According to the National Institutes of Health (NIH), in America there is an epidemic of people awake at night who are not getting enough sleep – and many of them are children.

Seven-year-old Abraham Carcoma is one of them. Every night at bedtime, his mother kisses him good night, and every morning, when she wakes him up, he says, “I just put my clothes up, and then go back to sleep.”

He tosses and turns most of the night, not getting enough real rest. That’s why in the morning, according to his father, Carlos Carcoma, “that’s when he feels tired and he says ‘I want to keep sleeping, I don’t want to wake up, I don’t want to get up, I want to stay in bed.’”

Abraham is among the 1-3% of children with sleep apnea, which simply means he has trouble breathing. In Abraham’s case, it’s because of enlarged tonsils. But according to sleep specialist Dr. James Wellman, sleep apnea is only one sleep disorder, and it’s far from being the most common. “I think the most common sleep disorder in a child is insufficient sleep. Simply put, they don’t get enough sleep.”

The NIH reports that one in four children has troubling sleeping, and almost one in six falls asleep at school. Moreover, according to studies performed at Tulane University Medical School, not surprisingly, children who don’t get enough rest are more likely to have bad grades and behavior problems. But how can a parent tell if their children are getting enough hours of sleep? The answer is counterintuitive, because the principal symptom isn’t sleepiness during the day; rather, it’s hyperactivity.

Dr. Wellman says that tired kids “wiggle in the chair, move around, look out the window … something to try to help self-stimulate themselves to overcome that sense of sleepiness. Rarely will a child say ‘I’m sleepy.’”

He says that in the typical “go-to-bed” wars in some many American homes, children will resist a regular and, in their opinion, early bedtime. But he counsels parents to eliminate distractions and be firm. He says parents’ unequivocal marching orders should be “’in your room … no computer, no television’ …maybe let them read.” He adds that it’s critical to eliminate distractions in order to “create a certain degree of relaxation so sleep can come on naturally.”

If you stick to the same bedtime night after night, in most cases the result will be the blissful face of a sleeping child, Dr. Wellman says.

Tips for Parents:
We know that sleep is essential for survival and good health, but why? That’s a question even experts can’t fully answer. Sleep disorders are described in Merck’s Manual as “disturbances in falling asleep, staying asleep or duration of sleep or abnormal sleep behaviors, such as night terrors or sleepwalking.” Many children have sleep problems, including the following:
- Frequent awakening during the night
- Talking during sleep
- Difficulty falling asleep
- Waking up crying
- Feeling sleepy during the day
- Having nightmares
- Bedwetting
- Teeth grinding and clenching
- Waking early

According to Arkansas Children’s Hospital, how children perform in school is sometimes impaired by sleep apnea, the absence of breathing during sleep, and poor sleep habits. The hospital says sleep apnea is present in up to 20% of children in the lowest 10th percentile of their class. How much sleep children and adults need varies, but here are some general guidelines from Merck’s:
- Age Total Number of Hours of Sleep
- Newborn 13 to 17
- 2 years 9 to 13
- 10 years 10 to 11
- 16 to 65 years 6 to 9
- Over 65 years 6 to 8

The American Academy of Child and Adolescent Psychiatry (AACAP) says many childhood sleep problems are related to irregular sleep habits or to anxiety about going to bed and falling asleep. Persistent sleep problems may also be symptoms of emotional problems. To minimize sleep problems, the AACAP recommends that parents develop a consistent bedtime, along with regular bedtime and sleep routines for children.

If professional help is needed, sleep center laboratories can evaluate, diagnose and treat people who suffer from all types of sleep disorders. The following symptoms may signal a need for referral to a sleep lab:
- Insomnia
- Hypersomnia (too much sleep)
- Severe snoring or choking
- Nightmares
- Abnormal sleep as witnessed by observers

In older children, sleep can also be disturbed by mood disorders, substance abuse and attention deficit hyperactivity disorder. The good news is, as children grow up, they usually overcome common sleep problems, as well as more serious disorders (parasomnias). However, the AACAP suggests that parents with ongoing concerns should contact their pediatrician or a child and adolescent psychiatrist.

References American Academy of Child and Adolescent Psychiatry
Arkansas Children’s Hospital
Merck’s Manual

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