Working with Tired Young People: 12 "sleep facts" to Tell Kids and Teens about Sleep in the Therapy/Classroom
/As a professional working with children and teens, I see tired and sleepy children and teens in schools and in the therapy room almost every single day. Research suggest that between 25 and 40% of young people have some kind of sleep problem, with some studies suggesting up to 75% of specific child/youth populations struggling with a sleep issue. I know this is a wide variation - it seems to depend on how you ask the question and who you ask - but even if we take the middle figure, the suggestion that half of the next generation don't get enough sleep is concerning. Longitudinal research on this issue is scarce (although emerging) but for what it's worth, it definitely seems to me as a clinician that sleep deprivation in children and teens has become more prevalent over the past 20 years.
Given the (known) significant effects of sleep deprivation on educational and psychological outcomes, it is important we as professionals continue to be vigilant for, and work on helping children and teens get more sleep at home. Of course partly this needs to happen via parent education. But I also think there is a role for us as professionals to be directly talking and educating children and teenagers themselves about this issue.
But other than "you need to get more sleep" - what exactly should we be telling them? What do young people themselves need to know?
Below are what I believe to be the 12 most important sleep concepts young people should know and ways of phrasing them so that young people understand.
1. "Some people need more sleep, and some need less. The best guide to know if you haven’t got enough sleep is whether you are sleepy the next day."
Young people (and sometimes adults too) can get fixated on how many "numbers" of hours of sleep they need. Unfortunately it's not this simple. There have been more than 30 different sets of guidelines published by many different health bodies (internationally) over the last hundred years. Also, some young people do need more sleep than average, and some need less. The best guide for all of us (at any age) is daytime sleepiness. If we are sleepy and tired during the day, then we probably need more sleep and are not getting enough. Helping children and teens notice their daytime sleepiness is important, as often chronically sleep deprived young people are so accustomed to the feeling of being sleepy that they don't realise this feeling is not normal.
2. "It’s normal to wake up during the night - we all wake up (very briefly) every 90 minutes."
Some children and teens I work with are very worried about waking up at night, and think it's abnormal to do so. It can be useful for us to let them know that we all have "sleep cycles" of about 90 minutes, and we all wake (often very briefly - and so briefly that we don't remember) every 90 minutes and this in itself is not a problem
3. "When we don't get enough sleep, we will have more problems remembering information, learning new ideas, feeling relaxed and happy, staying fit, recovering from illnesses, playing sport, moving and reacting quickly"
Some young people need more motivation to be able to change their sleep habits. For these children and teens, it's important for us to explain the sufficient range of problems associated with sleep deprivation. Sometimes parents will have done some of this - but they've often just focused on one area. For example, they might say "sleep is important" or "you'll be grumpy tomorrow".
This often isn’t sufficient reason for young people to do anything about it. Given that changing sleep habits can be hard and involve a lot of sacrifice on behalf of the young person, it's important for them to know exactly why doing this will be beneficial for them. I find that finding out what each young person cares most about - and then explaining the effect of sleep deprivation in that particular area of value for the young person - can be useful. For example, some young people are highly motivated to do well in sport - and explaining research on strength and speech will help this young person increase motivation for changing sleep habits. Some young people are highly motivated to feel less anxious and sad - helping these young people understand the effects of sleep deprivation on mood is useful. Some young people are highly motivated to maintain good health and body weight – helping these young people understand the effects of sleep deprivation on these issues can be useful (it goes without saying that this one in particular needs to be done very carefully and with great sensitivity).
Of course providing information about sleep deprivation is only an important topic of conversation if in fact the young person is NOT already motivated to change their sleep habits. Some children and teens are already motivated to get more sleep, in which case detailed explanations about the effects of sleep deprivation only make them feel more anxious.
4. "One good way to get to sleep more easily at night is to regularly get up earlier in the morning - and then move around, get into light and eat first thing the next day."
If children and teens don’t have any problems getting to sleep at night when they need to, then it can be fine to for them to “sleep in” at times. If they do have problems getting to sleep however, then sleeping late in the morning - even if it's just on weekends - will often mean they have trouble getting to sleep again the next night.
I explain to kids and teens that once they get up, they should "reset" their body clock - which means turning on some bright lights (or opening blinds to let sunlight in), having breakfast and even doing some light exercise if this is possible. Resetting their body clock early in the morning like this, helps them get to sleep earlier at night.
With children I'll sometimes draw a picture of "Good Mornings for Good Sleep". For teens, we will often make a list of the three things to do before X am and save it on their phone.
5 "Another good way of getting to sleep more easily at night is to do more exercise during the day".
The more minutes of exercise children and teens do during the day the quicker they fall asleep at night. The only exception to this is team sports played very late at night - unfortunately these seem to delay sleep in most young people. Otherwise, encouraging children to do more exercise, sport and incidental movement during the day is important as it has a direct positive effect on sleep.
6. "Be really careful about taking naps during the day. Short naps can be great if you don’t have problems sleeping. If you do have problems sleeping then even a short one can make it harder to get to sleep at night."
Teens in particular who sleep during frees or after school, or during the afternoon on the weekend will often have more trouble getting to sleep at night than those who don't do this. They then don't have enough "sleep debt" built up by night time to get to sleep - stay awake until very late - and then have trouble getting up in the morning. And the cycle repeats itself. I will often discuss naps with teens (this is less frequently an issue with younger children in my experience, although it does sometimes occur).
7. "You need to turn off your devices at least 30 - 60 minutes before bed. Looking at blue light from phones or laptops “turns down” a “sleep hormone” called melatonin and makes us feel more alert."
There are now several years of studies which show an association between late night electronic device use and sleep quality. Some preliminary studies have shown that even a "quick" look at our devices in the middle of the night can interfere with not only getting back to sleep, but getting enough "slow wave" (deep) sleep.
Unfortunately we all see children and teens who are using devices at night – and the pull to do this is so strong that they often don’t have the motivation themselves to switch them off. In my experience it usually requires parents to put in boundaries in this area because children/teens find it difficult to make these changes independently. However, I still like to education young people on this topic in order to "back up" any parent rules, and I also find there are some young people who find this information is motivating enough to put their own boundaries in place.
With regards to how to teach young people about this - personally I find if I actually provide the science to them - for example explaining experiments which have been done, and showing them pictures of the brain and telling them about sleep hormones - is most successful.
8. "When you go to bed, make sure your room is really dark, cool and quiet. "
Even small amounts of light and heat can reduce sleep hormones. I tell children and teens about this, and encourage them to cover up clock lights, close the door, take off a blanket and even use ear plugs if needed.
9. "When you go to bed. Close your eyes, relax your muscles and stay as still as you can. Test yourself to stay super still for a minute or two and then wriggle around if you need to and then try to stay super still again."
It's amazing how many children don't know this basic fact: you can't get to sleep when you are moving around. Of course, staying really still in bed is a struggle for some young people for a range of reasons. Helping them learn to do this is a slow process - but it's important to be working on it.
I use my “Still-Wriggle” game for younger children where I get them to challenge themselves to be “super still” for increasing numbers of seconds (sometimes I get them to practice this in my office lying on the floor with a tissue box on their stomach which they are not allowed to "tip off” before having a “wriggle break” and then repeating, but for an extra few seconds each time. I’m quietly very chuffed at the number of parents who tell me about the “Still-Wriggle” game being a successful fixture of their night time routine with their children 😊
10. One way of helping yourself get to sleep is to say calm thoughts to yourself about getting to sleep or make calm pictures or images to put in your head.
Kids and teens need coaching about specific "getting to sleep strategies" like using calm thoughts and imagery. It sounds simple, but some young people don't know what to put in their head when they are trying to get to sleep. Teaching them to say calm thoughts to themselves, use their imagination to visualise calm scenery or "mini movies", or go over a book/TV show can be really helpful.
In sessions with children and teens, I create a “Sleep time Movies” list with children. We prepare in advice some topics for them to think about. For some children this movie been about them having an unlimited credit card to buy presents for their family and friends (“Jane the Gift Girl”), for some teens it is a movie which recreates their favourite movie but with them in the main character role. The possibilities are endless and I’ve had such fun with young people coming up with these! (Hint – little trap to watch for which I fell into with one young creative lad– don’t make the movies so interesting it keeps them awake for hours in excitement!)
Some young people of course also feel really anxious about NOT being able to get to sleep and become anxious about insomnia, thereby keeping them awake. This is where our cognitive strategies are important. Sometimes we need to help young people create calm thoughts about sleep itself like “I'm ok”; "I'm getting better at getting to sleep all the time", "My muscles are getting more and more relaxed".
Finally, some young people immediately start going over all their worries at bedtime. This is where I use “worry box” or “worry time” rules and strategies so that children and teens know that bedtime is not time for thinking about or trying to solve problems. This is easier said than done of course, but an important goal to work on.
11. "If you can’t get to sleep within about 15 mins of having your eyes closed and being really still, get up and do something boring for a few minutes, and then try again."
Staying in bed for hours trying to get to sleep is agonising, miserable and counter-productive. It can be convenient and comforting for parents to know their children and teens are in bed, however if they are lying awake for long periods of time this means they are setting up an unconscious association between being awake and in bed, which will cause more problems. If children and teens have genuinely been lying still, with eyes closed (not on their phone/devices), and with a relaxed body, late enough at night - and are not asleep, it's better for them in the long run if they get up, do something boring (do some stretches, walk to the bathroom and back, look at a magazine or book (not electronic device) and then try again 15 minutes later.
Explaining this to parents is important. Of course it's also important to be empathic towards parents of younger children who are desperate to have some adult time at the end of the night. I often work on teaching children to do their “getting up and doing boring tasks” independently. For example, I help children create a written "can't get to sleep plan" in their bedroom which they need to follow before asking for parent help. How successfully they can do this will of course depend on their age.
12. "Have trouble with sleep? You’re not alone. It's not easy - and it takes practice"
Given the high frequency of sleep problems in childhood and adolescence, it can be useful to let young people know that there is nothing (necessarily) seriously or unusually wrong with them, that difficult with sleep is very common.
I like to tell children and teens (and their parents of course) that learning to get enough sleep is like learning to manage our physical fitness, or learning to read - or any other tricky area of life. It takes some time, effort and sacrifice. I tell young people to be patient with themselves as they learn getting these sleep skills.
Good luck with your work with young people and their families in this important area.
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If you work with primary aged children and would like show them a short animated video teaching them these facts about sleep, then we have one in Calm Kid Central which they can watch (and then complete an activity sheet/quiz on their sleep habits). Click on the button below to learn more about Calm Kid Central (or log in if you are a member).
I have also written an article for parents about how they can educate or tell their kids/teens these 12 facts themselves at home. You can read this parent article (feel free to distribute freely to your parent/caregiver networks however might be useful) by clicking here.
