Pediatric Associates of the NW Blogs

Everything You Ever Wanted to Know About Sleep!- Part I, School Aged Children and Teenagers

M. Allison Moorman, MD
March 24, 2017 09:00AM

Sleep: it’s one of the most important aspects of our children’s health and one of the hardest aspects to prioritize. Most parents wonder if their child is getting enough and many struggle to get their kids to get to sleep in the first place. 

The American Academy of Pediatrics (AAP) recently endorsed a statement published by the American Academy of Sleep Medicine (AASM) that proposes new guidelines for the recommended amount of sleep in a 24 hour time period for children ages 4 months through 18 years.  That is a lot tackle in one blog!  This installment will focus on school-aged children and teenagers.   

The AASM and AAP now recommend that children ages 6-12 years old get 9 to 12 hours of sleep and teenagers get an average of 9 hours per night (or 8-10 hours in a 24 hour period).  There is a range because the right amount of sleep will be slightly different among individuals, but the take home point is that the minimum has increased from 7 to 8 hours and the average has increased from 8 to 9 hours for teenagers.  This understandably seems daunting to those parents who already fight over bedtimes and drag sleepy teens out of bed each morning (read: ALL parents.)  So, what can we do to help promote healthy sleep habits for these age groups? 

"Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health."

To help promote adequate sleep in this age group, remember to keep all electronics out of the bedroom including televisions, iPads, computers, etc.  Work on establishing a bedtime routine that is consistent and doesn't last longer than 30 minutes.  Fear of the dark can still be an issue in this group.  Use of night lights can be helpful, or try making "monster/bad dream/etc. spray."  Take a spray bottle and fill it with water. Add a few drops of lavender essential oil and leave it to the child to spray any "scary areas" or to make bad dreams go away.  

Keep the sleep environment as peaceful as possible and avoid stimulating activities in the hour before bedtime (for example television and video games.)    Use the evening time before bed as family time and take advantage of the opportunity to play a family board game or share stories from the day.  Your kids are listening to you.  Talking about family values may seem obvious and overstated, but it really does have a positive impact in the teenage years, especially when started early. 

Speaking of teenagers...

"Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. "

So what does "optimal health" mean?  The AASM states that regularly getting adequate sleep leads to improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Not getting enough sleep each night is associated with an increase in injuries (think sleepy teenagers behind the wheel), high blood pressure, obesity and depression.  

How can we get teenagers to value the importance of sleep?  It's not easy, because they already know everything, and how do we not get that they only need 3 hours of sleep per night. (“GEEZ Mom, leave me alone” ring a bell? If so, this is a great time to reiterate that lack of sleep can affect emotional regulation). 

Here are some better suggestions:

1. Focus on fostering a conversation about ways lack of sleep may be impacting your teen.  For example, chronic sleep deprivation can look a lot like ADHD. Hitting the "snooze" button in the morning and falling asleep in the car or while studying are all signs of sleep deprivation.  Help your teen to identify some aspect of his/her life that may be affected by lack of sleep, and then use this as a starting point to discuss a reasonable sleep goal.  

2. Break down the goal in to small, approachable steps.  It can seem overwhelming to a teen (or anyone) to think of changing bedtime from 2 am to 10 pm.  Instead, make a goal of going to bed 15 minutes earlier each week until you reach your goal.  Provide encouragement and positive reinforcement with each step.  

3. Above all, GET THE CELL PHONE OUT OF THE BEDROOM.  Unless they are paying for it, it's yours, and you get to make the rules around usage.  Consider a family phone basket or charging station in an area away from the bedrooms and have all screens "go to bed" 1 hour before bedtime.  This is helpful for adults as well, and won't make your teenager feel singled out.

The Role of Melatonin

Melatonin is a hormone produced by the brain and is thought to play a role in circadian rhythm, the regulator of sleep and wake cycles.  Melatonin can play a role in helping children sleep, but data are limited and there are no official guidelines on dosage or duration of use.  It is readily available over the counter, so if you are considering trying this, please consult your child's healthcare provider first.

When it's Something More Serious

If your child snores loudly or has periods where he/she stops breathing for a few seconds (called "apnea"), let your healthcare provider know. These can be signs of Obstructive Sleep Apnea and may warrant consultation with an Ear, Nose, and Throat (ENT) specialist to discuss removal of the tonsils and/or adenoids.  

If you feel you have tried everything and your child or teen still struggles with difficulty falling asleep, staying asleep, and seems chronically tired, please discuss this with your child's healthcare provider.  Obtaining a sleep study or referral to a Sleep Medicine specialist may be indicated for further evaluation.

Sleep Hygiene Tips

See below for a list of sleep hygiene tips from one of our psychologists. Dr. Shannon O’Dell. This is a wonderful, easy to read guide that highlights the above recommendations.  

Try some of these actions to establish good sleep habits: 

DO: 
-    Try to go to bed at the same time each night
-    Get up at the same time each morning
-    Make sure you are getting enough hours of sleep at night (9-10 hours)
-    Get regular exercise
-    Go outdoors to get light and fresh air during the day
-    Make sure your room is at a comfortable temperature 
-    Keep your room quiet and dark while sleeping
-    Use your bed ONLY for sleeping, not as a place to do homework or use electronic devices
-    Do some relaxation exercises before bed
-    Have a regular bedtime routine – do the same things each night to cue your body that it is time to sleep (e.g. a warm bath or shower, read for fun, etc.)

DO NOT
-    Exercise right before bed
-    Do something exciting right before bed (watch a suspenseful TV show, play video games, get into an argument with family or friends)
-    Have caffeine after lunch-time 
-    Read in bed
-    Watch TV or use any computer devices in bed
-    Go to bed too hungry or too full
-    Take naps during the day
-    Look at your alarm clock; instead turn it away from your bed so you cannot see it

Sweet dreams!