Doctors are reporting a dramatic increase in children with sleep disorders, which affect their physical and mental health. Why? – Plus expert tips on a good night’s rest
Across the world, children are sleeping less. It’s not just young children like Elise who can’t switch off: from toddlers to teens, bedtimes are getting later and average sleep duration is falling. (Everyone’s needs are different, but health professionals recommend that five-year-olds should get around 11 hours a night, 10-year-olds around 10 hours, and 15-year-olds nine hours). The NHS is seeing more serious problems than ever: hospital attendances for children under 14 with sleep disorders have tripled over the past 10 years. Specialist paediatric services are overwhelmed: Sheffield children’s hospital has seen a tenfold increase in referrals over the last decade. A 2011 study based on schoolteachers’ observations found that English students are the most sleep-deprived in Europe.
There are a number of reasons for this, chief among them our increasing dependence on technology, a more child-centred style of parenting, poor diet and the example set by an older generation, who work longer hours, come home later, and constantly check their phones.
Addressing the issue won’t just benefit children’s health, the specialists argue: it will save money. At a time when NHS services are extremely stretched, and adolescent mental health services face a funding crisis, Britain’s sleep problem is costing unnecessary millions in prescriptions, GP appointments and specialist care.
NHS Doncaster has the only free specialist service in the country. Children’s Sleep Charity provides a clinic, that supports families of children of all ages, regardless of whether they have a disability. Parents can refer themselves and get an appointment within weeks; it can take four months to get a referral to a paediatrician. The charity runs clinics several times a month in locations around Doncaster, but for the rest of the country; the lack of funding is causing concern amongst parents and health officials.
Founder Vicki Dawson survived five years as a sleep-deprived mother. “When you become a parent, you expect a certain level of sleep deprivation – babies don’t sleep. But when that continues over a number of years, it really starts to take its toll. I experienced memory loss, it was hard to concentrate at work, even driving was difficult and dangerous. I asked for help from my GP, and nobody was able to offer me any advice other than to recommend books. When you’re sleep-deprived and you’re working, the last thing you’re capable of is reading a book.”
A former deputy headteacher, Dawson last year gave up her day job to run the charity full‑time. She gets up to 200 emails a day. “We can’t meet the demand. We have parents telephoning from across the UK, and that feels like a huge responsibility because there’s nowhere else.” The charity can fund one-to-one support for local families; everyone else has to read its leaflets online
The waiting area at Wheatley children’s centre is filled with mothers with grey faces and hollow eyes. Many of them have spent vast amounts of time and money trying to get their children to sleep. They have tried books, online parents’ forums, white noise, scented oils, vibrating teddies, light shows that project on to the bedroom ceiling. Some have put furniture up for sale to try to meet the cost of private help.
Parents are waking up to the hazards of the digital age,with health advisors suggesting that parents switch it all off an hour before bedtime to give the brain time to relax.
TV on demand, addictive games and fear of missing out on social media make it harder than ever to switch off
It’s well established that technology tells our brains not to go to bed. The blue light emitted from tablets, smartphones, computers and LED TVs interferes with the production of melatonin, the hormone naturally released as the sun goes down that makes us feel sleepy. The blue light filters now available on many devices address only part of the problem: TV on demand, addictive games and fear of missing out on social media make it harder than ever to switch off. Even when we do, our brains are still in overdrive; technology that didn’t exist 10 years ago has taken over our children’s lives in completely unforeseen ways.
According to a recent survey by consultancy Censuswide, over 80% of children in the UK now have their own phone by the age of 12. By 10, 58% have their own tablet, and two-thirds of teenagers say they use these devices in the hour before bedtime.
“The look of horror on a teenager’s face when you say, ‘You really shouldn’t have your technology right before bed.’ They think they need it,” parents said. “It’s like asking them to remove their right arm.”
“Many children do not realise what a book is or how to use there hands forgetting that they ever liked reading or creating things; even Lego is becoming obsolete,”
Poor sleep is a potential timebomb for a child’s physical and mental health, and academic performance.
The behavioural approach recommend by the ‘Childrens Sleep Charity’ takes time, but is very effective: 92% of the 167 families who used the clinic over the past year reported that their child’s sleep issues were successfully resolved within six months. And in the cases where they can’t help, the charity refers families to Sheffield children’s hospital for overnight observation.
Dr Heather Elphick, who leads the service in Sheffield, is one of a handful of paediatric sleep specialists in the country. She says that most GPs tend to reach for the prescription pad. “They don’t have any other options. If every general practice had a sleep practitioner they could refer a child to, in most cases they would avoid the need for medication.”
Synthetic melatonin in tablet form is commonly prescribed to children with sleep issues. It is unlicensed for use by anyone under 55, but GPs can prescribe it at their own discretion; the number of unlicensed NHS prescriptions has increased tenfold in a decade.
Health officials suspect many children are being misdiagnosed with ADHD when they are simply not sleeping properly. “Sleep deprivation can lead to behaviours which mimic ADHD. In some cases we can intervene, improve their sleep and avoid that diagnosis,” she says. “Chronic sleep deprivation can also lead to mental illness – particularly in adolescents, where it can lead to depression.”
Poor sleep is a potential timebomb for a child’s physical health, too, compromising the immune system and creating a greater likelihood of picking up infections.
People know about sugar and obesity. We now need to wake up to the importance of sleep
Catherine Hill, a consultant paediatrician at Southampton children’s hospital, argues that sleep is as vital to a child’s wellbeing as good nutrition – perhaps even more so – quoting robust research that shows sleep-deprived rats died more quickly than those that were starved. That is what sleep can help you with. It’s free, and available to us all, but understanding the effects of radio technology on the brain from things like phones and the wireless is an ever present necessity for parents to have a healthy and intelligent child, by understanding the risks they face.
Perhaps the greatest long-term health risk to a child who doesn’t sleep is the danger of becoming obese. The mechanism by which sleep-deprived children are more likely to put on weight isn’t fully understood, but there are many strong hypotheses. As well as having less energy to exercise, and more opportunity to eat because they are awake for longer, it is thought that the body’s balance of leptin and ghrelin – the hormones that tell our brains we’re full or hungry – is abnormal in children who haven’t slept enough. Tired children are more likely to crave foods that are high in fat and sugar.
“Sometimes when I’ve had a terrible night’s sleep, I think, ‘Oh, do I have to do training today? Can I just have a McDonald’s?’ I never knew that was from being tired. I thought that was from being lazy.”
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Today’s teenagers have grown up in a tech-obsessed, sleep-deprived culture, and have now hit an age when they are under pressure to perform academically. Sleep physiologist Dr Guy Meadows regularly goes into secondary schools to run workshops for teenagers, many of whom have no idea how much bad sleep is impairing their ability to learn.
“Some research showed that if children are sleep-deprived by just an hour a night, it could reduce their cognitive academic performance by up to two whole years,” he says. Meadows is calling for sleep to be a compulsory part of personal, social, health and economic (PSHE) education. “We need to recognise that sleep is one of the most powerful performance-enhancers known to humankind. If you are serious about your child’s academic performance, then schools and parents should be really helping them get good quality sleep on a regular basis.”
We’ve had families who have split up, parents who’ve not been able to work: it has cost society in benefits
This is because, when we are sleeping, our brains are very active. While in deep sleep, all the information children have learned gets selected, consolidated and stored in the long-term memory, so it can be put to good use at a later date. A child has to be awake enough to be focused and attentive in the first place, Meadows says, and then well-rested to recall those memories and use them to solve problems in future. Poor sleep can affect every stage of the learning process. “If you’re pulling an all-nighter and cramming for exams, you’re actually preventing your brain from laying down the information you’re learning,” he explains.
“Our benchmark of what’s normal is changing. For children and adults, waking up feeling tired is becoming the new normal. So people are just reaching for energy drinks, reaching for caffeine as ways of coping and seeing that as perfectly normal. Parents need to make their children aware of the importance of sleep, and perhaps become role models for their children, showing them, ‘I don’t stay up late, I have a regular bedtime, I don’t stay on my smartphone before bed.’”
It is also possible that many parents don’t recognise their child isn’t sleeping enough: most of the teenagers who participated in a recent survey for the Children’s Sleep Charity said they had problems falling asleep and difficulty getting up; but 80% of their parents said they didn’t think their child had an issue at all.
For the NHS, there are big savings to be made. Lee Golze, the NHS Doncaster manager who agreed to fund the local clinics, says it’s one of the most cost-effective things he has ever commissioned. “A direct, face-to-face intervention, with a five-week follow-up, is £80,” he says. Compare that to the cost of prescribing a child synthetic melatonin for a year: “An average dosage, maybe an appointment with a clinic and a follow-up with a consultant, would be about £1,000.”
Dawson claims the savings to the public purse go even further. “Children are taking up paediatrician and GP appointments that are not appropriate for them. We had one child recently where we improved his sleep and the school was able to withdraw the number of teaching assistants they had – again, a cost-saving benefit. We’ve had families who have split up, parents who’ve not been able to work: it has cost society in benefits.” But, for the moment, these savings are just for Doncaster.
“We desperately need to get children’s sleep on to the public health agenda,” says Catherine Hill. “We’ve done it with nutrition – people understand the dangers of sugar and obesity. We now need to wake up to the importance of sleep.”
“The main difference we’ve made is to turn the television off and not give her the tablet. I haven’t been running around trying to cram everything in, and we’ve solely focused on the bedtime routine. She’s been so much happier in the morning – you can just see it in her face when she wakes up.”
“I feel a little bit embarrassed and a little bit guilty, actually,” Nick adds, “because we thought we were doing everything right. You get so much advice about diet and food. Five a day, seven a day, whatever. But you don’t get any advice about sleep.”
Here are a few ways to help you and your family sleep better:
1 Avoid sugary snacks and caffeine, particularly at supper time. Opt for alternatives like banana, porridge or wholemeal bread.
2 Think about the bedroom environment: is it calm and conducive to sleep?
3 Have a consistent routine that you follow every evening in the hour before bedtime.
4 Consider whether bathtime is relaxing. If it isn’t, separate it from the bedtime routine. If it is, have the bath 30 minutes before bedtime to allow the body temperature to rise and then drop again – this helps us feel sleepy.
5 No screen activity in the hour before bed; no TVs, computers, phones or tablets.
6 Activities involving hand-eye coordination help the brain wind down before bed, eg jigsaws or colouring in.
7 Have a set wake-up time, even at the weekend.
8 Provide your child with a visual cue so they know when it’s time to get up, like a light on a timer. That way they know it’s time to sleep when the light is off.
• Source: the Children’s Sleep Charity.