Sleep! Little child! Sleep!

Tired full-time: everyone who shares their life with one or more children is familiar with this condition. In the beginning, it is the equinox that drains all parental energy. Later, it's a developmental leap that has to be dealt with at night. The dark monsters that creep into the little ones' dreams. Or the first day at nursery or the fear of school.

Sleep disorders are nightmares for parents and children, which both suffer from time and again. The result: the child sleeps in the parents' bed. The parents on the edge of the parents' bed, whispering the mantra of all sleep-deprived parents: «It's a phase. Just a phase.»

But for some children, this phase takes a long, very long time. Take Sina, for example. Her mum Doris recalls that the nine-year-old practically never slept during the day or at night from birth. Ten times between 10 p.m. and 6 a.m. it was time for mum to sound the alarm! After a year, the intervals became longer. But her daughter still needs to be close to her parents from time to time.

These fragmented nights endured over the years were not without consequences. «My sleep is no longer what it used to be. When I wake up in the night, I find it difficult to fall asleep again,» explains Sina's mum.

There is no such thing as normal sleep behaviour, says the sleep researcher.

Sleep is essential and vital. Yet science has still not discovered why we sleep. Nevertheless, we do know: Humans need to sleep. Attempts to break sleep records have ended in breakdowns or psychoses.

There are many explanations as to why sleep is essential. Sleep serves physical recovery, memory formation, learning and because our sensory functions are limited at night anyway. One popular scientific approach that has yet to be proven is that of brain development.

Why sleep and brain maturity are connected

Because a child is constantly learning and its brain development is in continuous operation, it should also sleep a lot. That's what most parents think. However, it is problematic to derive a specific duration from the need for sleep. This is because the need for sleep varies greatly between children of the same age. There are big sleepers and little sleepers, those who recover quickly and others who need a long sleep phase to get back on their feet.

Every child therefore needs an individual number of hours of sleep. Being able to recognise this in the context of the respective phase of life and development: this is the real challenge of a parent's life. How much sleep does my child need? How much is normal? And when is something no longer normal?

Developmental paediatrician Peter Hunkeler from the Sleep Centre at the Children's Hospital in Zurich has a comforting answer for parents. He says: «There is no such thing as normal sleep behaviour.» In children of the same age, the difference can be up to 6 hours. However, knowledge of the normal development of children's sleep is helpful for parents so that they can better understand their child's sleep behaviour, says the paediatrician.

«Children are not just small adults who sleep a little longer, but otherwise do not differ from adults in their sleeping behaviour,» says Hunkeler. Children sleep differently. They first have to learn how to sleep and, above all, how to sleep through the night: the structure of sleep always reflects the maturation process of the brain.

Mysterious sleep

Sleep is a complicated organism. In newborns, a sleep cycle lasts only one hour. The older children get, the less sleep they need. As with adults, how much can vary greatly. Two-year-olds need 10 to 16 hours a day, ten-year-olds only 8 to 12 hours and teenagers 9 to 10.

Sleep itself consists largely of light dream sleep and only a small part of deep sleep. After the deep sleep phase, we wake up after around 60 minutes to experience a lighter dream sleep, known as REM (rapid eye movement) sleep, for around 20 minutes at the end of the cycle. The eyes move rapidly during this phase. The brain is then active in a similar way to when we are awake, we twitch in our sleep, breathe irregularly and are more easily woken up. REM sleep is then replaced by deep sleep. The closer we get to the morning, the shorter deep sleep lasts.

20 to 30 per cent of all children under the age of 6 have sleep disorders.

The younger the child, the longer the REM phases last, in which the child breathes irregularly, the face grimaces and the arms and legs twitch. This is why young children in particular wake up again and again, sometimes every hour, like Sina: she has not yet learnt to fall asleep again between sleep cycles, as older children and adults have learnt to do.

The older a child gets, the more it learns about sleep. The difference between day and night, for example, that there is life during the day and rest at night. However, how the brain develops also depends on the individual.

At the age of 24, when the brain is fully mature, a sleep cycle lasts around 90 minutes. Lighter phases of dream sleep alternate with phases of deeper sleep. Then a new cycle begins. When we fall asleep at the beginning of the night, we quickly sink into a deep rest from which we are difficult to wake: The muscles are relaxed and the frequency of brain waves decreases the deeper we sleep.

Night-time caravans are totally normal

Many children have developed their own sleep rhythm at some point. However, there are also children who have difficulties establishing their own rhythm. For them, the Sandman fails and parents become restless. According to modern sleep medicine, they have no reason to be.

There are many reasons why a child wakes up at night (even though they may have always slept soundly before). «Only in the rarest of cases is there a developmental disorder behind it,» says paediatrician Peter Hunkeler. The figures prove it.

Almost all children are familiar with sleep disorders. 20 to 30 per cent of all children under the age of 6 have difficulty falling asleep or staying asleep. 10 per cent of children between the ages of 6 and 12 and 15 to 20 per cent of adolescents complain of difficulties falling asleep or waking up at night.

Certainly, the doctor's statement is reassuring. Nevertheless, a child who regularly comes tapping in the night and later lies hard-boned and panting in the parents' bed can be a real pain in the arse. Lack of sleep is known to turn even the most loving parents into zombies - developmental phase or not, mantra or not.

Although this can affect the whole family, these behavioural disorders are not harmful to the child and do not require extensive medical clarification, say the doctors. An informative discussion and personal counselling are often sufficient, says Hunkeler.

This is because a child can only sleep as much as its personal needs. If they have to spend more time in bed, they may have trouble falling asleep or staying asleep, depending on their age.

Disorders occurring during sleep

A common version is the so-called awakening disorder. This is an incomplete awakening from deep sleep. They typically occur in the first few hours after falling asleep and are frequent and harmless sleep phenomena in toddlers and school-age children. They often run in families.

Waking disorders include pavor nocturnus, the so-called night terrors in infants, and sleepwalking in school-age children. Night terrors occur in around 5 per cent of all children, usually starting at the age of 2 to 3 and becoming more frequent around the age of 6 to 7. During night terrors, the child is beside themselves, screaming and sweating; they are unresponsive and cannot be woken up. The episode is over after five minutes, the child falls asleep again immediately and does not remember it the next morning.

When sleepwalking, children are quiet but suddenly get up and walk around. They can open doors and even windows. In both cases, paediatricians advise parents to be with their child, but not to wake them up and protect them from injuries or unsecured doors.

Anxiety dreams are also known as waking disorders. They occur in the second half of the night and during REM sleep. The child is awake, cries or screams and calls for the parents because it wants to be comforted. The trigger is an anxiety dream, which the child also remembers.

Nine-year-old Sina knows them too: «When I have bad dreams, I dream about robbers or burglars,» she says. Then she goes to bed with mum and dad. Everything is fine there.

Sleep disorders with an organic cause

There are also numerous sleep disorders that also affect children, but which are far rarer than the forms described above. Obstructive sleep apnoea syndrome (OSAS), for example, is one of these. It is a breathing disorder during sleep that is caused by a narrowing of the upper airways. Affected children snore, have repeated pauses in breathing, sweat and sleep restlessly. Around 10 per cent of all children snore in their sleep, but only 1 per cent of them have sleep apnoea syndrome.

Accompanying symptoms can be daytime tiredness or hyperactivity. The pauses in breathing can lead to a lack of oxygen with effects on the brain and heart. OSAS is therefore diagnosed in the sleep laboratory using monitoring equipment.

Another very rare disorder - only 0.1 per cent of the population is affected - is narcolepsy. Narcoleptic children can suddenly fall asleep while talking, eating or even on a bicycle.

The duration of such sleep attacks ranges from a few seconds to half an hour. In the early stages of narcolepsy, children often have enormous difficulty getting out of bed in the morning. Shortly after getting up, they are confused, aggressive and easily become abusive.

«It is very important to recognise narcolepsy at an early stage, as daytime sleepiness can severely impair performance at school and teachers and pupils often misinterpret the symptoms as laziness and listlessness if they are not informed,» says Peter Hunkeler. If the (school) child complains of being very tired during the day, needs an afternoon nap after school or repeatedly falls asleep while reading or watching television, it may be a case of daytime sleepiness.

Daytime sleepiness can have many causes, such as inadequate sleep hygiene, neurological and psychiatric disorders, sleep-related breathing disorders or the intake of certain medications. If the child does not get enough restful sleep, this can result in mood swings, attention and memory disorders as well as an impairment of complex and creative thought processes.

Teenagers in particular are familiar with delayed sleep phase syndrome . They complain that they can only fall asleep shortly before midnight and have great difficulty getting up in time for school. This also causes problems for parents, who often complain that they literally have to drag their child out of bed every morning. This syndrome need not be a cause for concern.

It is important for parents to know that the sleep-inducing melatonin is released later in adolescents than in children before puberty. This is why teenagers can only fall asleep around 10 p.m. or later. «For many teenagers, a radical cure works for one or two weeks,» says Peter Hunkeler.

During this so-called sleep restriction, the teenager sleeps so little that he is so tired on Friday evening, for example, that he falls asleep by himself, usually before midnight. On Sunday, he should then get up or be woken up at the usual time on school days. But here too, according to Hunkeler, it is important to bear in mind the variability of sleep duration. A 16-year-old needs between 6.5 and 9.5 hours of sleep per night. This means that a short sleeper cannot be sent to bed at 10 p.m. because he would otherwise wake up too early.

Most sleep disorders can be successfully treated.

From now on, the sleep-wake times should be adhered to regularly - including at weekends. According to the sleep expert, a daily structure with fixed times set by the parents helps this teenager to adjust their internal clock.

Lark or owl?

And then there are the larks and the owls. Leon (11) is one of these morning children. Even as a baby, getting up at 6 a.m. was no problem for him. A typical morning child who has his best time before midday. Even at sleepover parties, he is the first to get up in the morning.

He simply can't help it - and doesn't mind: «I get much more out of the day that way,» he says. He would like to sleep longer in the morning because his colleagues do the same, he admits. «But it's not that easy.»

His schoolmate Lisa and her little sister Sina are the complete opposite. Both like to turn night into day. Even the seven-year-old rarely goes to bed before half past nine, says her mum Brigitte. «She's a total night owl.» A child who only gets tired later in the evening, for example, should not be put to bed at 7 p.m., according to a new study on sleep physiology by the Children's Hospital in Zurich.

In general, she has children who don't care about sleep at all. «After almost eleven years, I've got used to it,» says Brigitte laconically. But the sentence was particularly bad: «What, your child still doesn't sleep through the night?» You can really get a mum down with that.

Paediatrician Peter Hunkeler agrees. In times in which even small children are increasingly standardised, in which they are expected to develop in a very specific direction, sleep development is becoming even more important. «The social expectation that a child should be sleeping alone and through the night by six months at the latest puts a lot of pressure on many parents,» he says.

The doctor's final advice: listen more to your instincts. Read fewer advice books. And to have a calm saying at the ready when one of the many parental bluffs is heard in the playground, on too small chairs at parents' evening or at dinner with friends.

After all, the unrestrained urge to test (usually female) strength with the growing child does not stop when the child is 1.90 metres tall and has door-wide shoulders.

Tips against sleep problems for children aged between 6 and 12

Children of this age generally fall asleep quickly and effortlessly, have a healthy sleep and are awake and well-rested during the day. Sleep problems at this age manifest themselves more in bedtimes than in sleep itself. Some children like to postpone bedtime in order to watch television, read or do homework. There is no universal optimum sleep time, i.e. some children - just like adults - need less sleep than others. It is wrong to send children to bed when they are not the least bit tired. However, a tired child is a cause for concern.

Tips for teenagers (sleep hygiene)

• Verzichte auf Nikotin und geh erst zu Bett, wenn du dich müde fühlst.
• Körperliche Anstrengungen, Mahlzeiten und Koffeinkonsum sollten zwei Stunden vor dem Zubettgehen vermieden werden, weil sie das Einschlafen erschweren können.
• Widme dich vor dem Schlafengehen einer ruhigen Tätigkeit und verzichte auf Radio, Fernsehen, Computer und Telefon.
• Im Schlafzimmer sollte es nachts dunkel sein; auf der Toilette nur gedämpftes Licht verwenden.
• Versuche, immer zur gleichen Zeit aufzustehen – auch am Wochenende.

Read more about sleep:

• Sollen Kinder bei Ihren Eltern schlafen? Das Familienbett ist umstritten.
• Die vier grössten Mythen zum Thema Schlaf
• Kann mein Kind denn zu wenig schlafen? Fragen an den Schlafforscher
• Ist das Handy Schuld an den Schlafstörungen?
• Teenager brauchen genau so viel Schlaf wie Kinder