps
Do not apply adult insomnia criteria rigidly to children. Distinguish normal developmental sleep changes from pathology. In pregnancy, avoid unnecessary medications and prioritize behavioral approaches.
Rule of thumb: In a child with snoring and daytime symptoms, suspect OSA and evaluate for adenotonsillar hypertrophy before labeling behavior problems as primary.