«Many parents overestimate their child's need for sleep»

Mrs Liamlahi, how are parents who come to the sleep consultation with their children?

Most of them are very tired and many of them suffer a lot.

Because your child wakes up several times a night?

Yes, this is a common issue with young parents. But we also see parents with schoolchildren or teenagers. They are particularly concerned about the issue of falling asleep. Many schoolchildren and teenagers who come to our consultation hours lie awake late at night.

How much sleep does a child need in first grade?

There are average values and recommendations with regard to sleep requirements, but the variability (differences, editor's note) between children is very large. A seven-year-old child needs an average of ten hours ' sleep, but the variability ranges from eight to twelve hours.

Parents often expect short sleepers to get more sleep than they need.

There are children who get by on less than eight hours of sleep, which can also be quite normal, and there are children who need more than twelve hours of sleep. Most of the children we see in our consultation are short sleepers. The problem is that their parents often don't realise this and expect more sleep from their child than they need and can therefore sleep.

For what reason?

In simple terms, sleep behaviour is essentially regulated by two processes. On the one hand by what is known as sleep homeostasis and on the other by the circadian rhythm. Sleep homeostasis describes a process in which the readiness to sleep and sleep pressure steadily increase while we are awake. During sleep, the sleep pressure is then reduced again. The longer we are awake, the greater the sleep pressure, i.e. the more tired we become and the deeper and longer we sleep as a result.

And what about the other process?

The circadian rhythm is a regular, sleep-dependent process and is also known as the internal or biological clock. This is synchronised to our day-night rhythm every day and is influenced by light or brightness as well as social timers such as everyday noises, meals, bedtime or playtime. The individual characteristics of the circadian rhythm determine our chronotype.

If we are the «lark» type, we get up early and well in the morning and are correspondingly tired early in the evening. The opposite is true for the «owl» type. This chronotype is genetically determined. Children have an earlier chronotype and are more likely to be larks.

During puberty, the internal clock changes, the chronotype becomes later and young people become more like owls. From around the age of 20, the chronotype slowly becomes earlier again. Ideally, the internal clock and sleep homeostasis are synchronised. If the sleep pressure is high enough and the circadian wakefulness decreases, we fall asleep well.

What advice do you have for mums and dads whose children don't seem tired in the evening?

Firstly, we ask the parents to fill in a so-called sleep-wake log, in which they record over 14 days when their child is awake, when they go to bed, when and how long they sleep - and also at what times they are awake during the night.

Owls have a hard time in our society, as they are expected to be in a certain place early from the start of school at the latest.

Among other things, we use this information to determine the child's average sleep requirement. Parents are often unaware of this value and send their child to bed too early, with the result that they cannot fall asleep or wake up during the night and do not fall asleep again straight away.

So there would be no problem if parents knew their child's actual sleep needs?

This knowledge often helps a lot. But a regular rhythm and an appropriate evening ritual can also help the child to fall asleep and stay asleep.

How do I find out how much sleep my child needs?

Generally speaking, you can say that a child is getting enough sleep if it is developing well, is fit and rested in the morning and gets through the day without being tired too often. If you want to know exactly, you can keep a sleep log for 14 days. The school holidays are a good time to do this, as you don't have to wake the children during this period.

And what if my child is the chronotype owl, who tends to fall asleep late and doesn't get out of bed in the morning?

Owls have a hard time in our society, as they are expected to be in a certain place at an early time from the start of school at the latest. What helps these children is good sleep hygiene and, above all, a regular rhythm with consistent wake-up times. The more regular the rhythm is, the better the internal clock can adjust to it. Daylight has a supporting effect. Light in the morning helps to inhibit the release of melatonin, which in turn helps to set the internal clock. Melatonin is a sleep-promoting hormone.

In summer, it gets light early in the morning. What do we do in winter?

Of course, it is more difficult without daylight, but if you manage to maintain the rhythm, the children will eventually be tired enough to fall asleep in the evening. It is very important to know that this changeover takes at least 10 to 14 days. So it's worth sticking with it. In the evening, a relaxing evening ritual, where you can read aloud, for example, has a sleep-promoting effect. A ritual makes the evening predictable and provides security. Media consumption or frolicking should be avoided at least 30 minutes before lights out. In the morning, it is important to make it as bright as possible, i.e. open the curtains and switch on the light.

Many parents who have two or more children have to fulfil different sleeping needs, which often leads to conflicts.

If the younger child has to go to bed earlier than the older one, it is usually easier as you can rely on the age difference. If the older child needs more sleep than the younger one, it becomes a little more complicated because the older one doesn't like to go to bed before the younger one. You have to come up with something.

With night terrors, children wake up after one to three hours, cry and scream, but are not really conscious.

One option, for example, would be to wake the younger child a little earlier in the morning and let the older one sleep. It is also problematic if the younger child is awake early in the morning and wakes the older child. In this case, I would also send the nine-year-old to bed with his six-year-old brother at 8 p.m. so that he gets enough sleep.

How does sleep change in the first years of school?

The need for sleep decreases with increasing age, with the difference between a five-year-old and an eight-year-old child being around one hour. At this age, the child makes greater developmental progress in terms of emotional and cognitive maturity. An eight-year-old already has a better understanding of time; for example, they can better understand the duration of actions and are more likely to understand that they should get ready for bed while their father or mother looks after their younger sibling. It is also easier to explain to them that it is getting too cramped in their parents' bed and that you would like them to sleep in their own bed at night. However, how well a child can accept this depends not only on age and cognitive maturity, but also very much on the child's need for security and closeness.

How do I deal with the fact that my child is very challenged at school and often seems tired during the day?

Is the child really tired or does it just seem that way? Does it regularly fall asleep during the day while reading, after lunch, on short car journeys or in front of the TV? If the child actually falls asleep frequently in such situations, this is known as daytime sleepiness. In this case, the child probably needs more or better sleep than it is getting. If the child has enough opportunity to sleep and still shows daytime sleepiness, you should consult a paediatrician to see if there are any physical causes for disturbed sleep.

If your child does not fall asleep on such occasions and still seems tired, this may not be related to sleep at all. Here too, it is worth consulting the paediatrician to rule out the possibility that a physical illness is the cause of the increased tiredness. If the child is healthy but still tired, parents should ask themselves the following questions: How is my child? Is he or she over- or underchallenged? Do his or her personal capabilities and the daily routine at school match? Do they perhaps need more breaks in their free time?

What are the so-called parasomnias all about?

First of all, according to the international classification, a total of seven categories of sleep disorders can be distinguished. It is typical of a sleep disorder that sleep is impaired in some way. By far the most common sleep problems in children and adolescents are difficulties falling asleep and staying asleep. Parasomnias, in which behavioural abnormalities occur during deep sleep, are also common in children and adolescents.

Do you have an example?

The most common parasomnia that parents of pre-school and school-age children present to our consultation is night terrors. Typically, children fall asleep and then wake up one to three hours after falling asleep, crying, screaming and appearing frightened. Their eyes are open, but they are not really conscious. After about five to ten minutes, the children suddenly go back to sleep and can't remember anything in the morning. It is particularly stressful for the parents as they are worried.

What can parents do?

Here too, it helps to establish a regular rhythm and it is important to make sure that the child gets enough sleep. If the child is sleep-deprived, the deep sleep phases are longer and «deeper», which increases the risk of night terrors. It also occurs more often when the child is ill or upset, for example before their birthday. This sleep disorder usually progresses.

Sleepwalking often occurs in schoolchildren. The children wander around the home and can do very complex things, such as going to the toilet. However, they are not really conscious. Their eyes are open and you can talk to them, but there is no real dialogue. Sleepwalking also usually occurs one to three hours after falling asleep, during the deep sleep phase. You should not try to wake the children, but remain calm and wait until the night terror or sleepwalking is over.

Your mental state certainly also has an influence on the quality of your sleep.

That is correct. There are psychiatric illnesses that are associated with sleep disorders, including depression in particular. It is important that we look at the different areas of a child's life in sleep counselling. What stress factors can play a role? How is the child doing at school and at home? In some cases, it is advisable to initiate a physical examination, for example in a sleep laboratory.

When children reach puberty, their sleep changes. They then become late sleepers. What is this related to?

Late risers is not the right term, as young people do not sleep more hours than they used to, but go to bed later and therefore struggle to get up in the morning. There are two main processes responsible for this. While sleep pressure increased quite steeply during the course of the day in childhood, this increase slows down in later years. This means that it takes longer for teenagers to feel high sleep pressure and become tired.

Secondly, the internal clock changes. Young people become more «euliger». This is not so dramatic for young people who were larks as children. For adolescents who were owls as children, however, it becomes difficult. Due to the shift in their internal clock and the slow increase in sleep pressure, adolescents are fit when they should actually be asleep and then only fall asleep far too late.

And then have a problem in the morning.

Yes, for the simple reason that their need for sleep is not reduced. This does decrease over time, but not so much that this deficit would be compensated for. In addition to these biological changes, there is also the decreasing influence of parents on bedtime in the evening. Teenagers tend to orientate themselves more towards their friends or peers, which is also important.

Young people are not lazy and comfortable, as is often assumed, but chronically overtired.

They are physically active in the evening or busy with digital media, perhaps they still have to study and the blue screen light also suppresses the release of melatonin. And so many teenagers are not lazy and comfortable, as is often assumed, but chronically overtired, as the biological and social changes during puberty make it difficult for them to fall asleep on time.

Why is it important for teenagers to get enough sleep?

Getting enough and good sleep is important at any age, as it plays a significant role in our mental and physical health. In addition, children and adolescents are developing and a lot is happening in the brain. Brain activity during deep sleep is linked to brain maturation and learning processes. It is important to get enough sleep so that what has been learnt sticks in the brain and is consolidated in the long term. And in general, we can say that a chronic sleep deficit makes us less receptive and therefore less efficient. We also act more impulsively and no longer assess risks well.

So how can you support your teenager?

Parents can hardly influence school start times, so the options are rather limited. It is important that the young people themselves are motivated and want to change something. One important point would be to maintain a regular rhythm with regular wake-up times, letting plenty of light into the room in the morning and ensuring good sleep hygiene - getting enough exercise during the day, being out in the fresh air, no more caffeinated drinks from midday, a relaxing evening ritual, only going to bed when you are tired, a cool, dark bedroom.

This also includes not taking electronic devices into the bedroom when you go to bed. You should start doing this at an early age and also practise it as a mother or father. It's also good for us adults if we don't use our mobile phones as an alarm clock and quickly check something or messages before switching off the lights.

There are now blue light filters.

As far as the effect of light is concerned, such filters help, but there is a great risk that messages or chat histories will keep us busy again and prevent us from falling asleep. It would be better to designate a place in the hallway or living room where we leave our mobile phones and other digital devices when we go to bed and buy an alarm clock.