Differential Diagnosis for a 12-year-old with Difficulty Falling Asleep and Frequent Nighttime Waking

• Single Most Likely Diagnosis
  • Insomnia: This is the most common sleep disorder in children and adolescents, characterized by difficulty initiating or maintaining sleep, or both, despite adequate opportunities to sleep, leading to impaired daytime functioning. The symptoms described fit well with insomnia, especially given the age of the patient and the nature of the sleep disturbance.
• Other Likely Diagnoses
  • Sleep Anxiety or Stress: Anxiety and stress can significantly impact sleep patterns, making it hard to fall asleep or stay asleep. Given the age of the patient, school-related stress, social pressures, or anxiety about the future could be contributing factors.
  • Sleep Hygiene Issues: Poor sleep habits, such as irregular sleep schedules, use of electronic devices before bedtime, consuming caffeine or heavy meals close to bedtime, can lead to difficulty falling asleep and staying asleep.
  • Restless Leg Syndrome (RLS) or Periodic Limb Movement Disorder (PLMD): These conditions can cause discomfort or involuntary movements in the legs, leading to difficulty falling asleep or frequent awakenings.
• Do Not Miss Diagnoses
  • Sleep Apnea: Although less common in children than in adults, sleep apnea can cause frequent awakenings and should not be missed due to its potential impact on cardiovascular health and daytime functioning.
  • Diabetes: Nocturia (waking up to use the bathroom) can be a symptom of undiagnosed diabetes, making it crucial to consider, especially if accompanied by other symptoms like increased thirst or hunger.
  • Thyroid Disorders: Both hyperthyroidism and hypothyroidism can affect sleep patterns. Hyperthyroidism might cause difficulty sleeping due to increased metabolism and alertness, while hypothyroidism can lead to sleepiness but also restless sleep.
• Rare Diagnoses
  • Narcolepsy: Characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. Although rare, it's essential to consider in a child with significant sleep disturbances.
  • Kleine-Levin Syndrome: A rare disorder that causes recurring periods of excessive daytime sleepiness, often accompanied by automatic behavior and confusion. It's more common in males and usually starts during adolescence.
  • Sleep-Related Movement Disorders: Including conditions like bruxism (teeth grinding) or rhythmic movement disorder, which could disrupt sleep but are less likely to be the primary cause of the described symptoms.