Dr. Henry Paul, MD

Psychiatrist, Author and Educator

SOME IDEAS FOR HELPING CHILDREN SLEEP

February 27th, 2014

Joannie has been a poor sleeper all of her life but when she turned seven last year it got even worse. She goes to sleep late, wakes up a lot, and is always tired. I work two jobs and its exhausting me too. What can I do?

Sleep Hygiene

Here are some things you can try that most likely will help to solve the problem.

First, make sure that a regular bed time (and wake time) is adhered to and that any bedtime rituals start thirty minutes before the desired sleep time. Bedtime rituals should include pleasant activities such as reading to your child, rubbing, and soothing. Sleep onset associations like being rocked or fed by you at the time of going to sleep should be minimized.  For example, try to put the child in bed before falling asleep when rocking. Make sure that daily schedules are adhered to in all areas of life. Limit napping. Make sure your child has a balanced diet with enough food, gets adequate amounts of exercise,  and is protected from excessive chaos in the house such as violence, shouting, emotional upheavals, and quarreling. Bedtime should be three to four hours after eating, and there should be no heavy exercise for at least two hours before going to bed. After dinner the atmosphere should be one of relaxation and quiet activities, and emotional issues should be avoided as should any rough play and caffeine. The room should be a normal temperature, and be dark and quiet without clocks or televisions. If needed, teach your child some relaxation techniques such as deep breathing.  The major thing to keep in mind is that as sleep time approaches the goal is to induce a relaxed drowsiness, not an emotional or active time.

If a parent abides by these sleep hygiene suggestions the great majority of children will sleep well consistently. Of course from time to time there will be awakenings, especially if a child is sick, disturbed, or scared, but these are episodic and usually respond to gentle and firm reassurances and do not require special interventions. Do remember that not all children sleep exactly the same and there will be variation from child to child, but knowing your child’s natural patterns and adjusting your ways to your child’s rhythms go a long way to pleasant night times.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT SHOULD WE EXPECT ABOUT SLEEP WITH CHILDREN?

February 25th, 2014

Our son Randy has always been a hyper-type but over the years he has received great school treatment and understanding. He was diagnosed as having ADD and has done well with tutoring and special programs. But he has never slept well and I read that his poor sleep can lead to all sorts of problems.

I want to focus my next few blogs on sleep disorders with children.  I’ll discuss the sleep problems, sleep hygiene, the four parasomnias, and the use of medication.   I want to start by making it clear that, in general, use of medication for common sleep problems for children and teenagers should be a last resort. While the use of sleeping pills (hypnotic medication) has grown astronomically in adults, this should not take place for our youth.   What is important is what we call “sleep hygiene”, and that should be your first course of action.

It is important and often tedious for parents to do what is necessary to ensure that their child sleeps well and enough. Nearly all common behavioral sleep problems, such as bed time refusal, bed time resistance, difficulty falling asleep, frequent awakenings, getting up too early, and the like can be overcome without the use of medication.

Let’s first identify the sleep problems.

In general some sleep knowledge is helpful. Children sleep less as they get older. Newborns and infants can spend half of their time sleeping. But by four months old, regularity of sleep starts with the establishment of regular circadian patterns. These regular biological patterns contribute to regularities in sleep and waking, activity levels, hormone secretion, and other biological phenomena.

Although four months marks the establishment of some regularity of sleep cycles it is not usually until one year old that the frequency of night awakenings significantly diminishes. By four years old most children do not need to nap but often do need eleven to twelve hours of sleep. By early to mid-adolescence sleep patterns are quite close to those of adults who require about seven to eight hours of sleep.

Sleep problems

It should be noted that so-called sleep problems have a lot to do with what particular parents find tolerable in their children which in turn is affected by their own sleep patterns, the subculture in which a child is raised, and the overall tolerance of the household to a child’s awakenings. It is also important for parents to know what to expect at various ages in order to know when a sleep problem exists.  It is important that a child gets enough sleep. A child who does not get enough sleep can be plagued by many problems which include:

  • Irritability
  • Impulsivity
  • Inattention
  • Moodiness
  • Aggressiveness
  • Fatigue
  • Learning problems
  • Child/parent interaction disturbances
  • Overweight
  • Having to be awakened regularly

In addition to the common causes of insomnia including stress, anxiety, stimulus overload, and caffeine, there are other causes which should be ruled out such as obstructive sleep apnea, restless leg syndrome, side effects of medication including ADHD and antidepressant medications, chronic illness, autism, developmental delays, ADHD itself, depression, and anxiety disorders. After these have been ruled out, common insomnia can be handled without the use of special sleep medications in almost all cases.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.