As summer vacation draws to an end, school children and teens will no longer have the luxury of sleeping late in the morning or napping in the afternoon. Parents, faced with the task of helping their children adjust to a new school schedule, invariably will have questions about the appropriate sleep requirements for their children.  

What is the optimal amount of time for school-age children to sleep? 

  Between the ages of 6 and 12, most children fall asleep fast, sleep soundly and are fully alert throughout their waking hours. The sleep problems of early childhood have usually subsided. Going to bed at an appropriate time, rather than the quality of sleep, often proves to be the major problem with this age group. A child may push back the bedtime hour in order to watch television, read or do homework. Even though there is no set number of hours that children need to sleep, a good rule of thumb is a minimum of eight hours of time in bed.

  Studies show that teen-agers need to sleep an hour longer each day than they did in their pre-teen years. If permitted to sleep as long as they wanted, teenagers would average about nine hours of sleep each night, but they usually sleep one or two hours less. The predictable consequences of this sleep loss are dozing in class and sleeping late on the weekends to catch up. Late hours, a heavy after-school work schedule may be harmful to a teen-ager's sleep. 

How do I get my child to go to bed on school nights?

  While it is a mistake to make children go to bed long before they  are ready for sleep; a sleepy child at school is a cause for concern. Insufficient sleep can make a child irritable and cause them to perform poorly in the classroom. The first step to remedying this problem is to enforce a regular bedtime and awakening schedule seven days a week. If the child is going through a stressful period or time of change, try to discuss worries during the daytime to prevent bedtime worrying from becoming a habit. Ask children to avoid consumption of caffeine within six hours of bedtime.

  Teen-agers may experience delayed sleep phase syndrome which is usually a habit of not going to bed until early morning hours and then having trouble getting out of bed for school. Teens often do well with a weekend "crash" treatment. If they stay up all night on Friday and then stay awake all day on Saturday, they should feel sleepy enough on Saturday night to fall asleep between 9 and 11 p.m. They should then get up on Sunday at the time they would usually awaken for school. From then on, they need to adhere closely to the same bedtimes and wake times seven days a week.

Is sleeping in class a sign of a sleep disorder?

  The most common cause of sleeping in class is insufficient sleep the night before. In addition, medications such as cold or allergy medicines may predispose children to sleepiness. Poor quality sleep can be caused by excessive emotional stress or inadequate treatment of a medical problems, such as asthma. Drugs, including alcohol, disrupt the quality of the sleep cycles. There are primary sleep disorders, however, which may impair the child's daytime level of alertness and performance.

  Children with narcolepsy show sleepiness far beyond that of even mildly sleep-deprived children. Narcoleptic children may fall asleep while talking, eating or even while riding a bike. Attacks of muscle weakness brought on by laughter or excitement can occur. During the early stages, however, children may experience great difficulty in getting up in the morning even with eight or nine hours of sleep. Upon being awakened, they can demonstrate confusion or aggressive behavior. Evaluation in a sleep laboratory can confirm this diagnosis and initiate appropriate treatment with medication.

  Children with Obstructive Sleep Apnea Syndrome (OSAS) usually snore loudly and may complain of morning headaches. Other nighttime symptoms may include difficulty breathing, sweating, persistent bedwetting and disturbed sleep. Excessive daytime sleepiness, which is a hallmark of this condition in adults, is not as prevalent in children. After confirmation of the diagnosis in a sleep laboratory, treatment with adenotonsillectomy (removal of the tonsils and adenoids) is successful in most cases.

Can sleep problems mimic or worsen other common conditions?

  Attention Deficit Hyperactivity Disorder (ADHD) is a condition defined by symptoms of inattention, overarousal, hyperactivity, impulsivity and difficulty in delaying gratification. Sleep disturbances appear to be common in this group of children. Most parents realize that fatigue in children - especially younger children - often leads to over-activity and irritability. Inadequate or poor sleep can mimic, if not worsen, ADHD-like symptoms in children.

  One of the original studies of Obstructive Sleep Apnea Syndrome in children reported a high incidence of impaired school performance, hyperactivity, decreased intellectual functioning and emotional problems in children with this sleep disorder. Most of these children were receiving counseling for ADHD. Recently, in a large study of more than 2,000 children, the children identified as demonstrating behavioral, developmental or academic problems also showed increased signs of disturbed sleep and sleep-related breathing difficulties in the group.

  It is important that sleep disorders, including narcolepsy, insufficient sleep syndrome, schedule disorders, nocturnal seizures and obstructive sleep apnea, be considered and ruled out before labeling a child with ADHD. Treatment and outcomes for these and other sleep disorders may be very different from the prescribed treatment for ADHD.