Appendix D: Sleep Resources

Appendix D

Sleep Resources

Sleep: Key Messages for Parents from a Researcher

Wendy A. Hall, RN, PhD Professor Emeritus, University of British Columbia School of Nursing

Parents may wonder why there would be information about sleep in a book about learning language. Many studies of children of all ages have shown that night-time sleep that meets children’s needs is associated with better problem-solving and communication skills, more vocabulary, better emotional functioning, and better performance at school. We have tables that show that very young babies require 14 to 17 hours of sleep a day, babies between 6 and 12 months need 12 to 16 hours of sleep per day, and toddlers and pre-schoolers need 11 to 14 hours of sleep per day, all of those amounts include naps. Five year-olds need 10 to 13 hours of sleep per day and 6 to 12-year-olds need 9 to 12 hours per day.

Parents decide if their child has a sleep problem. Some parents are happy to have a family bed from the time their children are small, following guidelines from health professionals about how to have safe sleep when sharing a bed: https://www.healthlinkbc.ca/hlbc/files/pdf/safersleep-for-my-baby.pdf. Other parents do not want their children sleeping with them and only resort to bringing their children into bed when they are desperate to get some uninterrupted sleep. While newborns and young babies feed frequently during the night, by the time a baby is 6 months old parents are expecting he or she will sleep for a long period at night. Uninterrupted sleep is important for parents because it is hard for parents to be patient, warm, comforting, and confident about their parenting when they are sleep deprived.

Children beyond 6 months of age are very aware of their environments and they do best with predictable daytime routines for sleep, feeding, and play, and consistent bedtime routines. Parents can try to create the best conditions for older babies and children to fall asleep by keeping their sleep environments cool, dark, and quiet, having short (about 20 minutes)

sleep routines, and letting babies and children fall asleep independently. That means without having a parent present rocking, feeding, or holding their children. Falling asleep on their own helps children learn to calm themselves when they are upset (self-soothing) and prevents them from fully waking up when, as often as 5 to 7 times a night, they move between sleep stages. Children fully wake up when their situation is not the same as when they fell asleep; they think they need those conditions, e.g. a parent present, to go back to sleep.

For young babies, it can help parents avoid being sleep deprived if they reduce their expectations about what they can accomplish in the daytime and try to sleep when the baby sleeps. Asking friends or family members to help so a parent can get some time is also important. Try to put a baby to bed drowsy but not fully asleep so they can fall asleep on their own.

For older babies, leave curtains and blinds open during the day so the child can see the light. Use daytime diaper changes and feedings to play, sing, and chat with your baby. At night keep rooms dim or dark and avoid talking to help children stay drowsy. Bedtime routines should have feeding at the beginning of the routine not at the end of the routine.

For all children, keep any activities after dinner calm and avoid strenuous physical exercise (increases core body temperature which interferes with sleep). Avoid screen time which also interferes with sleep. Bath time can be part of the routine if not too stimulating. Putting on pyjamas and then brushing teeth can be following by a short song and a short story. Kiss and hug the child goodnight and put them in bed. Leave the room. There are strategies you can use if your child is not sleeping through the night independently and you want to change the situation. Look at controlled comforting or camping out online: https://www.babysleep.com/. For pre-schoolers and young school-age children, it is important to set limits around the bedtime routine. Keep it short, no more than 20 minutes, and give them only one more chance for a drink or going to the toilet or a

I wish to acknowledge that this resource draws on information provided by: Dr. Tisha Gangopadhyay, Dr. Andrew Macnab and Dr. Anamaria Richardson

Sleep: Key Messages for Parents from a Pediatrician

Dr. Anamaria Richardson, B.Ed., MD, FRCPC Educator and pediatrician with a special interest in patient-centred care

Sleep continues to fascinate researchers … and frustrate families.

Sleep is extremely important for brain development, which is why our child needs to have time with uninterrupted sleep. During sleep the brain seems to be developing and synthesizing everything that’s happened during the day.

song. Older school-age children benefit from parents setting limits on screen time and homework and actively getting them to bed by 9:00 pm.

If a child goes through some changes, e.g. new home, new daycare/school, new teacher etc., they may have some problems with going to sleep. Try to determine whether there are some worries or fears that are preventing the child from falling asleep. Talk about what is happening. There may be problems with the bedtime routine needing change as a child develops and grows. Review your strategies and perhaps move to reading only hard copy books before bed.

If your child is afraid at night, you can give your child a stuffed animal or special blanket to protect and comfort them. For older children, listen to their concerns and feelings. You may need to modify the sleep environment with a night light or a hallway light. While you want to talk with your child about nighttime fears too much talking can make the situation seem very important. You can invent a game to check for anything scary or have sparkles you can put under their bed. Comfort your child because this will pass. If you cannot see any improvement you may want to reach out to a professional.

Here are some facts about sleep:

Sleep is fundamental to life and survival. Our brain releases transmitters and hormones that respond to the light cycle (day-night cycle or circadian cycle), and guides our brain into sleep mode. Sleep is a complex series of stages that we cycle through multiple times per night. Blue light which is created by screens confuses the brain into thinking it is daytime and can interrupt the natural sleep-wake cycle.

What is a sleep cycle?

Sleep is divided into non-REM (stages 1-4) and REM (rapid eye movement) sleep; in each stage the brain waves slow down and we enter deeper sleep until we enter REM, when the brain re-activates and we experience dreams. Each cycle takes about 90 minutes, and later in the night we spend more time in REM; babies tend to spend more time (about half) their sleep in REM!

How long is normal sleep (including napping)?

Age Duration 0-3 months * 14-17 hours 4-11 months 12-15 hours 3-5 years 10-13 hours 6-13 years 9-11 hours 14-18 years 8-10 hours

* Newborns need to wake every 3 hours to feed. They are not able to sleep longer until they are a little older.

Bedtime is usually dependent on when our child needs to wake up, and our cultural background as different cultures go to bed at different times. By listening to our child’s cues during the night and during the day we can figure out if they are getting enough sleep.

Common issues:

Difficulty with sleep is usually divided into two main categories: Sleep onset (difficulty falling asleep) • Restless leg syndrome or periodic limb movement syndrome • Myoclonic jerks – experienced while falling asleep, and can wake little babies • Behaviour (including fears, wanting to spend time with us, or exerting independence by resisting bedtime

Sleep maintenance (difficulty staying asleep) • Parasomnias (Sleep walking, sleep talking) • Night terrors (usually in the non-REM sleep, children “wake up” crying, or screaming, but are actually sleeping) • Bedwetting – up to 5% of children will wet the bed until about 10 years of age

Why does this matter?

When our child can’t sleep, usually we can’t sleep either. When we are sleep-deprived it is difficult for us to be the patient, responsive and fully present parent we want to be and that our child needs. When our child is sleep-deprived it is difficult for them to get what they need to be able to learn, grow and regulate their behaviours during the day.

Learning to fall asleep or self-regulate takes practice, and we can often help by creating consistent bedtime routines.

Sometimes, however, our child has difficulty with sleep. There can be a variety of causes of poor sleep. Stress is a common one and can come from exciting things about to happen or worries that are on a child’s mind. This may be an opportunity to reflect on our week to see if there have been any new stresses that are making sleep harder.

If our bedtime routines are consistent and there are no apparent external reasons for poor sleep, this may be a sign that something else is going on beyond our reach. Our

child may have an internal driver for sleep disturbances. In this case we should seek out medical support from someone, such as a pediatrician. Our child may be dealing with anxiety, sleep apnea, Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) or another neurodevelopmental delay or disorder related to brain structure or chemistry. Having the guidance of professionals who care about families and study sleep issues can provide us with much-needed support.

Additional Sleep Resources

“Safer Sleep for My Baby” Perinatal Services BC, BC Ministry of Health https://www.healthlinkbc.ca/hlbc/files/pdf/safer-sleep-for-my-baby.pdf

Best Start Resource Centre: Ontario’s Maternal, Newborn and Early Child Development Centre “Sleep Well, Sleep Safe” https://resources.beststart.org/wp-content/uploads/2019/01/K49-E.pdf