One in ten children suffer from a sleep disorder but most of us – including GPs and paediatricians – know very little about the signs and symptoms, says Dr Chris Winter.
In his new book The Rested Child, the American neurologist talks about why the "tired, wired, or irritable child" may actually have a sleep disorder.
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We now know that a person's relationship with sleep is formed at a very young age so the way parents talk to kids about it can have lifelong effects, Dr Winter tells Kathryn Ryan.
Parents can create a sense of anxiety around sleep by responding harshly to the child who gets out of bed after bedtime, he says.
"[The response shouldn't be something like] 'If you don't get to sleep you're going to fail your maths test and you won't make the rugby team'.
"[It should be more like] 'That's okay because it's natural not to sleep. Why don't you just keep reading your comic book and I promise you sleep will come'.
"Those are the kinds of encouraging things we need to be saying to kids because it really sets the foundation for how we view sleep as adults."
As a culture, we focus way too much on the hardline bedtime but it can be good to make 'lights out' a later time that your child decides, Dr Winter says.
"Give them that dominion that you're not under any pressure to fall asleep at this designated moment."
If you enforce the child's 'wake up' time kindly and firmly – and make it clear to them that in the morning they'll pay a price for staying up – bedtime will take care of itself, he says.
This doesn't include device use in bed which is always bad news for children's sleep, he says, even when it's somewhat educational, such as learning about sea lions on YouTube till 2am.
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So how do you know a child may have a real problem with sleep?
Sleeptalking is usually normal and sleepwalking is to some degree normal, Dr Winter says, but if parents are concerned about their child's sleep activities they should start tracking their frequency.
"Every time your kid has a little episode of screaming out [while they're asleep] indicate it on a calendar. After a few months, do you feel like the frequency is getting better, is it getting worse, is it staying the same?
"At some point, if you feel instinctively that [the behaviour] is too disruptive, there's never anything wrong with taking a sleep study to see if sleep is playing a role."
He recommends parents first look at age-based recommendations for sleep duration to make sure they're not expecting too much.
"A lot of times kids can't sleep because you're asking them to sleep way longer than they're genetically programmed to do."
For a child, insomnia usually kicks off after a worrying event, but the "performance anxiety" they then develop about sleeping is what perpetuates the problem. Dr Winter says.
When a child tells you they didn't sleep at all they're not lying – that is their perception – although it's not biologically possible.
"When you define insomnia it's not an ability to sleep, it's the fear of an inability to sleep. And when that fear really gets going it not only starts to create chaos with sleep but with the perception of sleep."
On the other end of the scale, excessive sleepiness is a common sign that a child's sleep capacity may be "unpredictable, weak and inefficient", Dr Winter says.
This could be a child who is hard to wake up or sleeps away the weekend even though they're getting adequate amounts of rest.
Sleep apnea can occur in kids without significant snoring and narcolepsy is often mistaken for depression or attention problems, he says.
- Listen to an award-winning RNZ programme about sleep apnoea here.
Dr Winter encourages parents to investigate whether low-quality sleep could be the root cause of their potential attention or mood disorder.
"What could be easier than saying to your child's doctor 'I heard a guy on a radio interview that talked about sleep and my child does have some interesting aspects to his sleep. He complains of being tired a lot. How would you feel about some sort of sleep evaluation prior to evaluating our child for depression or ADHD or starting an anti-anxiety mediation?"
