Regular readers of this column know that I think a lot about (my wife might say obsess over) the role of sleep in the whole wellness package. I suspect that many parents here in Brunswick believe that regardless of their child’s diagnosis, I always will manage to include "more sleep" in my list of therapeutic recommendations. Whether the problem is a sprained ankle or nocturnal leg pains, better sleep habits couldn’t hurt.
Dr. William G. Wilkoff
I have recently stumbled across two new studies that have added more fuel to my fire. The first was a survey of more than 15,000 adolescents by James E. Gangwisch, Ph.D., and his associates in the journal Sleep (2010;33:97-106). These researchers found that adolescents who were depressed had shorter sleep durations and later bedtimes than those who were not depressed. Surprisingly, there seemed to be no difference between the groups when they were asked to report whether they were compliant with their bedtimes. In other words, it appears that simply the parental act of setting a bedtime had some protective effect.
The second study was by Erika Gaylor, Ph.D., a researcher from SRI International in Menlo Park, Calif. She reported at the annual meeting of the Associated Professional Sleep Societies held in San Antonio that earlier bedtimes were associated with higher scores in several developmental areas including receptive language and early math, in a survey of 8,000 preschoolers. I was unfortunately not surprised to learn that three-quarters of the children had bedtimes between 8 and 10 p.m. and that a little more than 20% got to bed at 10 p.m. or later. Children living in a higher socioeconomic status household were more likely to have an earlier bedtime and to have been given a rule about bedtime.
I suspect that you aren’t surprised by the findings in either of these studies. My mother knew all this stuff already. In fact, anyone who has been observing children for more than a handful of years could have predicted the results. Ben Franklin was right, at least about the early to bed bit. But why isn’t the message filtering down to parents?
Are we pediatricians not being vocal enough about the importance of sleep? How much anticipatory guidance do you give parents about sleep? Do you wait for them to raise the issue when they perceive a problem? Do you recommend a bedtime? These studies suggest to me that the benefits of having a parentally mandated bedtime are so substantial that every pediatrician should be including this recommendation at every visit.
We all have participated in the Back to Sleep initiative. Why not a To-Bed-by-Seven campaign aimed at new parents. Although adolescent depression and sub-optimal school performance don’t tug at our emotions the way that SIDS does, they are nonetheless problems that affect a larger segment of the pediatric population. And there are scores of other conditions – including obesity, attention-deficit/hyperactivity disorder, and migraine headaches – that have some link to sleep deprivation.
I don’t have to tell you that it won’t be an easy sell. Societal forces that have nudged children’s bedtimes well out of the healthy range are deep and complex. A parent who returns from work after 7 o’clock would like to have some "quality time" with his or her child and share in the bedtime ritual is not going to accept this recommendation happily. It should be our job to point out that there isn’t much quality going on when a child is kept up past a healthy hour. However, I may just have to be content when I can get the family to at least set a bedtime – even if I know it is too late. It looks like half a loaf may be better than none at all.
This column, "Letters From Maine," regularly appears in Pediatric News, an Elsevier publication. Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@elsevier.com.