How to help your children sleep betterHow to help your children sleep better

If you’re a parent of school-age children, sleep is probably a hot-button issue in your household. In an ideal world, bedtime would be a quiet, relaxed affair, with everyone gradually winding down in preparation for a night of rest. If “quiet” and “relaxed” don’t exactly describe your family’s pre-sleep routine, trust me—you are not alone. For many families with children, bedtime is chaotic. Kids are wound up and full of resistance, parents are tired and short on patience. The result? Everybody feels frustrated, and nobody—including children—gets the sleep that they need.

Kids, like adults, have chronotypes, which influence their sleep habits and their daytime activity. Throughout childhood, kids move through different chronotypes at different stages of their development, before settling in to an adult chronotype at around age 21. Toddlers are often Lions—up early and hitting the ground running with a ton of energy, and likely to crash hard later in the day. Most teens are Wolves—sluggish and slow to get going in the morning, they become more alert and energized later in the day and in the evening, and may be inclined to stay up well after their (probably Bear) parents have gone to bed. In between toddlerhood and the teen years, school-age children may become Bears—the middle-of-the-road chronotype that is most closely aligned with the solar cycle. Some school-age children may hang on to Lion tendencies from their toddler years, while others may zip ahead into Wolf preferences before they hit adolescence.

When it comes to chronotypes and sleep routines, no two children are exactly the same. One of the best things you can is pay attention to your child’s chronotype as it shifts with their growth and age, and adjust their routines—and your expectations—accordingly. (Need a refresher on your chronotype and what it means for your sleep and your life? Take this quiz: http://www.thepowerofwhenquiz.com )

How much sleep do kids need?

To help your children sleep at their best, you first need to know how much sleep is enough. Sleep needs change throughout childhood and adolescence. As a parent, you can’t put a child on your adult sleep schedule and expect them to be rested and to function at their best. Children and teens need more sleep than adults do to fuel their growth and development. The National Sleep Foundation sets specific guidelines for sleep amounts in children throughout their stages of development.

Pre-school children, ages 3-5

This is an age when children’s daily lives begin to become busier and wider, and their days become more full of activity. Somewhere around ages 4-5, many children will give up daytime naps. This is a crucial stage in a child’s sleep development. These years are a time to establish solid sleep habits and sleep routines, and to build children’s ability to manage their sleep with more independence throughout the night, including learning to soothe themselves back to sleep when they wake during the night. This also a stage in a child’s life when sleep problems, if left un-addressed, can become chronic.

Recommended amount of sleep: 10-13 hours a night. For some children, 8-9 hours may be enough, while others may need as much as 14 hours a night.

School-age children, ages 6-12

These middle-childhood years are a time of tremendous growth for children—physically, emotionally, intellectually, and socially. During these years, children’s sleep patterns tend to become stable, with much more night-to-night consistency. Naps become rare, as children experience low levels of daytime sleepiness.

With full school days and after-school activities now the norm, children’s bedtimes are often pushed later into the evening. Children may also need to rise earlier in the morning. It’s easy for children’s sleep schedules to become irregular, with bedtimes, in particular, varying from night to night. The result? Children during this stage of life are at higher risk for insufficient sleep.

Recommended amount of sleep: 9-11 hours a night. Some children in this age group may be fine with 7-8 hours, while others may need as much as 12 hours.

What sleep deprivation looks like in kids

The signs of insufficient sleep in children can be easy to miss. That’s because a tired child often doesn’t act at all like a tired adult.

When tired, we adults tend to slow down and expend less energy in almost everything we do. A tired child will often be wired and hyperactive, seemingly full of energy. Parents who look for signs of tiredness that are similar to their own are likely to miss some pretty clear red flags signaling that their children aren’t getting enough sleep.

Short on sleep, children experience negative changes to mood and behavior. They’re more likely to struggle academically, and to experience social conflict with peers. These are some of the common consequences of sleep loss in kids—they’re also among the most important signs of a child who isn’t sleeping enough.

Be on the lookout for:

    Behavioral problems:
    Hyper-activity
    Poor impulse control
    Aggressiveness

Mood changes:

    Irritability
    Heightened sensitivity (being quick to cry and difficult to console)
    Anger and frustration

Cognitive challenges:

    Difficulty paying attention
    Memory problems
    Lack of flexibility and adaptiveness

Performance deficits:

    Academic problems
    Social issues and conflicts with peers

If you see your school-age child getting more hyper at the end of the day, having trouble with homework or with dropping grades, arguing more often with friends or siblings, or any other of the symptoms above, take a close look at your child’s sleep routine and how much sleep they’re getting on a regular basis.

Sleep issues in kids—and what parents can do

Sometimes, a child’s sleep difficulties go beyond having a bedtime and wake time that allow for ample nightly rest. Other sleep problems can interfere with both the quantity and quality of a child’s sleep, leading to many of the symptoms I’ve listed above. Let’s look at four common sleep problems in young children, and steps parents can take to resolve them.

Sleep onset association disorder
Often, young children get accustomed to falling asleep with a parent nearby, or the television on, or sleeping in a parent’s bed. A comforting presence helps the child relax and fall asleep, feeling safe and secure. Sleep onset association disorder occurs when children become so conditioned to these particular circumstances that accompany falling asleep that they can only fall asleep when those specific conditions are met. If a parent doesn’t re-create the same routine or environment every time the child wakes up, the child may stay awake for prolonged stretches of the night. This can be a cause for sleep deprivation in younger school-age children.

What parents can do:

Crying it out. This method, known as “extinction,” involves letting a child who wakes in the night cry on their own, without parents intervening, until they fall back asleep. This strategy is tough on parents, but tends to be very effective.

Timed check ins. There is also a graduated version of crying it out that employs periodic checks on a child who wakes in the night and can’t fall back to sleep. If your child wakes, give him a few minutes on his own to soothe himself back to sleep. If he continues to call for you, visit him briefly to comfort him. Keep the lights off. Encourage him to stay in bed, and don’t get into bed with him. After a minute or two at the most, leave the room. If your child continues to be awake and calling for you, extend the amount of time he’s left alone to self-soothe before each time you return to his room.

If a child expresses fears associated with being alone in his bedroom at night—monsters in the closet, tree shadows on the wall, a fear simply of being alone—the graduated exposure of timed check ins can help your child work through these fears. Remove any environmental stimuli that may be upsetting your child—close the curtains to end the dancing shadows, open the closet to show him it’s empty. After that, give your child gradually longer stretches of time to be on his own, learning to manage his fears, before you return to his room for a comforting check.

Limit setting sleep disorder
This very common sleep problem occurs when parents are unable to set consistent rules around bedtime. What happens when there aren’t well established bedtime rules that get enforced consistently, night after night? Prolonged bedtime struggles that are the stuff of parents’ nightmares. Children refusing to get in bed. Endless requests for just one more glass of water, or one last story. A litany of excuses from a child running around the house about why she can’t stay in bed.

This sleep issue occurs most often with children ages 2-6, and usually results in children finally falling asleep much later than their recommended bedtime—which results in sleep deficiency the next day.

What parents can do:

Make bedtime consistent. Nothing encourages bedtime resistance more than a sense that parents themselves aren’t serious about bedtime. As tempting as it may be to stretch the rule, be firm and be consistent, night after night.

Close the bedroom door. Children often prefer to fall asleep with their door open. They feel good about drifting off to sleep with that connection to the light and sound of their parents in the other room. Parents can explain that door can be left opened if the child stays in bed.

Timed check ins. This system can also work to help a child stay in bed long enough to fall asleep. Parents give children a schedule of check ins they well make during the night—“I’ll be in every 10 minutes.” You provide your child reassurance and a sense of security, while also giving them time alone to learn how to stay in bed and fall asleep at the same time each night.

Reward good sleep habits. Find a reward system that incentivizes your child to go to bed and stay in bed every night. A sticker chart the child gets to fill in each day? A weekly trip to the bookstore after a full week of orderly bedtimes? Work with your child’s interests to make a fun reward around following bedtime limits.

Sleep terrors
About 1-3 percent of younger children experience the parasomnia known as sleep terrors, or night terrors. These disturbing nighttime awakenings may look like nightmares, but actually are a distinct sleep experience. A child experiencing a night terror will typically wake very suddenly and start screaming or crying. He’ll likely spend the next 3-5 minutes in a panic, confused and unresponsive to parents, sometimes mumbling or yelling, before suddenly calming down and falling back asleep. These episodes can be deeply troubling for parents. During a sleep terror, a child is neither fully asleep nor fully awake, but somewhere in between. Children almost never remember their sleep terrors the next day.

Sleep terrors generally come on between the ages of 4-12, and are most likely to occur in children ages 5-7. These sleep-disrupting episodes can occur weekly or more often—the younger a child is when he first experiences sleep terrors, the more frequent the episodes tend to be. Sleep terrors usually disappear by adolescence. Boys are more likely than girls to experience sleep terrors.

What parents can do:

Don’t try to wake your child from a sleep terror. Children are difficult to rouse from this state, and it may take them longer to fall back asleep if you wake them.

Create a regular sleep schedule that allows for plenty of rest. Sleep terrors may become more likely if a child is overtired. Behavior sleep problems, such as bedtime resistance and sleep onset association disorder, may make sleep terrors more likely.

Keep bedtime relaxed. Anger and anxiety may increase sleep terrors. Keep a child’s pre-bed routine as relaxing and low key as possible.

Schedule awakenings. This technique has parents wake a child 15-30 minutes before the time the child might normally have a sleep terror episode. This involves parents first observing the timing of their children’s sleep terrors to find a pattern they can anticipate. Research has shown scheduled awakenings may decrease sleep terrors in children.

Obstructive sleep apnea syndrome in children
Once thought to be rare in children, obstructive sleep apnea syndrome, or OSAS, is now recognized as a common sleep and health issue for kids. OSAS is a form of sleep-disordered breathing, which occurs when the upper airway is partially or fully obstructed, temporarily limiting or cutting off normal breath flow. OSAS may be most common in pre-school age children, because of the development of the tonsils in relation to the size of the airway in children this age.

Certain factors put children at risk for OSAS, including:

    Obesity
    Acid reflux, also known as “GERD”
    Repaired cleft palate

What parents can do:

Parents need to know the symptoms of OSAS. There are symptoms that occur during sleep as well as signs of the sleep disorder in children’s waking life.

OSAS sleep symptoms in children:

    Loud snoring
    Difficulty breathing, including snorting, gasping or pauses in breath
    Restless sleep
    Sweating during sleep
    Sleeping in unusual positions

OSAS behavior and performance symptoms in children:

    Trouble waking in the morning
    Daytime sleepiness
    Hyperactivity
    Attention span difficulty
    Aggressiveness
    Difficulty learning
    Social withdrawal

It’s important for parents to seek diagnosis and treatment for OSAS in children. Left untreated, OSAS can lead to other health problems in children, including behavioral issues and developmental delays. If you suspect your child may have OSAS or a problem with breathing during sleep, talk with your pediatrician. There are a range of treatments available for OSAS, including:

    Weight loss
    Positional therapy—changing positions during sleep to open the airway
    Decongestant and other nasal treatments
    Devices, including oral mouthpieces and CPAP
    Surgery

Parents who educate themselves about their children’s sleep needs and potential sleep issues are taking an important first step toward improving their children’s sleep. Your children’s sleep affects their own health and performance, and the health and dynamics of your family.

What about teen sleep? That’s a subject worth its own article. Coming up soon, I’ll look at the specific needs and risks associated with teen and young adult sleep.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com