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Children’s sleepChallenges and opportunities
Dr Andrew Mayers, PhD, MBPsS
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Children’s sleep
Overview
How common are sleep problems in children?
What are the problems?
Who is it a problem for?
The child
The family
Causes?
Solutions and suggestions
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Children’s sleep problems: prevalence
Sleep problems in children common
About 25–40%
Sleep problems in children can persist
Don’t underestimate impact
But do be aware that there are solutions
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Children’s 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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Sleepwalking
May appear distressing – but it is quite normal (in children) 15% of children aged 4-12 sleepwalk
Generally occurs in deep sleep in 1st/2nd ‘cycle’ of sleep Children tend to spend more time in deep sleep than adults
Which may explain increased incidence in children In adults, sleepwalking my be caused by several
factors In children, it is just part of normal development
Mostly ‘quiet’ walking about – but can be ‘agitated’ Also see ‘sleep terrors’ later
Typical behaviours Clumsiness, ‘glazed’ look, poor ‘nonsense’ speech,
repetitive behaviour, some bedwetting
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Sleepwalking
Event usually forgotten – especially if not woken And it’s best not to wake child (may get embarrassed)
NOT associated with room sharing, being alone, being afraid of dark
May be associated with lack of sleep and/or emotional problems
Rarely needs any treatment But seek help if very frequent or very disturbing
Child could get hurt Avoid bunk beds, lock outer doors, keep floor clear… Possibly fit ‘alarm’ to doors Consider ‘sleep improvement’ – see later
Usually disappears by puberty
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Night terrors
More extreme form of sleepwalking – and rarer (1-6%) Quite different to nightmares
Nightmares occur in lighter sleep and may ‘recalled’ Sleep terrors tend to occur in deep sleep Sleeper usually unaware of night terrors
Sudden ‘agitated’ arousal – child appears violent and terrified
More likely in toddlers – through to 5-7 But can go through to adolescence More frequent in younger children
If younger than 4 – may be at least once a week May be related to stress and some medications
If frequent and disturbing – talk to GP
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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 Temper tantrums, quarrel with siblings… Accidents
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Sleep problems: consequences
Chronic problems disrupt family life Affects parental sleep
Especially if child enters parental bed Increased relationship strife Arguments with/about siblings
Blame, unfairness, disruption Increased punishments Poorer mood and mental health in family
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Sleep problems: possible causes
Irregular sleep-wake schedule
Bedtime and rising
Lack of bedtime routine/supervision
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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How much sleep?
Recommended:
Infants (pre-school): 14 hours
School children (4-12): 9-11 hours
Adolescents (13+): 8 hours
But there are cultural an societal variations
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Good sleep – some tips for children
Bedtime/wake-up time should be consistent every day Should not be > 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 30–60 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 Child’s 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 75°F or 24°C 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