What to do if the child can't sleep well?

Anyone who has slept little or even pulled an all-nighter knows exactly what is missing the next day: concentration, energy, spontaneity and a good mood. In addition, the ability to absorb and react is in the cellar. Instead, the appetite for sweet and unhealthy foods increases and the body craves to finally get what it has been deprived of - sleep.

«Sleep is essential for the survival of humans and animals - even more important than food,» says Albrecht Vorster, neuroscientist, author and head of the Swiss Sleep House at Inselspital in Bern. «If we don't sleep for three weeks, we die - we can actually last longer without food.»

During sleep, space is made in the brain to absorb and categorise new information.

Albrecht Vorster, neuroscientist

According to the neuroscientist, the reason why it is so important for us to get enough sleep is that we have a nervous system. Nervous systems are designed to constantly adapt to the environment by building new nerve connections, i.e. learning.

However, the space in the head is limited by the bony skull. In order to continue to function properly despite the constant build-up processes of neural pathways, corresponding degradation, remodelling and integration processes must therefore take place elsewhere in the brain. And this happens primarily during sleep.

«During sleep, protein residues are flushed out of the intercellular spaces and the brain is virtually cleansed,» says Albrecht Vorster. «In addition, nerve connections, i.e. synapses that are not being used, are «cut back» so that new learning is possible again in the first place.» In addition, what is learnt is placed in the existing knowledge context.

Sufficient sleep is important

A complex process that explains why sufficient sleep is so important, especially during childhood and adolescence, when the brain is still developing rapidly. «Brain development is not actually complete until the age of 25,» says Vorster. «If children and adolescents sleep poorly or too little during this sensitive phase, this has a demonstrably negative effect on their learning and memory performance.»

This is because during sleep, especially in the deep sleep phases, experiences and new information are transferred from the short-term memory to the long-term memory of the brain, compared with existing knowledge and then consolidated. This means that they can be retained for longer and can be recalled more easily later. If sleep is too short or is disturbed - for example by regular snoring - this has a negative impact on cognitive abilities.

So it's no wonder that sleep is a big issue in everyday family life - especially as sleep problems are common. According to the German Federal Statistical Office, around 30 per cent of German eleven-year-olds sleep badly at least once a week, and this figure rises to 39 per cent among fifteen-year-olds.

Experts estimate the figures for Switzerland to be similar. If children are unable to sleep well over a longer period of time, parents worry about their children's ability to concentrate, their school performance and their physical and mental health. But how do sleep problems arise in childhood and adolescence and how can parents promote healthy sleep? This dossier aims to get to the bottom of these and other questions.

Of larks and owls

First of all, sleep is extremely important for our mental and physical health. But why is it sometimes so difficult to get to sleep? «Good sleep needs three main ingredients, all three of which have to work together - not just one or two. That's often the problem,» says Albrecht Vorster.

Firstly, there must be sufficient sleep pressure. Sleep pressure builds up over the length of time you are awake. This means that the longer you are awake, the greater the sleepiness. However, if sleep is taken during the day, for example an afternoon nap, the need for sleep is reduced again according to the length of the nap - and may then be absent in the evening.

Good sleep needs three things: enough sleep pressure, the right time and relaxation.

Albrecht Vorster, neuroscientist

The second ingredient that plays a major role can be summarised as the right time. «We humans are natural night sleepers and have an internal clock that is genetically programmed a little differently for everyone, similar to hair colour or body size,» explains sleep expert Vorster.

«In this context, we also talk about the so-called chronotype, which is roughly divided into early and late types, also known as larks and owls.» While early types are naturally alert in the morning and soon become tired in the evening, the opposite is true for late types. They are active in the evening but find it difficult to get out of bed early in the morning. «The same applies to the length of sleep. There are long and short sleepers who need more or less sleep in order to feel rested afterwards,» adds the neuroscientist. «Both are normal.»

Two big sleep-brakers

The third ingredient for sleep can be summarised under the heading of relaxation. Or to put it another way: stress and worry are poison for sleep. This is because stress activates the sympathetic nervous system and thus the release of stress hormones such as cortisol and adrenaline.

This increases blood pressure, heart rate and muscle tension. In addition, the production of the dark hormone melatonin, also known colloquially as the sleep hormone, is hindered and the sleep rhythm is altered as a result. Worrying and brooding also increase brain activity, which makes it difficult to switch off, let go and relax, which is necessary for sleep.

We only speak of a problem falling asleep if it takes significantly longer than 15 to 30 minutes.

Rabia Liamlahi, paediatrician

Of course, other factors also play a role, such as light and darkness, a regular sleep routine with reliable sleep rituals that always follow the same pattern. According to sleep scientist Albrecht Vorster, this is a particularly effective way of signalling to the body that it is time to sleep.

It is usually difficult to fall asleep

This is also confirmed by Rabia Liamlahi, a specialist in paediatrics and adolescent medicine and senior consultant in developmental paediatrics. She advises parents of sleep-challenged children from babies to teenagers at the University Children's Hospital Zurich's sleep clinic. «It's usually falling asleep that causes problems for children in primary school,» says Rabia Liamlahi.

However, we only speak of a problem falling asleep if it takes significantly longer than 15 to 30 minutes. According to the doctor, the body needs this long to shut down. The use of electronic media such as mobile phones, games consoles and PCs, acute worries, conflicts in the family, fears about an upcoming test, but also joyful excitement, for example because of an upcoming birthday, can keep children awake for an excessively long time.

«If this only happens from time to time, it's understandable and to a certain extent normal,» says Liamlahi. In such cases, it is important to always take the child seriously, to comfort and reassure them, to solve problems as far as possible and to regulate the use of mobile phones and PCs well.

But what if there is no obvious reason for the sleep problem? What if everything is going well at school, the games console or iPad have long since been put away and the child simply can't get to sleep despite a quiet evening?

Sleep pressure must be high enough

«The reason often lies in the lack of pressure to sleep, when the child is told to go to bed even though it is not yet tired enough,» says paediatrician Liamlahi. «This is because the individual need for sleep is distributed very differently across the population - and can vary greatly even between siblings.»

In fact, children's need for sleep decreases as they get older. While first-graders still need an average of eleven hours of sleep, twelve-year-olds manage on average with around nine hours. However, these are only average values. The actual amount of sleep needed by individuals can vary greatly, even among children of the same age.

Sending a short-sleeper child to bed too early is counterproductive.

Rabia Liamlahi, paediatrician

According to the Zurich Longitudinal Studies, the long-term studies conducted by the University Children's Hospital Zurich, the natural sleep requirement of six-year-olds ranges from just nine hours for short sleepers to twelve and a half or even thirteen hours for long sleepers. At the age of ten, the range is between eight and a half and eleven hours per night. At the age of twelve, it is still between eight and ten and a half hours. And there are always children who need even less sleep. «But many parents don't even realise this. They base their bedtimes on average values, general recommendations or even their siblings,» says Liamlahi.

However, if a six-year-old child who is a short sleeper is put to bed at 7 p.m. and is expected to sleep until 7 a.m., they have to lie awake for several hours until the sleep pressure is high enough for them to fall asleep. This is very stressful for the child and usually leads to conflicts in the family in the long term.

If sleep problems persist for months and increasingly put a strain on family peace, the sleep expert advises seeking professional help in good time so that targeted countermeasures can be taken.

A good first point of contact for sleep problems is the paediatrician. They usually know the child and the family well. There are also special regional sleep consultations for children, to which the paediatrician refers children or which parents can contact directly.

Organic causes

In addition to the chronotype, developmental disorders, attention deficit hyperactivity disorder (ADHD) or depression can also be responsible for sleep problems. Organic causes must also be taken into account during an examination.

Among other things, the doctors check the child's weight. This is because children who are very overweight have a higher risk of sleep breathing disorders. They also look in the mouth, as malpositioned jaws or enlarged palatine and pharyngeal tonsils can impair breathing during sleep.

«In sleep medicine, there are around 100 different sleep disorders. Some of them have a clear organic cause,» says Bigna Bölsterli. She is a neurologist and head of paediatric sleep medicine at the Eastern Switzerland Children's Hospital in St. Gallen.

In contrast to adults, children who have over-napped can get very hyper, are fidgety, nervous and unfocussed.

Bigna Bölsterli, neurologist

For example, doctor Bölsterli observes sleep breathing disorders such as obstructive sleep apnoea in schoolchildren. In children, it is important that the palatine and pharyngeal tonsils are large and continue to grow in the first few years before slowly becoming smaller at primary school age. Heavily overweight children are also affected, says Bölsterli.

«These children can often be heard snoring and breathing interruptions can occur, which is associated with a deterioration in sleep quality, corresponding daytime sleepiness as well as learning and concentration problems.» Depending on the cause and severity of the sleep breathing disorder, it may be necessary to remove the tonsils or reduce weight in the case of obesity.

What a lack of sleep does to children

Restless legs syndrome, which is comparatively common in adults, can also occur in childhood. «Around 3 per cent of children feel pulling, tugging, tingling and an urge to move their legs, especially in the evening when they are resting, which makes it difficult for them to fall asleep and leaves them tired and unable to concentrate during the day,» says Albrecht Vorster. «This sleep disorder can actually be treated well. Unfortunately, it still often goes unrecognised in children and is sometimes confused with ADHD.»

This is because children react very differently to too little or poor sleep than adults. «While tired adults are mainly listless, slow and sleepy during the day, children who have slept too much can become very hyper. They are then fidgety, nervous, restless and unfocussed at school. This can look like ADHD to the outside world,» confirms Bigna Bölsterli.

When the night terror comes

According to Bölsterli, another typical sleep disorder in children is the so-called night terrors, also known as pavor nocturnus. This occurs mainly in toddlers up to early primary school age. It is an extremely worrying disorder for parents, but in itself harmless and usually temporary. It occurs more frequently in families and is probably related to brain maturation.

«Affected children wake up very frightened, usually screaming from a deep sleep. They sweat, tremble, are not really responsive and cannot be calmed down,» reports Bölsterli. «After around 10 to 15 minutes, they fall asleep again and usually have no recollection of it the next morning.»

Parents often misjudge their child's need for sleep.

Bigna Bölsterli, neurologist

This sleep disorder is caused by a combination of deep sleep and an internal or external wake-up stimulus. This can be, for example, a loud noise or discomfort caused by a feverish infection. During night terrors, only one part of the brain is awakened, particularly the part responsible for emotions. The conscious mind, which categorises and regulates emotions, remains in deep sleep.

Night terrors become less frequent with increasing age. However, it can return in the form of sleepwalking - even in children who have already had a night terror. «This is because sleepwalking is basically the same faulty mechanism, with the motor centre awakening in isolation rather than the emotional centre,» explains the sleep expert. It is important to protect affected children from possible accidents during sleepwalking. As the brain matures, however, this phenomenon also develops in many cases.

Sleep cannot be forced

However, by far the most common reason why parents with primary school-aged children visit a sleep clinic is difficulty falling asleep. «Depending on how narrowly you define the criteria, around 10 to 20 per cent of this age group are affected,» says Bölsterli. «A lack of sleep hygiene, i.e. behaviour that promotes healthy, restful sleep, and school stress do play a role here. In very many cases, however, we also see that parents' false expectations about the amount of sleep their child needs are responsible for the sleep disorders.»

The pressure of having to fall asleep, but not being able to, eventually leads to affected children developing a fear of going to bed.

Bigna Bölsterli, neurologist

Children who lie in bed for longer than their sleep needs or are sent to bed too early, contrary to their chronotype, simply cannot fall asleep. Even if they try very hard. On the contrary: a real vicious circle develops in the long term.

«This is because the pressure of having to fall asleep but not being able to does eventually lead to children no longer trusting themselves to fall asleep naturally. They develop a fear of going to bed, which then prevents them from falling asleep again,» emphasises the sleep doctor. «This can cause the sleep disorder to become chronic.»

The natural sleep rhythm

In order to get a precise picture of the sleep problem and the actual need for sleep, the sleep doctors work with a so-called sleep log. For 14 days, parents should record when the child goes to bed, when it actually sleeps, when it wakes up, how long it is awake and when it eats meals. «We often recognise children who are short sleepers when we evaluate the log. They need comparatively little sleep and should be sent to bed later,» says Bigna Bölsterli.

However, this measure alone is often no longer sufficient. Especially if the problem has existed for some time. In many cases, the children have to learn to fall asleep again. «This usually takes several weeks, during which those affected should consistently go to bed and get up at the same time every day according to the same sleep ritual and, if possible, eat their meals at the same time,» says the sleep expert.

«In persistent cases, we also recommend temporarily shortening bedtime even further to increase sleep pressure even more.» Because when they are extremely tired, these children also manage to fall asleep. As a result, they gradually regain confidence in their ability to fall asleep.

Before it gets that far, however, parents have many ways to help their children fall asleep: a quiet atmosphere before bedtime, no more digital media, no heavy meals, no frolicking and keeping a close eye on the child. And ask yourself honestly: Are they really tired? Or do I just mean that they need to go to bed so that they can perform well at school the next day?