Children

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Childrens sleepChallenges and opportunities

• Dr Andrew Mayers, PhD, MBPsS

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Childrens sleep

• Overview
• How common are sleep problems in children?
• What is normal sleep for children?
• What are the problems?
• Who is it a problem for?
• The child
• The family
• Causes?
• Solutions and suggestions

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Childrens sleep problems prevalence

• Sleep problems in children common
• About 2540
• Sleep problems in children can persist
• Dont underestimate impact
• But do be aware that there are solutions
• Before we explore those problems (and solutions)
• What do we know about normal sleep?

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How much sleep?

• Recommended
• Infants (pre-school) 14 hours
• School children (4-12) 9-11 hours
• Adolescents (13) 8 hours
• We will explore this in more depth shortly

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Sleep cycles

• Sleep EEG stages
• Stage 1 light sleep
• Stage 2 getting deeper
• Stage 3 deeper sleep
• Stage 4 deepest sleep
• Stages 3 and 4 represent slow-wave sleep (SWS)
• Rapid-eye-movement (REM) sleep
• Appears after 1st cycle
• Periods of intense brain activity
• Frequent and intense bursts of eye movement
• Referred to as active sleep in younger children

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How we can measure sleep

• Sleep electroencephalography (EEG)

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Sleep cycles

• Sleep for ALL humans presents in cycles
  throughout night
• This is an example of healthy adult sleep

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Age differences in sleep
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Age differences in sleep
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Age differences in sleep
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Age differences in sleep
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Key facts

• Most children stop napping 3-5 years
• Nocturnal sleep tends to increase at that point
• Night waking in toddler/pre-school common
• 20 wake up at least once a night
• 50 at least once a week
• After that, going back to sleep may be a
  behavioural problem
• Ability to do so without parental intervention
• Self-soothing
• Good time to establish routines

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When self-soothing becomes problem

• Toddlers are more mobile!
• Make way to parental bed on waking
• Cognitive development
• Establish own beliefs and night-time fears
• Establish transition objects (dolls, teddies,
  pacifiers)
• Attachment issues may develop
• Separation anxiety
• Increased independence and autonomy
• Bedtime resistance may develop
• How do parents overcome this?
• Is it too late to change behaviour later?
• We will address these (and other issues) later

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Childrens sleep problems

• Typical problems
• Difficulty settling
• Refusing to go to bed
• Coming downstairs repeatedly after bedtime
• Others settle easily but wake several times
• Parents disturbed by crying or calling for
  attention
• Creeping into their parents bed
• More unusual problems
• Nightmares, sleep terrors, sleep talking, sleep
  walking, bedwetting, tooth grinding

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Sleep problems consequences

• Tired children
• At school
• Hyperactivity and inattention
• Poor concentration
• Poor impulse control
• Disruptive behaviour
• Emotional problems
• Performance
• At home
• Inter-sibling fights
• Family stress, physical and mental health
• Parents relationship with each other

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Sleep problems possible causes

• Irregular sleep-wake schedule
• Bedtime and rising
• Problems rooted in toddler-child transition?
• Lack of bedtime routine
• But some children are night owls!
• Poor daytime exercise
• Caffeine
• Inappropriate food
• Room/bed sharing
• Use of technology in bedroom
• TV, computers/internet, game consoles, mobile
  phones

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Modern technology and sleep

• Recent study (2008) more than 500 schoolchildren
  researched
• Aged 6-12 (average 9 years)
• Watching TV before bedtime had little effect on
  amount of sleep
• But bedtime and wake-time later
• Especially on weekdays
• Playing video games OR using Internet just before
  sleep-time ?
• Poorer sleep outcomes than children who did not
  do this
• At least 1 hour shift in bedtime/wake-time
• Worse effect on weekdays than weekends

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Good sleep some tips for children

• Bedtime/wake-up time should be consistent every
  day
• Should not be gt 1 hour difference in bed/wake
  time
• School nights vs. non-school nights
• Have nightly bedtime routine
• Prepare child for bed
• Young children about 30 minutes before sleep
  time
• Older children about 3060 minutes
• Best to keep TV/Games consoles out of bedroom
• Or carefully restrict use
• Employ good sleep hygiene

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Sleep hygiene

• Warm bath
• It worked for your baby
• Adults report better sleep after having bedtime
  bath
• So why not school children?
• Reading
• Can help solve problems of night-time fears
• Help child with improving reading
• Good bonding between parent and child
• Relaxing
• Reduce night-time fears
• Recommended routine for children of all ages

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Sleep hygiene

• Physical environment
• Childs bedroom should be a quiet, darkened, warm
  place
• Noise and light increases risk of problem sleep
• A room too hot (or cold) may disrupt sleep
• No hotter than 75F or 24C
• Lighting
• Lights out encourage sleep onset
• Lights on associate with getting up
• Reinforces sleep and wake times
• Many children will not sleep with the light off
• Use glow lights

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Sleep hygiene

• Spend time in daylight every day
• Daytime exercise
• Adult research ? physical exercise good for sleep
• But not within 3 hours of bed time
• So, probably good for children too!

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Sleep hygiene

• Daytime food/drink
• Avoid caffeine drinks 4 hours before bedtime
• Caffeine also in some foods so watch that
• Large quantities of food too near to bedtime
  should be avoided
• Main meal not less than 2 hours before bedtime
• Light snack just before bed OK, but use snooze
  foods
• Contain sleep-promoting chemicals
• Dairy products, meat, poultry, beans, rice
• Food high in carbohydrate and calcium also
  useful
• e.g. peanut butter sandwich, oatmeal biscuit,
  milk

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Behavioural methods

• Reinforcement and extinction
• Reinforcing and rewarding good bedtime behaviour
• Cuddles, praise etc
• Some therapists encourage star charts
• Great evidence of helping maintain desired
  behaviour
• Ignoring bad behaviour helps it go away!
• We call this extinction
• Behaviours tend not to repeated if not reinforced
  

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Behavioural methods

• Unmodified extinction
• Child left to cry self to sleep
• Can be very stressful (for child and parent)
• Graduated extinction (controlled crying)
• Rather more acceptable than unmodified extinction
• Parent progressively increases time taken to
  respond
• Brief intervention say 15 seconds with minimal
  interaction
• Extinction with parental presence
• Parent remains in room during extinction
  procedure
• Can incorporate fading out
• Parent gradually removes themselves from bedroom
• Presence more reassuring to child

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Summary

• Sleep problems common in children
• More so if child has other problems
• Problems relate to two factors
• Sleep timing
• Sleep arousal
• ? problems for child and the family
• Causes
• Irregular/unsupervised routines, poor exercise,
  poor diet, inappropriate bedroom technology, room
  sharing
• Solutions
• Consistency, sleep hygiene, behavioural
  programmes

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Further reading?

• All materials (including these slides) now on my
  website
• http//www.andrewmayers.info/Workshops.html
• Several published papers also on that website
• Helping children sleep
• Poor sleep hygiene
• Video games and sleep
• Violent video games
• Neurocognitive effects of sleep disruption
• Sleep disorders prevalence
• Sleep problems in primary school children