Healthy Sleep Routines for Children
Four Common Questions About Sleep
Why do we need sleep, and how much do we need each night?
Does it matter when we go to sleep?
What constitutes a sleep disorder?
How do we address challenges with sleep?
Why we need sleep, and how much we need each night or 24-hour period:
Sleep provides our brains and bodies with the necessary time to restore tissue health, increase energy, and release hormones for growth and development. Sleep impacts both physical and cognitive development and behavioral consequences. Studies have shown a connection between sleep and memory, indicating that a nap helps consolidate learned information (Kurdziel et al., 2013; Lokhandwala and Spencer, 2020). Sleep can positively impact a child’s ability to regulate, self-soothe, and meet challenges. According to Chaput, 2019 Tremblay et al., 2016, 2017, the following guidelines show the amount of time infants and children require sleep, including nap times.
2. Does it matter when we go to sleep?
Yes, it matters; however, this varies based on age and biology. An infant’s sleep cycles are generally 50 minutes each with four cycles, whereas a 3—to 5-year-old’s sleep cycle requires 90 minutes. Infants show high variability in their sleep, but by the time they are toddlers, sleep variability is low.
Infants are not born with the components of circadian rhythms; rather, they develop this rhythm postnatally. The infant’s cues to wake are based on physical needs such as feeding or needing a diaper change. It is not until they are 3 to 4 months of age that the rhythms of night and day affect the baby’s sleep.
Sunlight and sunset influence the body’s circadian rhythms and melatonin production. When we understand how biology affects a child’s ability to settle and fall asleep, we can better judge optimal bedtimes for that child. Some research suggests that if bedtimes set by parents are not within the “optimal” range for their child’s biology, that child may struggle with sleep. So, it is not as easy as saying bedtime should be at 7 pm. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925339/).
For older children, teenagers, and adults, research has shown the most optimal time for the restorative sleep cycle is between the hours of 8 pm and 12 am due to circadian rhythms, which are the 24-hour internal clocks in our brains responsible for regulating levels of sleepiness and alertness.
The Four Stages of Sleep Are:
Stage 1: NREM: Muscles start to relax, body temperature drops, eye movements slow, and we can easily be awakened in this state
Stage 2: NREM: Breath and Heart rate regular, learning turns into memories, synapses are pruned, active bursts of brain activity
Stage 3: NREM: Deep Sleep dominates the first third of sleep. This phase supports complete relaxation, slows down pulse and breathing rate, activates the immune system for tissue repair, releases hormones for growth, regenerates neurotransmitters, and slows brain waves.
Stage 4: REM: This stage dominates the last third of sleep duration. Rapid eye movements occur as brain activity mimics an alert state, allowing for vivid dreams, but muscles feel paralyzed (except for the heart and lungs).
3. What constitutes a sleep disorder?
When the quality of sleep drops to the point of causing impairment in daily function, a sleep disorder is suspected. Left untreated, a sleep disturbance can affect overall health and well-being. Sleep disorders present in different ways, including insomnia, latency, parasomnias or sleepwalking, night terrors, nightmares, restless leg syndrome, narcolepsy, and obstructive sleep apnea. Sleep disturbances have been associated with conditions such as ADHD, ASD, Mood Disorders, and Anxiety.
Researchers are looking at the correlation between insufficient sleep and problems with memory, mood, performance, and health concerns. Better quality sleep is associated with better performance on working memory tasks. Adequate sleep between ages 0 and 4 results in better emotional regulation.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925339/); (Pisch et al., 2019); (Chaput et al., 2017);
4. How do we address challenges with sleep?
The treatment of sleep challenges is threefold: We must examine the person, the environment, and the occupations (activities and routines) surrounding sleep. Intervention aims to improve emotional regulation, increase participation in daily occupations, and promote health and well-being.
When we look at the person or child, we consider their individual biology and circadian rhythms, sensory processing, medical needs, cognitive reasoning level, nutrition, hydration, and positioning.
When we address the environment, we can evaluate and change aspects such as temperature, lighting, bedding, sound, humidity, and furniture arrangement.
When considering occupations that affect sleep, we can consider sleep hygiene and daily bedtime routines, sleep preparatory activities, stories, mindfulness, progressive relaxation and breathing exercises, and daytime activity routines.
As many of us have experienced, a good night’s sleep can make all the difference in how our day goes. Nevertheless, even when we know we can have better sleep habits or routines, we often overlook or omit some basic things that can significantly impact our sleep quality. In closing, here are some ideas to consider that may improve sleep:
Even 10-15 minutes of morning sunlight (without sunglasses) can have a biological effect on circadian rhythms and melatonin secretion, which is needed for sleepiness at night.
Eating high-protein and high-fat foods within 2 hours of bedtime can disrupt sleep.
Eating dinner 3-4 hours before bedtime can aid in proper digestion and reduce the risk of reflux and restless sleep.
Digestion warms the body up to work, and sleep needs our body temperature to cool down.
Physical activity and exertion warm up body temperature. Body temperature starts to decline one to two hours after physical activity, which can help sleepiness kick in. Avoid heavy physical activity within 1-2 hours of bedtime, but keep in mind individual differences and adjust accordingly.
Physical fitness and sleep quality show a high correlation. Getting outside in the morning and late afternoon for moderate physical activity can improve sleep quality.
Blue light from electronics interferes with melatonin production and negatively impacts sleep quality. Turn off screens at least 1.5 to 2 hours before bedtime, and avoid looking at screens in a darkened room.
When the body produces too much cortisol, it can interfere with sleep because it gives the brain an energy spurt and can increase heart rate.
Soft amber light is more conducive to getting sleepy and can be used when a night light is needed to induce calm.
A darkened room helps those without nighttime fears. Use blackout curtains or an eye mask.
A cool room, between 65-68 degrees Fahrenheit, facilitates sleep
A quiet environment matters: nothing louder than a whisper (35 decibels)
Use background noise wisely: white noise can mask disrupting noises that alert the nervous system, such as traffic, television or voices in the next room, wind and weather sounds, and snoring.
Research has shown that a Consistent Bedtime Routine helps tremendously. Being consistent includes consistency between weekends and weekdays.
Having both parents involved in the sleep routine can be effective.
Look into the use of a “Wearable” that tracks sleep.
For more information or to schedule a consultation, visit playright.com
References:
Stearns, Ryleigh, et al. “Promoting Health Across the Lifespan: Sleep Topics.” 2016, https://core.ac.uk/download/pdf/228578729.pdf.
Healthy Digestion - ReRoot Functional Nutrition Coaching. https://rerootnutritioncoach.com/re-root-blog/f/the-digestive-journey-how-your-body-transforms-food-into-fuel/
Bedtime Routine And Handy Tools To Combat Sleep Struggles In Children. https://sg.theasianparent.com/bedtime-routine-and-handy-tools-to-combat-sleep-struggles
Kimberley Arnett-DeSimone, a career pediatric occupational therapist in Huntersville, North Carolina, authored this post.
