The goal of improving sleep is to promote optimal alertness. A child who is overtired has a harder time falling asleep than a child who is well-rested, and the timing of sleep is often crucial. Putting a child to bed too early or too late may result in a significant delay in falling asleep.

Sleep loss is cumulative. A child who goes to bed a little late each evening or misses a nap intermittently may become significantly sleep deprived within a few days. The majority of children under age 4 years can only meet their sleep requirement by taking naps (they usually cannot obtain all their sleep at night). The symptoms of chronic insufficient sleep in the young child are often subtle and misleading. For example, he or she may appear overactive rather than tired and sleepy. Chronic and cumulative sleep loss, even for brief durations, is likely to be harmful to learning.

Children develop attitudes about nutrition and exercise at a young age. The same holds true for sleep. Sending a child to bed as punishment or allowing a late bedtime as a reward may send the wrong message. The right time can be determined by knowing your child's circadian rhythm (biological clock) of alertness and sleepiness. The rising time each morning is the best behavioral indicator of a particular child's sleep/wake rhythm. Keeping a regular schedule strengthens circadian rhythm, which in turn promotes quality sleep.

Signs of Insufficient Sleep
• Falls asleep in the car, in a highchair or when watching TV when it is not nap time.
• Frequently awakens tired and crabby in the morning and following naps.
• Seems irritable, difficult to please off and on during the day, especially between 4 and 6 p.m. (may hit, spit or bite during this time if significantly sleep deprived).
• Appears unusually clingy and will not let mom out of sight intermittently during the day, especially between 4 and 6 p.m.
• Has to be awakened most mornings, looks as if he/she could easily sleep another hour.
• Often has a very short attention span; can't sit to look at books with parent for more than a few minutes (when sleep loss is severe, appears overactive or "wired").

By Nancy Birkenmeier, BSN, RN, St. Luke's Hospital Sleep Medicine and Research Center.

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