Every living organism, whether it’s plants or animals, needs downtime or a time designated for complete rest. For most living things, but especially all animals including humans, this downtime is known as sleep. Sleep is a natural process governed by the circadian rhythm or the sleep-wake cycle, which in turn is regulated by daylight—you stay awake during the day and sleep at night.

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If this circadian rhythm is disrupted for any reason, sleep problems and sleep disorders can emerge. This is especially true for children because sleep is one of the primary activities of their brain during early life. You might have observed that a newborn baby sleeps for the best part of the day and night, and this is because a newborn does not have a sleep cycle. Healthy newborns sleep for 16 hours a day—though they wake up intermittently to feed and be changed when they dirty their diaper.

The circadian rhythms in newborns only start developing at about six weeks old. It takes them three to six months to develop a regular sleep-wake cycle, and yet until about two years of age, most children would have spent more time asleep than awake. The US National Sleep Foundation estimates that a child spends 40% of his or her childhood asleep, and this percentage is vital because sleep directly impacts the mental and physical development of children. 

Studies also indicate that sleep patterns in early life, especially good sleep hygiene, can also impact overall health later in life. A child taught to maintain a healthy sleep cycle may stick to it for the rest of their life, which can ensure good health. So, it’s important that your newborn gets all the sleep he or she needs now and throughout the childhood years. Here’s everything you need to know about sleep problems in children and how to overcome them.

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  1. Importance of proper sleep for children
  2. Takeaways
  3. Tips for better sleep in children
  4. Signs of sleep disorders in children
  5. Common sleep problems in children
  6. Understanding normal sleep in children
Doctors for Sleep problems in children

As mentioned before, sleep is vital for the development of children during their early years. The US National Sleep Foundation explains that there are two stages of sleep, and both play an important role in how the mind and body function.

  • Non-rapid eye movement (NREM) sleep: Also known as quiet sleep, the deep states of NREM sleep can improve blood supply to the muscles, speed up tissue growth and repair and release major growth and development hormones in the body. NREM sleep restores energy in the body.
  • Rapid eye movement (REM) sleep: Also known as active sleep, the body becomes inactive and the brain turns active during REM sleep. Dreams occur in REM sleep while the body becomes immobile and the breathing and heart rates become irregular.

In newborns, NREM and REM sleep take up equal amounts of time, and the sleep cycle is of about 50 minutes. As the baby grows up, the duration of REM sleep reduces, so much so that at around six months of age, it’s just 30% of the baby's sleep time. Both these types of sleep and their proper ratio are important for the development of the baby.

Studies show that not getting enough of either REM or NREM sleep can lead to weight abnormalities, obstructive sleep apnea, restless legs syndrome, insomnia, and a number of developmental, behavioural and social difficulties. Children who get enough sleep, on the other hand, are active, attentive and behaviourally, socially and developmentally sound. Their physiological and mental health both have a healthy status and the risk of many diseases is reduced.

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Sleep is an essential biological function, and good sleep hygiene is important from the very beginning of life. This means giving your baby a good start in life and avoiding all types of sleep problems as he or she grows up. It is important that you remember the following:

  • Help your newborn become a self-soothing secure sleeper as soon as his or her circadian rhythm starts to settle. This means establishing healthy sleep patterns after your baby crosses the six-month mark.
  • It is natural to enjoy your infant or toddler’s dependence on you, to rock him or her to sleep. But remember that the best outcome for your baby as they grow up is to be well-adjusted and independent. Maintaining proper sleep hygiene can help you do that. 
  • If you do see a sleep problem emerging, don’t delay a visit to the doctor. Delays in diagnosis can have negative outcomes, which is certainly not something you would want.

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Proper sleep hygiene and sticking to the natural circadian rhythm without disruptions is the best way to ensure that your child does not have any sleep problems either.

Remember that while adults have the option to take medications if severe sleep disorders show up, drugs are usually avoided for children. This is because sedatives or any other class of medications that may help people sleep can lead to fatigue, cognitive impairment and mood disorders in children.

The following are some tips every parent can and should use to prevent sleep problems in children.

  • Establish regular sleeping and waking up times for your child as early as possible. Since circadian rhythms start developing at age four to six months, you can regulate exposure to daylight, activity levels, leisure, winding down, bedtimes and wake-up alarms from this age itself. Consult your paediatrician about how to establish this cycle properly.
  • Maintain discipline. While it is absolutely fine to allow delayed bedtimes or sleeping in on special occasions, like during a vacation or holidays or the day after an exam, try not to make this type of relaxation a norm. As mentioned before, you need not be harsh about this discipline—gently explain why your child must follow this routine, but make sure you establish it and follow through on it.
  • As your child grows up, ensure that they get enough physical exercise. Physical activity increases the body’s temperature, and once the temperature comes down, your child is likely to feel sleepy. If outdoor sports is not an option, then teach yoga, dance, table tennis, etc., to your kid to make exercise a regular thing.
  • Make sure your child’s sleep environment is cool and cozy. During infancy, your baby’s cot and sleeping areas should be safe. As your baby grows up, ensure his or her room has soothing colours, less noise and disruptions to ensure a proper sleep environment.
  • Keep digital devices, television and other gadgets that emit blue lights turned off well before bedtime. These devices not only distract children and delay sleep times, but can also lead to headaches and other issues that disrupt sleep.
  • Focus on nutrition, especially as your child grows up. Good nutrition promotes healthy sleep, and lack of sleep can lead to eating disorders, malnourishment and associated health issues. Ensure that your child gets enough dietary fiber, vitamins, minerals, complex carbs, proteins and antioxidants through his or her diet. Avoid introducing caffeine and other foods which may disrupt sleep.

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Each of the above-mentioned sleeping problems in children may present with different symptoms. The following, however, are some common symptoms you can look out for in your child:

  • Snoring
  • Breathing pauses during sleep
  • Difficulty falling asleep
  • Difficulty staying asleep
  • Daytime sleepiness or difficulty staying awake during the day
  • Unexplained decrease in daytime energy, activity or performance levels
  • Unusual events during sleep, like talking, walking, nightmares, etc.

These signs could indicate that your child has a deeper issue that is disrupting his/her circadian rhythm. Consult a paediatrician as early as possible if three or more of these symptoms start showing up regularly in your child.

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The American Academy of Family Physicians (AAFP) indicates in a 2014 study that about 50% of children experience sleep problems. Early detection and treatment—which inevitably involves the maintenance of discipline and sleep hygiene, but may require medication or therapy in severe cases—of these sleep problems may help to avoid physical or psychological impairments and the more severe consequences of sleeping issues in children. The following are the most common pediatric sleep problems:

Restless legs syndrome in children

An unpleasant sensation in the legs, the urge to move them and growing pains are all symptoms of restless leg syndrome. The exact prevalence of this issue among children is not known, but limited studies indicate it to be about 2%. Dopamine dysfunction, genetics and iron deficiency are said to play a role in this sleep disorder. Diagnosing restless leg syndrome in children is even more difficult because kids can be quite vague about their symptoms, and this could mean that parents miss the early signs or neglect the issue.

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Delayed sleep phase disorder in children

In delayed sleep phase disorder, a person’s circadian rhythm is delayed by approximately two hours—that is, the person sleeps at least two hours after the conventional bedtime. This disorder is more common among children closer to the adolescent phase and has a prevalence of 7-16%. This problem is usually diagnosed when a sleep log or journal, or even a timetable, is maintained. Not only does this sleep problem lead to difficulty waking up, tardiness, daytime sleepiness especially during school hours, but can also affect the child’s cognitive and metabolic functions.

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Behavioural insomnia of childhood

Behavioural insomnia of childhood refers to a child's inability to fall asleep and/or stay asleep. It affects 10-30% of all children. There are two types of this kind of insomnia:

  • Sleep-onset association type: Where the child is unable or unwilling to fall asleep or go back to sleep in the absence of specific conditions.
  • Limit-setting type: Where the parents don't set appropriate limits and the child is unable or unwilling to fall asleep unless he or she gets his or her way. This may include not being able to sleep unless they're rocked or allowed to sleep with parents, etc. 

This type of sleep issue can be disruptive and impair the child’s development. It can only be resolved when the parents set appropriate boundaries and allow children to be self-soothing sleepers at an early age.

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Parasomnias in children

Sleepwalking, sleep talking, confusional arousals (waking up disoriented or confused), sleep terrors and nightmares are known as parasomnias—they affect 50% of children.

Parasomnias are undesirable events associated with sleep. They usually occur during sleep-wake transitions. Confusion, automatic behaviours, difficulty waking up, amnesia and rapid return to sleep are common symptoms associated with parasomnias.

Studies show that parasomnias usually resolve by the time a child reaches adolescence, but in 4% of cases, there may be a recurrence of these issues. Proper sleep and psychological therapy may be required in severe cases.

Obstructive sleep apnea in children

Obstructive sleep apnea, or OSA, is characterized by upper airway obstruction which disrupts both oxygen intake and normal sleep patterns. The prevalence of OSA in children is 1-5%. It may occur in adults due to the relaxation of soft tissues like the tongue and palate while sleeping, but in children, the main cause of OSA is enlarged tonsils and adenoids.

OSA in children usually occurs between two years and eight years of age, which coincides with peak tonsil growth. This is also the reason why children are more prone to tonsillitis at this age, and this infection can make OSA worse. Snoring is one of the chief symptoms of OSA, but it’s also prevalent in 27% of children and this can make the diagnosis of OSA difficult.

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Snoring in children

Snoring occurs when a person’s airways are blocked, and it is associated with disrupted sleep, daytime sleepiness, fatigue and decreased oxygen levels in the body. About 27% of all children experience snoring during their childhood years. Snoring is usually linked to other health problems, like obstructive sleep apnea, obesity, and respiratory infections. So, it’s important to consult a paediatrician if your child snores.

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Proper and sufficient sleep is vital for babies and their development. But the first step to knowing if your child has a sleep problem or not is to understand what normal sleep is, and what abnormal or problematic sleep is. A child’s circadian rhythm, and therefore their sleep pattern, changes as they grow up. The following is everything you need to know about normal sleep patterns in children as they grow up.

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Toddler sleep schedule (1-2 years)

Toddlers aged one to two years require about 11-13 hours of sleep every day, and their daytime naps usually start to recede. By the time they are 18 months old, most toddlers nap only once during the day, and this nap may last for an hour to three hours. Too less or too much of sleep or nap-time might indicate a sleep problem, and napping too close to bedtime is not recommended at all.

This age is quite ripe for sleep problems in children. Increased motor, cognitive and social skills may lead to a sense of independence and curiosity, which can interfere with sleep. Not only is your baby developing an imagination at this time, but he or she can also get out of their cot easily to solve personal crises like separation anxiety. Daytime sleepiness, apart from movement and conversations during the night, are sure-shot signs of sleep problems at this age.

Sleep in school students (6-13 years)

Children aged 6-13 years need 9-11 hours of sleep every night, but they may in fact sleep less depending on their daily activity levels.

There is usually a gradual increase in homework, sports and other activities during this age. Many children also develop hobbies. This may also affect their sleep patterns.

Television, internet and digital devices also take up more of the children's time now. Blue light emissions from digital devices can also delay or disrupt sleep.

Resistance to bedtime, difficulty falling asleep, anxiety and other problems may interfere with sleep at this age.

Poor or inadequate sleep can lead to mood swings, daytime sleepiness, attention deficit hyperactivity disorder (ADHD), and cognitive impairments that may become evident in schoolwork and academic results.

While you don't need to be harsh, gently explaining to your child why he/she needs 9-11 hours of sleep—and the complications they may arise if they do not sleep enough—may work.

Preschooler sleep issues (3-5 years)

Preschool children usually require 11-13 hours of sleep every day, but their need to nap during the daytime reduces a lot. Their daytime nap between the ages of three years and five years might last for 30 minutes to an hour. Any more or any less may indicate a sleep issue. 

With further development of motor skills, difficulty falling asleep, waking up and moving around in the middle of the night, and other sleep-disrupting issues may turn up. Your preschooler baby is also likely to have an active imagination, which is why nighttime fear and nightmares are quite natural. However, chronic nightmares, sleep terrors, sleep talking and sleepwalking are serious sleep problems that may come up at this age and require proper medical attention.

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Infant sleeping pattern (4-11 months)

Most babies start developing circadian rhythms between four to six months of age, which means less nighttime feeding and changing for you.

Roughly 70-80% of babies learn to sleep through the night by the time they are nine months old. By this age, they sleep nine to 12 hours a day—a large part of which is through the night, with 30- to 50-minute naps during the day as they get closer to the 12-month mark.

As they grow older, babies learn more sleep cues and you can tell when they are sleepy through these cues. It’s best to put them down to sleep when they show these signs instead of letting them fall asleep in your arms. This teaches babies how to fall asleep by self-soothing, instead of depending on your touch. 

This not only helps them developmentally but also ensures that you enjoy the perks of having a less clingy and well-adjusted child. Developing this type of sleep security at this age can also help to avoid sleep problems and disorders. Sleep-secure infants also have less separation anxiety and illnesses. You can help this development along by keeping the baby active during the day, and dimming the lights and creating a safe and sleepy environment at night.

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Newborn sleep habits (0-3 months)

As you might know, newborn sleep is around the clock and disrupted only by the need to be fed, changed and nurtured. This means a newborn sleeps for 10-18 hours of the day, but there’s no regular schedule for this. Each time the baby sleeps, he/she could be asleep for anywhere between a few minutes and several hours.

Muscle movements like twitching, smiling, sucking and restlessness are normal, especially during NREM sleep. Newborns usually fall asleep very quickly, and show signs like becoming fussy, rubbing their eyes and yawning before falling asleep. Sudden infant death syndrome or SIDS is a huge risk, so maintaining proper safety during these sleep hours is very important.

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References

  1. Stanford Health Care [Internet]. Stanford Medicine, Stanford University; Pediatric Sleep Disorders
  2. American Academy of Family Physicians [Internet]. Kansas. United States; Common Sleep Disorders in Children.
  3. National Health Service [Internet]. UK; Sleep problems in young children -
  4. SleepFoundation.org [Internet]. National Sleep Foundation. Washington D.C. United States; Sleep Strategies for Kids.
  5. SleepFoundation.org [Internet]. National Sleep Foundation. Washington D.C. United States; Children and Sleep.
  6. Stanford Children's Health: Lucile Packard Children's Hospital [Internet], Stanford. USA; Infant Sleep
  7. Moturi, Sricharan and Alvis, Kristin. Assessment and treatment of common pediatric sleep disorders. Psychiatry (Edgmont). 2010 Jun; 7(6): 24–37. PMID: 20622943
  8. Fricke-Oerkermann, Leonnie. et al. Prevalence and Course of Sleep Problems in Childhood. Sleep. 2007 Oct 1; 30(10): 1371–1377. PMID: 17969471
  9. Kotagal, Suresh and Pianosi, Paul. Sleep disorders in children and adolescents. BMJ. 2006 Apr 8; 332(7545): 828–832. PMID: 16601043
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