Psychology Examines Sleeping Problems in Australian Children

Psychology Examines Sleeping Problems in Australian Children

The 27th International Congress of Applied Psychology (ICAP) recently looked at the main factors that affect Australian children's sleep and presented psychological solutions to assist children in get a good night's sleep.

Psychologists from the University of South Australia and members of the Australasian Sleep Association, Associate Professor Kurt Lushington and Dr Sarah Blunden looked at normal and abnormal sleep in children and highlighted the effects of sleeping problems on children of different ages, from infants to teens.

Interview with Dr. Sarah Blunden

Dr. Sarah Blunden is a Private Consultant in children's sleep who has her own business as well as working as a Pediatric research fellow at the University of South Australia. Dr. Sarah Blunden wears two hats: she has the clinician role as a Psychologist for children's sleep disorders and she also researches them at the same time. "It is really hard work, because they are both full time jobs but it is really great to be able to marriage the two in together. I can research problems and then I understand that, that is what it means when I see a child, who has that particular problem," explained Dr. Sarah Blunden. For more information please see: www.sleepeducation.net.au

What are the main factors that are affecting children's sleep?

Dr. Sarah Blunden: In general, the things that affect people sleep can be divided into three areas:
Physiological: that can include snoring, sleep apnea, periodic limp movement disorder, nightmares, night terrors etc;
Psychological: particularly for young children: bed time reluctant, fear of the dark, bed time anxiety, inability to sleep alone etc;
and Environmental.


Can you explain what both normal and abnormal sleep in children?

Dr. Sarah Blunden: We know what normal sleep is and that we need to have the correct quantity and quality of sleep and per age we need to have a certain amount of sleep and it is best if we get that sleep in one consolidated block, once we have stopped napping, as a child.

We also need to have a correct percentage of the different stages of sleep to be considered normal sleep. This includes REM (Rapid Eye Movement Sleep) and NREM (Non-Rapid Eye Movement Sleep). Normal sleep consists of the correct quantity and correct quality and anything that doesn't sit into this pattern, can become abnormal. Most kids go through some transient sleep problem throughout their life; it is a question of whether or not it becomes a problem. What makes it a problem is four things:
How often it happens: so if the child has a nightmare every night
How severe is the problem: if they having a night terror, how bad is it?
The affect on the child: are they sleepy, are they getting poor sleep and therefore showing signs of tiredness in the day?
The affect on the family: how exhausted is everybody?


What is the difference between a nightmare and a night terror?

Dr. Sarah Blunden: Nightmares are dreams, they are in REM sleep and kids are able to remember them in the day, so they wake up and say "I was being chased by a monster" when they remember them, it frightens them. We think that dreaming is to do with learning, that we are putting bits of information into little boxes in our brain, to try and make sense of it. Whereas night terrors are not dreams, we are not awake, we are not asleep, we are half way between both, we can't remember them the next day and they're not real. Night terrors only happen in deep sleep and REM sleep is not deep sleep.


How does snoring affect children?

Dr. Sarah Blunden: Snoring is the sound of air trying to get through to the upper airways; it vibrates with the energy or the effort that it takes to get the air through the airways. If the air is having trouble getting through then oxygen is having trouble getting through, a child who snores, whether they have a blocked airway or an airway that partially closes up overnight, which is sleep aperna, then the oxygen doesn't get through to the brain and the body has a defense mechanism that wakes it up. If you are a snorer and that is a problematic snore, in other words you have oxygen problems, you body will wake up all the time, throughout the night, to try and keep yourself okay, which means you have seriously disrupted sleep. You have oxygen depletion which means there might be oxygen problems with the development of the brain, in serve circumstances. We don't know if this is long-term or yet on top of this you have the sleep disruption which is a double whammy.


What are the solutions for the sleeping problems?

Dr. Sarah Blunden: At first you need to find out what kind of sleep problem it is: physiological, psychological or environmental, if it is a physiological problem like snoring you need go to a respiratory physician. Unfortunately the first call for children for a bad snore is to have their tonsils and adenoids out, as it is often because of their over proportion, that they snore, because they are blocked at the back of the airways.

If it is night terrors they can be treated with what is called Digital Wakening, the idea is that you wake up the child before it happens, you need to understand what the timing of the terrors is.

For psychological if it is anxiety related then you treat the anxiety and therefore see a psychologist, such as myself. If it is bedtime reluctance then it is a behavioural management program of encouraging your child to go to sleep and helping parents set guidelines.
If it is an environmental problem, such as a child is watching too much TV or drinking too much coffee, then it is a question of organising good sleep routines and habits.


Research has shown that 16% of adolescents stay up till after 2am. How can we encourage our teenagers to get sufficient sleep on school nights? Is this an environmental problem?

Dr. Sarah Blunden: Yes, it is a bit of both actually; interestingly adolescents have a double problem. We fall asleep because our body has an internal mechanism that makes it sleepy; one of them is the innate sleep/wake cycle. I go to bed about 10pm, so my body gets ready to sleep at about 9-9:30pm when I have a release of melatonin which is the sleep/wake hormone and my body system begins to slow down. In adolescents, for some unknown reason, that is delayed and the melatonin doesn't kick in until later on. With a pre-prepubescent child who might go to sleep at 8:30-9pm, their melatonin is kicking in about 45 minutes earlier, whereas an adolescents' melatonin is delayed and they don't become sleepy until later therefore they don't go to bed until later and they can't fall asleep. When they are lying in bed for a few hours they play games- which means it is like a double edged sword.


In saying that is it important to go to bed around the same time every night?

Dr. Sarah Blunden: It is, that is really important for all of us because our body has a set rhythm and our body likes to be predictable because everything sits in a nice pattern then. If you have a regular bedtime, I'm not saying you need to have the same bedtime every night, but more or less in the same timeframe, then your body understands that it is sleep time and your body system will work in sync. Without having a regular sleep pattern your body doesn't understand what is going on. For example with a junior school child who goes to sleep at 8pm during the week and 11pm on a weekend- that will muck up their rhythm and it is also going to make them sleepy the next morning and make them sleep in the next morning which will make them really sleep the next night when they go to bed and it begins to push it forward and forward each time. In adolescents that's particularly a problem.


How many hours of sleep is required for a teenager?

Dr. Sarah Blunden: We think 9 and a quarter hours.


How many hours of sleep is required for an adult?

Dr. Sarah Blunden: Between 7 and 9 hours. There are no rules as to what we need, we don't actually know what we need but what we know is that when we don't get it we have consequences. Most studies have shown that most adults need between 7 and 9 hours sleep- which is a big difference because there is a lot of individual differences about what people actually need. Humans are very reliant, we can survive on less sleep, than we actually need, for quite a while, it is a question of how well we are doing and how well our bodies and our minds are functioning.


If someone, of any age, is struggling to sleep, what is the best solution for them?

Dr. Sarah Blunden: The main thing is to find out where this is coming from, they could speak to their doctor to see there is nothing medical going on. If there is nothing medical going on then maybe it is stress-related insomnia which means they're stressing too much and they cannot relax the brain and therefore they are worrying. Of the people that have insomnia a very large proportion of those are anxiety related.


The 27th International Congress of Applied Psychology (ICAP) 2010 was held in the Southern Hemisphere for the first time, bringing together more than 3000 delegates from 60 countries, including prominent psychologists, researchers and keynote speakers. The Congress is held every four years and was brought to Melbourne in 2010 by the Australian Psychological Society (APS) and the International Association of Applied Psychology (IAAP). For more information please see: www.icap2010.com

Interview by Brooke Hunter