Why Sleep Matters

Spend some time with the Dettmann family in Emmetsburg, Iowa, and you'll know why so many school-age kids wish they could throw their alarm clocks out the window. Tyler, a 17-year-old high-school senior, is usually up at dawn so he can make it to band or choir practice at 7:20 a.m. A couple of nights a week, he also works as a waiter at the local country club and doesn't get home until 9 p.m. Fifteen-year-old Travis, a sophomore, also gets to school early for choir and doesn't leave until after 6:30 because of football practice. Trevor, a 12-year-old seventh grader, plays football and participates in community theater. And every night, they all have at least an hour of homework. The biggest challenge for their mom, Sonya, is getting the boys to turn out the lights. "They don't think that they're tired," she says. "They look at the clock and say, 'I'm older this year. I shouldn't have to go to bed'."

In fact, that's exactly what they should do if they want to stay healthy. There's growing evidence that a chronic lack of sleep can lead to obesity, mimic the symptoms of attention deficit disorder and contribute to depression, among other ailments. Losing just a few hours of sleep a week makes a big difference. Brown University's Mary Carskadon, who studies children's sleep, says tired kids get lower grades, don't do as well in sports and have more emotional problems than youngsters who get adequate rest. "We used to think that sleep loss mostly had an effect on the brain," Carskadon says. "Now it's becoming more and more apparent that the effects are widespread." Teens are especially at risk. According to a survey by the National Sleep Foundation, only 15 percent reported sleeping at least 8.5 hours on school nights, the minimum doctors think they need. That sleep deprivation can be life-threatening. In one recent study of car accidents, nearly half of all drivers who fell asleep at the wheel were younger than 25.

As all parents know, getting kids to bed on time is a challenge at any age. The battles begin at birth. Newborns' sleep cycles are notoriously unpredictable, with a few taking long naps from the start, while many others seem to be alert (and crying) 24/7. No one knows exactly how many hours of sleep an individual baby needs, but the average is about 14.5 hours a day, according to the National Sleep Foundation. A regular sleep pattern should begin to emerge at about 6 weeks and, by the age of 1, most babies will make it through the night and take a couple of daytime naps as well. At that point, the best way to nurture healthy bedtime habits in young children is to follow a nightly routine that might include a bath and a story. Avoid TV or videos, which can overstimulate kids.

If a child still has problems getting to sleep, psychologist Jodi Mindell advises parents to take a look at "environmental problems" like street noise or curtains that let in too much light. Mindell, associate director of the Sleep Disorders Center at The Children's Hospital of Philadelphia, suggests buying room-darkening shades or fans to create white noise. With 2- to 8-year-olds, who like to stall around bedtime, Mindell recommends including all the nighttime requests you can think of (kissing the dog good night, going to the potty) in your pre-bed routine.

Once children enter school, parents often think they're losing control of bedtime because the days just don't seem long enough to fit in everyone's activities. Although the years between 3 and 12 used to be considered the "golden age" of sleep (between the obstacles of babyhood and adolescence), more recent research has shown that almost a third of elementary-age children experience sleep problems such as sleepwalking, night terrors, trouble falling asleep or narcolepsy. Parents might not realize what's wrong because tired kids aren't like weary adults. Kids often become inattentive and fidget more while adults nod off. "We suspect it may have something to do with children's unique drive to stay awake and learn," says University of Michigan neurologist Ronald Chervin. "They may be innately wired to have that as a high priority. If they have underlying sleepiness, they have to shift their attention or create their own commotion to stay awake."

Irregular hours aren't the only reason kids lose sleep. Depending on the age, as many as 12 percent of children may snore, which isn't necessarily a concern. But the snoring could also mean that the youngster is suffering from apnea (impaired breathing) the most common sleep disorder. About 2 percent of children, particularly those born with craniofacial deformities and enlarged tonsils and adenoids, suffer from apnea. Alex Cuttler, an 8-year-old from Syracuse, N.Y., was born with a cleft lip and palate. Although those problems were corrected with surgery when he was a baby, he was always a poor sleeper. "It took him so long to go to bed at night and then he was up so early," says his mother, Michelle. Finally, last year, after reading about apnea on the Internet, she took Alex to St. Joseph's Sleep Center in Syracuse. Doctors watched him all night in a formal sleep study and found that he was waking every 12 minutes because he couldn't breathe. Now, a portable mask called a CPAP forces heated air into his windpipe as he sleeps from 8:30 p.m. to 7 in the morning. He's much happier. So is his mother.

Even the most attentive pediatricians sometimes don't pick up their young patients' sleep disorders. Sleep science is often neglected in medical school and many doctors don't think to look for these problems. Patients and families don't always bring it up either. In a 2001 study, Chervin and his colleagues found that fewer than 15 percent of children with sleep problems had that information on medical-history charts. And only four out of 830 patients studied had received effective treatment for sleep problems.

One area that has received a lot of attention lately is teenagers' sleep needs. Researchers have found adolescents' natural body clock keeps them up until at least 11--which is a problem because most also have to wake up early for school. An increasingly popular solution is to start classes a little later. University of Minnesota scientists have been following the progress of high-school students in Edina, Minn., which in 1996 became the first district in the country to switch to a later start time (from 7:20 to 8:30 a.m.). In 1997 Minneapolis followed Edina's lead and changed its start time to 8:40 for 12,000 secondary students. The results were so encouraging (more alert students and fewer depressed ones) that 34 districts in 19 states have since followed Edina's example. "There's a belief that we're making it too soft for teenagers if we listen to their body clocks," says University of Minnesota professor Kyla Wahlstrom. But, she says, teenagers don't choose their sleep patterns.

Teens who've learned good sleep habits as younger children are less likely to run into trouble--even if their classes start at dawn. Take the Reinmuth family of Rancho Santa Fe, Calif. Kyle, 10, and Kelly Rose, 8, are already involved in so many activities that their mother, Colleen, gets a little breathless just listing them: soccer, baseball and golf for Kyle along with ballet, Irish dancing, gymnastics, jazz dance, tennis and soccer for Kelly Rose. But the Reinmuth kids get plenty of sleep, their mother says. Kelly Rose is in bed by 8:30; her brother turns in half an hour later. They usually wake up rested at 6:30 in order to be at school by 8. Their mother limits stimulating activities like videogames and doesn't allow them to watch violent TV programs. She also makes sure they don't drink caffeine in soft drinks. Most important, perhaps, she makes sure to get plenty of sleep herself. "Sleeping is my luxury," she says. "I may not do a lot of the other things I enjoy but I get my eight hours." Her example could be the best sleep aid of all.