Is sleep impacting your child's performance at school?

Sleep is increasingly being recognised as a factor in children who are having trouble at school, either in terms of their learning or behaviour. Some estimates suggest that 1/3 of all children are not having enough sleep or have a problem affecting their sleep quality. Children who are not sleeping well may have problems with attention, concentration, memory and learning. Children who are sleep deprived are twice as likely to disobey instructions compared with children who have slept well.  Thus, good sleep is crucial to your child succeeding at school.

Is your child having enough sleep? Most primary school aged children need 11-12h sleep per night and teenagers perform best with 8-9h sleep per night.  If your child is having enough sleep they should be able to wake by themselves and feel refreshed in the morning.

Approximately 6% of school aged children are diagnosed with Attention Deficit Hyperactivity Disorder, ADHD. This condition is characterised by problems with attention, concentration, hyperactivity or impulse control. More than half of children diagnosed with ADHD have a sleep disorder. Because of the overlap in symptoms some children with a sleep disorder are misdiagnosed as having ADHD. Those who do have ADHD may have exacerbated problems due to a sleep disorder. One study found that treating sleep problems in children with ADHD was as effective as stimulant medication in improving their function.

Does your child have trouble falling asleep? This could be due to a problem with their body clock. The use of electronic devices in the period leading up to bedtime can delay the production of melatonin, the hormone which regulates sleep. Conditions such as ADHD are associated with a delayed peak in melatonin in the blood. Children with a delayed body clock have trouble falling asleep, sleep through the night but are hard to wake in the morning.

Sleep quality is also important. Children who snore or mouth breathe may have broken and consequently poor quality sleep. Problems are more common in those who snore loudly, who breathe harder in sleep or who have enlarged tonsils. Approximately 2% of children have unusually restless sleep with frequent legs movements. Leg movements in sleep are more common in children with low iron stores or a family history of restless legs.

Problems affecting sleep quality may be evaluated by having a sleep study. These are performed in hospital overnight and involve monitoring a child’s breathing, restlessness and brain waves to evaluate their sleep quality.

Sleep quantity and sleep patterns may be monitored using a sleep diary. Watch-like devices which measure movement (actigraph) can also be used to evaluate sleep and have been shown to be more accurate than parental observation. These devices are best at determining when a child fell asleep and woke up during a period of monitoring in the child’s own home. However, these devices are not as accurate at evaluating sleep quality. Thus, actigraphs are often used in combination with a sleep study to evaluate a child’s sleep quantity and quality.

Top tips:
1. Ensure your child has a consistent night time routine
2. Your child’s bedtime will need to be early enough to allow for adequate sleep quantity for their age
3. Avoid electronic devices with screens in the hour leading up to bedtime and while in bed
4. Most children should be able to fall asleep within 30 minutes, monitor how quickly your child falls asleep
5. Is your child snoring or having restless sleep?
6. Consider talking with your family doctor if your child is having trouble at school and has a problem with their sleep

Dr Scott Burgess PhD FRACP
Paediatrician specialising in sleep disorders

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