Your teenage child doesn’t go to sleep on time — or wake up in time for school. His grades are slipping.
Your school-age child can’t sit still in class. She seems hyperactive.
Your toddler treats bedtime like an invitation to literally bounce off the walls.
You’re losing sleep, too — not knowing what to do about your teen, who seems lazy, or your kids, who seem hyperactive and out of control.
Enter Pearl Yu, MD. According to her, all of these issues, and more, could be related to an underlying need for sleep.
Yu is on a mission to get people to go to sleep. “Our society does not respect sleep at all,” she says. “We think it’s a failure to need sleep. I’m trying to dispel that.”
Yu is nothing if not passionate about the necessity of sleep.
A pediatric sleep specialist, Yu sees the gamut of sleep issues in her office, from bedwetting to sleep terrors. Mostly, though, parents come to her with kids whose problem is basic: The kids are overtired and need sleep.
To which Yu says, “The most common reason a kid is sleepy is the kid isn’t spending enough time in bed asleep.”
This seems like a simple solution. Herself a parent of two, she empathizes with the challenges parents face getting enough quality time with their kids. “I’m a pretty practical person,” she says. “The morning and evening times are the most precious times with your kids, especially for working parents.”
And then there’s the issue of sports or other after-school activities — basketball, football, soccer — that end as late as 10:30 at night. “It’s ridiculous,” she says. “Not respectful of the fact that kids need sleep.”
According to Yu, school-age children need 10 hours of sleep every night. “They should be asleep by 8:30 p.m. if they wake up at 6:30 a.m.,” she says. Ideally, it should take half an hour (or less) to fall asleep.
Not allowing enough time for sleep is just one factor. Other factors that can interfere with a child or teenager’s sleep:
- Developmental changes
- New school or other life changes
- Exercising too close to bedtime
- Not exercising at all
- Nutrition and weight
- TVs, computers and other distractions in the bedroom
- Genetic predispositions for different sleep cycles
- Sleep disorders
And not getting enough sleep can take its toll on children in a range of ways.
The Dangers of Sleep Deprivation
While our society places little priority on sleep, Yu sees the serious consequences of sleep deprivation all the time — harm to a child’s:
- Mood, causing depression
- Learning and success at school
- Peer relationships
Without enough sleep, Dr. Yu explains, “You’re grumpy, you’re grouchy, you don’t have tolerance and it’s hard to focus and take things in.”
She points to the example of a teen who was “failing in school, had a bad attitude, couldn’t listen. I did a full workup,” she says, and discovered “the kid needed a lot of sleep — like 10-12 hours of sleep — he was very sleep deprived. So I wrote a letter to his school asking if the kid could come in at 10 a.m. — and he’s thriving now; he’s a very bright kid who was just really tired.”
School performance is not the only aspect of a child’s life endangered by lack of sleep.
“In children with a predisposition for parasomnias (events arising out of sleep, such as bedwetting, sleep terrors, sleepwalking and sleep talking),” she notes “sleep deprivation can exacerbate these events in terms of frequency and severity.”
One child, she remembers, suffered from sleep deprivation for a full week, which triggered a sleepwalking incident. “She almost killed herself,” Yu explains. “The girl jumped off a one-story building, landed on the grass and fractured her arm.”
Another danger is misdiagnosis and all the consequences that follow.
Sleep issues often get masked by other diagnoses, like ADHD. Toddlers and school-age kids, when sleep deprived, often display counterintuitive behavior, “bouncing off the walls because they’re so tired they don’t know what to do with themselves.” Giving these kids Ritalin, a stimulant, for being hyperactive doesn’t make sense — why would you give a hyperactive child a stimulant?) unless you consider that the stimulant may actually be working to treat exhaustion from sleep deprivation. Yu makes the caveat that not all ADHD children have sleep problems; but if you have a child with ADHD with undiagnosed or untreated sleep issues, the ADHD may be more difficult to control.
Yu estimates that “about 30% of kids diagnosed with ADHD have an underlying sleep issue that needs to be treated; even if it doesn’t get rid of ADHD, addressing the issue of sleep can make everything else easier to treat.”
When a parent brings a teen or school-age child with sleep issues to her office, Yu is thorough. She takes a full history, accounting for life disruptions, developmental changes, anything that can affect sleep. She rules out and accounts for pathological sleep problems, disabilities, parental interactions, anxiety, the environment, obstructive sleep apnea and other sleep disorders in order to get a full picture.
Often Yu diagnoses teens with delayed sleep phase syndrome, which just means that there’s “a mismatch between when your body is ready to go to sleep and wake up and your environment. It’s only a problem if you’re forced to be on a schedule.”
Many people, Yu says, have this syndrome, but compensate for it. “They can walk around sleep deprived and still be high-functioning. They live with it and suffer, having no idea.” Others, however, “can’t tolerate any sleep deprivation; it causes depression, mood disorders, weight gain. It depends on genetic variability as to how much sleep deprivation you can tolerate.”
One patient came to Yu with insomnia. “This 14-year-old girl was trying so hard to go to bed at 9 p.m. She had no TV in her room, no computer, kept her room dark, but no matter what, she still couldn’t fall asleep until midnight. She definitely had anxiety going to sleep.” Once Yu diagnosed the teen with delayed sleep phase syndrome and encouraged her schedule to be adjusted, the struggle to sleep completely disappeared.
Yu says the girl was grateful to discover “’that’s what I have and everyone tells me I’m lazy!’” The parent, too, Yu says, was relieved. “She said, ‘Is this genetic? Oh my goodness, I’ve had this problem all my life and no one has told me this!’”
Yu’s best answer for most sleep issues is for people to listen to their own bodies. “If you’re not ready to go to sleep until midnight, you can’t take a sleep aid at 8 and think you’ll be asleep at 9. Sleep aids wear off over time. I can give you stimulants to get you through the day and help you be functional, but you have to catch up on your sleep. They will eventually become ineffective.”
She advises patients to figure out how much sleep they need and how much sleep deprivation they can tolerate and then make reasonable schedule and environmental changes to fit their individual sleep requirements.
Yu told one student bluntly that due to her body clock, she probably would not be happy pursuing a career as an orthopedic surgeon. “I had to counsel her,” she says. “She could probably compensate for a while with the long hours, but for a whole career where you have to get up at 4 a.m.? She’d be very unhappy.”
The basic message: “I tell my patients no medicine will replace sleep.”
Sleep Strategies and Treatment
“What I offer is a tailored program,” Yu explains, referring to the services she offers in her main location at the Forest Lakes Health Center in Charlottesville. She also has satellite clinics in Culpeper once monthly and in Fishersville twice monthly.
She advises parents to get referrals from their primary care doctor or pediatrician earlier rather than later. “When I see what a kid has gone through already, it makes me sad, when I could have helped.”
Does your child or teen have sleep or behavior problems?
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