Transcript Children’s sleep Challenges and opportunities Dr Andrew Mayers, PhD, MBPsS Children’s sleep  Overview  How common are sleep problems in children?  What are the problems?  Who is it.

Children’s sleep
Challenges and opportunities
Dr Andrew Mayers, PhD, MBPsS
Children’s sleep
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Overview
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How common are sleep problems in children?
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What are the problems?
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Who is it a problem for?
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The child
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The family
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Causes?
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Solutions and suggestions
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Children’s sleep problems: prevalence
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Sleep problems in children common
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About 25–40%
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Sleep problems in children can persist
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Don’t underestimate impact
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But do be aware that there are solutions
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Children’s sleep problems
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Typical problems
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Difficulty settling
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Refusing to go to bed
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Coming downstairs repeatedly after bedtime
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Others settle easily but wake several times
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Parents disturbed by crying or calling for attention
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Creeping into their parents’ bed
More unusual problems:
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Nightmares, sleep terrors, sleep talking, sleep walking,
bedwetting, tooth grinding
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Sleepwalking
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May appear distressing – but it is quite normal (in children)
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15% of children aged 4-12 sleepwalk
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Generally occurs in deep sleep in 1st/2nd ‘cycle’ of sleep
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Children tend to spend more time in deep sleep than adults
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In adults, sleepwalking my be caused by several factors
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In children, it is just part of normal development
Mostly ‘quiet’ walking about – but can be ‘agitated’
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Which may explain increased incidence in children
Also see ‘sleep terrors’ later
Typical behaviours
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Clumsiness, ‘glazed’ look, poor ‘nonsense’ speech, repetitive
behaviour, some bedwetting
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Sleepwalking
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Event usually forgotten – especially if not woken
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And it’s best not to wake child (may get embarrassed)
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NOT associated with room sharing, being alone, being afraid of dark
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May be associated with lack of sleep and/or emotional problems
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Rarely needs any treatment
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But seek help if very frequent or very disturbing
Child could get hurt
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Avoid bunk beds, lock outer doors, keep floor clear…
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Possibly fit ‘alarm’ to doors
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Consider ‘sleep improvement’ – see later
Usually disappears by puberty
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Night terrors
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More extreme form of sleepwalking – and rarer (1-6%)
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Quite different to nightmares
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Nightmares occur in lighter sleep and may ‘recalled’
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Sleep terrors tend to occur in deep sleep
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Sleeper usually unaware of night terrors
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Sudden ‘agitated’ arousal – child appears violent and terrified
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More likely in toddlers – through to 5-7
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But can go through to adolescence
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More frequent in younger children
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If younger than 4 – may be at least once a week
May be related to stress and some medications
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If frequent and disturbing – talk to GP
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Sleep problems: consequences
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Tired children
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At school
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Hyperactivity and inattention
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Poor concentration
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Poor impulse control
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Disruptive behaviour
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Emotional problems
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Performance
At home
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Temper tantrums, quarrel with siblings…
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Accidents
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Sleep problems: consequences
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Chronic problems disrupt family life
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Affects parental sleep
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Especially if child enters parental bed
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Increased relationship strife
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Arguments with/about siblings
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Blame, unfairness, disruption
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Increased punishments
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Poorer mood and mental health in family
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Sleep problems: possible causes
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Irregular sleep-wake schedule
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Bedtime and rising
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Lack of bedtime routine/supervision
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Poor daytime exercise
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Caffeine
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Inappropriate food
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Room/bed sharing
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Use of technology in bedroom
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TV, computers/internet, game consoles, mobile phones…
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Modern technology and sleep
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Recent study (2008): more than 500 schoolchildren researched
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Aged 6-12 (average 9 years)
Watching TV before bedtime had little effect on amount of sleep
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But bedtime and wake-time later
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Especially on weekdays
Playing video games OR using Internet just before sleep-time 
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Poorer sleep outcomes than children who did not do this
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At least 1 hour shift in bedtime/wake-time
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Worse effect on weekdays than weekends
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How much sleep?
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Recommended:
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Infants (pre-school): 14 hours
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School children (4-12): 9-11 hours
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Adolescents (13+): 8 hours
But there are cultural an societal variations
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Good sleep – some tips for children
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Bedtime/wake-up time should be consistent every day
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Should not be > 1 hour difference in bed/wake time
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Have nightly bedtime routine
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Prepare child for bed
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Young children – about 30 minutes before ‘sleep time’
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Older children – about 30–60 minutes
‘Best’ to keep TV/Games consoles out of bedroom
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School nights vs. non-school nights
Or carefully restrict use
Employ good ‘sleep hygiene’
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Sleep hygiene
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Warm bath
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It worked for your baby
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Adults report better sleep after having bedtime bath
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So why not school children?
Reading
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Can help solve problems of night-time fears
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Help child with improving reading
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Good bonding between parent and child
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Relaxing
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Reduce night-time fears
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Recommended routine for children of all ages
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Sleep hygiene
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Physical environment
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Child’s bedroom should be a quiet, darkened, warm place
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Noise and light increases risk of problem sleep
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A room too hot (or cold) may disrupt sleep
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No hotter than 75°F or 24°C
Lighting
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Lights out – encourage sleep onset
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Lights on – associate with getting up
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Reinforces sleep and wake times
Many children will not sleep with the light off
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Use ‘glow’ lights
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Sleep hygiene
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Spend time in daylight every day
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Daytime exercise
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Adult research  physical exercise good for sleep
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But not within 3 hours of bed time
So, probably good for children too!
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Sleep hygiene
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Daytime food/drink
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Avoid caffeine drinks 4 hours before bedtime
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Large quantities of food too near to bedtime should be avoided
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Caffeine also in some foods – so watch that
Main meal not less than 2 hours before bedtime
Light snack just before bed OK, but use ‘snooze foods’
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Contain sleep-promoting chemicals:
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Dairy products, meat, poultry, beans, rice
Food high in carbohydrate and calcium also useful:
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e.g. peanut butter sandwich, oatmeal biscuit, milk
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Behavioural methods
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Reinforcement and extinction:
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Reinforcing and rewarding good bedtime behaviour
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Some therapists encourage star charts
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Cuddles, praise etc
Great evidence of helping maintain desired behaviour
Ignoring ‘bad behaviour’ helps it go away!
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We call this ‘extinction’
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Behaviours tend not to repeated if not reinforced
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Behavioural methods
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Unmodified extinction
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Child left to cry self to sleep
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Graduated extinction (‘controlled crying’)
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Can be very stressful (for child and parent)
Rather more acceptable than unmodified extinction
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Parent progressively increases time taken to respond
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Brief intervention – say 15 seconds with minimal interaction
Extinction with parental presence
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Parent remains in room during extinction procedure
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Can incorporate ‘fading out’
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Parent gradually removes themselves from bedroom
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Presence more reassuring to child
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Summary
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Sleep problems common in children
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More so if child has ‘other’ problems
Problems relate to two factors
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Sleep timing
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Sleep arousal
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Causes…
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 problems for child and the family
Irregular/unsupervised routines, poor exercise, poor diet,
inappropriate bedroom technology, room sharing
Solutions…
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Consistency, sleep hygiene, behavioural programmes
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Further reading?
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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
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Poor sleep hygiene
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Video games and sleep
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Violent video games
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Neurocognitive effects of sleep disruption
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Sleep disorders prevalence
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Sleep problems in primary school children
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