Feature

Sleep

Is your kid getting enough?

Peter and Michael Mierau with mother Elizabeth Troutt.
Peter Mierau with his mother Elizabeth Troutt and brother Michael Mierau.
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The importance of sleep

Awake in the night

Sleep disorders in children

BY JOEL SCHLESINGER
Winnipeg Regional Health Authority
Wave, September / October 2016

Some weekends, Peter Mierau likes to sleep in.

Like many teenagers, the 16-year-old Grade 11 student at Sturgeon Heights Collegiate enjoys getting his fair share of shut-eye.

But Peter's idea of sleeping late differs from many of his peers.

While teens are renowned for sleeping well into the late morning, sleeping in for Peter means waking up at 7:30 a.m. - or possibly 8 a.m., if he's feeling especially sluggish. It's the same for his 14-year-old brother, Michael.

How are they able to get up so early and still be well rested?

Simple. In addition to being early risers, the boys also make sure they get to bed at a decent hour, usually somewhere between 9 p.m. and 9:30 p.m. This ensures they get a minimum of 10 hours' sleep every night, even on the weekends.

Getting a good night's rest just makes sense as far as the brothers are concerned.

"I don't want to feel tired and I learn much better when I am fully awake," says Peter. "If I do stay up past 9 p.m., what I do after is really not worth doing because I'm very inefficient at it."  

The early to bed, early to rise routine works for Michael, too. "It helps you in a lot of ways," he says. "You can do homework in the morning before you leave for school and you don't have to rush out the door because you were late getting up in the morning," he says.

As one might expect, the brothers' sleep habits are much appreciated by their parents.

"My husband, Maurice, and I feel we've won the lottery in this respect," says the boys' mom, Elizabeth Troutt.

As she explains, arguments over getting to bed just don't happen in their household, she says. "It feels like the motivation is more intrinsic than external, at this point, to get their sleep and feel well rested."

But while kids like Peter and Michael may be focused on making sure they get a good night's rest, a lot of kids are not. That simple fact was underscored in the most recent Report Card on Physical Activity for Children and Youth, which is produced every year by ParticipACTION, a national non-profit organization dedicated to promoting physical activity.

In giving the nation's children and youth a Grade B for sleep, the report card notes that most kids are getting the rest they need to maintain good health. But it also points out that as many as one third of children between the ages of five and 17 are not. The picture's even worse for teens 16 to 17 years of age - nearly one in two are not getting enough sleep. In addition, the report card says that kids overall are sleeping about 20 to 60 minutes less than they did a few decades ago.

So how much sleep does a kid need?

Health experts say that depends on the individual. Nonetheless, it is generally accepted that children between the ages of six and 12 require between nine and 12 hours of sleep a night, while kids between the ages of 13 and 18 need about eight to 10 hours of sleep a night.

Falling short of these targets can affect the health of children and youth in a number of ways, says Dr. Ana Hanlon-Dearman, an associate professor of pediatrics and child health at the University of Manitoba and Medical Director of the Child Development Clinic.

As she explains, a good night's rest helps balance the body's hormones and promotes the growth and development of all of our organs, including the brain.

"Sleep is beneficial for basically everything," says Hanlon-Dearman. "You name it, sleep helps regulate or maintain it."

There are some obvious benefits for kids who get a good night's rest. They are better able to learn, concentrate and regulate their emotions. "Those are the things we always associate with it and know about," says Hanlon-Dearman. "If we don't get enough sleep, we're crabby the next day and have a short fuse."

But there are other health effects associated with sleep that are less well known. For example, research suggests that a lack of sleep can affect a child's appetite through two hormones - leptin and ghrelin.

Leptin is often called the "satiety hormone" because it regulates energy balance by inhibiting hunger, while ghrelin is referred to as the "hunger hormone" because it promotes appetite.

As Hanlon-Dearman explains, when you get enough sleep, you produce more leptin, which signals to the brain that your energy levels are fine. But a lack of sleep can reduce leptin production, signalling the brain that more energy may be required. Conversely, a lack of sleep will increase the production of ghrelin, which, in turn, signals the brain that it's time to eat.

"Sleep and appetite are hormonally and neurologically regulated," says Hanlon-Dearman. When you're tired, you often get "the munchies because your hormones are miscuing a little bit." Rather than sensing we're tired, we feel hungry.

Dr. Ruth Grimes, a Winnipeg pediatrician, says a lack of sleep can also affect a child's weight by increasing his or her body's level of cortisol, which is a hormone associated with stress. 

"From a metabolic standpoint, when our brain is not rested, our bodies are put into a state of heightened awareness, and that causes our adrenal glands to produce more cortisol," she says. "Cortisol promotes development of fat in our body, so adequate sleep is required to manage weight."

The ParticipACTION report card makes the case that a lack of sleep is also an underlying cause of inactivity among children, which itself is a contributor to a number of health issues, including obesity, heart problems and diabetes, just to name a few. "Kids who are tired out from running around sleep better, and those who have slept well have more energy to run around," the report says. "And society is starting to pay attention to the fact that the reverse is also true and troubling: kids aren't moving enough to be tired, and they may also be too tired to move."

So, in addition to lacking the energy needed to be active, a lack of sleep can also cause kids to eat more than they might otherwise and promote the development of fat in their bodies. Needless to say, this can lead to a long-term pattern of poor health from childhood into adulthood, which increases the risk of developing a range of health problems, including high blood pressure, early onset Type 2 diabetes and cardiovascular disease.

So what accounts for kids not getting enough sleep?

Hanlon-Dearman and Grimes say many factors figure into the equation.

While younger kids, by and large, get the sleep they need, issues can creep up around transitions in life. Going to school or moving to a new school, for example, can cause anxieties that manifest themselves in sleep issues.

Teens, meanwhile, often have too much going on - whether it's hockey, homework or using their personal electronic devices to hone their personal relationships. The latter is often a source of contention with parents.

"Teenagers like to be connected, but it's at the expense of their sleep and ultimately at the expense of their focus and concentration, stress levels and physical wellness," says Hanlon-Dearman.

She says she has heard her share of stories from concerned parents that their teenage children are up until the wee hours of the morning on social media and texting their friends. That they're driven to do so is hardly surprising, she adds. Nor is it surprising that they tend to be non-compliant when their parents tell them to turn off the electronics and get to sleep.

"Teenagers are developmentally wired to separate from their parents - that's part of their job - and to engage with their own social group, so, having parents say to them, ‘You've got to turn off your phone or tablet to get a good night's sleep,' they're inclined to resist that," she says. "They're also developmentally wired to listen to their friends."

That doesn't mean teens sleep less. They still require and will try to get the sleep they need. That's why they can be so hard to wake for school, and why they sleep late on weekends.

As a result, some researchers have advocated for starting school later for teens to match with their more night-owlish behaviour.

"I think there's some logic to that," says Hanlon-Dearman. "Though it'd be difficult to implement because of the way our society is set up around nine to five work hours."

Unlike their parents, teens tend to "phase-shift" their sleep habits. "Adolescents, because of their hormones and growth, shift forward," she says. "They want to go to bed at midnight or one in the morning, but then they want to get up at 11 a.m. or noon, or later."

Still, most children, one way or another, manage. And each one is different.

"You have to know your child and know your household schedule." Some are "morning larks and others are night owls," Hanlon-Dearman adds. Others can handle physical activity within an hour of bed, while some need a couple of hours to wind down.

Screen time is also variable. While most experts agree it is poor sleep hygiene to have a TV or smartphone in the bedroom, or to even engage in screen time within an hour before bed, it's dependent on whether a child can handle it. Some can, some can't, she says.

The science, however, points to screen time inhibiting sleep.

"If you're already having trouble falling asleep, the blue light that's emitted from some of the larger screens can be enough to suppress your body's melatonin, and that's the sleep hormone," Hanlon-Dearman says. "Melatonin is released when the lights go off and it's suppressed when the lights go on."

And an affinity for screen time in the bedroom is hard to break once a child enters the teenage years.

"Healthy use of technology time has to be set early on," says Grimes. "You'll never get an adolescent used to four hours a day on the iPad to stop using it before bed just because their marks are slipping."

The pattern is difficult to break in part because it's habitual, but also because parents who try to exert control over a teenager are often not as effective as well-developed internal controls. In other words, kids need to decide for themselves that they need to get a good night's sleep. But building a desire to self-regulate can take time, which means parents have to start developing a pro-sleep strategy early on in their child's life.

"If parents haven't prioritized sleep as important from the start, it becomes more difficult for parents to manage, support and enforce good sleep habits in adolescence," says Grimes.

It's similar to cultivating good manners, a work ethic, kindness and thoughtfulness, and good eating habits. "All of those patterns have to be set early in childhood."

So what can a parent do to help ensure their kids get the rest they need?

First and foremost, it is important for parents to be good role models.

"If they see you as the parent, for instance, texting through the night and watching TV until two in the morning, it's going to be hard to expect your children to do what you're not doing," says Hanlon-Dearman.

Although sleep is a natural process that will inevitably occur, getting a "good sleep" involves training.

Simply put, we learn how to sleep. Parents spend considerable time setting their infants on regular sleep schedules. The same goes with toddlers, and the process can be onerous and difficult, as most parents can attest.

"We talk about sleep training lots when it comes to families with young babies," Hanlon-Dearman says. "We don't talk about that with older kids, adolescents and adults."

But the learning process still goes on, even if we don't realize it.

As kids age, they often adopt the same habits as their parents, and if their parents tend to stay up late, get up early, and compensate with ample doses of coffee, their children will often want to follow the same path as they get older.

None of this is news in the Mierau-Troutt household. The good sleep habits of Peter and Michael have been years in the making.

"We've had a large emphasis on sleep - forever," Troutt says. But there was a stage in life when their sleep was not optimal. When the boys were five and three years old, they experienced difficulties falling asleep and staying asleep.

"So we read as much as we could and received a lot of coaching about sleep hygiene," she says.

The family set regular hours for getting to bed. The boys' screen time is limited to one hour a day, and they cannot use electronics within an hour of bedtime. All electronics, in fact, are banned from the bedroom. The only permitted activities are reading books and writing in a journal (both of which tend to foster rather than hinder sleep, says Hanlon-Dearman).

Yet while habits are best developed early on, parents can still help their teenage children engage in better sleep hygiene by limiting their screen time. It just has to be done in a manner in which teens feel like a partner in their own well-being rather than being told what to do.

"They have to do it for themselves," Hanlon-Dearman says. "It you don't support your kids in doing it for themselves, they won't."

Certainly Peter and Michael "get it."

"At the ages they're at now, which are 16 and 14, they both voluntarily ensure they get enough rest," Troutt says.

That's not just a proud mom's braggadocio. Peter can attest to his hankering for a good night's sleep - even at sleepovers.

"I'll put myself to bed often even if my friends are still up because I don't like the feeling of being tired in the morning," he says.

And his attitude toward rest bodes well for the coming year, which will be busier than any year before it.

"He's entering Grade 11 and he has a pretty ambitious slate planned, and I'm already thinking that may not be doable next year - the homework done by nine, along with the extracurricular activities and budding relationships," his mom says. "It may be we adapt the schedule or tweak it."

Peter - an excellent student - has ambitious goals for school, university and a career. And, ironically, electronics will play a big part.

"I want to do something that will change the way we live or use technology, like Steve Jobs," Peter says in reference to the founder of Apple computers. "But just because I have a very strong interest in technology, doesn't mean I let it rule my life."

And that includes not letting it get in the way of a good night's rest - because not getting enough is just so not cool.

Joel Schlesinger is a Winnipeg writer.

Wave: September / October 2016

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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