Good advice for improving the sleep of children in the 1st to 6th grades

The Swords of Iron War and the trauma caused by the events of Saturday, October 7th, affects the way of life of many families in Israel. The quality of sleep, both ours and our children's, is among the first to be affected by this situation. In this article, we would try to clarify the importance of sleep for students of the 1st to 6th grades of elementary school, describe how both trauma and habits affect the quality of sleep of children in this age group, and give some recommendations on how we can preserve and even improve the quality of sleep in this age group. This guide is intended for parents to children.
Parents may call Tipat Halav's nurses hotline at *5400, extension 9, Sunday through Thursday, 16:00-21:00, and Friday, 08:00-13:00.

Why dedicate time to sleep?

Sleep is an essential component in nearly every area of our life:

• It helps us grow: the growth hormone is secreted while we sleep.
• It accelerates our recovery from injuries.
• It reinforces our immune system.
• It preserves our alertness when performing tasks like riding a bicycle or listening in class.
• It improves our precision and the quickness of our response in sporting activities, afterschool activities and play activities.
• It is also beneficial for our mental health and for our emotional self-regulation: if we sleep well, it is easier for us to find and maintain friendships and to cope better with difficult situations in life.

What is considered sufficient sleep for elementary school aged children?

Between the ages of 6-12, the body requires between 9-12 hours a day.

What behaviors and environmental factors may affect the quality of sleep?

The most prevalent sleeping disorder is a late bedtime hour, due to preoccupation with other activities. For example:

• Screen time: meaning the use of mobile phones, Tablets, laptops or stationary computers and television. The damage to sleep is caused by several reasons: postponing the bedtime hour due to preoccupation with viewing, emotional overstimulation due to exposure to stimulating or disturbing contents on media channels, as well as the exposure of the eyes to the blue light from the screens that inhibits the excretion of melatonin, the sleep hormone.
• Changes to the sleep environment may disrupt both the duration and the quality of sleep: like sleeping in an unfamiliar place. Many children and their families were forced to leave their homes due to damages to their homes or over concerns related to the war. Usually, it will take us several days to get used to the change, but certain disruptions such as noise or light in the bedroom, unfamiliar bed and beddings and the disruption of social life and familiar activities will make it difficult for us to fall asleep and may make cause us to wake up too early.

What sleep disorders are characteristic of school-aged children and what do they mean?

1. Insomnia, including difficulty falling asleep (the most common disorder), repeated instances of waking up during the night or waking up sooner than expected, which also disrupts our ability to function during the day. Following a traumatic event, there is a significant increase in the occurrence of insomnia. Even without a traumatic event, some 20% to 40% may suffer from insomnia. This may be caused by lack of parental boundaries, tensions in the family, disruption by siblings or pets who share the child's bedroom, incongruence between parents' expectations of the child to sleep a relatively high number of hours and the child's physical sleeping needs, as well as hyper-sensitivity by certain children that causes them to be "overstimulated" by events or thoughts that make it difficult for them to fall asleep.
2. Some children experience erratic behaviors that happen while they sleep. These may include, among other things, sleep-walking (up to 15% of all children), especially prevalent in the 5-10 age group; bad dreams or nightmares that are very prevalent in the 6-10 age group; dozens percent of children may experience nightmare, but only in about 5% of them it will take the form of difficulty falling back asleep or even fear going back to sleep, by which point these nightmares constitute a sleeping disorder.
3. A small percentage of children may experience sleep apnea, that is to say, disruption to the flow of air due to temporary constriction or obstruction of the airways in the mouth. While sleeping, sleep apnea may be manifest in snoring, choking, restlessness and even waking up. During daytime, sleep apnea causes hyperactivity, attention deficit and poor academic performance that are similar to children with ADHD. Some children may also suffer from daytime sleepiness. Sleep apnea appears among 1% to 5% of all children, especially in the 2-8 age group. It is usually caused by enlargement of the tonsils and their surrounding tissues. However, in overweight children, this condition may appear in up to 50% of all children.

These disruptions (as well as other, less prevalent ones) may adversely affect sleep quality, duration and timing. Below are some of the most prevalent consequences of these disorders:

• Decreased attention, memory and IQ.
• Increased instances of being late for school or missing entire days.
• Increased risk for anxiety and depression.
• Obesity.
• Increased blood pressure.
• Increased tendency to develop diabetes.
• Decreased sport ability.
• Decreased emotional self-regulation and increased tendency for violence.
• Increased propensity for accidents and physical clumsiness.

How can we prevent and cope with sleep disorders?

Preserving and extending our sleep duration

Most of us have a set wake up time during the week (and a pretty early one at that), and so, in order to extend our sleep duration, we should go to sleep earlier. To successfully achieve this, we should perform the following actions:

• Sunlight exposure in the morning and around midday, for about fifteen minutes at a time. Sunlight re-synchronizes our inner clock and also pushes backwards the hands of our inner clock so that we feel sleepy at an appropriate hour. Sunlight also provides resistance/protection from exposure to light from screens and other sources of light during evening time, so that the hands of our inner clock will not be pushed forward for a later bedtime hour.
• Pay attention to the body's signs when it communicates to us that it is ready to sleep:
  
  • "Heavy" eyelids.
  • Microsleep or sudden, temporary episode of sleep.
  • Repeated yawning.
  • Difficulty concentrating while reading or performing other activities.
• Engage in physical activity during the day: at least 60 moments of physical activity every day.
• Remove obstacles:
  • Avoid exposure to bright light sources, especially blue light, in the evening. You may want to download an app that prevents blue light emission from your screens during evening time. You may also want to dim the lights in the bedroom an hour before bedtime.
  • Do not play video games or watch television after your bedtime.
  • Avoid chocolate and hot chocolate in the evening.
  • You should avoid stimulating or disturbing activities an hour or two before bedtime. Reading messages an hour before bedtime may compromise the calm that you need to fall asleep quickly.

What to do if the children still wake up in the middle of the night?

Check the cause:

• Do they drink anything before bed? If so, you may want to make sure that they drink several hours before bedtime, to allow their body enough time to dispose of this liquid before they go to sleep.
• Do they snore loudly or wake up feeling choked up, hoarse or dry mouthed? You may want to check with your family practitioner if there is a need for sleep tests to rule out sleep apnea.
• Do they wake up due to flailing their legs while they sleep (usually you will find their bedding thrown all around)? Here, too, you may want to check with your family practitioner if there is need for a sleep doctor.
• Do they suffer from nightmares? If this is not something passing, you should know that there are certain types of behavioral therapy that a sleep doctor or a psychologist may help you with.

Sleep benefits both body and mind and assists each and every one of us to maintain our continued functioning that we need throughout the year, and especially during those difficult times.