Sleep: A Primary Concern

Poor sleep habits can have a significant effect on a child, particularly at school, reports Suzy Mills.

School is a giant leap for children and parents alike. Especially after long holidays. With the wealth of new experiences, increased independence, long days and social relationships, it’s little wonder children are tired by the end of the day.

An older study at Melbourne’s Murdoch Childrens Research Institute (MCRI) led by Dr Jon Quach found that solving sleep problems could make the transition back to school smoother. The study’s report, ‘A Brief Sleep Intervention Improves Outcomes in the School Entry Year: A Randomized Controlled Trial’, (September 2011 edition of Pediatrics). It adds to previous research that shows poor sleep habits in school-age children affect five core school-readiness attributes: physical health and wellbeing; social competence; emotional maturity; language and cognitive skills; and approach to learning.

According to the Longitudinal Study of Australian Children, about one-third of four to five year olds have a sleep problem. This includes difficulty falling asleep (12.8 per cent), night waking (18.1 per cent), snoring (9.7 per cent) and morning fatigue (9.1 per cent). Many children cope with an occasional lack of sleep, however ongoing sleep problems not only have repercussions for school transition, but can also affect long-term health and behaviour.

Quach says sleep disturbance has implications in the classroom and playground, as children struggle to come to grips with the academic and social demands of school. “How well a child makes the transition to school is not determined by their academic ability alone,” he said. “They also need to have the social and emotional skills to interact with their friends and teachers, as well as the concentration required to learn in class. We know from previous research that children who have less sleep have shorter concentration spans, are three times more likely to have emotional problems and two times more likely to have poor peer relationships.”

Primary-school-age children need 10 to 12 hours of sleep each night. So how do parents know if their child is getting enough sleep?

Psychologist Professor Sarah Blunden, who runs Sensible Sleep , offers a guide. “If children wake by themselves, it is a pretty good indication that they’re getting enough sleep,” she says. “But if they need waking every morning, and are dragging their feet or not wanting to eat breakfast, it would suggest that there is a lack of quality sleep.”

Chronic sleep problems can have a significant impact on academic performance. The link between sleep apnoea (obstructed breathing during sleep) and lower IQ was made by Johns Hopkins Hospital (USA) in 2006 in the research article ‘Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury’. Other studies have since confirmed the relationship between sleep and school performance for all age groups. Blunden said one study found that children with problematic daytime behaviour were five times more likely to report sleep disturbance, and that specific behavioural concerns, including inattention, hyperactivity, mood and school performance, were associated with a range of sleep disorders.

Along with problems at school, poor sleep patterns can also lead to significant health issues such as lowered immunity, obesity and depression. “Sleep needs to be made a priority for families,” says Blunden. “It may take a bit of adjustment, but the consequences of not making the changes are too great to not give it a go.”

Blunden places sleep problems in three categories: psychological, environmental and physiological. Like Quach’s team at the MCRI, she suggests improving children’s sleep hygiene. This includes a relaxing and consistent evening routine with a set bedtime; practising relaxation and ways to deal with worry and stress; no TV, phones or computers an hour before bedtime or in the bedroom; and no vigorous exercise or activity one hour before bed.

For the common scenario in which children lie in bed at night, tired but unable to fall asleep, Blunden and Quach both suggest adopting a consistent and early wake-up time to shift a child’s rhythm into alignment. “We found the majority of problems were around getting to sleep,” said Quach. “One strategy was about setting a consistent bedtime routine for children on all nights of the week, not just on school nights. This involved developing a positive and enjoyable bedtime routine for the child.”

Another technique used by Quach’s team was ‘bedtime fading’. “For this technique you temporarily shift the child’s bedtime close to their natural sleep-onset time,” he said. “As the child learns to fall asleep quickly, the bedtime is slowly shifted in increments of 15 minutes every few nights until the child learns to sleep at a more age-appropriate time.”

If such interventions don’t improve sleep habits, Blunden suggests examining psychological or physiological issues. She stresses that ‘psychological’ doesn’t necessarily indicate mental illness, but in most cases means a behavioural issue. “As a psychologist, my job is to understand behaviour and try to work out a way to modify it in order to solve the problem,” she says. “Children don’t want to be lying in bed feeling miserable. If they’re not sleeping, there is some kind of issue that needs investigating.” There are also several physiological problems that can affect sleep quality, such as restless legs syndrome and bedwetting, for which a GP is usually the first point of consultation.

Quach and his team have shown that solving sleep problems can improve a child’s chances of a successful transition to school and prevent significant long-term behavioural and health problems. According to Flinders University Child and Adolescent Sleep Clinic Professor Michael Gradisar, “Sleep is not valued as much as it should be in Australia, but based on the evidence, sleep at all developmental stages should be taken more seriously. Our recent data shows many parents will try various sleep tips in books and on the internet. But if this doesn’t work, they really should seek a health professional who specialises in treating sleep problems.”

Illustrations by Shane McGowan