Sleep deprivation

By Nathalie Vallerand

For many children, sleep doesn’t come easily. Some become expert bedtime stallers; others wake up several times during the night. The bottom line is that children now sleep slightly less, on average, than previous generations.

Over the past few decades, both adults and children have started sleeping less. Studies show that children now sleep from 30 to 60 minutes less per day. That might not seem much, but it’s enough to affect mood, attention span and memory.

“Children are going to bed later than before, but their wake-up time has remained the same. This means they’re sleeping less,” notes Dominique Petit, researcher with the Center for Advanced Research in Sleep Medicine at the Hôpital du Sacré-Coeur de Montréal. “Furthermore, many go to bed too late. When bedtime is later than 9 p.m., children take longer to fall asleep and wake up more frequently during the night.”

So, why have bedtimes become later? In many families, both parents work. As a result, this delays suppertime and then bedtime. “As well, some parents feel guilty for putting their children to bed instead of spending more time with them,” Petit adds. “They therefore tend to be less strict about bedtime.” Not to mention that evenings are often filled with all sorts of activities. Your toddler may not yet participate in any, but the busy schedule of other family members can have an impact on her.

“When meal and bed times are not regular, it affects the routine, and routine is crucial for a child’s sleep,” explains Concordia University psychology professor Jennifer McGrath, who has led research into sleep. Moreover, the more activities are done out of daylight hours, the more children are exposed to artificial lighting in the evening, which affects their rhythm. Your child may therefore have more trouble settling into her sleep schedule based on daylight and darkness.

Light from screens (computer, tablet, cell phone, TV) also affects a child’s rhythm in addition to stimulating the brain and reducing sleep time. An American study showed that children between the ages of 3 and 5 who watch television after 7 p.m. have more sleep troubles. “Access to screens in the evening delays bedtime, increases the time it takes to fall asleep and causes more night waking,” McGrath adds.

Common sleep problems

According to Evelyn Constantin, pediatrician and co-director of the Montreal Children’s Hospital Sleep Laboratory, 25 % of children have sleep issues. “This can climb up to 90 % among children with a developmental delay, AD(H)D, pervasive developmental disorder or cerebral palsy,” she adds.

Here are the most common sleep-related problems :

• Difficulty going to bed

“I’m hot ; I’m thirsty ; I have to go potty ; I want another hug…” Some children have great imaginations when it comes to stalling their bedtime! Between ages 2 and 5, many display what’s known as bedtime resistance. “It’s normal that your toddler tries to keep you close for as long as possible,” says Dominique Petit. “But it’s in everyone’s best interests to set clear boundaries.”

• Difficulty falling asleep

The average time it takes for a child to fall asleep is generally 30 minutes. If it takes longer than that, it’s because she’s not going to bed at the right time. If it’s too late, the toddler may be more agitated and therefore find it harder to fall asleep, especially if she’s overtired. If it’s too early, on the other hand, her body may not be ready to sleep yet. For a child to fall asleep quickly, it is therefore important to set a schedule that respects her natural rhythm as much as possible, and to have a regular bedtime routine. Plus, there should be about 4 hours difference between naptime and bedtime so that falling asleep isn’t an issue, especially after age 3.

• Difficulty falling back asleep alone during the night

Between the ages of 1 and 3, children wake up on average 3 times per night, which is normal and nothing to worry about if they are able to go back to sleep right away. However, it becomes a problem if the child starts crying, calling for her parents or getting up each time she wakes up. This happens most with toddlers who are used to falling asleep with a parent present.

2-year-old Éloïm’s parents know something about this. His mom got into the habit of lying down with him until he fell asleep. An enjoyable moment at bedtime, no doubt, but much less so in the middle of the night. “He would wake up two or three times and need his mom to fall back asleep,” says dad, Étienne.

“If you always stay with your child until she falls asleep, you teach her that she can’t do it without you,” says Dominique Petit. “If she wakes up at night, she’ll call for you.” The difference between a good and bad sleeper is, in part, the ability to fall back asleep alone after waking up. Your child will sleep better, and so will you, if you show her how to go to sleep on her own.

This is what Éloïm’s parents are now trying to do. “At bedtime, we read him a story and then we tell him we’ll return to check on him later,” says Étienne. “Often, he falls asleep before we come back. The great thing is that he’s now more able to fall back asleep on his own during the night.” To make sure they don’t go through all that again with their youngest, 8-month-old Anaël, the couple puts him into bed while he’s still awake.

Other sleep disturbances

5-year-old Lytycya snores when she sleeps. But when her dad, Éric, realized her breathing was also stopping for a few seconds, he got worried. At the hospital, he found out it was sleep apnea, a condition that affects between 1 % and 5 % of children. “If your child snores, breathes through her mouth or has respiratory pauses during the night, you should consult a doctor,” recommends Dr. Evelyn Constantin.

Other common sleep disturbances include night terrors, teeth grinding, sleep walking or sleep talking. These usually aren’t serious and often resolve themselves. However, if they occur several times a week over several weeks, it’s best to seek medical advice.

Sleeping to grow

When your child sleeps well, he’s in a better mood. But did you know that getting a good night’s sleep also helps him to learn and to be in better physical and mental health?

While your child sleeps, his brain is working hard. It is busy storing all the day’s learning into memory. Neurons connect, allowing your child to gradually gain better control of his emotions and acts, to solve problems, to reason, and to develop intellectually. Good sleep also boosts his immune system. Last but not least, while he sleeps, your child releases hormones that help him grow.

If a child is regularly deprived of sleep, however, he runs a higher risk of suffering from language delay. “He may also be more agitated and impulsive when he starts school,” says Dominique Petit from the Center for Advanced Research in Sleep Medicine at the Hôpital du Sacré-Coeur de Montréal. A child who is sleep deprived also has a harder time learning. He may have difficulty concentrating, retaining information, thinking and finding solutions.

Daytime naps are also important and help consolidate learning. An American study revealed that when children don’t nap, they are more anxious, less playful, and less good at problem solving. “Other studies have shown that children who didn’t take their regular nap tended to forget what they’d seen earlier in the day,” says Petit. Of course, after a certain age, a child no longer needs to nap in order to function well and learn.

Sleep and weight

Children who sleep less also run a higher risk of becoming overweight, observes Jennifer McGrath, director of the Healthy Heart Project, a Concordia University research project on sleep and obesity. “Sleep deprivation increases the levels of cortisol, a hormone that plays a role in how the body reacts to stress and which is also linked to obesity,” she explains. It can also impact the hormones related to appetite and hunger signals. As a result, children who don’t sleep enough tend to eat more.

The link between sleep deprivation and obesity actually appears early. Dominique Petit notes that at 2-and-a-half years old, toddlers who sleep less than 9 hours per day are already more likely to be overweight.

But it’s not just the amount of sleep that counts. Jennifer McGrath’s work has shown that the quality of sleep has an even higher impact on the risk of obesity. “Children who sleep less well, who go to bed too late and who wake up more often at night are more likely to carry extra pounds.”

Those who need less sleep

That said, the quality and length of your child’s sleep depends on several factors, including his temperament. Some children sleep a lot, others a little less. However, children who genuinely require less sleep (e.g. those who sleep one or two hours less than the minimum recommended time) are relatively few and far between. “To fall into this category, your child would need to be able to function well in general and be in a good mood during the day, despite sleeping less than other children his age,” Dominique Petit explains.

Before concluding that your child doesn’t need as much sleep as the experts recommend, it’s important to pay attention to cues that may indicate that he’s sleep deprived : difficulty waking up in the morning, difficulty concentrating, agitation, aggression, impulsiveness, irritability, repetitive colds or other infections, and so forth.

Just like other children, a child who doesn’t need as much sleep still needs to go to bed at the same time every night, to have a calm bedtime routine, and to learn to fall asleep on his own in order to get good-quality sleep.

Obstacles to sleep

All parents want their children to sleep well, but there are several factors that can affect sleep without our even realizing it. Here’s a look at the most common obstacles to getting a good night’s sleep and a few tips on how to overcome them.

Irregular supper and bedtimes

This is the greatest challenge when trying to balance work and family life! When you get back from work at 6 p.m. and one of the family has an activity that evening, it’s not always easy to keep a consistent mealtime and bedtime routine. Even so, it’s good to try to stick to a stable schedule if you can.

“This regulates your toddler’s biological clock and helps her fall asleep more easily,” explains Jennifer McGrath, psychology professor at Concordia University. “That’s why it’s also good to stick to the same routine on weekends too.”

While there is no miracle solution for hectic weeknights, some popular suggestions for balancing work and family life can help : planning the menu for the week and preparing a few meals on the weekend, limiting evening outings, dividing household chores between you and your partner, etc.

It’s also important to watch for your child’s sleepy signals so you can put her to bed at the time when her biological clock asks for it. “When my daughter needs to sleep, she whines, loses her patience for no reason and twists her hair,” describes Pascal, father to 5-year-old Félix, 2-year-old Manue and 5-month-old Matéo. Other children rub their eyes, yawn, stare into space, look for a fight, and so on.

No bedtime routine

According to experts, this is the main cause of sleep trouble in toddlers. If you establish a predictable and reassuring routine (e.g. bath, pyjamas, teeth brushing, story, hugs, and sleep), your toddler will sleep better and fuss less about going to bed. “A little ritual reassures a child, since she knows what to expect,” says Dominique Petit from the Center for Advanced Research in Sleep Medicine at the Hôpital du Sacré-Coeur de Montréal. “What’s more, she learns to associate sleep with the various steps to falling asleep.”

Father of four children between the ages of 5 and 21, Éric knows what a difference a routine can make. “With my older children, I didn’t have a routine or regular bedtime, and it was always difficult to put them to bed. With my younger ones, 5-year-old Lytycya, and 6-year-old Lukas, I always do the same things in the same order. They understand that it’s time for bed and they sleep very well.”

It’s also recommended to promote calm activities in the hour before bedtime, like reading, listening to soft music or drawing.

Too many screens, not enough physical activity

As several studies have shown, spending too much time in front of screens (TV, tablet, cell phone, computer) affects sleep. In fact, it’s better to avoid them altogether before bed. Your child should not have a TV or other screens in her room either.

You should also limit screen use during the day so that you leave more time for physical activity in particular. As Lukas’ dad has discovered : to get a good night’s sleep, your child needs to move. “When my son isn’t active enough during the day, he has a hard time falling asleep at night.” The Canadian organization Participaction highlighted the importance of sleep in its last Report Card on Physical Activity for Children and Youth. “Kids aren’t moving enough to be tired, and they may also be too tired to move […] it’s a vicious cycle,” reads the report.

Certain bedtime habits

In her research, Dominique Petit has noted that parents, often without meaning to, adopt bedtime habits that do not actually promote better sleep. For example, a parent who stays with their child until she falls asleep, or brings their child into their bed when she wakes up in the night, actually teaches the child that she needs an adult beside her to be able to go to sleep. A child who learns that she can fall asleep without assistance, on the other hand, also learns that she can fall back asleep on her own during the night. Her night wakings will be shorter and she will enjoy longer, more restorative sleep.

“The best thing is to teach your baby to fall asleep on her own as soon as possible,” says Dominique Petit. At just a few months old, you can put your baby to bed before she’s actually asleep. Around 6 months old, babies don’t usually still need to be fed at night. If your child wakes up and cries, go to see her to make sure everything is okay, recommends the specialist, but leave her in her crib. To soothe her, you can simply caress her and speak to her softly.

What if your 1- or 2-year-old still needs you in order to settle? There are several methods to help her fall asleep on her own and just as many opinions on the matter. For example, some parents may decide to try the progressive sleep training method (waiting 5-10-15 minutes), while others are not comfortable doing this. This method entails waiting for progressively longer periods before going to check on your child if she starts crying—first 5 minutes, then 10, then 15.

Studies show that this is an effective and safe method; however, Marie-Hélène Pennestri, psychologist and assistant professor at McGill University, interprets the results with caution. “It’s very difficult to make a direct link between the use of a sleep training method and the emotional development of children in the long term. It’s just one factor among many others,” she says. Nevertheless, she adds that it’s still better to try a sleep training method than to be depressed and develop a poor relationship with your child. “However, if parents don’t feel comfortable with it, we shouldn’t tell them it’s the only solution. If a parent uses the method because he or she feels social pressure to do so, it probably won’t work and no one will feel good about it.”

The way you react to a child who makes repetitive requests (potty, water, kisses, etc.) to stall bedtime can also be key. It’s normal for a child to test limits. However, if you say yes to everything or you react according to your mood, the situation will reoccur night after night. Since your child will learn that she sometimes “wins”, she will continue to try. To reduce bedtime requests, it’s therefore important to set limits and stick to them.

Some parents also choose to reinforce good behaviour with a reward. This is what Manue’s parents have done so that she stops getting up ten times a night. “When she stays in her bed, she gets a sticker that she sticks on a board,” explains Pascal. “After three stickers, she’s allowed a little something.”

Source : Naître et grandir magazine, October 2016 Research and copywriting : Nathalie Vallerand Scientific review : Evelyne Martello, clinical nurse, Sleep Disorder Clinic, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital

Photos : Nicolas St-Germain, iStock.com/Bodler, iStock.com/IPEKATA, iStock.com/Bodler