Wednesday 20 March 2019

Lack of sleep can greatly affect a child's development

A study by the American Academy of Sleep Medicine found that four-year-olds with a regular bedtime scored better in tests to assess developmental progress than those without a regular bedtime.

The effects of sleep on development and academic achievement continue beyond a child's early years
The effects of sleep on development and academic achievement continue beyond a child's early years

Shane Cochrane

In England, all those in young offender institutions are to have a 10.30pm bedtime imposed. According to the UK's Justice Secretary, it will bring discipline to their lives. Unsurprisingly, the plan hasn't been well received, particularly amongst prison reform groups.

But, while enforced bedtimes as a method of discipling young offenders is highly controversial, there's ample evidence that, for those teens and younger children not in prison, a regular bedtime is a very good thing.

The brain changes dramatically during early childhood. New connections between brain cells are constantly being made, facilitating learning and healthy mental development. University of Colorado researchers have found that these connections become stronger during sleep, and that as much as 20pc of the connections between the left and right hemispheres of the brain are made during sleep.

A study by the American Academy of Sleep Medicine found that four-year-olds with a regular bedtime scored better in tests to assess developmental progress than those without a regular bedtime. The same children also did better in tests to assess literacy and mathematical ability. Such were the results that the researchers concluded that helping children maintain a regular bedtime was an important way for parents to help their children develop early language and literacy skills.

But the effects of sleep on development and academic achievement continue beyond a child's early years. Several studies have examined the effects of irregular bedtimes on older children.

A study of 13- to 18-year-olds found that those who regularly went to bed after 11.30pm performed poorly in tests, particularly when the tests were held early in the morning. And at university, researchers have found that those with poor sleep habits struggle to concentrate or retain information. According to the American Academy of Sleep Medicine, sleep problems have the same effect on a student's academic performance as binge drinking or marijuana use.

Of particular concern is the growing evidence of the detrimental effects poor sleep habits have on behaviour and mood. A UK study examined the sleep patterns and behaviours of 10,000 children. The researchers found that a child without a regular bedtime was more likely to have behavioural problems - such as hyperactivity, emotional difficulties, difficulties interacting with peers and conduct problems. By examining the same children at different ages, the researchers could see that these problems worsened as the children got older.

It was seeing behavioural problems like these on a daily basis that prompted Jane Dare to take action. "I was working with children with behavioural problems and I realised there was a link between sleep and behaviour. In Ireland, not a lot was being done about it, so I did a lot of research, and trained at the main sleep clinic in the UK. And then I set up Sweet Dreams."

Sweet Dreams provides help for parents with young and older children.

"The main behaviour issue, if you're talking about older children, is mood disturbance: moodiness, irritability, depression and anger," she says. "There's also some cognitive impairment, where children experience memory problems, have difficulty concentrating, and struggle with decision making and problem solving."

Left unaddressed, many of these children can grow up to become very vulnerable young adults. A study of 16,000 adolescents by Columbia University found that those with a bedtime of midnight or later were 25pc more likely to suffer from depression and 20pc more likely to have "suicidal ideation" than those with a bedtime of 10pm.

So, given the grim consequences, why do we find it so hard to have a regular, sensible bedtime?

It should come as no surprise that television, the perennial bad guy of child development, is one of the main contributors to late and irregular bedtimes. And studies have consistently shown that children with televisions in their bedrooms go to bed later, sleep less and have more disrupted sleep.

A study by Iowa State University found that children sleep better, perform better at school and behave better when their parents limit the amount of time they spend watching television. In the Iowa study, the improvements due to increased sleep were small at first - and not always recognised by parents - but increased over time into substantial changes.

Sometimes the improvements can be quite dramatic. "One child I worked with was only sleeping for four hours a night," says Jane Dare. "He had a television and video in his bedroom, and I told the parents to take them away. They looked at me - but they did it. And that child now sleeps for 11 hours a night."

Currently, smartphones and tablets have taken over as the main barriers to a regular bedtime.

"We're seeing awful problems with smart devices because of the light they emit," says Breege Leddy of the Insomnia Clinic at Bon Secours Hospital, Dublin. "And exposure to that light is cutting down on melatonin production."

Melatonin is produced by the pineal gland and is responsible for regulating sleep.

"Your biological clock's main method of control is the light-dark cycle," explains Jane Dare. "If you have light going into your eyes from your smart phone, it affects your biological clock and you're not producing melatonin."

But not all of the problems are external. While teenagers may enjoy active social lives that keep them out late, and may also enjoy tweeting about their active social lives on their smartphones, they are also at the mercy of biology.

"During puberty teenagers just cannot get to sleep before 11pm," says Jane. "We don't know why, but something happens with their hormones and they get what's called delayed sleep-phase syndrome."

This means that even those who want to maintain a regular bedtime will struggle to do so. Some specialists have even proposed later school start times to compensate for this phenomenon, "but that's never going to happen," says Jane.

Of course, there are many reasons why children and young adults aren't able to maintain regular bedtimes: school and exam pressures, sporting commitments, illness, medication, and perhaps a lack of awareness of the need for a regular bedtime. And sometimes, as one study found, some parents work late and want to spend some time with their children before putting them to bed.

But, the good news is, with a little education and some work, most of the harm can be undone.

In a University of Michiga designed sleep education programme, four-year-olds and their parents were taught about healthy snacks before bed, reading rather than watching TV to unwind, and the benefits of being in bed by 8pm. After only one week, the children were getting an average of 30 minutes extra sleep per night.

"I think it would be fabulous to be able to go into schools and do sleep programmes and get people to understand the consequences of lack of sleep," says Jane.

However, this education still needs to be backed by action, and may involve parents limiting their child's TV and computer time, and removing TVs and electronic devices from the bedroom. Jane insists on these measures when she works with a family, and they seem to produce results - especially for younger children

But some children may need additional help. Jane Dare explains the process used at Sweet Dreams.

"We do a sleep diary for a week. It's very important to see what time they're going to bed and what time they fall asleep. We also look at how they fall asleep: do they need a television; do they need music; do they need a parent present?

"Then we introduce a really good bedtime routine - to calm and relax them."

The routine may involve a bath, reading a book, or turning down the lights before going to bed. The routine also entails the child going to bed at their "normal" time.

"Then we very gradually bring it forward," says Jane. "If the child normally goes to bed at 11pm, you can't put him to bed at 8pm and expect him to sleep. It's a slow process."

Of course, a regular bedtime is not just for children. While a regular bedtime may protect children and provide them with a better start in life, a regular bedtime for adults may undo some of the ravages of life. For example, new research is re-evaluating the relationship between depression and insomnia.

"There's a huge amount of research showing that insomnia is a consequence of depression," says Breege. "But new studies are finding that insomnia can precede depression.

"And it's also been shown that, if the insomnia is cured, it can double the chance of recovery from depression."

For anyone wanting to fix their bedtime, Breege recommends working backwards.

"There is no such thing as an ideal bedtime. If you're not sleepy you're not going to sleep. The most important time is your getting up time, because that stabilises your circadian rhythm, your body clock.

"Your getting-up time should be part of a strict routine, and it should be followed seven days a week. If your getting-up time is stable, usually you will feel sleepy at the same time every night. That's your body clock kicking in."

For anyone wanting to improve their sleep habits, Breege has one final piece of advice: "When it comes to changing sleep, everything has to be done in small measures. Sleep doesn't like big changes."

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