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ANN ARBOR,
MI - As summer's long days begin to shorten and the first day
of school looms on the horizon, children and teenagers alike are
savoring their final days of relative freedom from rigid bedtimes
and alarm clocks that ring too soon. Their parents, meanwhile, are
gearing up for the annual fight to re-establish sleep schedules
and cope with groggy, grouchy mornings.
So, what better
time than late summer to take a few tips from pediatric sleep experts
and start the school year off on the right note? Now's the time
to help children and adolescents make gradual changes to improve
their sleep habits - and to take note of whether they have sleep
problems that may warrant special attention.
Says Timothy
Hoban, M.D., a pediatric sleep specialist in the Division
of Pediatric Neurology at the University
of Michigan Health System, the issue of "sleep hygiene"
is crucial year round for kids, whose daytime alertness, school
performance, growth and development can suffer without proper sleep.
But many children and teens experience sleep disturbances that go
uncorrected.
"If you
look at the spectrum of problems that can affect sleep, I think
it's probably the rare child who doesn't have occasional problems
with insomnia, bedtime struggles, waking up groggy or oversleeping,"
he says, adding that many of these problems occur only once in a
while and can be addressed by parents following guidance based on
the latest sleep research. "It's a little tougher to estimate
how frequent the more severe problems are," he adds, but if
observant parents and doctors catch them, the disorders can often
be treated successfully.
Parents of
children with developmental issues, such as attention deficit hyperactivity
disorder, mental retardation and autism especially need to pay attention
to their children's sleep patterns, which are more likely to be
disrupted because of their condition or medication, Hoban says.
But all parents
should be aware that sleep problems aren't limited to adults. At
the U-M's specially equipped Michael
S. Aldrich Sleep Disorders Laboratory, Hoban and others study
the sleep patterns of scores of children a year, using monitoring
equipment to find evidence of everything from insomnia and sleepwalking
to breathing problems and narcolepsy. They and others are also discovering
that kids and teens have much different sleep patterns than adults.
Young children:
Making the transition
As children grow from infants to toddlers to preschoolers and kindergartners,
parents face a constant evolution of their offspring's sleep patterns.
The newborn who needed 16 hours of sleep and naps interrupted by
feedings develops quickly into a youngster who can sleep through
the night but needs a nap or two to achieve their nine to 13 hours
of needed sleep.
In these little
ones, struggles at bedtime and nighttime waking are common as children
try to exert their independence but still harbor some of babyhood's
traits. Hoban advises parents to establish a pleasant bedtime routine
at a regular time that includes such activities as brushing teeth
and tucking in, but to set limits and respond consistently to demands,
tantrums and stalling. Worries about the dark and monsters can be
fought with nightlights and reassurances.
Parents should
leave their children's room when bedtime comes, Hoban advises, to
avoid having the child become too dependent on having a parent present
in order to sleep, and to allow the child to develop his or her
own "settling down" abilities.
Elementary
and middle school: Fighting off daytime sleepiness with nighttime
routine
As children grow older, their push for control over their sleep
routines, and their need to get up early and stay alert all day
in school, makes good sleep hygiene habits even harder to establish
- but more important to stick to. If they aren't, the child's daytime
behavior can be affected.
"It's
becoming increasingly recognized that there are tired children in
school, and that the tiredness may take different forms," Hoban
explains. "It may not just be out-and-out sleepiness and falling
asleep, but also being grumpy or irritable, or having problems sustaining
attention."
School-age
kids obtain less sleep than they did only a few years earlier, often
getting by on eight to just over nine hours - which is often less
sleep than required for optimal daytime alertness and performance.
Their schedules increasingly become their own during the day and
evening, so they may try to exert the same control at bedtime.
"This
is a time when kids will sometimes push the limits," says Hoban.
"We actually see some kids this age having problems of sleep
deprivation, meaning that they may not allow themselves enough time
for sleep." Parents who try to impose naps may even make the
problem worse.
Sleep walking
and talking, and night terrors that provoke crying and screaming
without waking or nightmares, also arise more frequently at these
ages and disturb both the children and others nearby. So can apnea,
in which breathing interruptions during sleep can cause both physical
and behavioral problems. Parents should consult their child's physician
about these issues.
To confront
sleep deprivation and other problems, Hoban advises a mix of common
sense and scientific approach. "In general, we don't recommend
too many stimulating activities just before bedtime, like video
games and vigorous athletic pursuits. These can make it tougher
for a young person to gear down and be in a relaxed, quiet state
that's conducive to sleep," he says. "And we recommend
trying to keep bed times relatively regular because it helps govern
the body's circadian rhythm - the intrinsic brain activity that
governs sleep."
Keeping the
child's bed reserved "just for sleeping" instead of homework,
reading and TV can also help, especially for kids who have insomnia
that keeps them from falling asleep, or those whose circadian rhythms
are changing. "If somebody is not feeling sleepy, they should
get up, leave the bed, and be allowed to do something quiet until
they feel drowsy," Hoban suggests.
Teenagers: Victims of an unrecognized "delayed sleep phase"
syndrome?
As kids grow into adolescence, sleep deprivation and daytime sleepiness
take center stage due to rebellion against parental control, packed
school and activity schedules, and natural changes.
"Adolescents
will very often have irregular sleep habits, staying up substantially
later on weekends than on school nights and making it tough for
the body to establish its own circadian rhythms," Hoban explains.
"And teens may be balancing schoolwork, jobs and family activities
that may have an impact on their evening time and bed time."
Teens are natural
"owls", with a body clock that makes them alert and energetic
during the evening and inclined to sleep later than younger kids
and adults in the morning. Combine this with irregularity of bedtimes,
and early school start times, and some adolescents develop something
called "delayed sleep phase syndrome," Hoban says. Body
rhythms keep such teens from being tired until the wee hours of
the morning, and morning schedules prevent them from getting the
eight to 10 hours of sleep their bodies would normally demand.
"There
is increasing evidence in the medical literature that there is a
substantial proportion of adolescents with this tendency,"
Hoban explains. He notes that some school districts have started
to change their high school start times, to allow students to sleep
later in accordance with their natural rhythms. Not enough evidence
has come in to say whether or not this improves attendance and alertness,
Hoban cautions, but studies are under way.
As much as
possible, Hoban says, teens should heed the advice given to their
younger siblings, and try to get to bed around the same time each
night after a "wind down" time of quiet activity. Anti-insomnia
medication or herbs often help only temporarily and can't make up
for bad habits.
Facts about
kids, teens and sleep:
- The amount
of sleep an individual needs each day varies from person to person,
but generally is around 16 hours for newborns and around eight
hours for adults.
- Sleep is
crucial for maintaining physical well-being, helping to regulate
growth, and possibly in helping imprint long-term memory.
- Each night
of sleep features a repeating cycle of stages, marked by shifts
in brain and body activity. Dream-filled rapid eye movement, or
REM, sleep, and four stages of light and deep non-REM sleep all
occur in different amounts in children and adults.
- A 1999 survey
found that 60 percent of kids under age 18 complained of being
tired during the day, and 15 percent of kids reported falling
asleep at school, during the previous year.
- Half of
sleep time during infancy is REM stage, but by adulthood it's
only about 25 percent.
Find more information on the World Wide Web at:
UMHS Health Topics A to Z: Normal Sleep Patterns in Children
www.med.umich.edu/1libr/child/child42.htm
UMHS Health Topics A to Z: Sleep Disorders Clinic
http://www.med.umich.edu/neuro/sleep.htm
American Academy of Child & Adolescent Psychiatry: Children's
Sleep Problems
www.aacap.org/publicatsion/factsFam/sleep.htm
National Sleep Foundation: Sleep Tips for Teens
www.sleepfoundation.org/PressArchives/seven.html
Written by Kara Gavin
This information will be available in August from UMHS Telecare
at 800-742-2300 ext. 1010.
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