Tuesday, August 21, 2012

Good sleep hygiene for children

By Dr. Tom Jackson

Sleep hygiene refers to the set of habits and guidelines that promote consistently restful and sufficient sleep at night and complete alertness during the day. It's what you can do (and in some cases, not do) to help your child (and you) sleep easy and well.

Like dental hygiene, instilling good sleep hygiene habits early on in life will promote the retention and sustaining of those good habits throughout a child's lifetime. Sleep hygiene can even help children avoid a whole host of sleep-related disorders.

The clearest sign that a child has poor sleep hygiene (or could at least use some improvements in the area) is if he/she experiences nighttime sleeplessness and/or daytime sluggishness.

But that covers a broad base of issues, that could include any of the following:

bedtime resistance
anxiety about sleep
sleep onset delay
nighttime wakings
inadequate sleep duration
difficulty awakening in the morning
morning moodiness
daytime sleepiness
to name a few!

Every one of these issues - and more - can be traced (at least in part) to a lapse or gap in some aspect of proper sleep hygiene—and by the same token, every one of these problems can be alleviated (again, at least in part) by making the appropriate adjustments in sleep hygiene.

What follows are Four Pillars of Good Sleep Hygiene:

Bedtime Schedule
Bedtime Routine
Environmental Conditions of the Bedroom
Daytime Behaviors and Habits

1. Bedtime Schedule

Create a bedtime routine that works for you and your child, and then stick to it.

Sleep and waking cycles need to act in harmony with all other body cycles, such as body temperature, metabolism, dietary schedule, and hormonal activity—our “circadian rhythms.” Our bodies are designed to naturally seek out “homeostasis”—or the condition in which all body systems find balance. In order to achieve that homeostasis, all these circadian rhythms, must sync smoothly with one another.

For any bedtime schedule to work, it requires two key components:

It must include both a regular bedtime and a regular waking time. Make sure the times you select are practical and realistic for you and your child's other life schedules.
It should stay consistent 7 days a week. If you must adjust it for weekends, then don't adjust it by any more than an hour in either direction, or else you defeat the whole purpose. Their physiology simply will not know when it is time to sleep or be awake. And this goes double for teenagers.

Adults may find this framework an even harder challenge to meet than his children, because his own schedules usually differ from weekdays to weekends—and in many cases from weeknight to weeknight. Unfortunately, this irregularity in your own schedules may make it difficult to enforce a regular bedtime schedule in your children, but it makes it no less necessary.

At the same time, in order to be effective the sleeping and waking times you set must not merely be consistent and practical for your schedules, but he must also enable your child to get a sufficient amount of sleep—not too little and not too much. These days, most experts place the right amount at around 8 hours, although for younger children and teens the number may be closer to 10.

Think of a bedtime time schedule like setting your child's "biological clock." Set it right and your child's bodily rhythms begin to naturally run like clockwork.

2. Bedtime Routine

Establish a regular bedtime routine for your child. A regular bedtime routine, about 1/2-hour long leading up to bedtime itself, is how you can best help your child to prepare for a good night's sleep.

A bedtime routine involves engaging in comforting and familiar activities that are also relaxing.

Thirty minutes before bed is the time for a child to start winding down, not up. To be avoided during this critical time period are:

heavy emotional conversations
video games
active, rough-and-tumble play and cardiovascular/aerobic exercise
caffeine (chocolate, caffeinated teas, and some sodas)
lots of liquids (water, juice, milk)*
big meals and sugary snacks*

* Foods with predominantly carbohydrates and proteins (like milk and cookies), and foods with tryptophan (like milk and turkey) both can actually help a child, once fallen asleep, to stay asleep. Just remember to keep bedtime snacks light.

3. Good bedtime routine activities include

taking a warm bath
reading a story together
quiet, relaxing family time
listening to tranquil music, nature sounds, or a relaxation CD

As children grow older you can be more flexible with bedtime routines, which may grow to include a walk outside, a chat on the back porch about the day’s events or future plans, or perhaps playing a board game or card game or doing a puzzle together. Older children may want to retire to his room to read, listen to music or work on a favorite hobby before retiring for the night and possibly listening to a sleep program.

Whatever activities you (and your child) decide upon, the cornerstone of your child’s bedtime routine is that he know what time to slip into pajamas and brush his teeth, what time to be in bed, and how much time he can spend on in-bed activities such as reading.

4. Environmental Conditions of the Bedroom

Certain qualities of the setting in which you set your child down to sleep can play a significant role in the quality of his sleep.

Set a bedroom temperature that's comfortable and will remain consistent throughout the night, erring on the cooler side as it's more supportive of healthful sleep than an excessively warm room (that being anything over 75 degrees); and keeping that temperature consistent throughout the night can help avert nighttime wakings
Make the room sufficiently dark; a small nightlight is okay, if needed, but too much brightness interferes with restful sleep
ensure sufficient ventilation/air circulation, such as by cracking the door open or using a ceiling fan set on low; refrain, however, from leaving a window wide open all night for both safety and health reasons (additional air quality solutions follow at the end of this list)
Provide your child a quiet sleeping environment, for reasons that should be obvious
Shut off the television, and what's more take the television out of your child's bedroom; recall from Bedtime Routines above that all television-viewing should cease at least 30 minutes before bedtime anyway
Keep the bed for sleeping, in other words refrain from getting your child in the habit of associating his bed with anything other than sleeping, such as playing, reading, eating, or watching TV; for this reason, the value of these children's custom hime beds and playhouse beds that have become somewhat popular of late is questionable
Dress your child in comfortable pajamas/nightclothes, as the more comfortable she is the easier a time he'll have of falling asleep and staying asleep
For the same reason, provide your child with a comfortable mattress and pillows, bedsheets and blankets

4. Daytime Behaviors and Habits

Many of the factors that influence your child's sleep the most don't even occur at night. On the contrary, a variety of habits and behaviors that have a major impact on his sleep occurs in broad daylight.

The following are suggestions of daytime behaviors supportive of good sleep hygiene

Expose your child to sunlight first thing in the morning, as soon as possible after waking, as it helps to set his circadian rhythms for the rest of the day, and long-term for the rest of her life; additionally ensure your child gets sufficient exposure to natural sunlight on a daily basis
Don't use your child's bedroom for punishments or time-outs, as a child must feel comfortable, safe, and happy to be in his bedroom in order to fall asleep and sleep soundly—all of which are prevented when he starts associating his bedroom with punishment
Monitor the content of your child's television viewing, internet surfing, and video game playing, as exposure to excessively violent, disturbing, or confusing images could be responsible for many sleep disturbances, such as nightmares
Confront bullying or other prevalent emotional issues in your child’s daily life, as any number of daily stressors—from being subjected to bullying on a daily basis, to experiencing trouble in school, to facing emotional troubles at home like a divorce, a death in the family, a move, or a sibling rivalry—could direly impact your child's sleep
Discuss your child's medicines with her pediatrician, as some children's medications (including prescription drugs, over-the-counter medicines, and all-natural/herbal remedies) could have side effects that interfere with your child's restful sleep; if your child turns out to be on such a medication, your doctor can usually help you find adequate alternatives devoid of such side effects

Improvements in your child's sleep patterns likely won't happen overnight, but once you begin implementing good sleep hygiene practices in your child's life you're bound to notice positive results in due course.

Dr. Tom Jackson is a psychiatrist who has specialized in the treatment of sleep disorders and anxiety for the past thirty years. He is the creator of the DreamChild™ Adventures audio programs and author of the companion guide, DreamChild™ Adventures in Relaxation and Sleep (August 2012). He is currently Medical Director of a public mental health clinic and in private practice. For more information, please visit www.3DAudioMagic.com and www.ThomasJacksonMD.com

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