Sleep Health Article

Toddlerhood

Toddlers are far more physically active than infants, and their sleeping behavior and the timing of sleep cycles reflects their maturing brains. A toddler will spend only about 30 percent of her sleep time in REM dream sleep. Toddlers on average require 12 to 14 hours of sleep and may no longer need an afternoon nap to meet this sleep requirement. But research shows that children in the one to three-year-old range may actually average only about 11.7 hours of sleep.

Preschool

Children in this age group tend to be more troubled with nightmares and night terrors than younger children. They may resist going to bed at night because of fear of the dark or of some monster lurking under the bed. Parental reassurance and comfort and the addition of a night light may alleviate some of these concerns. Preschool children may also feel anxiety around the issue of toilet training and bedwetting.

School age

School-age children require from eight to 10 hours of sleep nightly. Adequate sleep is especially important as school children's lives become busier and stress levels rise. Sleep disruptions such as nightmares tend to increase with this age group as the child has more life experiences and anxieties to process. Parents should also monitor the child's use of caffeinated beverages which can cause sleep difficulties and add to the overall loss of adequate sleep.

Adolescents require at least 10 hours of nightly sleep. This is a busy time when many teens' lifestyles include school, work, sports, and other extracurricular activities, as well as socializing with peers. This increase in activity, together with early-morning school schedules, leaves little time for adequate sleep. Various psychological disorders also may trouble the adolescent, particularly anxiety and depression. Parents should pay attention to a young teen who shows sudden changes in eating habits, loss of interest in usual activities, and other behavioral clues that may indicate onset of depression.

Common problems

According to the "2004 Sleep in America Poll" published by the National Sleep Foundation, 69 percent of children younger than age 10 experience problems with sleep that may occur as often as several times a week. Sleep disruptions in children are usually a normal symptom of central nervous system development. In older children sleep disruptions may increase and intensify due to external stressors in the home or school environment. Sleep difficulties can also be a sign of physical or mental health problems. They are often present in children with attention-deficit/hyperactivity disorder (AD/HD) and in children who have experienced physical, psychological, or sexual abuse.

Childhood sleep problems and parasomnias include:

• Bedwetting: A common sleep problem characterized by involuntary urination during sleep. This is a routine occurrence in children up to five years of age. Bedwetting is also called "nocturnal enuresis."
• Nightmares: A common parasomnia characterized by dreams with frightening psychological content, a feeling of imminent physical danger, and a sensation of being trapped or suffocated. Nightmares occur during REM, or dream-time, sleep and trigger a partial or full awakening. The word "mare" in Old English means "demon."
• Insomnia: Difficulty falling asleep and remaining asleep, or early-morning awakenings. Insomnia may be short-term, due to stress or physical or psychological problems, or may be due to the lack of a healthy bedtime routine.
• Night terrors: A common childhood sleep disruption characterized by an abrupt arousal from stage 4 sleep within the first hour of the sleep period. The child may sit bolt upright in acute terror, screaming inconsolably. Night terrors are a confusional arousal resulting from immature sleep patterns with an intense activation of the flight or fight emotion. They occur in the deepest stage of slow-wave non-REM sleep. Night terrors are also called "pavor nocturnus."
• Sleep apnea: A serious and potentially life-threatening sleep disruption characterized by brief interruptions of airflow during sleep and frequent partial arousals throughout the night. Sleep apnea is less common than other sleep disturbances, occurring in about 2 percent of children.
• Sleep bruxism: A sleep disturbance characterized by grinding the teeth or clenching of the jaws during sleep. Sleep bruxism is common among children of all ages. This sleep problem usually subsides over time.
• Sleep rocking and head banging: A sleep disturbance characterized by rhythmical movements of the body during sleep. Rhythmical movements may be observed in children as young as six months. More dramatic movements, involving head banging and rocking, occur in as many as 60 percent of nine-month-old children. These sleep disturbances tend to decrease with age, appearing in only about 5 percent of children over two years of age.
• Sleep walking: A sleep disturbance characterized by a partial-arousal involving walking about for a few steps, or for much longer distances, with a glassy, trance-like appearance to the eyes. Sleepwalking occurs in the deepest stages of slow-wave, non-REM sleep within the first few hours of sleep onset. Researchers have found that as many as 15–30 percent of children experience at least one sleepwalking episode. Sleepwalking can be triggered by external stimuli, such as an abrupt noise, or by moving a sleeping child to a standing position. This sleep disturbance tends to run in families. Sleepwalking is also called "somnambulism."