Diseases

The symptoms of a lack of sleep are often obvious to watchful parents. Some of these tell-tale signs include:

• recurrently falling asleep in the car (excluding young infants);
• requiring extreme stimulation and repetitive reminders to get up in the morning;
• behavioral abnormalities such as excessive emotionalism, aggression, and crankiness; and
• an older child's (over 8 years of age) recurrent need for an afternoon nap.

Most teens need about 8 to 10 hours of sleep per day. Some studies have indicated that they have a different internal "sleep clock" than those younger or older than them. Researchers have demonstrated that teens are truly "night owls," and if left to their own devices, would spontaneously wake from a good night's sleep anywhere from 9:00 am to 10:00 am. High school teachers who have classes before this time period have empiric experience to second this observation. Younger children may need anywhere from 12-15 hours (infant: 2 naps plus nighttime long block) to 9-11 hours (middle school child).

Primary to establishing good sleep habits is a realization that sleep is a normal and necessary function. However, just as with other normal and necessary functions (for example, eating, toilet training, etc.), a battle may develop between parents and their child in this area. All children older than 5 to 6 months of age need to master the ability to self-soothe and relax in order to successfully fall asleep. Depriving them of this skill by either feeding or rocking them to sleep, reading until the child falls asleep, or lying down with the child in order to facilitate falling asleep, is a recipe for frustration - both for the child and the parent. Tired children (of any age) intuitively know when they are tired and, if provided the proper environment, will easily and quickly fall asleep. When they awaken during the middle of the night they are capable of falling back to sleep without parental intervention. In this circumstance, both child and parents awake refreshed the next morning.

Just as with adults, the amount of sleep children need varies with both age and unique needs of the individual. Below are general guidelines for children of various ages. If your child is happy and thriving, but needs more or fewer hours of sleep than indicated below - rest assured they will remain healthy. The National Sleep Foundation's 2015 Guidelines recommend the following for sleep in children and teens.

1. 1 to 4 weeks old: Neonates spend approximately 65% to 75% of their daily activity in a sleep state. Waking time is of short duration and it is rare for a child of this age to have a "day-night" cycle. Their day-night "clock" is not functional until 6 to 8 weeks of age. Mothers of newborns should use their infant's sleep pattern to sleep also.
2. 1 to 4 months old: Infants at this early age require sleep 14 to 17 hours of sleep per day. Many begin to develop a day-night cycle during the early weeks of this period. At this age, many infants have the ability to sleep evening blocks of 5 to 6 hours without interruption; however most will wake for feedings or diaper changes during the night.
3. 4 to 12 months old: Infants in this age range require 12 to 15 hours of sleep daily. Good news for parents - they begin to sleep for longer continuous periods at night. Also, early in this time period, many children benefit from multiple daytime naps, though there is significant variability between different infants.
4. 1 to 3 years old: While specialists point out that most toddlers need about 12 to 14 hours of daily sleep, many may be forced to survive on less. Daycare and erratically spaced car trips necessary for the needs of older siblings often deny or disrupt continuous sleep patterns, most often naps.
5. 3 to 6 years old: This age range commonly needs approximately 10 to 13 hours of sleep per day with younger individuals taking a nap after lunch. Any need for napping is generally absent by the time a child enters 1st grade.
6. 7 to 12 years old: Younger children in this age range commonly require 9 to 11 hours of sleep each night; pre-teens often receive 9 to 10 hours (though some may require more).
7. 12 to 18 years old: Middle and high school student lifestyle requirements (school, after school activities, dinner and finally homework) often reduce the sleep duration from the recommended 8 to 10 hours to 6 to 8 hours. The various social network computer websites coupled with cell phone text communication and television viewing also may cut into a teenager's sleep time.

These "don'ts" are adapted from "Sleep Problems: Your Child" University of Michigan Health Care System.

1. Don't put your child to bed with a bottle of juice, milk or formula. Sugar in such drinks promotes tooth decay. Water is acceptable.
2. Don't fill up the bed with toys. Limit the crib/bed to one to two "special" items. Too many items are over stimulating and the child will have a hard time not playing with them. Eliminate any object that might be a safety hazard.
3. Don't threaten to send your child to bed as a punishment. Bedtime should be an enjoyable experience that will promote falling asleep in a timely fashion.
4. Avoid caffeine before bed: Caffeinated drinks such as cola, chocolate, iced tea, energy drinks, etc.
5. Limit TV in the afternoon and at night. TV stimulation may carry on longer than you suspect. Having a TV in a child's room may be counterproductive to getting your child or teen to sleep. A 2014 National Sleep Foundation study indicates that 72% of children 6 years old to 17 years old have at least one electronic device in their bedroom. These children may get up to one hour less sleep per night as their peers without such devices in the bedroom.

The University of Michigan's Sleep Disorders program includes five issues that may be disruptive of good sleep practices. These include:

1. Sleep deprivation: As noted in the previously, the amount of sleep generally required varies with age and genetic predisposition. Unfortunately many older children, especially teens, do not receive an appropriate amount of sound sleep.
2. Night waking: All children after the first 7 to 8 months of life start to be more sensitive to internal and external stimuli. If an infant has not yet learned to calm himself and resettle back to sleep, the parents commonly are summoned to help the child return to sleep. This pattern may repeat itself several times each night.
3. Separation anxiety: Children experience this emotion commonly at 5 months of age as well as during the toddler years. Such children become anxious and are unable to enter a comfortable sleep pattern unless parents are present.
4. Resistance to sleep/settling problems: This occurs when your child does not want to go to bed at a reasonable time. Stalling, temper tantrums, and other resistance patterns are common. Parental persistence generally will resolve this common issue.
5. Parasomnias: Parasomnias are problems that disrupt sleep. Examples include night terrors, grinding of teeth, sleepwalking, etc.

These "do's" are adapted from "Sleep Problems: Your Child" University of Michigan Health Care System and "Healthy Sleep Tips" from the National Sleep Foundation.

1. Make bedtime a special time. Create special soothing and calming experiences with the opportunity for special "talks" or sharing experiences that foster comfort for both child and parent.
2. Study your child so you can determine when he is ready to sleep. Once this is determined you can start the "get ready for bed" routine with enough time in advance so the child doesn't get a "second wind".
3. Keep the bedtime routine consistent and simple. Mental and physical stimulation is counter productive. Dim lights starting about 10 – 15 minutes before going to sleep. Bright lights act as a stimulant to the child's brain.
4. Keep the bedtime routine portable. For example, it can occur whether at home or outside of the home (for example, in a motel during vacation).
5. Make sure your child is both mentally and physically tired at the end of the day. Children need between 30 to 60 minutes per day of vigorous playtime (depending on the age). Besides fostering good sleep habits, such a program will help maintain optimum weight gain.
6. Establish a restful atmosphere. Keep the lights dim, limit noise and electronic devices. Teens should turn off computers/TV's and cell phones when retiring to bed. The bedroom temperature should be between 60 F and 67 F or 15.5 C to 19.4 C.
7. Avoid afternoon naps in children over 6 years of age.

A common definition of sleep hygiene is "all behavioral and environmental factors that precede sleep and may interfere with sleep." Daytime sleepiness and trouble sleeping may be a reflection of poor sleep hygiene. Detailed specifics are listed below. General areas to consider include:

• Personal habits: Establish consistent routines around bedtimes and awakening times
• Sleep environment: The bedroom should be a slightly cooler temperature (between 60 F to 67 F or 15.5 C to 19.4 C), and eliminate any distracting noise in the bedroom
• Getting ready for bed: Establish a calming pre-sleep ritual (for example, reading, not watching TV) and
• Miscellaneous: Examples include limiting intake of foods/liquids/medications which may disrupt a restful sleep