Sleep Medicine

Patient and family education is important to us. Here you can learn more about sleep and healthy sleep habits, and view trusted insights from KidsHealth.org, the No. 1 most viewed health site for children, created by the experts at Nemours. We've also provided information from the most-respected non-profit organizations.

Healthy Sleep

All children need a good night’s sleep. It’s not only a time for rest, but sleep gives your child’s brain a chance to sort and store information from their day. When kids don’t get enough sleep or quality sleep, it can affect how they feel, act and do in school. Our pediatric sleep medicine specialists are here to get to the bottom of your child’s sleep problems and set your child on the path to a good night’s rest.

Natural Sleep Cycles: Five Stages of Sleep

Natural brain cycles are responsible for sleep, which is defined by 2 states:
  1. Non-REM (non-rapid eye movement) sleep, considered “quiet sleep” (5- to 20-minute intervals)
  2. REM (rapid eye movement) sleep, considered “active sleep” (60-70 minutes)

Normally, sleep occurs in stages that cycle several times throughout the night.

 
Stage 1: Non-REM Sleep

This is the transition from wakefulness to sleep. During this period the brain reduces activity and polysomnography (sleep study) shows high amplitude theta waves (slow brain waves).

 
Stage 2: Non-REM Sleep

At this time, the body’s temperature begins to decrease and the heart rate begins to slow to prepare for sleep. Bursts of rapid rhythmic brain waves (called sleep spindles) begin to appear.

 
Stages 3 & 4: Non-REM Sleep

These stages mark the transition between light and deep sleep where delta (very slow) brain waves begin to emerge in stage 3 and continue in intensity. Sleep walking and bedwetting often occur at the end of stage 4.

 
Stage 5: REM Sleep

After about 90 minutes of non-REM sleep, brain activity increases as the eyes begin moving rapidly and dreaming begins. REM is referred to as paradoxical sleep because muscles become more relaxed as the brain’s other systems become more active.


Good Sleep Habits

 
Independent Sleep

Consider the following recommendations to help your child develop good habits for getting to sleep on his or her own.

  • Keep your child’s room neat and clean — responsibility for this task will vary depending on your child’s age and abilities.
  • Put a nightlight or small light within your child’s reach.
  • A quiet fan or humidifier may allow for some “white noise” to filter out the noise coming from the rest of the house.
  • Place a few of your child’s favorite items around the bed so it becomes sort of a "mini-home."
  • Have a bedside table or shelf stocked with your child’s favorite books.
  • Give your child plenty of notice that bedtime is approaching. A predictable, consistent bedtime routine helps kids wind down toward sleep.
  • Set aside time to do something special with your child before bed. Avoid any activities that will excite your child. Let your child know your special time together will end at bedtime.
  • Once you finish playing or reading a story, tell your child goodnight and leave the room. If your child comes out, take your child back to bed and leave again.
 
Helping Your Preschool Child Develop Good Sleep Habits

Helping kids get enough sleep involves creating soothing and consistent bedtime routines.

The goal is for your child to learn to:
  • fall asleep on his or her own
  • not rely on your presence for this to happen
  • be able to go back to sleep during the night
  • go to bed at the same time every night — let your child know 30 minutes ahead of that time to get ready
Other ways to help your child develop better sleep habits:
  • make sure your child goes to the bathroom, washes up, and brushes his or her teeth
  • read a book with your child
  • make sure your child has a cup of water, a nightlight or anything else your child may need
  • remind your child to stay quiet and in bed
  • say goodnight
When your child goes to bed, make sure everything is done:
  • teeth brushed
  • said goodnight to everyone
  • had a drink of water
  • used the toilet

After your child is in bed, keep the TV and the rest of the home fairly quiet. Your child can awaken easily in the first hour of sleep.

If your child awakens, the goal is have the same conditions present that were there when your child fell asleep — that means you’re not present when your child falls asleep. Follow these recommendations for naptime too. You may be asked to track your child’s sleep in a sleep diary so you can measure progress made.

 
Sleep Tips for Teens
  • Try to stay on a schedule — go to bed and get up at roughly the same time each day, even on weekends. Don't sleep more than 2-3 hours later than usual.
  • Get into bright light as soon as possible in the morning, but avoid it in the evening.
  • Try not to nap during the day; or nap only for 20-30 minutes.
  • Avoid caffeine in the afternoon.
  • Don't exercise within 3 hours before going to bed.
  • Keep the temperature in your room comfortable.
  • Keep the room quiet and dark when sleeping.
  • Use the bedroom only for sleep, not for fun or watching TV. This will signal the body that when you are in your room, it's time to sleep.
  • Leave time to unwind before bed. Avoid stimulating activities like TV or lively music 30 minutes prior to bedtime.
  • Do not go to bed until you are drowsy. Trying to “make yourself fall asleep” will only make you wake up more.
  • Do not go to bed too hungry or too full — a light snack such as pretzels, crackers or popcorn just before bed may help make you drowsy.
  • Use a relaxation exercise, such as progressive muscle relaxation or guided imagery, just before bed.
  • If you are unable to fall asleep within 30 minutes, get out of bed and do something quietly in another room until sleepy.

Common Sleep Conditions

 
Bruxism (Teeth Grinding)

Bruxism can be a serious condition. Kids who grind their teeth are more likely to do it in the first half of the night, when they are less likely to be dreaming.

Teeth Grinding in Babies and Toddlers

Nearly half of all babies grind their teeth. It usually begins at about 10 months old, after the two top front teeth and two bottom front teeth come in. Generally, it’s nothing to worry about and usually goes away on its own without any damage to permanent teeth. After baby teeth are lost, if your child is still grinding, consult with your child’s dentist.


Teeth Grinding in Children and Teens

Children and teens also grind their teeth. Children with disabilities are more likely to grind their teeth, especially children with cerebral palsy and intellectual disabilities. Teeth grinding can cause tooth pain, jaw pain, and headaches. Also, it can wear down teeth.


Treating Bruxism

Nothing needs to be done if a child is grinding teeth once in a while and if it’s not too intense. It is usually nothing to worry about, as long as there is no damage to the teeth and no other symptoms.

 
Delayed Sleep Phase Syndrome

If your child or teen remains awake at least two hours past their usual bedtime because they are unable to fall asleep, it may signal Delayed Sleep Phase Syndrome (DSPS).

Often, it’s hard for someone with DSPS to wake up in the morning. If allowed to sleep until the late morning or early afternoon, your child feels rested and can function well. Many teens with DSPS describe themselves as being at their best in the evening and at night. They tend to “catch up” on their sleep during weekends.


Causes and Symptoms of Delayed Sleep Phase Syndrome

DSPS usually starts during the teen years and affects about 7% (1 out of 15) of teens. While the cause is unknown, sometime after puberty, most teens start staying up later at night and sleeping later in the morning.

Some symptoms may include:
  • Trouble falling asleep at a usual bedtime: Most teens with DSPS fall asleep late at night or in the early morning.
  • Difficulty with awakening in the morning: Since teens fall deeply asleep so late, most have difficulty getting up and ready on time in the morning.
  • Daytime sleepiness: Often teens who fall asleep late at night and awaken early for school suffer from feeling tired and sleepy during
    the day.
  • Other symptoms during the day: Sleepiness during the day and lack of energy may be mistakenly interpreted as depression. In addition, these teens may suffer from poor attention and motivation, sometimes diagnosed as attention deficit disorder.

Diagnosing and Treating DSPS

Keeping a sleep diary for a week gives enough information about when your child goes to sleep and wakes up to make a diagnosis.

Treatment includes resetting your child’s internal clock to establish the habit of being sleepy at a normal bedtime. If your teen isn’t motivated, it’s difficult to change the pattern.

To get back into a more regular schedule:
  • Don’t smoke and avoid caffeine or other stimulating drugs.
  • Limit daytime sleeping to one 15- to 20-minute nap, if any.
  • Go to bed earlier.
  • Gradually move back bedtime by 15 minutes intervals, that is, if your teen is going to bed at midnight, set bedtime at 15 minutes earlier at 11:45 p.m., for one or two nights, then 11:30 p.m. for one or two nights. Continue 15 minutes earlier every two nights, until bedtime is at 10 p.m.
  • Go to bed later: It’s easier for the body to get used to a later bedtime than an earlier one. Using a technique called “phase delay,” bedtime is delayed by 2 to 3 hours each night. For example, if a teenager usually falls asleep at 2 a.m. bedtime is delayed until 4 a.m. one night, 6 a.m. the next night.
  • Melatonin: There is limited evidence to support use of melatonin an hour prior to bedtime and this therapy should be used in consultation with your child’s doctor. Once the desired bedtime is reached, your teen must stick with their schedule every night for several months. Even one night of late night studying or socializing can return the internal clock to the delayed state.
 
Head Banging and Body Rocking

Babies often fall asleep when they are rocked back and forth by adults. Sometimes, babies and children rock themselves to sleep. When these rhythmic movements become intense, it results in head banging and body rocking, and known as “rhythmic movement disorders.” Your child may do this mostly when falling asleep (at naptime or bedtime) and then settle down once asleep.

Should You Worry About Your Child’s Head Banging or Body Rocking?

For most children, this behavior is not a cause for concern and most stop by age 4; however, you may have to watch your child a little closer. Children with other issues such as developmental delay, autism, or blindness may rock or bang their heads more forcefully and hurt themselves; consult your doctor.

Follow these tips:
  • It’s unlikely your child will hurt himself. There is no need to put extra bumpers in the crib or place pillows around it.
  • Be careful not to reinforce the head banging — try not to go to your child every time — you may be accidentally encouraging this behavior.
  • Move the crib or bed — move the crib or bed away from the wall if the noise is disturbing the rest of the family. If your child is in a bed, put guardrails on all sides.
  • Head banging and rocking can loosen the screws and bolts in your child’s crib or bed — tighten these fasteners on a regular basis.
 
Periodic Limb Movement Disorder (Twitching and Jerking at Night)

Periodic Limb Movement Disorder (PLMD) is a repetitive, sometimes intense movement of the limbs — usually the legs — during sleep that typically lasts a few seconds.

Most children and teens are unaware of the movements that feel like a tingling, crawling, creeping pain and look like brief muscle twitches or jerking movements. They tend to occur in groups, and last from a few minutes to a few hours, and can cause your child to awake during the night, which may lead to daytime sleepiness.

Children and teens with PLMD may also experience Restless Leg Syndrome, a related disorder that can happen at night or during times of rest, or on long car rides.


Causes of Periodic Limb Movement Disorder

PLMD may be related to low iron levels in the blood (anemia) or due to chronic illnesses, such as diabetes and kidney disease. However, for most children with PLMD, the cause is not known.

Symptoms may include:
  • leg movements
  • restless sleep
  • sleep disruption
  • daytime sleepiness
  • behavior and academic problems

Diagnosing and Treating Periodic Limb Movement Disorder

Your child’s doctor may order an overnight sleep study or polysomnography, in which you and your child will spend the night in a sleep lab at a hospital or clinic. While your child is sleeping, a sleep technologist will look for movements or wakings.

Treatments may include:
  • avoiding caffeine
  • treatment of iron deficiency
  • medications
Other recommendations may include:
  • keeping your child's room neat, clean and clutter-free
  • using a nightlight or small light within his or her reach which may help your child feel more secure during the night
  • using a quiet fan or humidifier
  • placing favorite items around your child’s bed
  • having a bedside table or shelf stocked with his or her books
  • giving your child notice that bedtime is approaching
  • avoiding activities that may excite your child at bedtime
  • leaving your child’s room after saying goodnight

Naps

The Importance of Naps

Nap. It's a small word, but for most parents a hugely important one. Why? Sleep is a major requirement for good health, and for young kids to get enough of it, some daytime sleep is usually needed. Crucial physical and mental development occurs in early childhood, and naps provide much-needed downtime for growth and rejuvenation.

Naps also help keep kids from becoming overtired, which not only takes a toll on their moods but may also make it harder for them to fall asleep at night. And naptime gives parents a brief oasis during the day and time to tackle household chores or just unwind.

Sleep Needs by Age

There's no one-size-fits-all answer regarding how much daytime sleep kids need. It all depends on the age, the child, and the sleep total during a 24-hour period. For example, one toddler may sleep 13 hours at night with only some daytime catnapping, while another gets 9 hours at night but takes a solid 2-hour nap each afternoon.

Though sleep needs are highly individual, these age-by-age guidelines give an idea of average daily sleep requirements:

Birth to 6 months: Infants require about 16 to 20 total hours of sleep per day. Younger infants tend to sleep on and off around the clock, waking every 2 or 3 hours to eat. As they approach 4 months of age, sleep rhythms become more established. Most babies sleep 10 to 12 hours at night, usually with an interruption for feeding, and average 3 to 5 hours of sleep during the day (usually grouped into two or three naps).

6 to 12 months: Babies this age usually sleep about 11 hours at night, plus two daytime naps totaling 3 to 4 hours. At this age, most infants do not need to wake at night to feed, but may begin to experience separation anxiety, which can contribute to sleep disturbances.

Toddlers (1 to 3 years): Toddlers generally require 10 to 13 hours of sleep, including an afternoon nap of 1 to 3 hours. Young toddlers might still be taking two naps, but naps should not occur too close to bedtime, as they may make it harder for toddlers to fall asleep at night.

Preschoolers (3 to 5 years): Preschoolers average about 10 to 12 hours at night, plus an afternoon nap. Most give up this nap by 5 years of age.

School-age (5 to 12 years): School-age kids need about 10 to 12 hours at night. Some 5-year-olds might still need a nap, and if a regular nap isn't possible, they might need an earlier bedtime.

Signs of Insufficient Sleep

Most parents underestimate the amount of sleep kids need, so be sure to watch your child's behavior for signs of sleep deprivation, which can range from the obvious — like fatigue — to more subtle problems with behavior and schoolwork.

Ask yourself:

  • Does my child act sleepy during the day?
  • Does my child get cranky and irritable in the late afternoon?
  • Is it a battle to get my child out of bed in the morning?
  • Is my child inattentive, impatient, hyperactive, or aggressive?
  • Does my child have trouble focusing on schoolwork and other tasks?

If you answered yes to any of these questions, consider adjusting your child's sleep or nap schedule. It may take several weeks to find a routine that works. Talk to your doctor if you have concerns about your child's sleep.

Naptime Routines and Other Concerns

The key to good napping can be as simple as setting up a good nap routine early on and sticking to it. With infants, watch for cues like fussing and rubbing eyes, then put your baby to bed while sleepy but not yet asleep. This teaches kids how to fall asleep themselves — a skill that only becomes more important as they get older. Soft music, dim lights, or a quiet story or rhyme at bedtime can help ease the transition to sleep and become a source of comfort for your child.

For toddlers and preschoolers, sticking to a naptime schedule can be more challenging. Though many do still love their nap, others don't want to miss out on a minute of the action and will fight sleep even as their eyes are closing. In this case, don't let naptime become a battle — you can't force your child to sleep, but you can insist on some quiet time. Let your child read books or play quietly in his or her room. Parents are often surprised by how quickly quiet time can lead to sleep time — but even if it doesn't, at least your child is getting some much-needed rest. If your child has given up daytime naps, consider adjusting to an earlier bedtime.

Many parents worry that naptime will interfere with kids' bedtime (and if a child takes a late-afternoon nap, this could be the case). But before you end naps entirely in an effort to wear out your child by bedtime, consider this: Well-rested kids are quicker to settle down at night than overtired ones. Overtired kids are often "wired" and restless, unable to self-soothe at bedtime, and more likely to wake through the night.

If you feel your child's late naptime is the cause of bedtime problems, try making the nap a little bit earlier, which may mean waking your child a little earlier in the morning so the nap can begin sooner.

You might also try waking your child from a nap earlier than usual so he or she has a longer active period before bedtime. In other words, try to make some adjustments before abandoning the nap — both you and your child will feel much better if there is one!

Reviewed by: Steven Dowshen, MD
Date reviewed: January 2013