Ask a UCSF Benioff Children’s Hospital Expert

by Lourdes DelRosso, MD, FAASM

Is my child getting enough sleep?

Sleep is crucial for all our daily activities, and a restful night of sleep will allow your child to excel in all his or her daily activities. Not getting enough sleep can have significant medical and behavioral consequences. The National Sleep Foundation recommends about 7-9 hours of sleep for adults and 8-10 hours of sleep for teens. School-age children need about 11-12 hours of sleep, toddlers 13-14 hours and infants anywhere from 14-17 hours. When children do not sleep enough they have difficulty waking up in the morning, they are tired during the day, and they have difficulty concentrating in school. Sleep deprived children are often hyperactive and irritable.

How can I get my child to have a regular sleep schedule?

Sleep is regulated by two main mechanisms: Process C and Process S.

Process C is our circadian clock. This clock is regulated by the light/dark cycle. Bright lights signal our brain that it is daytime and our brain shuts down the production of a hormone called melatonin. This substance sets our sleep time. The opposite occurs at night. In the absence of light, our brain produces melatonin and we start feeling sleepy. In the old days, with lack of artificial light, this cycle worked perfectly. Unfortunately this does not happen in modern society. With the use of electronics our brain receives artificial light from lamps, computers, video games, tablets and smart phones. Children who use electronics at night usually stay awake later.

The second mechanism that regulates sleep is called Process S, also called Homeostatic Drive. During our daily activities, our brain accumulates a substance called adenosine. The more this substance accumulates in our brain, the sleepier we are. In other words, with every hour we are awake we get more tired. When we take a nap during the day, we deplete this substance and we do not feel sleepy until later hours of the night. For healthy sleep habits, I recommend that older children and adolescents avoid taking naps during the day. Caffeine found in coffee, tea, chocolates and soda, blocks adenosine. Drinking caffeinated products interrupts Process S and makes us stay awake longer. The effect of caffeine can last up to 6 hours.

The combination of these two processes results in a healthy sleep routine. Children need to produce enough sleep-producing substances during the day, avoid caffeine, avoid bright lights at bedtime and keep a consistent bedtime routine.

What factors can prevent my child from getting a good night’s sleep?

Parents are rightfully concerned about the effects of medical conditions on the sleep quality of their children. It is very important that these conditions are treated to promote healthy sleep. Children with eczema often itch at night; children with uncontrolled asthma often wake up through the night coughing; children with allergies may have congestion, snoring and difficulty breathing at night. Medications can also affect sleep or have side effects that disturb sleep. Some medications produce insomnia, excessive sleepiness, night terrors, nightmares, or sleepwalking. Before starting a new medication either prescribed or over-the-counter, familiarize yourself with the possible side effects and talk to your pediatrician if your child exhibits new behaviors either at night or during the day when taking new medications.

Finally, there are sleep disorders that can affect children’s sleep. Snoring and gasping during sleep can suggest obstructive sleep apnea; kicking legs while sleep or having leg discomfort at bedtime can be a sign of restless leg syndrome; excessive sleepiness despite getting a good night’s sleep could represent narcolepsy; and the inability to fall asleep can be a sign of insomnia. If you suspect that your child has a sleep disorder, talk to your primary care physician who can make a referral to a sleep specialist.