Normative Childhood Sleep Problems and Remedies for Them
Jane B. Brooks, Ph. D. Department of Psychiatry
I. Introduction: Importance of Sleep and Promoting Healthy Sleep Habits
- By age 2, a child will have spent almost 14 months of life asleep and about 10 months in waking activities. Because the balance of sleep and waking time is about even between the ages of 2 and 5, by age 5, the child has still spent more of his or her lifetime asleep.
- We exert great effort to be sure that children in the early years of life receive the proper kinds and amounts of stimulation to promote the incredible development that occurs in these years.
- Because of the importance of sleep and survey data that suggest that approximately 20 to 30 percent of children do not get enough sleep or quality sleep, we need to exert effort to ensure that parents are aware of the importance of establishing healthy sleep habits for children.
II. Sleep Patterns of Normative Children
- The most recent figures are those from the National Sleep Foundation
III. Sleep Problems in Normative Samples of Children
- Definitions of Sleep Problems Vary:
- parentís report of trouble of getting to sleep, night awakenings.
- more objective actigraph records - digital recordings of activity during sleep that correlate highly with polysomnography, the best method - actigraphs are obtained from wrist-bands that take recordings of movements and yield reliable measures of sleep - can be worn during the night at home so sample sizes can be much larger.
- Percentages of children with problems vary from 15 to 30 percent-percentage decreases with age but still are about 18 percent in a random sample of children - sleep problems are related to stress in the family and negatively related to mothers' education.
- Neurobehavioral Effects of Sleep Problems
- Parent's ratings of children's poor sleep at age 4 are related to their ratings of children's decreased attention span, increased aggressiveness, and increased depression/anxiety.
- Age 4 sleep problems predict parents' ratings of children's poor attention, increased aggressiveness, increased depression/ anxiety at mid-adolescence.
- Studies of children between 7 and 12 reveal that objective measures of sleep problems are related to performance on cognitive tests indicating difficulties in sustaining attention and controlling impulsivity; poor sleep is also related to parents' reports of increased number of behavior problems in the area of noncompliant, externalizing behaviors.
- Other studies of children between 7 and 12 reveal that objective measures of poor sleep are related to teachers' reports of aggressive and delinquent behaviors and attention and social problems even when neither parents nor children report sleep problems.
IV. Increasing Amount and Quality of Sleep
- Children who extended sleep by one hour per night achieved gains on neurobehavioral tests equivalent to those gained in two years of development.
- Main way to improve sleep is to have parents train children to sleep at regular times for extended periods using some form of bedtime routine to set the conditions for sleep by have a ritual of winding down and getting ready for sleep; child is put down to sleep awake and alone and learns to fall asleep; if necessary, the child cries until falling asleep - Ferber recommends some form of reassurance to child, but Weissbluth favors going "cold turkey" though if that fails, he recommends gradually changing the parent's behavior - the method can be adapted to the age of the child.
- In doing the training, parents announce to children they will be using the Silent Return to Sleep method when the child gets up - the parent returns the child to bed with no conversation, no emotion, and no change of facial expression
- Sleep Rules Taught to Young Children and Rewarded: At bedtime, we:
- stay in bed
- close our eyes
- stay very quiet
- go to sleep
Marc Weissbluth, Healthy Sleep Habits. Happy Child (New York: Ballentine, 1999).
Ronald E. Dahl, "The Regulation of Sleep and Arousal: Development and Psychopathology," Development and Psychopathology 8 (1996): 3-27.
Alice M. Gregory and Thomas G. O'Connor, "Sleep Problems in Childhood: A Longitudinal Study of Developmental Change and Association with Behavioral Problems," Journal of the American Academy of Child and Adolescent Psychiatry 41 (2002): 964-971.
Ari Sadeh, Reut Gruber, and Amiram Raviv, "The Effects of Sleep Restriction and Extension on School Age Children: What a Difference an Hour Makes," Child Development 74 (2003): 444-455.