Sleep

Sleep problems are some of the most common issues faced by parents with growing children. This hot topic has been prepared to help parents and carers understand the issues associated with sleep as well as providing some useful tips on assisting children and young people to improve their sleeping habits.

Importance of sleep

Getting the right amount of sleep is important for a child's developing body. Parents can help by ensuring that good sleeping habits are practised at home. Good sleeping habits are essential requirements to achieve optimal development and wellbeing of a child. Ideally, depending on age and overall health, children and young people may need between eight to 16 hours of sleep everyday.^[1] In particular:

• babies from one week old to 24 months need between 13 to around 16 hours of sleep everyday
• three to nine year-olds need 10 to 12 hours, and
• 10 to 18 year-olds need eight to just below 10 hours of sleep each day^[2]

Differences between children and teenagers

Different children have different needs at certain stages of their lives. During childhood, children on average get about 10 hours of sleep at night. By the time they reach adolescence, the number of sleep hours is reduced significantly. This is normally due to some physiological changes and other socio-cultural reasons generally experienced at this time. Teenagers often develop a natural tendency to stay up late at night and wake up much later in the morning. This can be more obvious during school nights, when they may feel more alert in the evening and find it difficult to go to bed at a reasonable hour.^[3]

The onset of sleep problems and the symptoms to look out for

Sleep problems occur when someone's ability to get to sleep, or to stay asleep, is impeded significantly.

The symptoms of sleep disturbance for children and young people vary and also may change over time. These include:

• sleepwalking
• experiencing nightmares (or night terrors)
• frequently waking up in the middle of the night
• bedwetting
• teeth grinding
• daytime sleeping or falling asleep at inappropriate times
• unwillingness to go to sleep in some cases
• gasping or snorting while asleep^[4]

Some general causes of sleep problems

The causes of sleep problems may vary from child to child, and are influenced by factors such as the child's age, general health and home environment. Some of the commonly-known causes include:

• physical growth
• dietary deficiencies and unhealthy eating habits
• stressful home environment
• low mood
• some medications
• engaging in over-stimulating activities close to bed time
• stress (e.g. exam-stress for school aged-children)
• uncomfortable bed, pillow
• disturbances in the immediate environment (e.g. sudden drop in temperature, noise, etc)
• changes in the environment (e.g. transitioning from a small bed to a larger one, changing bedrooms, moving homes, etc)
• absence of routine at home (e.g. different bedtimes every night etc)
• physical illness and/or mental health problems

Common sleep disorders

Some sleep problems are mild and easy to resolve. Many children grow out of sleep problems. However, some sleep problems may become chronic, and have a serious impact on the young person. Professional help may be needed. These include:

• Obstructive sleep apnoea - a common sleep problem in children with allergies and weight issues^[5]. Symptoms may include snoring, gasping or choking and frequent sleep disruption. If not treated, it may cause a variety of concerns such as heart disease, problem behaviour, learning difficulty, and growth problems^[4]
• Narcolepsy - the inability of the brain to control the sleep cycle. Symptoms often include excessive sleepiness during the day, headaches in the morning and falling asleep while performing physical activities such as eating, talking to a friend, or doing exercise. In extreme cases, a child may hallucinate and/or experience paralysis during the first and last few minutes of sleep. Although most cases of narcolepsy are undiagnosed, known causes include genetic factors, hormonal changes, infection, stress and trauma^[6][7]
• Delayed sleep phase syndrome - a disorder in which a child falls asleep a few hours later than the desired bedtime and then has difficulty getting up on time. Children affected generally complain of an inability to fall asleep at night yet feel sleepy throughout the day
• Sleep-onset anxiety - is also termed 'sleep-onset associations'. It occurs when a child is unable to fall asleep or settle back to sleep when something (or sometimes a person) they associate with sleeping is not around. This leads to acute anxiety, which prevents the child settling into their normal sleep cycle. Attachment to an object or person at bed times is common for young children, however, failure to grow out of this attachment may indicate anxiety and stress problems which may arise from exposure to inappropriate media (e.g. TV shows, online materials, etc.), life transitions, stressful events such as family separation or death, or child abuse^[8][9]
• Insomnia - is when a person finds it hard to fall asleep, stay asleep, or settle back to sleep. A case may be mild or severe, depending on how often and for how long it is experienced. Some cases of insomnia may last a few nights; some may last a few weeks or months. This issue is often linked to other mental health issues such as depression, anxiety, and post-traumatic stress disorder^[10][11]

If you are concerned that your child may have sleep problems, a first step could be to discuss this with a general practitioner. Your doctor may refer you to a sleep specialist who can provide specialised treatment for your child's sleep problems.^[3]

Impacts of problematic sleep

Getting the right amount of sleep will contribute to an individual's health and capacity to be positive in their approach to life. If a child is sleep-deprived, the reverse is often observed. Although the impacts of sleep problems on children and young people are not well documented^[12], the available evidence indicates that a chronic lack of sufficient sleep may lead to:

• lowered physical and mental capacity to recover from sickness or deal with stressful situations.^[13] Prolonged problematic sleep may contribute to mental health issues such as depression or anxiety in children^[14]
• behaviour issues such as irritability, attention problems and hyperactivity^[3][10]
• effects on brain functioning, such as reduced ability to memorise, react on time, focus and concentrate.^[12] There may be long term negative impacts on a child's academic performance and school adjustment.^[15][16]

Sleep problems may also affect family relationships, as well as financial resources, particularly if regular medication or therapy is prescribed for your child's treatment.

Things parents can do

The following are some strategies that may assist parents to more effectively manage their child's sleep problems:

• Support your child to maintain a generally healthy diet and minimise unhealthy eating habits
• Encourage your child to exercise regularly and spend time outdoors
• Be aware of any discomfort, pain, or signs of illnesses
• Check the suitability of the child's bed as this will change with age
• Make sure that the room temperature is just right to promote sleep
• Try to minimise noise levels during sleep time
• Encourage a regular sleep routine
• Take safety precautions if your child 'sleep-walks'
• Use sleep medication only when prescribed by a doctor
• If you suspect that your child's sleep problem is serious, take them to a doctor or a specialist for proper diagnosis and treatment

Things to remember

Parents whose child experiences sleep problems eagerly wait for the time when their child is finally able to sleep through the night without any difficulty. In the meantime, it may be worth remembering the following:

• Some sleep problems may be normal at certain age levels and should not be a cause for alarm. For example, it is typical for a two month-old baby to wake up several times during the night yet have no problems at falling back to sleep
• Wetting the bed at night is another common problem for parents with young children. If your child can stay dry during the day, it does not necessarily mean they can stay dry during the night. It is common for young children to master daytime toilet training first before they can manage to stay dry during sleep^[17]
• When parents or teachers have concerns about a child's school performance and/or behaviours, sleep problems may be an issue. Maintaining a good relationship with the school is always helpful as they may be of assistance to you. Schools generally have resources that can help with mild cases of sleep problems^[3]

Different types of sleep problems require different interventions. Chronic sleep problems may take some time to change.

Who can I contact for more information?

You may wish to contact your local parenting help service/s for further information.

Helpful links

• NODSS - Narcolepsy and Overwhelming Daytime Sleep Society of Australia - http://www.nodss.org.au/childrens_sleep_disorders.html
• Raising Children Network - The Australian Parenting Website - http://raisingchildren.net.au/articles/persistent_sleep_problems.html/context/991
• Health Insite Australia - http://www.healthinsite.gov.au/topics/Children_and_Sleep

References

1. Sleep Difficulties. (n.d.). Novita Children's Services. (n.d.). Retrieved from: http://www.novita.org.au/ on 20 May 2011.
2. Sleep Disorders and Sleep Problems in Childhood. (2001). American Family Physician 2001 Jan 15;63(2):277-285, adapted from Ferber R. Solve your child's sleep problems. New York: Simon and Schuster, 1985.
3. National Association of School Psychologists. (2004). Sleep and Sleep Disorders in Children and Adolescents: Information for Parents and Educators. Retrieved from: http://www.nasponline.org/ on 19 May 2011
4. Sleep Apnea Detection. (n.d.). Healthy Children. Retrieved from: http://www.healthychildren.org/ on 20 May 2011.
5. Sleep Disorders in Children, n.d. WebMD. Retrieved from: http://children.webmd.com/ on 20 May 2011.
6. Nacrolepsy Fact Sheet. (n.d.). National Institute of Neurological Disorders and Stroke. Retrieved from: http://www.ninds.nih.gov/ on 20 May 2011.
7. http://www.narcolepsynetwork.org/
8. Boyse, K. (n.d.). Sleep Problems. Reviewed by faculty and staff at the University of Michigan. Retrieved from: http://www.med.umich.edu on 20 May 2011.
9. Lynn, A. (2007, November 23). Insomnia in Children - How to Help Your Child to Fall Asleep. Retrieved from: http://www.adoptionarticlesdirectory.com/ on 20 May 2011.
10. Sleep Disorders in Children. (n.d.). Retrieved from: http://children.webmd.com/sleep-disorders-children-symptoms-solutions on 20 May 2011.
11. What is insomnia? (n.d.). Retrieved from: http://www.cci.health.wa.gov.au/ on 20 May 2011.
12. Polimeni, M., Richdale, A., & Francis, A. (n.d.). The Impact of Children's Sleep Problems on the Family and Behavioural Processes Related to their Development and Maintenance. Parenting Research Centre, RMIT, Victoria, Australia.
13. Gregory, A.M. & O'Connor, T.G. (2002). Sleep problems in childhood: a longitudinal study of developmental change and association with behavioural problems. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 964-972.
14. Nauert, R. & Grohol, J.M. (2008, June 9). Child Sleep Problems May be Linked to Depression or Anxiety. Retrieved from : http://psychcentral.com/news/ on 20 May 2011.
15. Bates, J.E., Viken, R.J., Alexander, D.B., Beyers, J. & Stockton, L. (2002). Sleep and adjustments in preschool children: Sleep diary reports by mothers relate to behaviour report by teachers. Child Development, 73, 62-74.
16. Paavonen, E.J., Almqvist, F., Tamminen, T., Moilanen,. I., Piha, J., Rasanen, E., & Aronen, E.T. (2002). Poor sleep and psychiatric symptoms at school: An epidemiological study. European Child and Adolescent Psychiatry, 11, 10-17.
17. Toilet Training. (n.d.). Retrieved from: http://www.betterhealth.vic.gov.au/ on 18 May 2011.

Published: 15 November 2011