Advancing Children's Health

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New recommendations for a good night’s sleep

Published by , on Sep 1, 2017

It goes without saying that getting an adequate amount of sleep on a regular basis is important for all of us. But for children and teens, it’s even more critical. Not getting enough sleep can have widespread effects on overall health and day-to-day functioning. Good sleep quality and quantity are crucial for children and teenagers as their bodies and brains are still developing. Sleep helps support normal cognitive functioning, which aids with school performance, memory and positive behaviors.

Simply put, a good night’s sleep really does make a difference. Parents need to be watchful about how much sleep their children and teenagers get on a regular basis and do what they can to make sure they get enough quality sleep at night. Encouraging good sleep habits in the same way you’d encourage proper bathing or tooth brushing habits can help. To provide a framework for accomplishing this, sleep medicine expert Dr. Justin Brockbank shares the recommended sleep numbers for children and teens, information about sleep patterns in the teen years, and the sleep hygiene habits he often recommends to patients and families.

New sleep numbers

The American Academy of Sleep Medicine published new recommendations in 2016 for the amount of sleep children and teens should get every 24 hours on a regular basis. Their recommendations state that sleeping the number of recommended hours is associated with better health outcomes including improved attention, behavior, learning, memory, emotional-regulation, quality of life, and mental and physical health. Here are the daily amounts they recommend at various ages:

4-12 months: 12 to 16 hours (including naps)
1-2 years: 11 to 14 hours (including naps)
3-5 years: 10 to 13 hours (including naps)
6-12 years: 9 to 12 hours
13-18 years: 8 to 10 hours

Regularly sleeping fewer or more than the recommended number of hours is associated with adverse outcomes for a child’s overall health and daily life. Some of these negative outcomes include an increased risk of accidents, injury, hypertension, obesity, diabetes and depression, as well as an increased risk of self-harm, suicidal thoughts and suicide attempts.

Talk with your child’s doctor if you are concerned that your child is sleeping too little or too much. Evaluation for a possible sleep disorder may help.

Sleep & teens

While 8 to 10 hours is recommended for teens, some studies suggest that 9 hours per night is optimal for most adolescents. A recent nationwide survey, however, shows that only about 31 percent of high school students get eight or more hours of sleep on an average school night which means nearly 70 percent are not getting the sleep they need on a regular basis. Insufficient sleep in this age group is associated with higher odds of:

Smoking, drug and alcohol use
Sexual activity
Seriously considering suicide attempts
Feeling sad or hopeless
Physical fighting
Getting less than the recommended amount of daily physical activity
Getting more than the recommended amount of daily screen time/computer use

Part of the problem of inadequate sleep in teenagers is due to the natural condition that many children develop in the teenage years called delayed sleep phase syndrome. Teenagers tend to release a hormone in their brain called melatonin later in the day than children or adults. This hormone regulates our sleep-wake cycle, or circadian rhythm. Teenagers have a sleep cycle that makes them want to go to bed later at night and wake up later in the morning. In fact, many will naturally have difficulty falling asleep at a time that will allow them to get 8 to 10 hours of sleep at night.

The sleep cycle problem in teens is often further complicated by their use of screens at night, including while in bed. Light exposure from phones, tablets, computers and TV screens in the evenings further delays the sleep phase, resulting in even later sleep and wake up times.

The early school start time common for most high school students also contributes to inadequate sleep. Many school districts are looking at later start times for this reason. I encourage parents of adolescents (and future adolescents) to actively participate in encouraging their school districts to make these changes. Start School Later, Inc. is a non-profit organization dedicated to healthy school hours. Their website has valuable information regarding the importance of later school start times for teenagers and ways you can get involved in advocating for better school hours.

The hormonal changes and daily habits typically associated with the teen years can make getting a good night’s sleep challenging. It’s vital for children’s emotional, physical and cognitive health that parents continue to actively support good sleep habits during this stage.

Good sleep hygiene habits for all ages

From the toddler years to the teen years, the same nighttime habits can help promote good sleep quality and adequate sleep at night, which is what we consider to be good sleep hygiene. Each child may have a unique set of challenges related to falling asleep and getting enough sleep at night so the solution to a good night’s sleep – and good sleep hygiene overall – is often very individualized.

Stick to a regular bedtime. Figure out how many hours of sleep your child needs (based on age requirements) and determine the appropriate bedtime based on the time they have to wake up.

Have a standard bedtime routine and try not to deviate. This prepares the mind for sleep.

Avoid any caffeine use in children. If teenagers choose to have caffeinated soda or tea, they should limit this to one per day and have it before 2 p.m. Drinking caffeine in the afternoon can negatively affect sleep even many hours later.

Turn off all screens. Screen time should end at least 30 minutes (preferably one hour) before bedtime.

Avoid any activity besides sleep in the bed. Watching TV or even reading in bed suggests to the brain that the bed is a place for things other than sleep and this can result in problems with falling or staying asleep.

Promote a pleasant sleep environment including having the child sleep in their own bed. A pleasant sleep environment is one that is quiet and peaceful. Some may find it easier to fall asleep with background “white” noise, such as a fan. That may sometimes be helpful as long as the volume is not too high and the sound machine is not placed right next to the child’s head. Other ways to promote a pleasant sleep environment include having clean bedding that is free from clutter and a pleasant temperature in your child’s bedroom. If your child sweats at night, consider lowering the temperature or making an adjustment to pajamas or bedding.

Keep the lights low. Some children prefer having a nightlight on, which is OK, but any other light can inhibit sleep. Consider installing black-out shades if your child wakes up too early in the morning.

Make sure your child isn’t hungry. Hunger at bedtime may make it hard for your child to fall asleep. Depending on the timing of dinner, a child may need a light, nutritious snack before bedtime to help feel satisfied.

When to seek professional help

Even after doing all you can to improve your child’s sleep hygiene and make your child’s sleep environment conducive to good quality sleep, some children may still have difficulty falling asleep or staying asleep. Children may also have sleep problems that persist from habits established in infancy, such as needing a parent in the room in order to fall asleep. Some of these problems can be difficult to identify and correct without professional help.

Consultation with a sleep specialist may be helpful when it takes your child more than a half hour to fall asleep once in bed with the lights out, if they have multiple awakenings at night, if they have any unusual behaviors during sleep, if they seem excessively sleepy during the day despite getting the recommended amount of sleep, or if they have snoring, gasping sounds or breath-holding while asleep (these are symptoms of sleep apnea, which can severely impact the quality of sleep at night). Talk with your child’s pediatrician if you have concerns about your child’s sleep. They can help with many problems, and will be able to refer you to a pediatric sleep specialist if necessary.

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