Children and Sleep

By the age of two, most children have spent more time asleep than awake and overall, a child will spend 40 percent of his or her childhood asleep. Sleep is especially important for children as it directly impacts mental and physical development.

There are two alternating types or states of sleep:

Non-Rapid Eye Movement (NREM) or "quiet" sleep. During the deep states of NREM sleep, blood supply to the muscles is increased, energy is restored, tissue growth and repair occur, and important hormones are released for growth and development.

Rapid Eye Movement (REM) or "active" sleep. During REM sleep, our brains are active and dreaming occurs. Our bodies become immobile, breathing and heart rates are irregular.

Babies spend 50 percent of their time in each of these states and the sleep cycle is about 50 minutes. At about six months of age, REM sleep comprises about 30 percent of sleep. By the time children reach preschool age, the sleep cycle is about every 90 minutes.

Sleep and Newborns (1-2 months)

For newborns, sleep during the early months occurs around the clock and the sleep-wake cycle interacts with the need to be fed, changed and nurtured. Newborns sleep a total of 10.5 to 18 hours a day on an irregular schedule with periods of one to three hours spent awake. The sleep period may last a few minutes to several hours. During sleep, they are often active, twitching their arms and legs, smiling, sucking and generally appearing restless.

Sleep Tips for Newborns

• Observe baby's sleep patterns and identify signs of sleepiness.
• Put baby in the crib when drowsy, not asleep.
• Place baby to sleep on his/her back with face and head clear of blankets and other soft items.
• Encourage nighttime sleep.

Sleep and Infants (3-11 months)

By six months of age, nighttime feedings are usually not necessary and many infants sleep through the night; 70-80 percent will do so by nine months of age. Infants typically sleep 9-12 hours during the night and take 30 minute to two-hour naps, one to four times a day – fewer as they reach age one.

When infants are put to bed drowsy but not asleep, they are more likely to become "self- soothers" which enables them to fall asleep independently at bedtime and put themselves back to sleep during the night. Those who have become accustomed to parental assistance at bedtime often become "signalers" and cry for their parents to help them return to sleep during the night.

Sleep Tips for Infants

• Develop regular daytime and bedtime schedules.
• Create a consistent and enjoyable bedtime routine.
• Establish a regular "sleep friendly" environment.
• Encourage baby to fall asleep independently and to become a "self-soother."

Sleep and Toddlers (1-3 years)

Toddlers need about 12-14 hours of sleep in a 24-hour period. When they reach about 18 months of age their naptimes will decrease to once a day lasting about one to three hours. Naps should not occur too close to bedtime as they may delay sleep at night.

Many toddlers experience sleep problems including resisting going to bed and nighttime awakenings. Nighttime fears and nightmares are also common.

Sleep Tips For Toddlers: 

• Maintain a daily sleep schedule and consistent bedtime routine.
• Make the bedroom environment the same every night and throughout the night.
• Set limits that are consistent, communicated and enforced. Encourage use of a security object such as a blanket or stuffed animal.

Sleep and Preschoolers (3-5 years)

Sleep Tips for Preschoolers

• Maintain a regular and consistent sleep schedule.
• Have a relaxing bedtime routine that ends in the room where the child sleeps.
• Child should sleep in the same sleeping environment every night, in a room that is cool, quiet and dark – and without a TV.

Sleep and School-aged Children (5-12 years)

Children aged five to 12 need 10-11 hours of sleep. At the same time, there is an increasing demand on their time from school (e.g., homework), sports and other extracurricular and social activities. In addition, school-aged children become more interested in TV, computers, the media and Internet as well as caffeine products – all of which can lead to difficulty falling asleep, nightmares and disruptions to their sleep. In particular, watching TV close to bedtime has been associated with bedtime resistance, difficulty falling asleep, anxiety around sleep and sleeping fewer hours.

Sleep problems and disorders are prevalent at this age. Poor or inadequate sleep can lead to mood swings, behavioral problems such as hyperactivity and cognitive problems that impact on their ability to learn in school.

Sleep Tips for School-aged Children

• Teach school-aged children about healthy sleep habits.
• Continue to emphasize need for regular and consistent sleep schedule and bedtime routine.
• Make child's bedroom conducive to sleep – dark, cool and quiet.
• Keep TV and computers out of the bedroom.
• Avoid caffeine.

Snoring

Many if not most children snore on occasion, and about 10 percent or more snore on most nights. Snoring is a noise that occurs during sleep when the child is breathing in and there is some blockage of air passing through the back of the mouth. The opening and closing of the air passage causes a vibration of the tissues in the throat. The loudness is affected by how much air is passing through and how fast the throat tissue is vibrating. Children who are three years or older tend to snore during the deeper stages of sleep. Primary snoring is defined as snoring that is not associated with more serious problems such as obstructive sleep apnea syndrome (OSAS), frequent arousals from sleep, or inability of the lungs to breathe in sufficient oxygen.

Loud and regular nightly snoring is often abnormal in otherwise healthy children. Sometimes it is a sign of a respiratory infection, a stuffy nose or allergy; other times it may be a symptom of sleep apnea. In 2002, the American Academy of Pediatrics recommended that all children be screened for snoring and that a diagnosis be conducted to determine if a child is experiencing normal primary snoring or obstructive sleep apnea syndrome.

About one to three percent of children not only snore, but also suffer from breathing problems during their sleep. When snoring is accompanied by gasps or pauses in breathing, the child may have OSAS. Children’s muscles normally relax during sleep, but they can become so relaxed that the airway is narrowed or obstructed and sufficient air cannot pass through. This interferes with breathing, causing a pause in breathing that can last only a few seconds or as long as a minute. The brain is then alerted and signals the body to make an effort to start breathing again. This effort results in the child gasping or snorting, waking up and starting to breathe again. Because of these repeated arousals to breathe, the child may not get enough quality sleep and is likely to be sleepy or overtired during the day.

Contributing factors to sleep apnea may be obesity, allergies, asthma, GERD (gastroenterological reflux disorder), an abnormality in the physical structure of the face or jaw as well as medical and neurological conditions. In children, the most common physical problem associated with sleep apnea is large tonsils. Young children’s tonsils are quite large in comparison to the throat, peaking at five to seven years of age. Swollen tonsils can block the airway, making it difficult to breathe and could signify apnea. According to the National Center for Health Statistics, more than 263,000 children in the U.S. have tonsillectomies each year and sleep apnea is a major reason.

Undiagnosed and untreated sleep apnea may contribute to daytime sleepiness and behavioral problems including difficulties at school. In one recent study presented at the American College of Chest Physicians, children who snored loudly were twice as likely to have learning problems. Following a night of poor sleep, children are also more likely to be hyperactive and have difficulty paying attention. These are also signs of attention-deficit/hyperactivity disorder (ADHD). Apnea may also be associated with delayed growth and cardiovascular problems.