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Insights on childhood insomnia and its Homoeopathic treatment approaches – A narrative review
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Received: ,
Accepted: ,
How to cite this article: Kotian S, Noronha R. Insights on childhood insomnia and it’s Homoeopathic treatment approaches – A narrative review. J Intgr Stand Homoeopathy. 2024;7:19-27. doi: 10.25259/JISH_62_2023
Abstract
Insomnia is a sleep disorder that affects not only adults but also children. It can have a significant impact on a child’s well-being and development, leading to various issues such as daytime sleepiness, irritability and impaired academic performance. While the management of childhood insomnia typically involves behavioural interventions and, in some cases, medication, this article explores the scope of homoeopathic treatment approaches. This review article explores different therapeutic approaches for managing sleep disorders in children, such as behavioural therapies, cognitive-behavioural therapy for insomnia, light therapy and medication management. The insights provided in this review aim to offer an understanding of the scope and effectiveness of homoeopathy in treating childhood insomnia by understanding both the philosophical and therapeutic aspects of treatment, providing a holistic approach to address the underlying causes and improve sleep quality in children.
Keywords
Sleep medicine
Childhood
Insomnia
Homoeopathy
INTRODUCTION
Insomnia is a sleep disorder characterised by difficulty in falling asleep, staying asleep or experiencing non-restorative sleep. While it is commonly associated with adults, it can also affect children. Insomnia in children can have various causes, including environmental factors, underlying medical conditions, psychological issues and poor sleep hygiene.
Several studies have examined the prevalence and causes of insomnia in children. Published studies show that approximately 17% of school-going children are diagnosed with insomnia.[1] Studies have also found that psychological processes in children play a major role in causing sleep disorders, especially insomnia in children. Conditions like attention deficit hyperactivity disorder (ADHD) have been shown to have a direct correlation to insomnia.[2]
Insomnia in children can have a significant impact on their overall well-being and development. It can lead to daytime sleepiness, irritability, difficulty concentrating and impaired academic performance. In addition, chronic insomnia in children has been associated with an increased risk of mental health problems, including anxiety and depression.[3] Treatment approaches for childhood insomnia typically involve a combination of behavioural interventions and, in some cases, medication. Medications may be prescribed in certain situations, but they are typically used for short-term management.[4]
The core of homoeopathic treatment lies in improving bodily functions to enhance overall quality of life. Homoeopathic medicines are not prescribed solely to induce sleep but rather to address the underlying causes, both psychological and physical, that contribute to insomnia. Many studies have been conducted to scientifically prove the efficacy of homoeopathic remedies and compounds to tackle insomnia. A randomised, double-blind and placebo-controlled study aimed to determine the efficacy of individualised homoeopathic simillimum in treating chronic primary insomnia, showed a significant increase in sleep duration, along with a substantial improvement in the individual sleep-related questions and especially sleep impairment index scores from 3.34 to 1.47 in the case group, when compared to the placebo group which had a minimal increase from 3.53 to 3.35. These findings underscore the potential of homoeopathy as a viable treatment modality for primary insomnia, offering a valuable alternative to conventional treatments.[5]
The extensive range of medicines available in the Homoeopathic Materia medica offers specific indications for symptoms of insomnia. While behavioural interventions should also be considered, these remedies have shown remarkable clinical results. The following article aims to provide an overview of different homoeopathic approaches to treat insomnia, with a particular focus on children.
FACTORS CAUSING INSOMNIA IN CHILDREN
Insomnia in children can be influenced by various internal and external factors. Recognising these causes is crucial for effectively treating the child’s sleep disturbance, as it prevents unnecessary over-medication while addressing the underlying predisposing factors. When children start attending school, they are exposed to a range of new environments for the first time in their lives, which can significantly impact their sleep patterns. Understanding and addressing these environmental factors are essential for promoting healthy sleep in children.
Some of the specific causative factors of insomnia in children are,
Environmental factors
Environmental factors play a significant role in a child’s sleep quality. Factors that can contribute to insomnia in children include:
Noise: Excessive noise in the child’s environment, such as loud music, traffic sounds, or a noisy household, can disrupt their sleep and make it difficult for them to fall asleep or stay asleep.[6,7]
Light: Bright lights, including streetlights or electronic devices emitting blue light, can interfere with the child’s natural sleep-wake cycle and make it harder for them to fall asleep.
Temperature: An uncomfortable or extreme temperature in the child’s bedroom, whether it’s too hot or too cold, can disturb their sleep and cause insomnia.
Bedtime routine and environment: Inconsistent or insufficient bedtime routines, lack of a comfortable and inviting sleep environment, or sharing a bed with a sibling or parent can all impact the child’s ability to sleep well.
School environment: Academic pressures, homework load, or performance anxiety can create stress in children, leading to sleep difficulties.[8]
Changes in routine or environment: Transitioning to a new school, moving to a different house, or going on a vacation can disrupt a child’s sleep routine and trigger insomnia.
Electronic devices and screens: Excessive use of electronic devices before bedtime, such as smartphones, tablets, or TVs, can interfere with the child’s sleep patterns due to the stimulating effect of the screens and the blue light they emit.[9]
Family environment: Family conflicts, disruptions in the household, or a stressful home environment can impact a child’s sleep and contribute to insomnia.[10]
Psychological causes
Insomnia in children can have various psychological causes. Here are some possible psychological factors that may contribute to insomnia in children:
Fear: Fear in children is a common phenomenon and can be one of the major causes of insomnia. Children may experience fear of the dark, ghosts, monsters, or sleeping alone. These fears can create anxiety and make it difficult for the child to fall asleep easily. The fear may result in heightened alertness, racing thoughts and a sense of vulnerability, all of which can contribute to insomnia in children.[11]
Anxiety and stress: Children may experience anxiety related to school, family issues, social pressures, or other stressors. This anxiety can lead to difficulty in falling asleep or staying asleep throughout the night.
Traumatic experiences: Children who have experienced trauma, such as physical or emotional abuse, accidents, or witnessing a distressing event, may develop insomnia as a result of the psychological impact of the trauma.[12]
Depression: Children with depression may have difficulty sleeping due to changes in sleep patterns, such as insomnia or excessive sleepiness. Insomnia can be a symptom of depression or can exacerbate existing depressive symptoms.[13]
-
ADHD:[14] Children with ADHD may have trouble winding down at night due to
Hyperactivity and impulsivity
Racing thoughts and overstimulation
Emotional dysregulation
Comorbid conditions of ADHD, such as anxiety or sensory processing issues
Side effects of medications given for ADHD.
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Obsessive-compulsive disorder (OCD):[15] Factors in OCD leading to insomnia are
Obsessive/intrusive thoughts
Compulsive/repetitive behaviours or routines
Sleep-related obsessions
Perfectionism and bedtime routines
Hyperarousal and overthinking
Co-occurring anxiety and mood disorders
Medication side effects: such as selective serotonin reuptake inhibitors (SSRIs)[16]
Separation anxiety: Younger children may experience separation anxiety, especially when they are transitioning to sleeping alone or being away from their parents. This anxiety can disrupt their sleep patterns and lead to difficulty falling asleep.[17]
Poor sleep hygiene
Poor sleep hygiene refers to unhealthy sleep habits and behaviours that can disrupt sleep. Examples include irregular sleep schedules, excessive daytime napping, inconsistent bedtime routines and excessive screen time before bed. Studies have examined the relationship between electronic media use and sleep problems in children and found that increased screen time was associated with more frequent sleep difficulties.[18]
Predisposing medical conditions
Sleep-related breathing disorders: Conditions such as obstructive sleep apnoea (OSA) and snoring can disrupt a child’s sleep patterns. These disorders involve partial or complete blockage of the airway during sleep, leading to pauses in breathing and frequent awakenings. OSA may be caused by enlarged tonsils or adenoids, obesity or structural abnormalities of the airway.[19]
Allergies and respiratory condition: Nasal congestion caused by allergies or respiratory infections, like the common cold, can create breathing difficulties for children, especially during sleep. Research has demonstrated that this discomfort can significantly disrupt their sleep patterns and contribute to the development of insomnia. It is worth noting that medications commonly used to treat allergies, such as antihistamines, often have sedative effects.[20]
Gastrointestinal disorders: Certain gastrointestinal conditions, such as gastroesophageal reflux disease (GERD) or irritable bowel syndrome, can cause discomfort or pain that worsens at night, making it hard for children to fall asleep or stay asleep. It is noteworthy that insomnia can also act as a predisposing factor to cause GERD in many cases.[21]
Chronic pain: Chronic pain conditions, such as juvenile arthritis or fibromyalgia, can cause persistent discomfort and disrupt a child’s sleep. Pain may increase at night due to changes in body position or decreased activity, contributing to insomnia.[22]
Mental health disorders: Psychological factors, including anxiety disorders, depression or post-traumatic stress disorder, can contribute to insomnia in children. Mental health conditions often disrupt normal sleep patterns, making it difficult for children to relax and fall asleep.[23]
Chronic illnesses: Children with chronic illnesses, such as diabetes, asthma or cystic fibrosis, may experience symptoms that interfere with sleep. Frequent monitoring of blood glucose levels, breathing difficulties or medications may disrupt sleep patterns and contribute to insomnia.[24]
Medications: Certain medications, such as stimulants used to treat ADHD, corticosteroids or medications for chronic pain or asthma, can interfere with sleep. Stimulant medications may cause increased alertness[25], while corticosteroids such as dexamethasone can disrupt the body’s natural sleep-wake cycle.[26] Short-acting beta agonists given for asthma also have reported side effects of sleeplessness in children.[27]
Neurological disorders: Children with neurological conditions such as nocturnal paroxysmal dystonia[28], periodic limb movement disorder[29], and restless leg syndrome[30] may experience disrupted sleep patterns, leading to insomnia.
MANAGEMENT
There are various therapeutic approaches available for managing sleep disorders in children. These therapies aim to improve sleep quality, establish healthy sleep habits and address underlying factors contributing to sleep difficulties. Here are some common therapies for sleep disorders in children:
Behavioural therapies
Behavioural interventions focus on modifying sleep-related behaviours and establishing healthy sleep habits. These therapies may include:
Sleep hygiene education.
Bedtime routine: Implementing a consistent and calming bedtime routine to signal the body that it’s time to sleep.
Sleep restriction therapy:[31] Restricting the time spent in bed to match the child’s actual sleep needs which can help consolidate sleep.
Stimulus control therapy: Promoting associations between the bed and sleep using the bed only for sleep and avoiding stimulating activities in bed such as playing.
Graduated extinction/camping out Gradually reducing parental presence during bedtime to promote independent sleep.
Cognitive-Behavioural Therapy for Insomnia (CBT-I)
CBT-I techniques for school-aged children and adolescents include bedtime shifts (including sleep restriction), stimulus control, thought challenging, psychoeducation about sleep, sleep hygiene and relaxation techniques.[32] CBT-I helps identify and modify thoughts, beliefs and behaviours that contribute to insomnia. It combines behavioural techniques with cognitive restructuring to address sleep-related anxiety, rumination and negative sleep thoughts.
Light therapy
Light therapy involves exposure to specific wavelengths of light to regulate the sleep-wake cycle.[33] It can be useful in treating circadian rhythm disorders, such as delayed sleep phase disorder or shift work sleep disorder.
Medication management
In some cases, medication may be prescribed to manage sleep disorders in children. Medications such as melatonin or sedative-hypnotics may be used for specific sleep disorders or as a short-term intervention.
Melatonin is a hormone that plays a crucial role in regulating the sleep-wake cycle. It is naturally produced by the body in response to darkness and helps signal the brain that it is time to sleep. In some instances, melatonin supplementation may be recommended for children with insomnia to supplement this hormone, synchronise the body’s internal clock and promote sleep.[34]
HOMOEOPATHIC UNDERSTANDING OF INSOMNIA
H.A. Roberts, in his book ‘Principles and Art of Cure’, explains the scope of homoeopathy in cases of insomnia. In the chapter ‘Law of Palliation’, he highlights the significance of understanding and considering the concomitant symptoms associated with insomnia to effectively address it with homoeopathic remedies. The author acknowledges insomnia as a troublesome symptom that often requires palliative measures. However, applying the law of similar to the patient’s entire constitutional state, considering the accompanying symptoms that point to the appropriate remedy, still needs to be the primary approach.[35]
He explains how it becomes important to consider various factors that cause insomnia, such as worries, family disturbances and specific pain and distress in certain body parts. These factors are described as part of a broader symptomatology in which insomnia plays a role. The author encourages a thorough assessment of the patient’s condition, seeking to understand specific details such as whether the patient falls asleep when their knees are covered, if they are kept awake by a rush of ideas, or if fear of something happening prevents them from sleeping.[35]
STUDIES CONSIDERED IN THIS REVIEW
As evidenced in the Table 1[36-46], it is imperative to advocate for more rigorous randomised controlled trials (RCTs) in the exploration of homoeopathic interventions for insomnia, aiming for methodological robustness to enhance the reliability of findings. In addition, the incorporation of standardised scales in routine clinical setups for assessing sleep outcomes would facilitate a more comprehensive and comparable evaluation of treatment efficacy. Furthermore, there is a critical need for deeper investigations into the placebo effect in the context of insomnia treatment, acknowledging its potential role and impact on patient outcomes. Beyond that, exploring alternative measures such as hypnosis, meditation, and music therapy in the treatment of insomnia could provide valuable insights into holistic and non-pharmacological approaches, expanding the repertoire of available interventions for improved patient care.
| S. No. | Author/ Year |
Study design | Sample size | Outcome parameters | Medicines prescribed/intervention | Results | Duration of follow-up |
|---|---|---|---|---|---|---|---|
| 1. | Jong et al. (2016)[36] | RCT | 179: (Hom.-89, Glycine-90) |
Primary outcome- total complaints severity score Secondary outcome- IMOS, IMPSS |
ZinCyp-3-02 (Containing Cypripedium pubescens D4, Magnesium carbonicum D10 and Zincum valerianicum D12) | Significant reduction in the severity of sleep disorder-associated complaints. Treatment effectiveness and satisfaction assessments were more favourable for ZinCyp-3-02. |
28 days |
| 2. | Harrison et al. (2013[37] |
RCT- Double blinded | 46 males with PI 28 completed |
PSAS, SD | Homoeopathic complex medicine | Statistically significant improvement in pre-sleep arousal, and sleep onset latency. Wilcoxon signed-rank test revealed Gradual improvement. |
Four weeks |
| 3. | Bell et al. (2011)[38] | Double-blinded RCT | 54 (Coffea Cruda [n=26] and Nux Vomica [n=28]) | Eight all-night PSG and actigraphic recordings PSQI POMS Sleep diary parameters |
Nux Vomica 30ch or Coffea Cruda 30ch | Increase in PSG total sleep time and NREM, awakenings and stage changes. Actigraphic changes and self-rated scale effects -not significant. |
Eight weeks (One night a week) |
| 4. | Michael et al. (2019)[39] | Double-blind, RCT | 60 patients | 6 Item-sleep diaries (1: Latency to fall asleep, 2: Minutes awake in the middle of the night, 3: Minutes awake too early, 4: Hours spent in bed, 5: Total sleep time in hours, and 6: Sleep efficiency), ISI |
IH remedy | IH- significant improvements in all sleep diary outcomes except for item 3. Placebo- significant enhancements in item 6 and ISI score. Items 4,5,6, and ISI is significantly better in IH. |
Three months |
| 5. | Cooper and Relton (2010)[40] | Systematic review | 4 RCT, 1 Cohort study, 3 case series, 2600 case studies | Biomedical, Homoeopathy-specific and Complementary medicine-specific databases | |||
| Specific articles in the above systematic review | |||||||
| 6. | Carlini et al. (1987)[41] | RCT-crossover | 44 individuals with insomnia | Sleep duration, Latency, quality+ symptomatic evaluation | IH remedy | Both groups demonstrated significant improvements from baseline by day 15, and this positive trend persisted at all time points until the end of the three months across all measured outcomes. | Two phases- 45 days Homoeopathy followed by 45 days placebo. Follow-up every 15 days |
| 7. | Cialdella et al. (2001)[42] |
RCT | 96 insomnia patients (average 54 years)- who had received low-dose benzodiazepines for three months | Clinical Global Impression Improvement scale | Two formulaic homoeopathic medicines: Homeogene-46 and Sedatif-PC | No significant differences between the groups, with success rates of 67%, 60%, and 50% for Homeogene-46, Sedatif-PC and placebo, respectively. Secondary outcome- No significant difference (Return to benzodiazepine and treatment preference). |
Three months |
| 8. | Wolf (1992)[43] |
29 participants (15 cases, 14 control) | Symptomatic evaluation, including sleep time, Latency | Formulaic homoeopathic medicine- Requiesana | The Homoeopathy group reported improvement at 57%, while the placebo group showed a 29% improvement (ns). Both groups showed improvement in sleep time, Latency and sleepwalking. |
One month | |
| 9. | Kolia-Adam et al. (2008)[44] |
Double-blinded RCT | Not reported | Symptomatic evaluation-sleep duration, patterns | Coffea cruda 200c | 38-min improvement in the homoeopathy group and a 35-min improvement in the placebo group. (Difference between groups not significant). Improvement in sleep quality in both groups |
One month |
| 10. | Rogers (1997)[45] | Case series | 5 cases of sleep difficulty due to alcohol dependency | Sleep diaries and the PSQI | IH remedy | Improvement in Sleep diary, PSQI. Alcohol dependence- 2 patients showed marked improvement Two slight improvement, one no improvement |
Three months |
| 11. | Crump S et al. (1997)[46] |
Case series | 17 patients with insomnia | Symptomatic evaluation | IH remedy | 41% reported feeling ‘better,’ 12% reported feeling ‘much better.’, 12% reported no change, 35% dropouts |
Three months |
PI: Psychophysiological onset insomnia, PSAS: Pre-sleep arousal scale, SD: Sleep diary, RCT: Randomised controlled trial, PSQI: Pittsburgh sleep quality index, IH: Individualised homoeopathic, POMS: Profile of mood state, ISI: Insomnia severity index, IMOS: Integrative medicine outcome scale, IMPSS: Integrative medicine satisfaction scale
INSOMNIA ACCORDING TO HAHNEMANN CLASSIFICATION OF DISEASES
Causes and treatment
Insomnia as a true chronic disease
In his exploration of chronic diseases, Hahnemann delved into the three primary categories of chronic illnesses, that is the chronic miasms – Syphilis (the chancre miasm), Sycosis (the gonorrhoeal miasm) and psora (the itch miasm). Notably, Hahnemann emphasised that psora was distinct as a non-venereal miasm, while the other two had their origins in the adverse effects of syphilis and gonorrhoea, respectively.[47]
It is crucial to recognise that determining the miasmatic diagnosis for any given medical condition depends on various factors, that is ‘fundamental cause of the disease’, which is based on the complete way of life and all the aspects that an individual encounters in their day-to-day existence.
Regarding the chronic factors contributing to childhood insomnia, structural causes are infrequently observed, in line with the typical characteristics of psora. However, it is also important to consider the diverse physical, mental and social factors that children experience in their daily lives to comprehend the basis of their miasm. These factors collectively shape the individual’s miasmatic tendencies.
In his book ‘The Chronic Diseases, their Peculiar Nature and Their Homœopathic Cure’, Hahnemann mentions a few symptoms that are corresponding symptoms of latent psora.[47]
He has difficulty in falling asleep when abed in the evening; he often lies awake for hours.
Sleeplessness, from anxious heat, every night, an anxiety which sometimes rises so high that he must get up from his bed and walk about.
After three o’clock in the morning, no sleep, or at least no sound sleep.
Melancholy, palpitation and anxiousness cause her at night to wake up from sleep (mostly just before the beginning of the menses). In the Book by Dr S K Banerjee, Within the context of miasms, each miasmatic category exhibits distinct characteristics related to sleep patterns and symptoms. Most symptoms are classified under the miasm of Syphilis.[48]
Insomnia as an indisposition
Dr J T Kent describes indisposition as a state of illness or discomfort that arises from factors such as poor diet, unhealthy habits or an imbalanced lifestyle. In such cases, resolving the underlying cause, known as the ‘causa occasionalis’, often leads to a spontaneous cessation of the indisposition.[49]
Hence, the change in sleep hygiene environmental factors such as noise, smell and temperature responsible for insomnia are the states of indisposition and require no medication. A change of environment or correction of the cause is sufficient to bring about a change in the symptoms.
Insomnia as an artificial chronic disease
Insomnia can be considered an artificial chronic disease when it is a result of prolonged and intense exposure to strong medications, especially when administered in increasing doses. The powerful actions of these drugs can lead to a defensive reaction by the body’s vital force, which tries to protect itself from the destructive primary effects.
In accordance with Aphorism 75,[50] such artificial chronic diseases are often the most challenging to cure. The healing process needs to be initiated by the vital force itself. Therefore, it becomes essential to identify the factors contributing to this condition and take corresponding actions to prevent further progression before embarking on any therapeutic interventions.
Tapering the dose of the medication and removing unnecessary medication on consultation with the specialist should be about a change in the severity of the condition.
Insomnia as a symptom of one-sided disease
Sometimes, in one-sided diseases, sleeplessness or insomnia might be the only one of the characterised developed symptoms.[49] In such cases, the treatment approach follows the criteria outlined by Hahnemann. The focus lies on selecting a remedy based on symptom similarity and correspondence, aiming to administer the remedy that covers the most prominent symptoms and accessory symptoms presented by the patient – which can lead to a cure.
If the chosen remedy covers only the general symptoms and not the peculiar ones, the totality of both the accessory symptoms of the medicine and the disease should be considered. After administering the remedy, a new totality is formed based on the remaining symptoms, and the process of selecting and prescribing the medicine continues in succession until a cure is achieved.
Some of the specific rubrics of characteristic symptoms corresponding to its remedies are as follows (Relevant to children)
CONCLUSION
Homoeopathy in paediatric insomnia goes beyond symptom relief, focusing on underlying causes through holistic care. Studies demonstrate its efficacy in improving sleep patterns, considering physiological and psychological aspects. However, research lacks consistency in design and sample sizes, necessitating more rigorous trials. Collaborative efforts between homoeopathic and conventional healthcare providers could enhance care. Definitive evidence of homoeopathy’s efficacy requires further large-scale trials. Integration of homoeopathic care into holistic approaches alongside specific therapies offers comprehensive solutions. Continuous exploration and validation of novel approaches are crucial for evolving practices and refining treatment protocols in paediatric insomnia management.
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
Patient’s consent is not required as there are no patients in this study.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship
Nil.
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