Some parents have children who have always been perfect sleepers. You know the ones (and maybe you’re one of them, in which case I’m incredibly jealous). They’re the parents without bags under their eyes and without a little visitor climbing into bed with them every night. I’ve experienced a wide range of sleep issues with my five- and six-year-olds, including night terrors, bedwetting and insanely early wake-up times (no matter what time they go to bed). But when I worried about their sleep, it was always in relation to how it affected me and my husband, who were left zombie-like from sleep disturbances. When I started to see reports connecting the amount and the quality of sleep children get to their health, however, I realized I needed to start looking at my kids’ sleep for what it really is: a key to their healthy development.
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The Sleep-Health Connection
I can always tell when they haven’t had enough sleep because of the crying. About anything. (Seriously. I’ll say, “Good morning,” and they’ll burst into tears and scream, “You are so mean!”) Usually it’s nothing that can’t be solved with an afternoon nap—or so I thought.
A recent British study found that children who slept fewer than ten-and-a-half hours a night at age three (this excludes daytime siestas) had a 45 percent higher risk of becoming obese by age seven, compared with children who slept more than 12 hours a night. Studies also reveal a link between a lack of sleep and the risks of both diabetes and cardiovascular disease. These sound like adult problems, right? Wrong, says Rakesh Bhattacharjee, the director of Pediatric Sleep Medicine at MedSleep in Toronto and an assistant professor of pediatrics at the University of Chicago. “We’re looking at a higher risk of metabolic disorders starting early in life that can be irreversible,” he says. “Sleep might actually impact a child’s normal development, and this is of great concern to paediatricians.”
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Not getting enough sleep also alters the immune system, including an increase in the body’s level of inflammation. Plus, poor sleep has been linked to behavioural issues—not just general crankiness, but hyperactivity, aggression and diminished school performance.
According to Bhattacharjee, these issues often arise with kids who have sleep apnea, a disorder involving interrupted breathing, which results in frequent night waking and arousal (which is just enough of a disturbance in the brain waves that the sleep cycle is disrupted, but the child doesn’t wake). “Some evidence says a disorder like sleep apnea impacts cognitive function, especially executive function, and can mimic the presentation of ADHD,” he says.
Parents may recognize the signs that their child hasn’t slept well the night before, but the cumulative effects are harder to read. “A young child not getting enough sleep often seems to have too much energy,” says Bhattacharjee. She might be irritable and hyper, which may lead you to believe she isn’t tired—and to push bedtime even later. If you’re hearing from teachers that your child isn’t performing well, it’s worth looking at the amount or quality of sleep he or she is getting, says Bhattacharjee.
Is there a problem?
Disruptions in sleep can be a normal part of childhood, but sometimes there are underlying issues that can be solved. “A lot of parents don’t realize there are avenues they can explore, like seeing a paediatric sleep physician, if they’re concerned,” Bhattacharjee says. If your child is snoring nightly, for example, and seems overtired, it could be a sign of sleep apnea. If nightmares suddenly start and continue for weeks, you may want to evaluate what’s going on during the day or the type of media your child is consuming (kids can’t differentiate fantasy from reality until about age seven). Your doctor can also suggest some things to try at home, or recommend a sleep specialist to help you get to the root of the problem.
What’s the magic number?
According to the Canadian Sleep Society, the sleep needs of children per every 24 hours are:
* younger than two months: 16 to 18 hours
* two to six months: 14 to 16 hours
* six to 12 months: 13 to 15 hours
* one to three years: 12 to 14 hours
* three to five years: 11 to 13 hours
* five to 12 years: 10 to 11 hours
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Understanding The cycle
Sleep starts in stage 1 and progresses to stages 2, 3 and 4. Then, stages 3 and 2 are repeated before entering stage 5, REM sleep. Once REM sleep is over, the body usually returns to stage 2 and the cycle begins again. This is repeated about four to six times per night. Your REM stage usually lengthens with each cycle as the night progresses, and your longest REM phase will occur in the final sleep cycle of the night, which may last up to 120 minutes. A good quality sleep depends on the ability for you to cycle through these stages and make it to the final stage of REM sleep uninterrupted.
A version of this article appeared in our February 2014 issue with the headline “The Snooze Clues,” p. 58.