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By Melissa Tennen, HealthAtoZ writer
Is a nightmare afoot in Dreamland? Maybe. Your child might need more ZZZ's just to learn those ABC's.
"We used to think children were the golden sleepers," says Jodi A. Mindell, M.D., associate director of the Children's Hospital of Philadelphia's Sleep Disorders Center and author of Sleep Through the Night. "We're finding out that's not always true."
Welcome to America's newest health crisis -- exhausted children. And researchers are alarmed.
"In our modern society, adults aren't sleeping enough, and children are no exception," says David Gozal, M.D., director of Kosair Children's Hospital Comprehensive Sleep Medicine Center in Louisville, Ky.
Gozal's 1998 research was one of the first to examine the effects of sleep problems on children in elementary and middle schools. After decades of research in adults and even teens, researchers in the past few years are only seeing the tip of the iceberg in studying the problem in children, who have different physiology. And scientists don't know the consequences of poor sleep on a developing brain.
"We may be doing a very big disservice for our children," Gozal says.
At least half of all adult Americans today have some sort of sleep issue whether it's sleep apnea, depression-related or just not getting a full night's sleep. Adults are not making good sleep a priority and, consequently, children are falling into the same patterns.
Gozal estimates between 30 percent and 40 percent of children do not sleep enough. They actually need at least nine to 10 hours a night, which parents may not realize their child requires. Most adults should get between seven and eight hours sleep a night but multiple daily demands often make that unlikely.
And researchers like Judith Owens, an associate professor at Brown Medical School, believe sleep problems are learned behaviors from parents who do not necessarily value or understand the need for sleep. These parents do not listen to their own bodies' calls for sleep. And a vicious cycle begins with sleep-deprived children taking poor sleep hygiene into adulthood.
"We don't think of sleep as a health-related issue," she says. "We teach our kids about the importance of sunscreen and wearing a seatbelt. But we never talk about the importance of enough sleep."
It's also a product of modern society. "There are many other things that kids could be doing instead of sleeping," Owens says. "There are computers, homework, social activities, television. One hundred years ago, there wasn't much to do without electricity. Now there is always something going on around us 24 hours a day. You can go to the Stop 'n' Shop at three in the morning and not think anything of it."
Sleep problems in both children and adults are similar-not getting to bed on time, failing to fall asleep quickly, snoring, sleep apnea and others. Some are considered insomnia while others like snoring and apnea are sleep disorders.
Parents reported snoring in 17 percent of the children examined in a University of Michigan study. Apnea, a sleep disorder commonly found in adults, is where the sleeper temporarily stops breathing, disrupting the sleep cycle. Snoring can also cause poor sleep. In children with apnea or snoring, a crucial growth hormone, which is secreted in sleep, fails to function properly. Mindell says once this is corrected through minor surgery, children usually experience a growth spurt. She said lack of sleep might even suppress immune systems, making children more susceptible to colds and viruses.
"Children become irritable and cranky, and they cannot regulate their moods. They may get completely silly and can't stop laughing," Mindell said. "They have trouble with concentration, paying attention and decision-making. Lack of sleep affects classroom behavior. They become noncompliant in class, and they may be misdiagnosed as having attention deficit."
Insomnia and sleep disorders in children are becoming such a significant problem that the National Sleep Foundation (NSF), The National Association of Elementary School Principals (NAESP), The National Heart, Lung, and Blood Institute (NHLBI), and other health organizations partnered to educate children, parents, educators, and healthcare providers about sleep's importance for good health. The five-year "Sleep Well. Do Well. Star Sleeper" campaign uses Garfield as its "spokescat" to encourage children 7 to 11 years old to get at least nine hours of sleep each night.
"When you have an organization as large as that (NHLBI) interested in the problem, you can look at it as a validation that this is a real field," said Andrea Herman, executive director of the Better Sleep Council.
But are parents aware of the consequences? Parents know their child may be tired, but they might not realize the health implications for developing brains or poor sleep being the cause of poor performance in the classroom, Owens said. Many adults exist on such a low level of rest and don't always recognize how their own weariness affects their health and intellectual performance, she adds.
Gozal has been finding that parents are not aware of the problems in their children. Other studies show he may be right. A recent study in the journal Pediatrics found that out of the 11 percent of parents identifying a sleep problem with their young child, only half asked their pediatrician about the problem.
A study from Brown University found even more troubling implications. Mom and Dad may not even know how poorly children are sleeping. More than a quarter of kids surveyed from three elementary schools in Rhode Island said they had trouble falling asleep, while only 5 percent of their parents were aware of the problem. Teachers also said at least 10 percent of elementary-school aged children were sleepy during the day. "Many times we have to express our concerns to the parents that their child is not getting enough sleep," NAESP president Paul Young says.
More schools and parents are starting to recognize the behavioral and learning problems associated with lack of sleep, he said. He notes nurses, school psychologists and teachers try to work with families to correct the problem, but ultimately it's up to the parents to make sleep a priority with their children.
School principals agree. "Parents complain that their child stays up very late getting homework done-that they have too much homework. Children may be up until 10 or 11 with homework that only takes an hour," said Principal Jane Costa of an elementary school in Basking Ridge, New Jersey.
And what's the cause?
"Too many distractions," Costa said.
The Better Sleep Council offers 10 "do's and don'ts" to help your child get to sleep and stay asleep.
- Do help your child to get at least nine hours of sleep each night. To be their best, children need at least nine hours of sleep every night.
- Don't over-schedule your child. Too many after-school activities and commitments can keep children from precious sleep. Allow your child plenty of time for homework and chores each night to avoid being forced to stay up past bedtimes to finish school assignments.
- Do set a regular bedtime for your child and stick to it. A regular bedtime can help ensure your child gets a full night's sleep.
- Don't allow your child to consume caffeine too close to bedtime. Consuming foods like soda and chocolate in the evening can make it more difficult for your child to fall asleep.
- Do help your child develop a sleep ritual. Routine, relaxing activities such as having your child take a bath or you reading with your child can help the transition into sleep mode.
- Don't allow your child to get wound up in the evening. Tackle science projects, book reports, and other homework before or immediately after dinner. Allow your child at least one hour before bedtime to relax and unwind.
- Do make sure your child's bedroom is dark. The lights should be off and the shades closed in your child's room before bed. While a small nightlight is fine, your best bet is a dark room, which is the ideal for a good night's sleep.
- Don't allow your child to fall asleep in front of the television. Noise from a television, radio, or even loud conversations can keep your child from deep, restful sleep.
- Do pay attention to your child's mattress. Handing down an old mattress to a child isn't a good idea. Because mattresses wear out, you want to maximize your child's chances of restful sleep by making sure the mattress is comfortable and supportive enough for the child to fall asleep, stay asleep, and wake up refreshed.
- Don't let your child's room get too hot or too cold. Children (and adults) may have a difficult time falling and staying asleep in a room that's too hot or too cold. The ideal sleeping temperature is one that feels cold.
This article was reviewed and updated June 2007.
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