Sleeping Through The Night: Elementary School
As children enter the school years, we start to see a reduction in some of the behavioral sleep disorders. For many children, there are great surges in the ability to regulate emotions and self-sooth. Sleep in this age group becomes more distinct, and the pattern of sleep is much more reflective of adult sleep; sleep stages are much the same between children and adults, with some minor differences. To me, deep slow-wave sleep that can be observed observed in children looks like a symphony.
Recording of slo wave sleep in a 9 year old patient.
As children move into adolescence, slow wave sleep drops some of the amplitude and will remain consistently similar throughout the lifespan, until it changes again with old age.
Slow wave sleep as recording in a 22 year old patient.
There is an intense amount of activity occurring in the growing and developing brain of the school-age child. It is so easy to see elementary age children as smaller versions of ourselves when they start to utilize mature patterns of speech and activity, but we need to give their brains every possible opportunity to sleep as well.
The biggest challenges that we see in this age group are problems with inconsistent sleep timing, behavioral interference in sleep continuity, and parasomnias. It can be tempting to start to anticipate that your child can take responsibility for their sleep timing, but it is essential to maintain sleep periods in this age group. In particular, wake time should be consistent throughout the week, and sleeping in on weekends should be avoided. When a child sleeps in on the weekends, their circadian clock delays to the new wake time, and they can take them a rough couple of days to readjust at the beginning of each week. If this is chronic enough, they can develop a circadian rhythm disorder, in which their circadian clock does not match the demands of their school schedule. Our ability to focus is at its peak approximately three hours after our stable wake time, which means that a child sleeping in till 10 AM on the weekends may shift their peak focus to 1 PM, often later than they really need to be able to focus in school. It is not uncommon for me to see parents trying to compensate with caffeine in this age group, and there are concerns with caffeine consumption and children. In May 2013, the FDA and hours that they would be conducting an investigation of caffeine consumption in children after some academic studies indicated that the effects can harm brain development. So, skip the caffeine and give them adequate time to sleep!
Additional behavioral challenges for sleep continuity include struggles over screen time and general resistance to bedtime. For some children, the idea of sleeping independently can still be a challenge in this age group, but their increasing body size makes it a lot harder for them to worm in to bed between mom and dad. In my clinical work, I also find that kids who are struggling with sleeping independently can do a really good job vocalizing why they are struggling, which gives us a good path to work toward a solution. Example, the battery may feel strange or uncomfortable, and this can be an easy fix. Let them give input on how they would like the bedroom to be arranged, and be supportive of some of the struggles they may experience. It is essential to be supportive and validating of emotions, but remain consistent with encouraging them to sleep in their own bed. Help them to to identify safety devices (yes, even middle schoolers may be more comfortable with their blankie still in bed with them) and encourage the utilization of these devices when they are in bed. One bright child I saw came up with the idea of placing pictures of her favorite friends and family events on her ceiling. She kept a flashlight on her nightstand and could shine the flashlight on the pictures if she was feeling scared. Place focus on steps to success rather than frustration over the existing challenge, and establish rewards for successful nights. As far as screen time is concerned, it is best to eliminate screens for an hour prior to desired sleep time. For younger children, I recommend no screen time after dinner, so the kids engage in reading or play prior to bed rather than video games or television. There are a lot of blue light blocking devices on the market, but there has yet to be any demonstrated efficacy for these devices for children. Always remember, we need dark to sustain sleep so absolute darkness during sleep hours is ideal. Sources of light in the sleep environment can suppress overall drive for sleep, which can affect falling asleep or staying asleep.
The most common parasomnia in this age group is sleep-walking or somnambulism as it is technically named. Somnambulism occurs in that beautiful, deep sleep pictured earlier, so there is no conscious thoughts associated with the behavior. It tends to occur most often when children are sleep deprived or stressed, so sleep scheduling can be even more critical in this group. This behavior is not as disruptive to the family as night terrors, so most parents opt to ensure safety rather than trying to eliminate the behavior. Best way to ensure safety is to make certain that there is a clear path, and that all exterior doors are not easily opened. It is not uncommon for people to open simple locks or perform very automated tasks while sleepwalking, so it is essential to try to make the exiting the home a very complicated process. Many deadbolts have an internal key option and it may be worth a call to the locksmith to make this change. Adults with somnambulism have been witnessed trying to drive, eat, and engage in other behaviors, so do not be surprised if your child seems to be awake but acting somewhat oddly. The concept of not waking a sleep walker comes from the idea that they are in a very deep sleep, and will not be coherent when should you wake them. It is best to simply guide them back to their room. Somnambulism tends to disappear around puberty (it is very rare in adults), so it will likely be a distant memory in a few years.
One last bit, the middle school years are the time that children begin to practice independence in a more meaningful way, and sleep routine can be a good part of this process. Help them to establish a good wake time for each day, and show them how to use their alarm clock. We use alarm clocks in the sleep clinic for two purposes: establishing awake time and also creating a specific time that time in bed is over. For those larks out there, having an alarm clock can keep them from creeping into an earlier rise time, and for the owls, the alarm can help make sure they remain consistent with their schedule, even on the weekends. Help them to practice independence with their sleep and wake up routine, but make sure that you are consistent with your expectations of timing.
Looking for help with your child’s sleep? Get connected with Dr. Daley or Dr. Raines below.