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Sleep: Ferber Speaks

Sleep schedules refer to the pattern of when people fall asleep, how long they sleep and the time they wake up. Each of us has an internal "clock" that determines how much sleep we need, as well as our disposition toward being an early riser or night owl. Aside from these individual differences, however, most people follow the same basic sleep patterns at each developmental stage.



Sometimes, a child needs to have her sleep schedule adjusted for her own sake or that of her family. Depending on the child's age, her schedule can be "coaxed" -by reducing stimulation at night, reducing or eliminating naps, or setting an earlier or later bedtime. To make a successful schedule shift, however, parents need to understand typical sleep patterns at various developmental stages.



Sleep for Ages



Babies - "Babies basically have no schedule," says Dr. Richard Ferber, a world-renowned sleep expert and director of the Center for Pediatric Sleep Disorders at Boston's Children's Hospital. "Variable periods of sleep and times of eating are randomly distributed throughout the 24-hour day."



Although a newborn's biological clock exists and functions, frequent disturbances-such as hunger, discomfort or external stimulation-interfere with this clock and, therefore, with establishing any sleep patterns this early in their development. Babies do gradually establish a schedule as they mature.



"At this stage, parents should avoid setting a rigid schedule of feeding and sleep for an infant," says Ferber. "Instead, establish some regularity and get feedback from the child as to what works and then reinforce that." For example, parents can set a naptime, but if the child never falls asleep until an hour later, delay naptime an hour and see if the child falls asleep more readily.



Although babies vary greatly, the sleep pattern settles considerably for most at about 3 months of age. To the relief of many parents, the majority of sleep is now generally at night. Daytime becomes more predictable with increasingly longer periods of wakefulness; naptime and eating begin following a schedule, too. This stabilization reflects brain maturation, and the baby's patterns of sleep are now similar to those that will remain for the rest of his life.



"While some infants may be sleeping through the night by 3 months, parents should neither expect nor push for it," Ferber cautions. Longer periods of sleep at night gradually increase as the baby matures. At 3 months, most babies are capable of sleeping at least five to six hours straight.





By 5 - 6 months, they should sleep about nine hours at night and are mature enough so that there is no nutritional need to feed them during that time. "If feeding is offered, babies may learn to expect it at night," Ferber says, advising parents to keep interaction to a minimum if a baby wakes during the night.



At 5 - 6 months, babies usually take three naps in addition to sleeping at night. At about 6 months, they drop to two naps and, at about 1 year, they drop to a single nap. Nighttime sleep now increases to nine - 10 hours and napping decreases to about one - two hours. Most children give up napping by 4 years of age, and virtually all children stop napping by age 5.



From about age 5 through adolescence, children's sleep is the deepest and most restorative that it will ever be, and wakefulness during the day is unbroken by naps.



Adolescents and Teens - During adolescence, young teens tend to oversleep on the weekend to "make up" for the sleep lost while balancing academics and extracurricular activities during the week. Similar to shifting time zones, "sleeping in" during the weekend may make it difficult to fall asleep early enough on school nights. Ultimately, teens are more tired during the week.



"The body cannot function normally on such variable schedules," Ferber warns. "Besides physiological considerations, part of the problem is the school schedule requiring wake-up times that impose unrealistic bedtimes. Sixteen or 17-year-olds need about nine hours of sleep and often they're getting only about five during the week and 12 on the weekend."



Young Children and Napping



Parents of young children are often undecided about whether or not they should awaken a napping child. Ferber explains that children go into a deep sleep quickly, so even a short nap can have a significant restorative value that affects bedtime. If napping regularly causes problems with night sleep, he suggests shortening or eliminating the nap. Otherwise, he advises letting the child nap.



Making the transition from several naps to fewer or no naps affects some children differently than others. "Some children increase their nighttime sleep to make up for the missed nap, others don't," Ferber says. "Some children get very irritable during the time they used to nap, others do not."



When cutting down to one nap, parents should help a child shift that nap to the early afternoon, near the midpoint of his waking day. If the child is heading toward not napping at all, then build in some quiet play time in the afternoon to help him (and you!) get through the cranky spots.



"Regularity is very important to maintaining children's sleep schedules, but you do not need to be a slave to it," Ferber says. "Some youngsters are not affected by minor schedule changes. For others, an occasional skipped nap or mistimed nap not only affects bedtime, but may lead to increased wakings at night and irritability the next day."





Ferber also points out that child-care programs in which children are required to lie down for an hour during quiet time is not fair to children who never sleep during this time. Ferber maintains that these children should be allowed to get up and play quietly after about 10 - 15 minutes.



Scheduling Snags



The major obstacles to maintaining a sleep schedule that serves both parent and child are unrealistic expectations of children's sleeping capabilities, shifting schedules, irregularity in the family's schedule and environmental distractions. If parents want to help their child adjust her sleep schedule, they need to figure out how much time the child needs to sleep, and then pick a bedtime and waking time that allows that amount of sleep.



"Time in bed needs to be realistic," says Ferber. "If it takes a long time for a child to fall asleep, his bedtime may be too early." In such cases, letting the child go to bed later may result in a more relaxed evening for everyone.



In other households, parents complain about early risers. Ferber points out that it is not realistic to expect a child to get up at 6 a.m. during the week and then want her to sleep until 8 a.m. on the weekends. Both sleeping and eating schedules have to be consistent for a child to function optimally. If youngsters get up at the crack of dawn, eat and then fall back asleep around 7 a.m., Ferber explains that such an early nap is really an extension of the nighttime sleep and that parents should move the early-morning nap and feeding to later in the morning.



Parents can help children establish a workable sleep schedule by providing a predictable sleeping and eating routine. Some common obstacles to setting a consistent sleep schedule are:



allowing children to fall asleep whenever and wherever they get tired,


letting children wait up for parents whose work schedules may vary from night to night,


having a different weekday and weekend schedule, (this situation can be particularly acute with children of divorced parents sharing custody), and


not limiting stimulation at bedtime, such as children having a TV in their bedroom or there being too much noise or activity around them.



However, when regular routines are temporarily derailed by travel, sleep-overs and babysitters, getting back to the regular schedule as soon as possible avoids long-term sleep problems.



Adequate sleep and a regular schedule contribute greatly to a child's health and sense of well-being and security. Be sure that your children's individual needs are being met by any changes aimed at harmonizing sleep schedules with family needs.



"In our society, the importance of sleep is vastly underestimated," says Ferber. "For someone to be happy during the day, functioning optimally and learning efficiently, he or she has to have enough sleep on a regular schedule."

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