By Claire GagneAug 15, 2019
When he didn’t get enough sleep, five-year-old Jack* wasn’t himself in the morning. He was a cat. He would crawl around on the floor and answer his parents with meows. “That’s how we knew he was really tired,” says his mom, Rachel Torres.*
Bedtime was supposed to be 8 p.m. in their house, but Jack and his four-year-old sister, Isla, had a way of dragging things out. The pair would go to the bathroom or escape downstairs, so Rachel or her husband, Marco, would eventually lie down with them until they fell asleep, sometimes as late as 9:30 p.m. Often they would wake up in the night, calling out for their parents or crawling into bed with them. Some mornings, the kids would wake up as early as 5:30 a.m. because they needed to go to the bathroom or were just too restless to sleep anymore.
The late bedtimes and early wake ups were taking a toll on the whole family, but Jack seemed particularly affected. He was still visibly tired in the mornings and, when he wasn’t crawling like a cat, he would stumble into things and wander around, whining. At school, he would get frustrated with his kindergarten classmates and lash out by scratching or hitting, or burst into tears at the slightest injustice. His teachers said he had difficulty focusing. “He didn’t know what to do with himself,” says Torres. “I felt like a bad parent because he obviously wasn’t getting enough sleep.”
It’s likely little comfort to Torres, but her kid is far from the only one showing up at school or daycare exhausted from a lack of sleep. According to the American Academy of Sleep Medicine, kids ages three to five should be getting 10 to 13 hours of shut-eye a day, and six- to 12-year-olds should sleep between nine and 12 hours every night. But in a 2014 poll conducted by the National Sleep Foundation in the United States, nearly a third of six- to 11-year-olds were estimated to get eight or fewer hours a night. In Canada, a 2016 report by Participaction found that 31 percent of school-aged kids are sleep-deprived and are getting 30 minutes to an hour less sleep each night than kids were a decade ago. The report also showed that one-third of school-aged kids have trouble falling or staying asleep at least some of the time.
Late bedtimes, nighttime awakenings and early wake ups all reduce a child’s chance of getting a full night’s sleep. And while some kids have sleep disorders, like sleep apnea or restless leg syndrome, they’re the minority, says Shelly Weiss, a paediatric neurologist who directs the Sleep/Neurology Clinic at Toronto’s Hospital for Sick Children. “It’s definitely more related to lifestyle,” she says.
Wendy Hall, a registered nurse and sleep expert at the University of British Columbia in Vancouver, says more often than not, something in the kid’s environment or routine is getting in the way of them sleeping enough. “Things like not having regular household routines, not reinforcing bedtimes and screen use—not just in the evening but during the day—all affect sleep,” says Hall.
Getting kids to bed early and making them stay there long enough to have a good night’s sleep takes a lot of effort, and for parents who have already put in a full day, it can often feel like a battle not worth fighting. But there’s a lot at stake.
When kids sleep, processes take place in the brain and other areas of the body that support growth, health, memory and cognitive development. Information is solidified and stored in the long-term memory, human growth hormone is released, blood flow is sent to muscles to restore energy, broken-down tissues are rebuilt and nerve cells are rewired.
Kids who don’t get enough sleep are often irritable, forgetful and have difficulties with emotional regulation. But it’s not always obvious when a child is sleep-deprived. Some might just fall asleep on the way home from school, and their parents don’t realize it’s not normal to need a nap past the age of five. Other kids, especially toddlers and preschoolers, don’t look sleepy at all—they actually get wound up and hyperactive when they’re sleep-deprived. “Parents say, ‘He doesn’t look tired—I’ll keep him up,’” says Hall. Unfortunately, this can compound the problem.
What’s more, our busy modern lives aren’t designed with sleep in mind. Parents’ workdays are getting longer, which means dinner is pushed later into the evening, as is bedtime. Homework and activities eat up those precious post-dinner hours. One-year-olds entering daycare are often forced into a one-nap-a-day schedule before they’re ready; in some provinces, three- and four-year-olds are in full-day kindergarten programs when they really still need an afternoon nap. Some kids are up early to catch bus rides to school, and you know the coach who schedules a 7 a.m. hockey practice isn’t thinking about whether your kid is getting their recommend nine to 12 hours of sleep. “As a society, we’ve come to the conclusion that, for some reason, sleep is discretionary,” says Hall.
But one of the most concerning culprits of sleep derailment in modern times is far more inconspicuous: the rise of screens. The blue light emitted by tablets and smartphones interferes with the release of melatonin, a hormone the body produces to signal bedtime. That’s why experts recommend kids and adults turn off screens one to two hours before bed. But even screen use earlier in the day could interfere with sleep. A 2017 study of kids who were six months to three years old found that, for every additional hour a child spent on a touchscreen during the day, they got almost 16 minutes less sleep. More screen time was also associated with having difficulty falling asleep.
Parents often justify their kids’ screen use by recalling that they watched TV and played video games when they were younger, but the devices kids use today are different. “It’s much more interactive now, with bright, fancy movements, and kids are constantly swiping from this activity to that activity,” says Michelle Ponti, a paediatrician in London, Ont., and the chair of the Canadian Paediatric Society’s Digital Health Task Force. “The child’s brain is constantly having to make sense of all those visuals.” Those über-stimulating screens are also taking away time from other activities, like exercise and reading, that are conducive to a good night’s sleep. Older kids who keep their phones in their bedrooms are often on them into the wee hours, something parents might not even realize. According to a 2011 poll from the National Sleep Foundation, 72 percent of 13- to 18-year-olds bring their phones into their bedrooms before going to sleep. And 18 percent of them are woken up at least a few times a week by a phone call or text message.
With all the obstacles getting in the way of proper slumber, many parents find themselves in a sleep crisis. Jackie Penn,* for one, struggles to get her three kids to bed at a reasonable time. Her 10-year-old, Declan,* has attention deficit hyperactivity disorder (ADHD), and his medication suppresses his appetite during the day, causing him to be hungry in the evenings when it starts to wear off. But his evening meal interferes with bedtime, and bedtime is pushed even later twice a week when he has swimming. This means Declan is up until 10 p.m. His six-year-old and two-year-old siblings are along for the late-night ride. “I used to be a militant bedtime person,” says Penn. “But now my youngest goes to bed at nine.” In the mornings, she’s dragging them out of bed at 7:30 to get ready for school. Her kids are whiny and irritable. And though her two-year-old is able to make up some of the sleep during naps, “we’re all exhausted,” she says. “I’m always dropping my kids off late at school. It’s this hamster wheel of stuff that all relates to not enough sleep.”
The effects of poor sleep aren’t just evident the next day—they can also impact long-term health. Studies have shown that kids who are sleep-deprived run a higher chance of being overweight or obese. They are also at risk of high blood pressure and more prone to accidents, like falling off the monkey bars or their bikes. A study published in the journal Paediatrics in August 2019, by researchers at the CHEO Research Institute in Ottawa, found kids who don't get enough sleep (and spend too much time on screens) are more likely to act impulsively and make poorer decisions.
Kids who aren’t well-rested are also more forgetful, irritable and likely to engage in risk-taking behaviour, particularly as teens, and are more likely to have suicidal thoughts. School work often suffers, says Hall. Not getting enough sleep can make it difficult to focus and affects the brain’s ability to consolidate and remember what was learned during the day. Some kids even fall asleep during class.
One area that warrants particular consideration by parents and doctors, say experts, is the complex interplay between sleep and ADHD. It’s been well-established that kids with ADHD often have trouble falling asleep and staying asleep, which can be made worse by their medications, which are stimulants. Some researchers have even theorized that ADHD is actually a circadian rhythm disturbance, characterized by lack of sleep at night and behavioural challenges during the day.
At the same time, not getting enough sleep can cause impulsivity, inattention and problems regulating emotions—all signs of ADHD. But it’s important to note that a lack of sleep itself does not cause ADHD. “I think some professionals are a little worried that some of the indications of inadequate sleep could, if someone is not looking at sleep as a possible culprit in the situation, lead people to say, ‘Oh, your kid probably has ADHD—let’s put them on meds,’” says Hall.
Ponti says more and more kids coming into her clinic are running on fumes. These children are often dealing with behavioural, neurodevelopmental or learning challenges, and it’s only after probing that she discovers they aren’t getting enough sleep. “I take a very thorough family history and then do a complete physical examination to rule out other conditions,” says Ponti. If she thinks a child might have a sleep disorder, like sleep apnea, she refers the patient to a sleep specialist. “You would hate to miss sleep apnea and treat them like they have ADHD,” she says.
To try to suss out on your own whether your kid’s behaviour or emotional dysregulation is due to lack of sleep or something else, you could look at whether they perform or behave better on the weekend, when they don’t have to get up early for school. Or, make a concerted effort to increase the amount of sleep your kid gets for a week or two, and see if the behaviour improves.
While Penn is still figuring out how to improve her family’s sleep schedule, Rachel and Marco Torres took the plunge and contacted a sleep consultant, who gave them a few tips to help Isla and Jack sleep better. For starters, they hung blackout blinds and introduced an 11 p.m. pee break so they aren’t woken up by full bladders in the early morning. But the biggest change was a 7:30 bedtime, no matter what. “We sat them down at a family meeting to tell them how it was going to be going forward,” says Torres. “It took them a few nights to get used to it.” But the results were glorious: Rachel and her husband have time in the evenings to clean up and prep the next days’ lunches and still get themselves to bed on time. Rachel figures Jack is sleeping one or two hours more a night.
The cat is gone, and in its place is a well-rested, good-natured little boy who gets along with his peers. At school, Jack is more focused and better able to control his emotions. His parents aren’t hearing from the teacher about his behaviour as often. “Those little things that were bothering him aren’t bothering him anymore,” says Torres. She only wishes her family had made the change sooner.
*Names have been changed