Unlocking the Secrets to Achieving Deep, Restful Sleep: Tips and Insights
While there is more than sufficient evidence on the physical, mental and emotional benefits of good sleep, many families are deprived of this beautiful gift of rest and restoration.
There is a wide range of problems contributing to sleeping difficulties. Americans spend thousands of dollars investing in devices and other items on improving their sleep and are looking for the best mattresses, black-out shades, weighted blankets, sleep apps, to name a few. Unfortunately, while ensuring we have an ideal sleep environment, this is often not sufficient to address underlying sleep problems or habits that may be getting in our way of restful sleep. In this blog post, I discuss the components of restful sleep.
How do you know if your child has restful sleep?
Various wearable sleep trackers are available to inform you on how much sleep your child is getting. While these provide some additional information on the number of hours of sleep, a sleep diary/sleep log is often sufficient. A sample sleep diary is found here. You can use it to track;
When your child gets into bed
How long (on average) it takes them to fall asleep
How many times they wake up at night, and for how long
When they wake up in the morning
Before creating a sleep log, I recommend asking yourself these questions to determine if your child’s sleep is restful.
Does your child wake up in the morning without difficulty?
Does your child seem sleepy during the day? For example, are they falling asleep in the car on short trips?
Do they have difficulties with attention and learning during the day? Are you noticing more frequent tantrums or other behavioral/mood changes?
Are they sleeping in on weekends?
Most children with sleeping difficulties generally have some forms of daytime manifestations that may clue you into their inadequate sleep.
What are the components of restful sleep?
The main components to restful sleep include;
Sleep quantity
Sleep quality
Sleep continuity/ efficiency
Sleep quantity
People in the US are chronically sleep-deprived, with about 35% of adults reporting insufficient sleep. The statistics are even more concerning in our children, where 57.2 % of middle schoolers and 73% of high school students get less than the recommended number of hours of sleep. As a result, the National Sleep Foundation updated guidelines on the recommended number of sleep hours in children and adults, which varies by age. Note that these recommendations serve as a guide, acknowledging that each child’s needs change.
In summary, the recommended number of sleep hours by age are;
Newborn (0 to 3 months): 14 to 17 hours
Infants (4 to 11 months): 12 to 15 hours
Toddler (1 to 2 years): 11 to 14 hours
Preschool (3 to 5 years): 10 to 13 hours
School-age ( 6 to 13 years): 9 to 11 hours
Teen (14 to 17 years): 8 to 10 hours.
Young adult (18 to 25 years): 7 to 9 hours
Adult (25 to 64 years): 7 to 9 hours
Older adult (65+ years): 7 to 9 hours.
Recommended Sleep Duration. Adapted from Sleepopolis.com
Several factors can affect the number of sleep hours. Having adequate sleep opportunities ultimately determines the total time spent sleeping. For instance, due to the shift in their circadian rhythm (body clock), teens tend to prefer a later bedtime physiologically. Unfortunately, as most middle and high schools have an earlier start time, this impacts the available sleep opportunity, limiting their total sleep time. As a result, they try to make it up on the weekends by sleeping in.
Sleep Quality
The quality of our sleep can be affected by several internal and external factors. But, unfortunately, most people overlook some relatively simple elements that prevent them from obtaining the high-quality, restful sleep they need.
Examples of external factors affecting our sleep are; what we eat or drink, medications we take, our physical environment, use of devices, the effect of light. In general, these factors affect the depth of our sleep, decreasing the quality of sleep we get.
Light: Light is one of the strongest cues for our internal body clock (circadian rhythm) and sleep. There are light signal-sensitive cells in our eyes which feedback to our brain and tell it whether it’s daytime or nighttime. At night, melatonin, a sleep hormone, is released in response to these signals. Exposure to bright light at night decreases this melatonin production, delaying our internal clock to prefer a later bedtime. Sources of blue light include iPads, phones, video games, and tv are examples of commonly used devices that negatively impact your child’s sleep. Exposure to this light in the middle of the night can make it difficult to return to sleep. The ideal thing to do is ensure your sleep environment is dark. For children who may be afraid of the dark, using a dim night light is helpful.
Sleep environment: The sleep environment can have a significant impact on our sleep quality. Factors like light, noise, and heat can play an important role. Ideally, the bedroom should be cool to promote sleep. However, there are no prescribed temperatures that are optimal for rest as this varies with individuals. Find a comfortably cool temperature that works for you and your children. In the summer, keep a fan running and use lighter bedding. Some children like having some background noise to sleep. In these instances, you can consider a fan or a noise machine.
Caffeine: Caffeine is the most used stimulant in the US and is found in several beverages, including coffee, teas, soda, and energy drinks. Caffeine crosses into the brain and blocks adenosine, a substance that makes us sleepy as it builds up during the day. When caffeine blocks adenosine, we become more alert and vigilant. As a result, some children become more hyperactive or even irritable. The half-life of caffeine varies in our bodies and can be as long as 4 to 6 hours. As a result, caffeine consumed close to bedtime can keep you or your child up at night. In addition to delaying sleep onset, caffeine decreases the amount of deep sleep we get (that stage of sleep that leaves us feeling restful and refreshed). Typically, caffeine should be limited in children and avoided after 1 pm to decrease this metabolic effect. If you notice your teenager is relying on caffeine frequently, it is a sign they are not getting restful sleep.
Medications: If your child is on any medications, it is essential to note the timing of the dose to their bedtime. For instance, children with ADHD, anxiety, or depression may be on stimulants and other medications that affect their sleep quality.
Other factors like pain, discomfort, and stress can affect sleep quality, leaving us feeling unrefreshed.
Medical conditions can also worsen our sleep quality, ranging from the common cold, seasonal allergies, pain from reflux to more severe conditions like sleep apnea or restless leg syndrome. Obstructive sleep apnea occurs when your child has difficulty breathing at night and can manifest as snoring, gasping, or choking during sleep. In addition, they may have increased awakening as their breathing gets interrupted. Restless leg syndrome (RLS), a condition that causes discomfort in the legs, leading to an urge to move around, further disrupts sleep. RLS can occur as a sign of iron deficiency.
Sleep continuity
Sleep continuity or sleep efficiency refers to the proportion of time your child spends asleep to the time spent in bed. For example, children may have prolonged nighttime awakenings, and while they are in bed for the recommended hours of sleep, only a tiny fraction is spent sleeping.
We go through different stages of sleep broadly classified into non-REM sleep and REM sleep. We cycle through these sleep stages, and it is normal to have brief awakenings (called arousals). We all wake up 2 to 5 times at night, and this is entirely normal. We often don’t remember these awakenings as we can fall right back to sleep. When these awakenings become prolonged in conditions like insomnia, our sleep is disrupted.
In addition to insomnia, prescribed medications, anxiety, and depression can also lead to fragmented sleep.
Children with autism, ADHD, or other developmental conditions may have abnormal sleep patterns, manifest as frequent and prolonged nighttime wakings.
Benefits of Restful Sleep in Children
Sleep is an essential building block for your child’s overall health, including mental, emotional, and physical well-being. As a result of restful sleep, children have
Better energy
Increased attention span and alertness
Improved mood
Better learning and memory
Stronger immune system
Improved decision making
Safer driving in our teenagers
What happens when our children don’t get restful sleep?
There is mounting evidence showing that insufficient sleep affects learning, growth, development, and our children’s physical and mental health.
Hyperactivity
Daytime sleepiness
Decreased attention span
Negative impact on learning and performance
Increased frequency of illnesses due to a weaker immune system
Increased risk of obesity, high blood pressure, and diabetes
Poorer mental health including an increased risk of anxiety and depression as well as suicidality
Increased risk-taking behaviors
Drowsy driving with increased car crashes
How can we ensure our children get restful sleep?
It is essential to look at restful sleep from a more holistic approach, find out the barriers to getting restful sleep and address these barriers to achieve the desired goal.
Set their sleep goals depending on their sleep needs. As your child grows older, the number of hours of sleep changes. So making sure they get adequate sleep quantity is the first step in getting restful sleep. Also, the challenges you face with a toddler’s sleep, for instance, is different from that of a teenager’s, and as such, it helps to set the right expectations.
Practice healthy sleep habits. Healthy sleep habits are fundamental to having restful sleep. You can follow the following essential tips.
Have a consistent bedtime and wake time
Establish a regular bedtime routine
Keep the sleep environment cool, dark, and free of noise or distractions
Avoid sleeping in places other than the bed. Also, avoid other activities in bed
Limit devices and screen time at least 30 to 60 minutes before bedtime
Avoid any large meals, caffeine, or sugary treats before bed.
While exercise promotes deep sleep, limit the temptation to wear out your child before bedtime as it may cause them to be too wired to fall asleep.
3. Make sure there are no underlying conditions that fragment sleep. For example, while some issues may seem minor to us, pain, allergies, or the common cold can take a toll on your child’s sleep. Also, addressing any underlying mental illness such as anxiety and depression can improve sleep.
Suppose you have any concerns that you or your child have an underlying medical condition like snoring, sleep apnea, and restless legs syndrome preventing restful sleep. I recommend speaking to your family doctor to discuss these concerns. In addition, you may need to see a sleep specialist for some of these conditions.
The American Academy of Sleep Medicine has a list of accredited sleep centers found here.
The first line I would still recommend is to establish healthy sleep habits.
Yours restfully,
Dr. Brown
