Beating the Back-to-School Bedtime Blues

With the return of school just around the corner, parents everywhere will soon be renewing their age-old struggle – the battle of bedtime.

The stakes are high and go beyond what time the lights go out. The American Academy of Sleep Medicine says getting enough high-quality sleep is associated with improved attention, behavior, learning, memory, emotional regulation, and mental and physical health.

The good news is that parents have an ally in this fight – their family pediatrician.

Unfortunately, a recent study suggests parents and pediatricians aren’t always on the same page when it comes to discussing and documenting sleep problems. That is a missed opportunity, said Albert Ho, MD, pediatric sleep specialist with Trinity Health Medical Group’s Grand Rapids-based Sleep Medicine center.

“Healthy sleep habits absolutely should be one of the topics covered in every well-child visit,” Dr. Ho said. “Parents’ concerns about their child’s sleep can cause stress to the entire household, negatively affecting quality of life, and children themselves can voice their own struggles with sleep to the pediatrician.”

Parent-pediatrician disconnect

The study, published in the journal Academic Pediatrics, concluded that clinicians often neglect to document when parents report children’s sleep problems, such as snoring, insomnia and insufficient sleep. In questionnaires completed by 170 parents, about 92.3 of preschoolers had at least one sleep problem. However, a review of electronic medical records found that clinicians documented sleep problems for only 20 percent of those children. Referrals to sleep specialists were documented for only 1 percent.

The researchers wrote that the findings support better screening and education to enhance conversations between parents and physicians about sleep problems in children.

“There’s a lot to cover in every visit with your pediatrician, but it’s important not to overlook sleep hygiene,” Dr. Ho said. “Healthy sleep is critical to a child’s development and overall well-being. Sleep problems also can be an indicator of other health issues. The good news is that a lot of problems centered around falling asleep can be solved with behavioral adjustments, and medical solutions are available if necessary.”

Dr. Ho recommends that parents begin with an understanding of the amount of sleep needed for their child’s age. The consensus from the American Academy of Sleep Medicine is:

• 4 to 12 months: 12 to 16 hours per day (including naps)
• 1 to 2 years: 11 to 14 hours per day (including naps)
• 3 to 5 years: 10 to 13 hours per day (including naps)
• 6 to 12 years: 9 to 12 hours per day
• 13 to 18 years: 8 to 10 hours per day

Source: Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion

https://pubmed.ncbi.nlm.nih.gov/27707447/

Simple screening tools can also help focus attention on sleep problems. One example is known as BEARS:

B=bedtime issues

E=excessive daytime sleepiness

A=awakenings at night

R=regularity and duration of sleep

S=snoring, which could indicate sleep apnea

“Parents should be comfortable discussing these issues with their pediatrician, asking questions about sleep habits, and enlisting their help in addressing problems,” Dr. Ho said.

Waking up to an opportunity

While resuming school schedules can be a challenge, this also can be a chance to reset healthy sleep habits that may have been relaxed during summer vacation, he said.

“This is a good time to educate your child about the importance of good sleep so they can help develop lifelong healthy habits,” Dr. Ho said.

The American Academy of Sleep Medicine recommends easing back into school routines over a couple of weeks. Other advice from sleep experts:

• Turn off smartphones and computers at least an hour before bed
• Avoid caffeine
• Establish a relaxing bedtime routine and a regular, consistent sleep schedule between school nights and weekends
• Eat a healthy diet and exercise regularly
• Keep the bedroom cool, dark and quiet

If behavioral changes fail to resolve sleep problems, parents should discuss the issue with their pediatrician. Trinity Health’s Pediatric Sleep Services can help address a wide range of common issues, such as:

• Bedtime refusal
• Central sleep apnea
• Circadian rhythm disorder
• Excessive daytime sleepiness (Hypersomnia)
• Insomnia
• Narcolepsy
• Nightmares
• Obstructive sleep apnea
• Periodic limb movement disorder
• Restless leg syndrome
• Sleep apnea
• Sleep-related hypoventilation
• Sleep talking
• Sleep terrors
• Sleepwalking

For more information or to schedule an appointment, contact our Pediatric Sleep Services in West Michigan or 616-685-6330.