1. Signs of sleep problems in children and young people
Dr Sarah Blunden
University of South Australia

2. What we will do Experience in the room?
Normal sleep – quantity and quality
Sleep problems in children
Effects
Co-morbidities
Chicken or egg?
Intervention strategies

3. How? Divided into Non – Rapid Eye Movement (NREM)
Four stages – 1,2, 3 and 4
Stages 3 and 4 are the deepest (slow wave – deep sleep) and the first 3 hours of sleep are NREM 1- 4
Rapid Eye Movement (REM )
Happens after NREM stages
These cycle through the night – more REM in the early morning
Sleep Architecture ( the patterns of sleep)
Pages 6-9 in the TT manual.

4. How - Sleep Stages
This slide shows the cycle of sleep through the stages of NREM (1,2,3,4) and then REM.
It demonstrates that :
We only go into stage 4 twice both during the early part of the night. This is why we rarely wake up in the first three hours of sleep. It is VERY deep sleep.
After the first two sleep cycles, we do not get to stage 4, but only get to stage 2 sleep.
That after REM periods, because REM sleep is light sleep, we are close to waking up and indeed often wake after REM periods.
REM periods increase in length and frequency towards the early morning Therefore :
We wake more often from sleep in the early morning because REM sleep is light sleep.
If we get up before our sleep period is finished we will miss out on much of our REM sleep (consequences are …???)
REM periods are more frequent during the early morning
This slide is presented on page 8 of TT manual 4

5. How Much Table taken from
SOLVE YOUR CHILD’S SLEEP PROBLEMS by Richard Ferber, MD. Copyright © Dr Richard Ferber 1986 and presented on page 9 of the TT manual and page 5 of the student’s workbook (SD)
Need to note that recent studies have suggested that in fact adolescents need more like 9 ¼ hours per night and not 8 ½ as suggested on the table.
Also interesting to note the small change in sleep needs from about year 8 to where they are.
91/4
91/4
91/4
91/4
91/4 5

6. Total time in bed has significantly decreased from 1985 to 2004
(30min; 5% change; p<.0001) (Dollman and Olds 2008)

7. When children don’t sleep enough….
Clear evidence of reduced:
Neuropsychological function
Memory, attention, intelligence
Emotional stability
Depression, anxiety, self esteem
Psychosocial function
Aggression, hyperactivity, peer relations, families, drug and alcohol misuse
Performance
school performance, sport
Physiological health
immune, cardio vascular and endocrine systems (weight status)

8. Daytime effects of sleep disturbance on children

9. Education Australia (Blunden & Chervin 2007) America
5 times more likely to have sleep disturbance
Sleep disorders = poor learning = lower IQ
Falling behind – loss of self esteem
America
Children on Ritalin for ADHD ceased medication
8/8 children in special schools able to return to mainstream schooling (Guilleminault et al 1981)
Children moved from lowest percentile to middle range of school grades with treatment of sleep disorders (Gozal 1998)

10. Students who don’t sleep are more likely to repeat grades..
Students in behavioural units compared to mainstream controls.
Students in behavioural units:
Had worse sleep (quantity or quality). They were 5 times more likely to have sleep disturbance
Had more ‘Ds’ and ‘Es’ than those who did sleep well (teacher report)
A = top of the class
B = above average
C = average
D = below average, almost failing
E = failing
F = bottom of the class
Had worse parentally reported school performance (Blunden & Chervin 2009)
They are NOT less intelligent – just sleepy
One of the studies undertaken by SB in South Australia evaluated the sleeping habits of children and how well they did in school.
The results showed that students (the ages ranged from 7 years – 15 years)
who did not sleep well (that is, had reduced total sleep time AND/OR had poor quality sleep) had more Ds and Es than children and adolescents who did sleep well. They were failing more often.
In other words poor sleep = worse academic performance and worse school grades.
Do you think the students who are failing are likely to go on to year 12?
What if better sleep can help them do better in school and maybe stay at school.
Page 18 – item number TT manual

11. What we can see that may be misinterpreted
Non completion of assignments, giving up.
Poorer learning outcomes
Remedial teaching
Increased failure rate
ADHD like behaviour, hyperactivity
Acting out – aggression
Mood disorders
Decreased participation in sport

12. Chicken or egg? ↓ sleep = ↑ anxiety = ↓ sleep
High achievers, competition, performance
↓ sleep = ↑ depression = ↓ sleep
Mood, manifestations of depression in kids
↓ sleep = ↓ coping = ↑ frustration = ↑ stress
↓ self esteem, learned helplessness ↓ trying = ↓ failure
↓ sleep = ↑

13. What can we do? What can a parent do? What can a professional do?
Teach children how to ‘self-soothe’
Regulate bed and wake times
Ensure adequate amounts of sleep
What can a professional do?
Be aware of the signs of fatigue in children during the day
Be aware of the relationship between sleep and mood, emotion
Sleep diaries?
Promote good sleep hygiene

14. What is sleep hygiene?
Sleep hygiene is what needs to be done to promote the best environment for good sleep…
No TV/computer games 1 hour before bed. No TV s in bedrooms.
Monitor mobile phone use in bed
No coke/caffeine 3-4 hours before bed
Ensure relaxing and regular bed time routine – special time, worry time, relaxation techniques
No vigorous exercise 1 hour before bed
Finish eating 2-3 hours before bed - hot milk is OK
Make sure the bedroom is comfortable (temperature, light, noise)
Set bedtimes and wake times (delayed phase, sleep onset insomnia, sleep propensity)
Use a sleep diary to check sleep habits.

15. Australian Centre for Education in Sleep (ACES)© Junior school Session 1

16. Websites