Children’s sleep
Typical problems
Dr Andrew Mayers
[email protected]
Children’s sleep
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Overview
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Types of problems
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Insomnia
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Sleep arousal
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Nightmares
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Night terrors
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Sleep walking
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Sleep problems in children?
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Sleep problems common in children
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Problems relate to two factors
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Sleep timing
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Sleep arousal
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 problems for child and the family
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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 specific problems:
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Nightmares, sleep terrors, obstructive sleep apnoea, narcolepsy,
sleepwalking, bedwetting, tooth grinding…
We should look at some child-specific DSM-5 sleep diagnoses…
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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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Inter-sibling fights
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Family stress, physical and mental health
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Parents relationship with each other
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Sleep problems: consequences
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Effects of poor child/adolescent sleep (O’Brien, 2009)
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For child, multiple behavioural and cognitive impairments
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For family, significant source of stress
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Learning, daytime function, conduct
Parental sleep, greater tension, reduced parenting
effectiveness
More sleep education needed and better sleep hygiene
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Sleep problems: consequences


Meta analysis - 86 studies and ~36000 children (Astill, et al 2012)
 Examined children aged 5-12
 Shorter sleep related to poorer cognitive performance, more
specifically…
 Executive functioning, multi-tasking, and school
performance
 But not with intelligence
 Shorter sleep duration associated with more behavioural
problems
 Internalising and externalising
 Drew on studies published across last 100 years!
So what’s new about children’s sleep problems?
 I feel there’s plenty – as we will see
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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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Problems rooted in toddler-child transition?
Lack of bedtime routine
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But some children are night owls!
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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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Possible causes
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Behavioural
 Negative association, family schedules, non-reinforced routines,
anxiety, poor sleep hygiene
Circadian problems
 e.g. delayed sleep-phase syndrome
Breathing problems
 e.g. snoring, sleep apnoea
Parasomnias
 Night terrors, nightmares, sleepwalking
Medical/developmental
 Asthma, eczema, epilepsy, autism… etc
Environmental
 Noise, light, ventilation, distractions, family trauma
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Modern technology and sleep
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Recent study explored impact of gadgets in bedroom (Oka et al 2008)
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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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Are violent video games worse?
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A Swedish study (Ivarsson et al. 2008) suggested not
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Violent games associated with greater heart activity
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Especially those played nearer to bedtime
They found no difference between games on sleep timing/waking
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But did find large differences in heart rate
But greater physical activity during sleep cannot be good
May indicate continued emotional and physical processing of game
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More ‘restless’ sleep?
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Could be reflected in dreams?
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More research is need
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Key facts
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Most children stop ‘napping’ 3-5 years
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Nocturnal sleep tends to increase at that point
Night waking in toddler/pre-school common
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20% wake up at least once a night
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50% at least once a week
After that, going back to sleep may be a ‘behavioural’ problem
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Ability to do so without parental intervention
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Self-soothing
Good time to establish routines
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When self-soothing becomes problem
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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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