Focus on Sleep

Sleep is essential not just for good health and happiness but also for our very existence. It is a complicated state controlled by complex brain mechanisms that involve going to sleep, waking up and switching between two very different types of sleep. Our sleep patterns vary throughout our lives, however the onset of puberty heralds particular changes that affect teens.

Although sleep problems are very common in children, some groups are at higher risk than others. It isn't that the problems are different but that there is a higher frequency and the pattern of occurrence is different.

For instance children with conditions which might result in neuro-muscular-skeletal pain such as Hypermobility Syndrome or Cerebral Palsy might not be able to get comfortable in bed or experience pain which will disrupt sleep. Some conditions such as Epilepsy or Asthma may be worse at night. Some children will have a physical difference that might result in breathing problems or Sleep Apnoea. Sensory impairment, chronic illnesses and some types of medication can also affect sleep.

Autistic children and others with neurodevelopmental disorders are particularly prone to sleep problems which can be a combination of behaviour and physical factors. Learning difficulties, depression, anxiety and other psychiatric conditions can also disturb sleep. It is also possible to have more than one sleep disorder affecting a child or young person.

What is sleep?

We still don't understand fully all the functions of sleep, but research has shown that all animals need it to varying degrees. Although we think of it as a time of rest, our brains are far from restful when we are sleeping and we have two types of sleep known as REM and Non REM, where REM means rapid eye movement.

We have an internal body clock which affects our levels of alertness and sleepiness throughout the day and night. The body clock makes sure that our sleep wake cycle is synchronised with our body temperature and our hormone levels. One particular hormone, melatonin, which is produced by the brain during darkness and makes us sleep, is suppressed during the day by sunlight which helps us keep alert.

Generally we are most alert in the evening before the onset of sleepiness, and people who home educate often find that this is a good time to do educational activities. There is no point in putting a child to bed before they are sleepy, as they will be unable to sleep, so it can make sense to wait until a child is showing signs of being sleepy. One of the advantages of home education is that the child doesn't have to be woken early in order to get to school on time, and can be allowed to sleep as long as needed.

The effects of lack of sleep or excessive sleepiness.

A lack of sleep can effect behaviour and intellectual function, and we know ourselves as well as our children can get really grumpy when we lack a good nights sleep. But a lack of sleep can also have physical effects such as causing 'failure to thrive' in a small child, reduced immune system function causing increase infections or being slow to heal. Lack of sleep or disturbed sleep can cause AHDH type behaviours which can result in a misdiagnosis. In adults it has been shown to have effects on diabetes, blood pressure and menstrual and pregnancy problems in women. When children do not sleep well, it affects not only their own health and behaviour but also the rest of the family, putting a strain on other children and the parent's relationship.

Sleep and Adolescence.

People are spread out between two extremes, referred to as larks, waking early and feeling sleepy earlier in the evening, or the opposite, owls. When puberty starts most teens sleep phase shifts to a later hour, so that they all become owls to a certain extent. This can mean that they take longer to feel sleepy in the evening, taking longer to get to sleep, and then needing more sleep in the morning. After much research some schools have moved the start of the day later for teens, and have found that exam results are up and truancy levels are down. Again one of the benefits of home education is that a child can still get enough sleep while they adapt to the later sleep phases.

When a sleep problem is suspected.

A parent should be concerned about their child's sleep if they find the child or young person has difficulty waking in the morning, is too tired to engage in activities, falls asleep or is overly sleepy during the day, has an increase in difficult behaviours or loses interest in activities, but generally feels better after a good nights sleep.

Sometimes a sleep disorder can be dismissed, misunderstood as the child being lazy, or just not noticed. But if someone suspects there is a problem it is worth looking at things more deeply. The first stage can be self help, then consulting a GP or Health Visitor, and if that doesn't help, then seeing a hospital specialist or sleep disorder clinic.

A useful first step is to make a note of what the problem appears to be, when it started, is it linked to any other problems or conditions the child has, and has anyone else in the family had a similar problem.

A sleep diary is very helpful for both self help or if you have to move on to the next step. Write down the waking time, how they were in the morning, what their behaviour is like durning the day, what time they went to bed, what time they went to sleep, and anything that happened in the night. Sometimes there are patterns that we can spot more easily when we write things down.

What can we do?

Medication is rarely an answer. Sometimes physical measures might be needed to deal with causes such as breathing problems or pain. Good sleep hygiene is also important, with a regular routine at bed time and plenty of natural light during the day. Computers and other electronic equipment often emit blue light which keeps people alert and slows the release of the hormone that makes us sleepy, so should be controlled in the run up to bed time. And if a child is not sleepy enough to go to sleep and is still awake after 20 minutes, then it is better for them to get up and be in another room until they are sleepy so that they don't associate bed with being awake.