If you ask a kid to take a nap when they’re 5, you might be asking for a fight. If you ask that same kid to take a nap 30 years later, you’re likely to get a thumbs up. Our opinions on many things change as we leave childhood, and sleep is seemingly high on that list. Regardless of how youth may feel about sleep, it is crucial for the adults in their lives to understand its importance to their functioning and how to promote them getting good rest, whether that always tends to go smoothly or not. Today, we’re going to differentiate normal and abnormal sleep habits and patterns in youth, as well as discuss the new PracticeWise sleep target area and resources for those looking to support youth with sleep difficulties.
What is normal sleep for youth?
One of PracticeWise’s consultants, Dr. Janelle Wagner, previously penned an excellent blog post on the importance of sleep for youth. To briefly summarize, a healthy amount of sleep for youth ranges by age—from 14-17 hours daily for young infants, decreasing incrementally across development to about 8-10 hours for adolescents. Besides overall amount, the quality, or restfulness, of sleep is also significant. Unfortunately, a variety of factors, including busy schedules, chronic involvement with electronic devices, and changes in sleep-wake cycles can all increasingly disrupt sleep throughout youth development. Though many of these disturbances may prove temporary or situational, ongoing difficulties in the area of sleep may indicate more pointed reasons for concern.
When should sleep difficulties in youth be a concern?
Sleep doesn’t always have to be perfect, and there is a range in what is considered normal for sleep behavior. That said, there are some specific circumstances that fall outside of range and that may be cause for concern. Here are some clinical sleep disorders that can occur in youth to look out for:
- Insomnia: Most folks are familiar with the term, insomnia, difficulty falling or staying asleep. The Sleep Foundation indicates that about ¼ of youth are affected by insomnia, but they differentiate between behavioral insomnia and conditioned insomnia. Behavioral insomnia is more likely to occur in young children who resist going to bed. Conditioned insomnia looks more like the adult version and is more often observed in teens who develop anxiety associated with bedtime and sleep.
- Sleep Terrors (Night Terrors): Affecting up to 30% of children, night terrors are one of the most common sleep disturbances in youth. However, they can also be quite stressful! Night terrors involve awakening suddenly in an intense state of fear or panic, with physical symptoms like screaming, fast breathing, racing heart, and sweating. The terrors are somewhat mysterious in that children are not typically in the dream phase of sleep, are not easily comforted or calmed, and do not usually have a memory of the episode afterward.
- Sleepwalking (Somnambulism): Sleepwalking consists of rising from bed, walking around, and even performing any complex actions (e.g., getting dressed, brushing teeth, making food) while still asleep or unconscious. About 5% of children may have sleepwalking disorder, which is about three times the rate at which it occurs in adults. Any type of sleepwalking is considered abnormal and can be considered a potential safety risk, warranting prompt evaluation and treatment by a medical provider.
- Restless Legs Syndrome (RLS): RLS involves a painless, but overwhelming impulse to move one’s legs. This issue is not strictly a sleep disorder; however, the urge is known to rise during rest states (i.e., bedtime) and can potentially disrupt sleep. This disorder is thought to affect 2-4% of youth, but it may be underdiagnosed in children due to their difficulty describing their internal experiences or the behavior being dismissed as “wiggliness.”
- Obstructive Sleep Apnea: Although this may commonly be thought of as an adult-only issue, sleep apnea can affect 1-5% of children. Sleep apnea is the result of temporary airway blockages and breathing interruptions in the night, which reduces quality of sleep. This condition can occur secondary to tonsil issues, obesity, or dental conditions in youth.
To complicate the picture somewhat, insomnia, hypersomnia (sleeping too much), and other sleep disturbances don’t all automatically mean a youth has a sleep disorder. These kinds of sleep issues can be symptoms of or associated with other psychological conditions like clinical depression, generalized anxiety, trauma, adjustment issues, ADHD, or autism. They can also result from medications, poor diet, or lack of physical activity. Even if it’s not a direct symptom, poor sleep can also create general risk for poor mental health, creating a chicken-or-the-egg problem. Needless to say, healthy sleep is a foundational pillar for overall health and should be a key priority for those supporting youth mental and behavioral health.
How can PracticeWise support healthy sleep?
Given the high health value of sleep, evidence-based interventions are key for combatting the high prevalence of sleep disorders and difficulties in youth. Luckily, PracticeWise has a new sleep resource in town! As PracticeWise’s newest problem area, Sleep is a broad clinical category, involving trouble with falling asleep, staying asleep, sleep quantity, sleep quality, and sleep timing.
How do PracticeWise’s Sleep target resources help with these concerns?
First, a provider might consult the PracticeWise Evidence-Based Services (PWEBS) tool, which is an online searchable database that allows providers to quickly learn about evidence-based treatments and common practices based on the area of concern (in this instance, Sleep) and a youth’s characteristics. A PWEBS search on Sleep can support providers with treatment planning as they examine the search results for the most common evidence-based strategies.
A provider starting conversations with a family around sleep might consider consulting a guide on Psychoeducation: Health Promotion to provide education to a family on the importance of sleep and basic recommendations for healthy sleep for youth. Moving into working on sleep hygiene for a youth, a provider might consider consulting the Antecedent/Stimulus Control Practice Guide, which would help the family learn to manage the home environment to make it most conducive to sleep (e.g., having a cool, dark room, comfortable bed, solid bedtime routine). The Cognitive: Adapt to Problem guide could also be helpful for youth who have anxiety about sleep or who have trouble shutting off their minds at bedtime. A large variety of other PracticeWise Practice Guides are relevant for successful sleep treatment (e.g., Differential Reinforcement, Goal Setting, Monitoring, Relaxation), and some of these practices also have full video-module distance learning courses for further provider education.
Summary
Good sleep is a universal factor in the health and development of children. There is a range of sleep behavior that may be considered normal and healthy, but there are also behaviors and patterns that fall outside of that range that may warrant behavioral health care. PracticeWise’s new Sleep target area can provide thorough, evidence-based resources and treatment options for providers and families looking to improve youth sleep and long-term well-being.
Further Information
- Learn more about the MAP system.
- Browse the On-Demand library for courses.
- Also consider checking out our past blogs on sleep and the effect of time changes on sleep and routines.
Author Bio: Dr. Taylor Thompson is a licensed psychologist and has provided psychological services to youth, young adults, and families for over 20 years. She completed her PhD in Counseling Psychology and School Psychology at Florida State University. She specializes in treating and assessing ADHD, learning disorders, anxiety, depression, autism spectrum disorders, behavioral disorders, and relational concerns. Dr. Thompson is currently the Assistant Dean of the Office of Student Counseling Services at the Florida State University College of Medicine. Learn more about Dr. Thompson on the PracticeWise team page.
