Sleep Problems: Overview
Sleep Problems: Overview
— Leslie E. Packer, PhD
Sleep disorders are fairly common in children, affecting over one-third of children in grades K – 4 and almost 10% of teenagers.
Sleep dysfunction has been linked to both academic and social/behavioral problems. For teens, early school starting times compound their problems. Teens who do not get enough sleep are involved in more car crashes, have poorer performance in school and in sports, and exhibit poorer performance at work.
Students with the kinds of neurological disorders described on this web site are likely to have additional sleep-related problems, as many of these disorders are associated with significant sleep disorders.
Restless Legs Syndrome, Periodic Limb Movements of Sleep, narcolepsy, insomnia, and sleep apnea are different types of sleep disorders that may all contribute to a poorer night’s sleep, but they do not all have the same effect on daytime functioning, and not all neurological conditions have the same types of sleep problems associated with them.
In addition to sleep problems associated with the disorders, some children and adolescents also suffer from sleep-related side effects of medications that are used to treat the disorders. Stimulant medications used to treat Attention Deficit Hyperactivity Disorder, medications used to treat mood disorders, and some of the medications used to treat tics can all produce sleep problems that can affect the child in the classroom. Some medications do not affect sleep per se but may make the student very drowsy or sleepy shortly after they take their medication.
TYPES OF SLEEP DISORDERS AND SLEEP PROBLEMS IN SPECIFIC DISORDERS
For an overview of the different types of sleep disorders and for a description of the types of sleep problems we see in ADHD, Tourette Syndrome, Obsessive-Compulsive Disorder, Depression, Bipolar Disorder, and Autism Spectrum Disorders, see this article I wrote on www.tourettesyndrome.net.
WHAT SCHOOLS CAN DO
Because sleep problems have a significant impact on academic learning, behavior, and emotion, schools should incorporate parent education and screening for sleep problems as part of a building-wide (and preferably district-wide) plan. The following elements would be useful to incorporate:
Screen for Sleep Problems
Screen all students for sleep problems that may contribute to behavioral or academic problems. You can use this simple survey from Challenging Kids, Challenged Teachers (2010).
Create an informational handout or packet that informs parents:
How much sleep is normal at each developmental stage:
- 3-6 years old: 10 – 12 hours per day
- 7-12 years old: 10 – 11 hours per day (some sources say 9-11)
- 12-18 years old: 8 – 9 hours per day (for teens 14-17: 8-10 hours per day); and
How to recognize the signs of a possible sleep disorder*:
- Frequent or chronic difficulty falling or staying asleep
- Sleepwalking, night terrors and other nighttime activities
- Sleeping too much, especially if the child has trouble waking up in the morning and getting to school on time – or falls asleep in school. While in some cases, this may be due to medication side effects, it needs to be investigated.
- Needing parents to be in the room to fall asleep.
In the packet, include sleep hygiene educational materials to help parents structure their home and the child’s routines. Use a simple tips handout such as this one, or a more detailed handout, such as this one from Challenging Kids, Challenged Teachers (2010).
If your school is starting too early for teenagers, read this backgrounder and related articles from the National Sleep Foundation and then look at what some schools have done to improve outcomes by starting school later. The South Orangetown Central School District also has a useful write-up of research on the health and academic benefits of later start times. In 2014, the American Academy of Pediatrics also issued a statement recommending later start times for middle schools and high schools.
Accommodate, Accommodate, Accommodate!
If a student is drowsy in class or sleeping in class due to medication side effects, their accommodation plan should include appropriate accommodations. Accommodation ideas can be found in Challenging Kids, Challenged Teachers (2010) and in Find a Way or Make a Way (2009). Sometimes, when the parents and prescribing physician are made aware of the impact in the classroom, the medication schedule or dosing can be adjusted, so do keep parents informed of your observations.
If despite the student’s efforts and the parents’ efforts, the student cannot get to school on time due to sleep/waking issues, their accommodation plan should include a later start time or a “lighter” first-period course that does not require peak attention and focus.
*Adapted from the Sleep Disorders Clinic and Lab at the Kennedy Krieger Institute