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Let’s Talk About Kids And Sleep

September 18, 2013

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Posted in: Hot Topics

Some kids sleep fine, and some kids don’t.  That’s a good place to start when you think about sleep problems and kids.  According to a good deal of research, kids who continuously sleep well, often do so from very early in their lives.  These are the kids with parents who look inexplicably rested despite having just brought a child into the world.  The other kids—the ones who don’t sleep so well—well, let’s just say that their parents can spend an awful lot on coffee.

So, when we talk about sleep and kids, the first thing to consider is whether the difficulty sleeping is a new problem.  If your child has always slept well and then, at something like age 8 or 9, he suddenly starts having a hard time falling asleep, you need to start thinking about some of the normal developmental challenges that might interrupt an otherwise placid bedtime psyche. These kinds of problems are the particular subject of this post.

Is the pre-adolescent with difficulty sleeping about to change schools?  Is she about to move?  Is everything all right at home?  You should even consider whether there are new foods in the diet; caffeine, even in the afternoon, is a fairly common culprit.

This list could go on for a while, but the general gist is to look for some kind of change in the home environment that might explain the changed sleep pattern.  You’ll also want to know how the sleep itself is disrupted.  Does the child have difficulty falling asleep? Does he or she wake more often, or is it a combination of both?  Finally, after you feel comfortable that there have not been significant enough environmental stressors to explain the changed sleep habits, you’ll want to consider the onset of psychiatric syndromes that we’ve discussed elsewhere on this site.  Depression, anxiety, trauma and bipolar disorder all share sleep disturbances as important harbingers and symptoms.  There are other, less common psychiatric syndromes as well.

The questions are about the same with adolescents, but there’s a new twist. We know that the adolescent brain is primed to stay up late—that’s hardly a news flash.  Teenagers are hard-wired to futz around deep into the night, and then sleep healthily late into the morning.

Teens, in fact, need even more sleep than slightly younger kids do; they use up a lot of energy as they rapidly mature.  It’s just that healthy teens stay up later and later, and still have to wake up at the same time the next morning to attend school, or work, or sports practice, or a host of other obligations.  The inevitable result is increasingly tired kids.  The first two periods of class in high school are often entirely different than the courses at the end of the day.  Every seasoned teacher knows this.

This means that the teen who stays up late isn’t necessarily having the same set of problems that the pre-teen could be suffering from.  It is still worth looking for these same stressors—new schools, changes in social standings, problems in the home—but many teens are as perplexed as their parents are about why they can’t fall asleep earlier.  Once you’re comfortable that the teenager isn’t depressed or anxious (remember that these conditions are much more common in adolescence), you’ll need to start thinking about sleep hygiene. 

How do we define sleep hygiene? For parents born before 1985, good sleep hygiene typically means reading before bed rather than watching TV. It may also include turning the clock around, if the passing time makes a teen anxious when sleep continues to remain elusive.  Other less modern culprits that make fairly regular appearances include late-night exercise, or phone conversations deep into the night.  An adolescent is biologically wired to connect with other teens, and to look good while doing it.  That means that kids are often talking on the phone and doing sit-ups and push-ups sometimes well past midnight.  Neither of these stimulating activities is particularly conducive to restful sleep.

However, we all know that the world has gotten a lot more complicated.  We’ve got texting, and Facebook, and wireless computers, and Skype, and Hulu, and Netflix, and all sorts of late-night distractions.  To the socially and intellectually-active brain of a teen, these consuming activities far out-compete the pleasant nighttime reading that used to do the trick.  When you’re 16, do you want to read a book, or chat with your friends?  Do you want to watch your favorite show when it airs, or watch ALL of your favorite shows at once through streaming videos?

This means that modern parents need to be even more vigilant around the sleep habits of their teenage kids than was the case as recently as 15 years ago.  The odds are stacked against the endeavor—kids have a way of feeding those hungry brains—but remember that poor sleep has a cumulative effect, and can lead to academic and social difficulties.  A sleep-deprived teen’s temper flares more readily.  She can’t study as well the next day, and she tends to bomb more tests than she used to.  These are issues that can snowball fast.

For parents of kids of all ages, here are some general guidelines:

The best cure, as simple as it sounds, is a consistent bedtime schedule.  For pre-adolescents, try sticking to a bedtime routine that allows these goals to be met:

  • 11 to 13 hours for a 3- to 5-year-old child.
  • 10 to 11 hours for a school-aged child. Remember that, like adolescents, school children spend time with TV, computers, and the Internet, all of which can erode time for sleep. This age group also may be drinking caffeinated beverages that can affect the ease of falling asleep at night. Watching TV just before bedtime may make it more difficult to fall asleep, and may create resistance or anxiety about bedtime.
  • If the current bedtime for your child is too late, move it 15 minutes earlier each night, until you reach the desired bedtime. Tuck resisters back into their own beds, promptly and repeatedly, until they get the message that you expect them to get to sleep on their own.

For all kids, and perhaps especially adolescents, these habits will help a lot:

  • Unplug the bedroom.  Turn off TVs, computers and cell phones. In fact, keep these things out of the bedroom.  This isn’t entirely possible with teens, but do the best you can.
  • Set a wind-down routine.  This is highly individualized, but the general idea is to decrease, rather than increase, activities that are too stimulating in order to allow for the peaceful onset of sleep.
  • Go decaf.  Drinking any caffeine during the day, and especially in the afternoon, can affect sound sleep.  Caffeine is found not just in coffee and cola, but also in tea and chocolate.
  • Reduce daytime stimulation. Overbooked kids who rush from band practice, to dance class, to dinner, to homework, may be too excited or agitated at bedtime to unwind. Experts recommend about one major activity per season.
  • Get help. If, despite these measures, your child still resists bedtime, has nighttime awakenings, or snores, talk with your doctor.  There are a number of health problems that are potentially to blame.  Psychiatric syndromes, sleep apnea, allergies or GI distress can all lead to poor sleep.  These conditions will require a clinician’s attention.

Finally, remember that poor sleep, or the lack of sleep, is a national problem. The United States is notorious among Western nations for its poor sleep habits. Adults are often as guilty as children when it comes to healthy bedtime routines.  Your kids are watching you more than you think, and if you show them how you properly prepare for bed, they’re that much more likely to follow suit.

Steven Schlozman

Steven Schlozman, Co-Director

Steven Schlozman, M.D. is co-director of The MGH Clay Center for Young Healthy Minds, and a staff child and adolescent psychiatrist at Massachusetts General Hospital. He is also an as...

To learn more about Steven, or to contact him directly, please see Our Team.

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