Sleep is bodily function, essential for good health, both mental and physical. It’s as important as drinking, eating and breathing. Do we take pills to breathe?
When I started out in practice, children, with rare exceptions, rarely had trouble sleeping, and they hardly ever needed medicine to fall asleep. Now, according to a study by Dr. Lauren Hartstein of the Sleep and Development Lab at the University of Colorado Boulder, 6% of preschool kids, and 19% of school aged children take melatonin regularly to fall asleep. That survey did not include all the kids who take stronger medicines, like the anti depressant trazodone, the ADHD (and anti-hypertensive) drug clonidine, and even addictive medicines like lorazepam to sleep.
Most parents think melatonin is harmless. It’s a natural hormone. It comes from our own body, right? But natural does not mean harmless. Poisonous mushrooms are “natural.” But you wouldn’t allow your child to eat one!
And we’ve seen the dangers of taking hormones like androgen supplements to build muscle, with their toxic effects on the liver, and the reproductive system. Similarly taking melatonin chronically may interfere with puberty in children. This is especially true since even a small sounding dose like 3 mg is six times what a child’s pineal gland naturally secretes daily.
And melatonin, like other herbs and supplements, is not regulated by the FDA. Studies have found that various melatonin preparations may have far less or far more of the hormone in each pill; some of the melatonin was also found to be contaminated with other substances.
Finally, melatonin and other sleeping herbs and medicines do not actually give children, or adults that much extra sleep! A study published in Consumer Reports found that sleep pills, on average, increased the amount of time someone sleep by only six minutes. That’s not even a cat nap!
(Melatonin does help with jet lag, where a person’s circadian sleep cycle is disrupted by traveling to another time zone. So it may be helpful, temporarily, in the case of a teen who is used to staying up very late, and needs to adjust their bedtime to a more reasonable hour. It also may be useful with children on the autism spectrum; these young people may be lacking in this particular hormone.)
What does help kids fall asleep and stay asleep? Part of the solution is to address one of the major reasons for the insomnia epidemic today: Electronics. Staying up in bed on a phone or a tablet, texting, gaming, watching video’s, or even reading a screen, jazzes up the brain. It keeps us from sleeping.
Another part of the solution is to get fresh air and exercise. Many kids don’t. And fewer time at school for Phys Ed and recess, it’s up to parents to ensure children to have time to run around and play instead of playing on their screens.
Anxiety is epidemic among children and anxious kids often have trouble falling asleep. Talk to your kids about what worries them— but do this long before bedtime. Address any problems they are having at school or with friends. If necessary seek professional help for worries that are really keeping them up, or for issues of depression, anxiety, substance abuse or marital discord within your family. No amount of medicine will help a child who is dealing with trauma at home or in school.
Have a good bedtime routine. Try to have a family dinner together, with time for TV or playing outside in the warmer months after homework is done, then electronics off bath or shower, snack and story. Even older children enjoy being read to, or reading with parents.
A child’s bedroom should be dark and quiet. There should be NO TV in the room.
A nightlight is ok if your child is scared of the dark. Younger children may enjoy using a “monster spray,” if they are scared of them in the bedroom, or having a flashlight hunt for any monsters or ghosts under the bed, where they may find a hidden treasure.
It’s best that young people do not take naps, even if they are tired. And bedtime and times to get up should be the same every day.
All this is part of normal sleep hygiene. Sleep hygiene is just as important as personal hygiene, for kids and adults.
Sometimes some simple coaching from you, your child’s doctor, or a therapist is helpful. I commonly see young patients who cannot fall asleep because they cannot turn the thoughts off in their heads. (Perhaps this is a problem for you too.) I teach these children and teens how to do relaxing diaphragmatic breathing.
Then I suggest that they imagine their thoughts are like floats in a parade, or clouds in the sky. They can watch them can and go. I especially like the image of a merry go round. The thoughts can be attached to those fancy colored horses and carriages. And they go round and around. So they may have a thought that keeps on showing up again. But that’s ok. They can simply notice them, then let them go. Until, eventually, they will drift off to sleep…..
Rarely, there may be a medical problem disrupting your child’s sleep. If you hear her snoring all the time, even when she does not have a cold, it might be a sign of sleep apnea, especially if you hear actual pauses in her breathing. Sleep apnea is most commonly caused by enlarged tonsils and adenoids; children who are obese are more likely to have this problem as well. Talk with your pediatrician if you feel that this may be a problem. There are other rare disorders which might cause sleep disruption in childhood, like restless leg syndrome; If you find that your child complains of creepy crawly feelings in his legs ends up with the sheets all in a bunch at the bottom of the bed in the morning, this may be an issue. Again, these sleep disorders are very rare. If you think they may be an issue, talk to your child’s doctor.
But most often, children just need help with this very natural bodily function. Think of the bedtime routine as a process of slowing down, of lights dimming, of slowing down the body and the mind.
The bedtime routine should be like sunset in nature.: The sun sets, birds chirp and then settle in to their nests, the winds quiet, and the world gradually darkens.
Have bedtime be a peaceful sunset for your little ones’ minds and bodies. And for you too.