Posts Tagged ‘ sleep ’

Sleep And School Performance: Setting The Stage For A Good Year For Your Child

Tuesday, August 28th, 2012

Once kids are school-age, we don’t talk as much about sleep methods as we do for infants and toddlers. What we focus on is setting the proper schedule for a child, and making sure that good – and repetitive – routines are in place to help a child get the sleep they need. And as kids (and parents) start the school year, it’s worth revisiting some of the key points  - especially since there is a large (and growing) research literature documenting how a lack of proper sleep can negatively affect school performance (at any developmental stage).

You need to determine if your child is getting enough sleep. You can click here to read a prior blog post that went into this in some detail, but here are some very rough averages to keep in mind:

Ages 3 – 5: 11-12 hours

Ages 6 – 8: 10-11 hours

Ages 9-11: 10-11 hours

Ages 12-14: 9.5 – 10 hours

Ages 15-17: 9 hours

Since these are averages, your child may get a little more or less than what is listed above. That’s not necessarily bad – all kids are different. But you need to look for signs that the amount of sleep they get is right for them – or put another way, wrong for them. Signs of sleep deprivation are most telling at any age. Kids should not have difficulties waking up at the designated time during the school year. You shouldn’t have to work hard to wake them – and if they use an alarm, they shouldn’t have a tough time waking up to it. They shouldn’t be overly groggy when they get up. During the school day, they shouldn’t be yawning a lot or finding it tough to stay awake in class (a number of studies are documenting this phenomenon in school classrooms). For young kids, they should be tired when it’s nap time (not way before). For older kids, they just shouldn’t be overly tired during the day. Younger kids may be tired at the end of the school day (especially in the afternoon if they go all day), but they shouldn’t be exhausted and look like they are going to crash (it’s a sign that they are not getting enough sleep at night) – they need to crash at bedtime. Older kids shouldn’t be falling asleep in the afternoon.

These signs of sleep deprivation are critically important – plenty of studies show that sleep deprivation is associated with less learning and lower academic performance at every age.

What do you do if your child shows signs of sleep deprivation? You need to revisit their sleep cycle and figure out how much sleep they are getting. Work backwards from the time they have to get up, and figure out a new target sleep time using the averages listed above (note: not just bedtime – you need to know when they are actually going to sleep). You can introduce gradual changes  - modify the sleep time by 15 minute intervals every few nights and try to build toward the goal. What you want to do is find that sweet spot where a child’s own rhythm will get them ready for sleep at the right time – and you will know when that happens when they fall asleep in 15 – 20 minutes or so once they are in bed. You may need to examine the sleep ritual. What is your kid doing the 30 – 45 minutes before it’s bedtime? This is typically not the time for electronics, stimulating games, or television. It’s supposed to be a quiet time that gets the body and mind ready for sleep – so, think relaxed conversation, reading, anything low-key. And it’s not a time for social media either (and this statement applies to younger and younger kids every year). Structuring this time, and monitoring to make sure the rules are followed, are important – especially if there is a TV or computer in your kid’s room. Sorry, there are no big tricks up the parenting sleeve – it takes some pretty firm parenting to get this done, and done on a nightly basis.

That leads to another point that applies to all kids these days, even if sleep isn’t an issue – the problem of irregular sleep patterns. Lots of kids are busy these days, especially as they get older. There are long after-school activities and homework. The schedule isn’t the same every day. Some nights the work load is heavier than others. But the goal is to try to keep the sleep consistent during the school week – literally night after night. Irregular sleep patterns have been shown to mess up kids’ metabolic systems and can, over time, lead to gradual signs of sleep deprivation. Here’s where parents and kids have hard choices to make concerning how they spend their time and do all the things they want to do. The reality is that sleep patterns rarely factor into that mix, and they need to be considered. Many research studies – including a recent one published in the journal Child Development – show that staying up late (think cramming for an exam) has a negative effect on performance the next day. Sleep is critical for memory formation, and the lack of alertness that comes with shortened sleep often leads to non-optimal performance. So try to be extremely rigid about the sleep time – and put that on top of the list when figuring out schedules for the school year.

The issue of busy schedules leads to another point – the utility of catch-up sleep on the weekend. In moderation, this can be a very good thing for kids. An hour or two extra sleep on the weekend days during the school year can recharge the batteries (and in fact have metabolic advantages according to some studies). More than that can mess up the sleep cycle for the next week. And the corollary is that kids who have activities that get them up early on the weekends may be missing out on some sleep they need (again, another choice for parents and kids alike). If that’s the case, it’s a stronger argument for making sure your child is getting enough sleep during the week, on a nightly basis.

These are some pretty solid guidelines from research. The reality is that making sure your child gets the proper sleep to support their physical and cognitive development takes a lot of work, and it’s acknowledged that parents are also over-scheduled and in need of their own sleep (which makes the effort at the end of the day, well, feel like effort). The upside is that once good sleep habits are formed, and a solid and successful sleep schedule is in place and executed faithfully, the whole process becomes rather automatic. Of course, even with the best intentions and effort, sometimes sleep issues become difficult to solve. If that’s the case, I strongly recommend talking to your child’s pediatrician about visiting a sleep clinic. They are very skilled on figuring out real solutions to real problems (though parents will still have to do the work at home). If you haven’t read it before, here’s a link to my description of what happens at a pediatric sleep clinic.

Child soundly sleeping via Shutterstock.com 

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Teens And Sleep: Less Hours, Better Grades, But At What Cost?

Thursday, February 23rd, 2012

Sleep seems to be in the news a lot these days. And a recent study – click here to read the blog post at Parents News Now – suggests that teens may need less sleep than recommended, because kids with the better grades reported getting less sleep. I wouldn’t be surprised if that’s the case – but I would argue that the high academic achievers get less sleep, not need less sleep. And that could be a big problem. 

The thing is, when we talk about younger kids and sleep deprivation, we note that they don’t do as well in school – they are, simply put, too tired to learn at an optimal rate. When we start to talk about teens, though, you see the “achievers” start to push themselves, and overload their afternoons and evenings with carefully selected extracurricular activities and studying (for advanced placement classes, no doubt). Educators use the phrase “resume building” – these kids are putting in overtime to build up their credentials for the college application process. So, it would be expected that they are getting less sleep and better grades. But … they may also be experiencing lots of stress. They may in fact be showing signs of sleep deprivation and pushing themselves through that. Some may be experiencing increasing levels of anxiety and stress. And some may – physically and psychologically – break down at some point.

So if the only goal is a high GPA, well then, less sleep may be better. But if the goal is to have a healthy, well-adjusted teen who is learning the important life lessons of striving for balance, making hard choices (like giving up an activity to make the daily grind less of a grind), the importance of taking care of one’s health – and just for the heck of it let’s throw in enjoying life – then I suggest we evaluate all these parameters, and not just grades, before we rewrite the sleep recommendations for teens. If you have a teen, the suggestion is that they get 8-9 hours of solid sleep nightly and have regular bedtimes and wake-up times. And whether they are getting this or not, look for signs of sleep deprivation. They’re not hard to spot. It shouldn’t be hard for them to wake-up on a school day. They shouldn’t be tired driving to school. They shouldn’t be tired during school. They shouldn’t need to look like they have to crash after school. And they shouldn’t look like they are exhausted at 11 pm because they still have studying to do. Should they push themselves a little? Sure. To the brink of exhaustion? No way. Not even if that gets them the best grades.

Image of exhausted teen via Shutterstock.com

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School-Age Kids And Sleep: Guidelines, Warning Signs, And Next Steps

Monday, February 20th, 2012

When you are dealing with an infant or toddler, the most pressing sleep issue is usually finding the right sleep method that gets your child to go to sleep, and stay asleep. When you are dealing with school-age kids (from kindergarten through high school), the challenge shifts to making sure that your child’s sleep is regulated nightly and that they are getting the right amount of sleep. Given the ongoing debate about how sleep recommendations are made – and what should be followed – I’m providing my take on the key guidelines, warning signs, and next steps as they apply to school-age kids, all in the service of providing information so that you can become the sleep expert for your own child.

GUIDELINES: Much of the recent debate concerns how the current guidelines have been generated – and the extent to which we need more science to make them more precise. While it would be terrific to have new research on this topic, the fact is the current recommendations offer pretty reasonable – though somewhat fuzzy – numbers to shoot for.  Here are some tables listing the average (meaning kids can get more or less) amount of sleep that is recommended by age that I am pulling from a source that I find very helpful – the University of Michigan Health System. (Do note that different recommendations are made by the National Sleep Foundation  - for example, the recommendation there for preschoolers is 11 – 13 hours per day – and the lack of universal guidelines are part of the reason that there is debate going on between experts). But as an illustration of how sleep changes with age, let’s stick with the University of Michigan guidelines and start with the transition in sleep requirements from age 3 to age 5.

AGE Night Day Total
3 years 10.5 1.5 (1 nap) 12
4 years 11.5 0 11.5
5 years 11 0 11

The big changes here are that naps are typically no longer needed by age 5 (this source does not put in a nap time at age 4, though it is noted that many 4-year-olds still nap), and the amount of required total sleep declines with age (from 12 hours at age 3 to 11 hours by age 5). If you look closely at this table, though, you will also see that the amount of nighttime sleep at age 4 and 5 may be more than that required at age 3 because naps are no longer taken. Of course, these are averages, so your child may deviate greatly from them – I’ll get to this point shortly so stick with me. So let’s move on to look at how sleep recommendations continue to change by age by considering ages 6 – 8.

AGE Night Day Total
6 years 11 0 11
7 years 11 0 11
8 years 10-11 0 10-11

The only change here (on average) is that less sleep may be required at age 8. How about ages 9 – 11?

AGE Night Day Total
9 years 10-11 0 10-11
10 years 10 0 10
11 years 10 0 10

Now we see the trend – between 7 and 11 years of age the shift is from 11 hours a night to 10 hours a night. Moving on to the transition to adolescence we find the following:

AGE Night Day Total
12 years 9.5 – 10 0 9.5 – 10
13 years 9.5 – 10 0 9.5 – 10
14 years 9.5 0 9.5

So another small shift is seen entering the teen years – the total nighttime sleep has gone down to settle at an average of 9.5 by age 14.

WARNING SIGNS: Okay, so now we have some rough guidelines. As I anticipated earlier, many of you are noticing that your child deviates from these – sometimes substantially. And that’s the biggest challenge to interpreting these kinds of guidelines – because every recommendation I encounter simply notes that children differ without telling you why they differ and if it’s problematic. Given that, we need to consider some warning signs that your child may not be getting enough sleep so that you can determine if you need to change their sleep schedule. I suggest you first determine if your child’s sleep patterns are regular. Regular sleep patterns are important physically for your child – recent research suggests that highly irregular sleep schedules during the school years are associated with a number of physiological changes that could signal the start of risk for metabolic conditions (including those that predict risk for diabetes). So if your child’s sleep varies greatly from night to night, that is, in and of itself, a signal that they are not regulated. By “varies greatly,” I would be conservative and say that it shouldn’t differ by more than 15 – 20 minutes from night to night (given that some nights might go later because of activities or homework requirements) – and in fact should be about the same.

Next, you can use some easily collected information about getting to sleep, and waking up. Does your child fall asleep pretty easily – meaning somewhere between 15 -30 minutes after the lights are off and it’s time for sleep? If not, this is sign that the sleep cycle is not sufficiently regulated. Similarly, is it hard to get your child up in the morning at the designated wake-up time? By “hard,” I mean a struggle. School age kids should be either waking up themselves or waking up easily to an alarm or your gentle way of letting them know it’s morning. And they should be alert pretty quickly. So if they aren’t getting up easily or seem groggy for a while, then it’s time to consider that you may need to adjust the amount of sleep they are getting.

Information collected throuhgout the day is valuable as well. They should not be sleepy during the day. They shouldn’t be dragging and yawning during school – and teachers shouldn’t be noticing this on a regular basis. (Signs of sleep deprivation in school are clearly associated with reductions in learning and classroom performance). They shouldn’t look tired after school. They shouldn’t look tired when they are in the car. They shouldn’t be yawning through dinner. And they shouldn’t be showing signs of fatigue while they are doing their homework. If any of these things are happening, it’s a good bet that they need more sleep.

You will often times see other indicators noted, like being cranky, irritable, etc. I don’t find these to be as helpful – unless they are happening along with some of the other signs I have just noted. Then you can be pretty darn sure there is a sleep problem.

NEXT STEPS: To be clear, what’s most important for you to determine is not so much how much sleep your child is getting – but the quality of it. If you aren’t seeing any signs of sleep deprivation, you can probably ignore the charts and figure that what you are doing is working just fine. But any sign of sleep deprivation noted above should be taken seriously and spur you to examine your child’s sleep patterns more closely. And a good place to start is to focus on what’s happening before bedtime – many sleep issues can be solved by changing the activities that happen before sleep. There are the electronic culprits that interfere with sleep on a more frequent basis these days – extended time devoted to TV, DVDs, social media, texting, and video games can mess up the required sleep cycle. These things are infiltrating kids’ space and time and some strict rules may need to be put in place, especially later in the night – and particularly if they are available in your kid’s room (you may think they are sleeping but they may not be). Outside activities can be wonderful but an intrusion on your kid’s schedule – you will need to figure this out and see if hard decisions need to be made (like not doing a given activity because it takes up too much time or gets your kid home too late). Homework can become an increasing time management issue as kids get older – especially in the middle school/upper division years and high school. If it is keeping your kid up later than you think is right for them, you will need to bring this to the school’s attention (many parents do these days, as parents and schools partner to find the right balance). All of these things should be considered to help define a regular bedtime that can work night after night. And, that said, since your kid’s wake-up time is probably pretty fixed (you know how much time they need to get ready, have a good breakfast, etc), you will need to adjust their bedtime. This is best done in small increments. Try adjusting the bedtime by getting your kid settled in for sleep 15 minutes earlier than you have been doing and stick with this for at least a week. Then if necessary try adding on another 15 minutes the following week (so that now they are going to sleep 30 minutes earlier than they used to). See if this results in a reduction in any of the signs of sleep deprivation.

All of this sounds like a lot. And it is. Regulating sleep in the school years is not an easy process. And if nothing is working – talk to your pediatrician about a referral to a pediatric sleep clinic. Simply put, getting your child the right amount of sleep is one of the best things you can do for school-age kids.

Image of Girl Sleeping via Shutterstock.com

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How Much Sleep Does Your Child Need? Even Experts Disagree

Thursday, February 16th, 2012

I’m used to seeing parents having spirited debates about sleep methods. But now sleep experts are having their own debate about sleep guidelines.

A recent paper suggests that the sleep recommendations for kids are, in essence, not supported by research. The implication is that kids may not really need as much sleep as we are told. An expert’s reaction to this paper was that, in general, the guidelines are backed up by enough research to make them useful.

So what do you, the parent, make of all this? Here are two things to consider.

First, keep in mind that the sleep recommendations – such as those provided by the National Sleep Foundation – have a lot of fuzziness built into them. How fuzzy? Check these out and notice the numbers that I have italicized and bolded:

Infants (3-11 months): typically sleep 9-12 hours during the night

Toddlers (1-3 years): typically need 12-14 hours of sleep daily

Preschoolers (3-5 years): typically sleep 11-13 hours each night

Second, consider why these guidelines are so broad.  Yes, you already know the answer.  Simply put, not all kids are the same – some kids need more sleep, others need less. And that’s where we should focus our attention in this debate. These figures do come from both research and clinical practice. As broad guidelines, they are reasonable. What I suggest is that the expert debate move on to address the real need for parents: to stop talking about how much sleep kids need on average and start developing better, empirically-supported, guideposts that help parents understand how to figure out how much sleep their own child needs. If a toddler sleeps 13 hours a night, is that enough? (It’s within the guidelines). If a toddler sleeps 11 hours a night, is that problematic? (It’s outside the guidelines). The problem is that these guidelines don’t give you the answer to these questions. It’s possible the toddler getting 13 hours of sleep needs more – and the toddler getting 11 hours of sleep does not.

So where does that leave you, the parent, right now? I suggest you become familiar with a few indicators that can tell you how well your child’s sleep routine is working beyond the obvious goal of having them sleep through the night (click here to read about this in more detail). You can start looking for these during the toddler years and beyond (once sleep patterns become established):

  • Does your child get to sleep around the same time most nights? (They should)
  • Does your child get to sleep within 15-30 minutes once they are settled in and it’s clearly time to sleep? (They should)
  • Does your child wake up pretty easily in the morning – and after a nap – without lots of prompting? (They should)
  • Does it feel like it takes a long time for your child to seem alert after waking up? (It shouldn’t)
  • Does your child seem tired a lot during the day (e.g., yawning, eye rubbing, etc) – excluding nap time?  (They shouldn’t)
  • Does your child fall asleep frequently when you drive – excluding nap time or if you are driving near bedtime? (They shouldn’t)
  • Does your child sometimes fall asleep (crash) much earlier than the usual bedtime? (They shouldn’t)

If you go through this list and find that your child is showing signs that their sleep routine needs adjusting, then it does. Continual sleep deprivation can have severe effects on kids, including interference with learning and compromised health. So getting a handle on this as soon as possible is important. In addition to doing your own research and trying out different methods, it’s often helpful to consult with your pediatrician. And if that doesn’t work, see if you can visit a pediatric sleep clinic – you can learn lots of little tricks that can help you set up a routine (click here to see my post from last month that discusses tips I learned) that can be calibrated to get your kid the amount of sleep that’s right for them.

Restful Sleep image via Shutterstock.com

 

 

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Tips On Getting Your Toddler To Sleep (Or What I Learned At A Sleep Clinic)

Tuesday, January 17th, 2012

I’ve heard from a lot of (tired!) parents about my recent blog post on the sleep challenges you’ll face in the toddler years - many have asked for more specific advice. So I’m offering some tips I received as a parent who took my toddler to a sleep clinic (as I was befuddled by the whole thing and waved the white flag!).

You need to convince your toddler that sleep is not a punishment. This to me is the biggest hurdle. Telling a toddler that it’s time to go to sleep can get translated in their head as “It’s time to stop doing something fun.” While you won’t be able to solve this entirely, you will need to find appealing – but not overly stimulating – things to do before bedtime that will transition them to sleep. Your child loves having books read to them and love it when you tell them stories.  The trick is to establish these activities (or a combination of them) as the first stage of the bedtime ritual – and it helps even more if you pick a favorite spot in the house where this happens. Make it fun and something to look forward to and plan on around 15-20 minutes of this. AND STICK WITH IT EVERY NIGHT – NO EXCEPTIONS! You are trying to create a routine. TV and any other electronic device is not advised during this transitional time.

You could make going to bed a bit of a game. Maybe it sounds silly to you, but you could try to put a little fun into that difficult time (for some) of actually making the move to your child’s room. Use your imagination. Put a voice to a stuffed animal who coaches them into their room. The idea is to do something that kids like and will look forward to. Kids love rituals if they are fun – and you want to create a “get in bed” ritual.

You may need to get them a big kid bed. We thought it was too early, but the clinic suggested that it was time and gave guidelines about making sure it was safe. The bigger point here is that change may be a good thing for some toddlers – and a big kid bed might make them feel a little pumped up about their development (which you can then use to your advantage by pointing out that big kids go to sleep at a proper time at night – all’s fair in sleep wars!)

You need to help your toddler handle their new emotions about sleep. Expect to do a lot of soothing. Toddlers start to experience changes in their sleep cycles which make them wake up after a few hours of sleep. They may be afraid of being apart from you. They may remember bad dreams. They may be a little scared about the big kid bed you just introduced! Find a transitional object (I used to use one of my T-shirts) for your kid to cuddle with along with a stuffed animal. And then consider that …

“Graduated extinction” can be a very helpful method for toddlers with sleep issues. We all have our favorite methods. But since the assumption is that nothing is working now (remember, I was at a sleep clinic), we started from scratch following the principles of graduated extinction. Here’s how we did it. Week 1: We sat up on the bed for about 10-15 minutes and then left the room (this was with full disclosure to our daughter). If she woke up crying, we would sit on the bed for 5-7 minutes. Week 2: We sat up on the bed for 5 minutes and then sat in a chair for 5 minutes (if she woke up crying we sat on the bed for 2 minutes and in the chair for 2 minutes). Week 3. Same as week 2, except we sat in the chair for 2 minutes and then left the room (if she woke up crying we repeated the process – the point being we eventually left the room). Week 4: Realized that she preferred if we sat on the bed for 10-15 minutes (the Week 1 routine) and then left the room before she was fully asleep (the sleep clinic clinician loved this on our follow-up visit because our daughter partnered with us to let us know what she liked). We stayed with this for quite a long time and she hardly ever woke up overnight.

Reward sleep behaviors! Find a simple (and cheap!) reward system. Stickers worked really well. Every morning if we met a goal (like getting back to sleep if she woke up or sleeping through the night) our daughter would pick out a sticker to place on a fun calendar in her room. If it’s a bad night for no reason (e.g., she wasn’t sick) – no sticker.

Monitor the naps really closely. Part of the deal was to calibrate the daily nap – 1 hour every day around 2 in the afternoon. We did whatever it took to make this happen. Walked her in a stroller. Drove her in the car. Didn’t care. The point was the nap was from 2-3 every day, no matter who she was with. The sleep clinic endorsed this and wan’t concerned with how we got her to sleep (the faster the better!) as long as we woke her up after an hour. Following this routine, she was tired around 9 at night and slept until 8 the next morning nearly every night.

Be vigilant about changes in the routine. Life happens. Kids get sick. Schedules change. Holidays arrive. Visitors arrive. Whenever you get thrown off, try to get right back into the routine and be really strict about sticking with it.

So that’s it – some tips from a real life visit to a sleep clinic. Will these tips work for you? Some may and some may not. Every kid is different. Some toddlers may seem “hard-wired” to not sleep much. But the principles discussed here are really important, as is the very serious endorsement of talking to your pediatrician about visiting a pediatric sleep clinic if these tips (or others you come across) don’t work. They will come up with a plan for you, your child, and your situation. And you all will sleep much better as a result. One other tip: there may be a wait of several months or more for an appointment at a sleep clinic. So if you are thinking of doing this it’s good to get the ball rolling ASAP.

Image of little girl not ready to go to bed via Shutterstock.com

 

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