Understanding Sleep Stages, Cycles, and the Effects of Sleep Deprivation
Sleep is a critical component of a child's development, allowing the body and brain to rest and recover from the day's activities. Children who get enough sleep are better able to concentrate, learn, and perform well in school. They are also less likely to experience mood disturbances, behavioural problems, and other adverse health outcomes.
Occupational therapists can play a vital role in improving children's sleep by working with them and their families to develop healthy sleep habits and routines. Occupational therapists can conduct assessments to identify sleep difficulties and develop individualized treatment plans to address these issues. They can also educate and support families to promote healthy sleep habits and routines, such as creating a relaxing bedtime routine and comfortable sleep environment.
In this post, we will explore the significance of sleep for a child’s development. We will also look at how occupational therapy can play a crucial role in improving your child's sleep routines.
Understanding Sleep Stages, Cycles, and the Effects of Sleep Deprivation
Sleep Stages and Cycles
Sleep can be divided into two main types: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Throughout the night, our sleep cycles through different stages of NREM and REM sleep in a repeating pattern.
NREM Stage 1: This is the lightest stage of sleep, often referred to as the transition phase between wakefulness and sleep. During this stage, which typically lasts just a few minutes, your body relaxes. You might experience slow eye movements and reduced muscle activity.
NREM Stage 2: As you progress into stage 2, your eye movements cease, and your brain waves slow down. This stage is still considered light sleep, but you become less aware of your surroundings. It generally makes up about 50% of your total sleep time.
NREM Stage 3: This stage is the deepest and most restorative stage. It's essential for physical recovery and growth. If you are awakened during this stage, you might feel groggy or disoriented.
REM Sleep: The first REM sleep stage typically occurs about 90 minutes after falling asleep. During REM sleep, your eyes move rapidly behind closed eyelids, and your brain becomes more active, resulting in vivid dreams. This stage is important for memory consolidation and learning. As the night progresses, the duration of REM sleep increases, with the longest periods occurring just before waking.
(Sleep Basics: REM & NREM, Sleep Stages, Good Sleep Habits & More, n.d.)
Effects of Sleep Deprivation
Sleep deprivation can significantly affect a child's health, well-being, and development. Some potential effects of sleep deprivation for children include cognitive impairments, emotional and behavioural issues, growth and development problems, and a weakened immune system (Owen et al., 2014).
Regarding cognitive function, lack of sleep can negatively impact a child's memory, attention, concentration, and problem-solving abilities, leading to difficulties in school and a decline in academic performance. Sleep-deprived children may also exhibit mood swings, irritability, and increased emotional sensitivity, and they may be more prone to anxiety and depression (Beebe, 2011)
Role of Occupational Therapy and Your Child's Sleep
Assessing Sleep Patterns
Occupational therapists can assess children's sleep difficulties using various methods, including informal and standardized assessments. Informal assessments may involve initial interviews with parents or caregivers, in which the therapist can gather information about the child's sleep habits and any factors contributing to poor sleep.
Standardized assessments are another tool that occupational therapists can use to assess children's sleep. Some commonly used assessments include the Children's Family Inventory of Sleep Habits (FISH) and the BEARS Sleep Screening Tool. These assessments can help identify specific sleep difficulties, such as bedtime resistance, nighttime awakenings, or sleep-disordered breathing. They can guide the development of individualized treatment plans to address these issues.
The BEARS Sleep Screening Tool
The BEARS Sleep Screening Tool is a standardized assessment tool used by healthcare professionals, including occupational therapists, to screen children for potential sleep problems. The acronym "BEARS" stands for five key areas the tool assesses: bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, and snoring or breathing problems during sleep.
The BEARS tool typically consists of a questionnaire completed by parents or caregivers. It asks about the child's sleep habits and patterns and any symptoms of sleep problems that the child may be experiencing. The tool can help identify potential sleep disorders, such as sleep apnea, insomnia, restless legs syndrome, and narcolepsy, which may require further evaluation and treatment (Owen, 2005).
Techniques for Improving Children's Sleep
Occupational therapists can educate children and their families on sleep hygiene, emphasizing the importance of healthy sleep habits and creating a sleep-conducive environment. This may involve helping establish a regular bedtime routine, avoiding stimulating activities before bedtime, and maintaining a quiet and comfortable sleep environment. Some examples of how an occupational therapist may work with a child to improve sleep hygiene include:
Regular bedtime routine: The occupational therapist suggests that the family start a bedtime routine where they read a story to the child, followed by gentle stretches and deep breathing exercises to relax the child before bed.
Limiting screen time before bed: Exposure to screens (TV, computer, smartphone, etc.) before bedtime can interfere with sleep. The occupational therapist may recommend that the child stop using electronic devices an hour before bedtime and instead spend that time participating in calming activities, such as colouring or puzzles.
Creating a sleep-conducive environment: Occupational therapists can provide guidance on optimizing the child's sleep environment. Recommendations may include using blackout curtains to reduce light, a white noise machine to mask any outside noises, and investing in a comfortable mattress and pillow to support the child's body.
Sleep schedule: Establish a consistent sleep schedule by setting regular bedtimes and wake-up times, even on weekends. This can reinforce the child's natural sleep-wake cycle and make it easier to fall asleep and wake up feeling refreshed. The occupational therapist works with the family to determine a bedtime and wake-up time that align with the child's sleep needs and daily schedule, emphasizing consistency's importance in promoting better sleep.
Relaxation techniques: The occupational therapist guides the child through various relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, or guided imagery, which can help them calm down and prepare for sleep.
Measuring Sleep Outcomes to Evaluate for Progress
Monitoring a child's sleep outcomes after implementing interventions is essential for determining the effectiveness of those strategies and making any necessary adjustments. Both occupational therapists and parents can use various tools to track and assess a child's sleep patterns. Here are some examples of how sleep diaries and sleep monitoring devices can be used to monitor sleep outcomes:
Sleep diaries: A sleep diary is a simple yet effective tool for tracking a child's sleep patterns, bedtime routines, and any sleep-related issues. Parents and children can record details such as bedtime, wake-up time, total sleep duration, night awakenings, and any sleep disruptions. Occupational therapists can review the sleep diary to assess the effectiveness of the interventions and identify any patterns or areas for improvement.
Sleep monitoring devices: Sleep monitoring devices, such as wearable sleep trackers, can provide more detailed information about a child's sleep patterns. These devices typically monitor factors such as sleep duration, sleep stages, and movement during sleep. By analyzing the data collected by these devices, occupational therapists and parents can gain insights into the child's sleep quality and assess the effectiveness of the interventions.
A Review of Sleep and Occupational Therapy for Children
Sleep is crucial to a child's well-being, growth, and development. Although it is not always straightforward. ensuring children get sufficient, restorative sleep is necessary for maintaining their physical and mental health. However, sometimes parents need a little help, and this is where occupational therapists step in. Occupational therapists can play an important role in helping children and their families by assessing their sleep habits, educating them and their families about sleep hygiene, and providing targeted interventions to address sleep-related issues. By working closely with children and their families, occupational therapists can help develop customized strategies and interventions that cater to each child's unique needs and challenges.
Tips for a Good Night’s Sleep
Set a consistent sleep schedule: Establish regular bedtimes and wake-up times, including weekends. This helps reinforce the child's natural sleep-wake cycle, making it easier for them to fall asleep and wake up feeling refreshed.
Create a bedtime routine: Develop a calming and predictable bedtime routine that includes activities such as reading, taking a warm bath, or engaging in relaxation exercises. This routine signals to the child that it's time to wind down and prepare for sleep.
Limit screen time before bed: Encourage children to avoid electronic devices for at least an hour before bedtime. The blue light emitted from screens can interfere with the production of the sleep hormone melatonin, making it harder to fall asleep.
Encourage physical activity: Ensure children participate in regular physical activity during the day, as this can help promote better sleep. However, avoid intense exercise close to bedtime, as it may make it harder for the child to wind down.
Create a sleep-friendly environment: Make the child's bedroom conducive to sleep by maintaining a comfortable temperature, minimizing noise and light, and providing a comfortable and supportive mattress and pillow.
Watch what they eat and drink: Encourage children to avoid caffeine and sugar close to bedtime, as these can interfere with their ability to fall asleep. Also, avoid large meals just before bedtime, but make sure the child doesn't go to bed hungry.
Teach relaxation techniques: Help children learn relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, or guided imagery, which can help them calm down and prepare for sleep.
Address anxiety and stress: If a child has anxiety or stress that interferes with their sleep, work with them to identify and address the issues. Encourage open communication and help them develop healthy coping strategies.
Be a role model: Parents can model good sleep habits by adhering to a regular sleep schedule, creating a relaxing bedtime routine, and maintaining a sleep-friendly environment.
References (click or tap to expand)
Beebe DW. Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr Clin North Am. 2011 Jun;58(3):649-65.
Owens JA, Dalzell V. Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study. Sleep Med. 2005 Jan;6(1):63-9. doi:
Owens J; Adolescent Sleep Working Group; Committee on Adolescence. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics. 2014 Sep;134(3):e921-32.
Sleep Basics: REM & NREM, Sleep Stages, Good Sleep Habits & More. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/12148-sleep-basics