The cost of not getting enough sleep for all ages

This article explains how much sleep a person needs by how old they are, and the health consequences of not getting the sleep you need.

Most Americans who spend part of the year on daylight saving time look forward to the extra hour of sleep when it's time to "fall back" to standard time. We are a nation of sleep-deprived people, and experts at The Ohio State University Wexner Medical Center say all ages suffer in various, unhealthy ways.

"For children, sleep deprivation can lead to behavior problems, trouble focusing and learning in school and it can affect their immune systems," said Dr. Aneesa Das, a sleep medicine specialist at Ohio State's Wexner Medical Center. "Chronic tiredness makes it harder to cope and process what's going on around you."

When children enter the teen years, sleep becomes a bigger issue. Das says a teen's circadian rhythm, or internal body clock, tells them to stay awake later and sleep later than children and adults do. She says only 15 percent of teenagers get the recommended sleep they need.

"Sleep is time the body uses to restore itself. Muscles and other tissues repair themselves, hormones that control growth, development and appetite are released. Energy is restored and memories are solidified, so we need to try to get regular sleep on a regular basis," Das said.

For adults, sleep loss is even more serious. It accumulates over the years and has been shown to contribute to several chronic diseases including heart disease, diabetes, high blood pressure, depression and obesity. Adulthood is also when sleep-related disorders, such as insomnia or sleep apnea, are more likely. During menopause, women often experience night sweats and insomnia due to changing levels of hormones. As men age, an enlarged prostate can lead to more frequent trips to the bathroom overnight. Certain medications can also disrupt sleep, such as those for heart arrhythmia, high blood pressure and asthma.

"Adult sleep gets more fragmented, or interrupted during the night," Das said. "This could be caused by a medical condition, caring for young children, light and noise disturbance, pets or just the stress of the day."

Here are the recommended hours of sleep we should get throughout our lifetime, according to the National Sleep Foundation:

• Infants: up to 16 hours total, including naps
• Toddlers (1-3 yrs): 12-14 hours, including naps
• Preschool (3-5 yrs): 11-13 hours, most do not nap after age 5
• School-age (5-12 yrs): 10-11 hours
• Teens: 8.5-9.5 hours
• Adults: 7-9 hours

To improve the chances of getting a good night's sleep, Das offers a few tips: don't perform vigorous exercise within four hours of bedtime; have a wind down routine that includes dim light; avoid using tablets, phones and laptops before bed because they emit blue light that interferes with sleep; try a warm bath two hours before bedtime and beware of sleep aid medications because they can have side effects.

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How important is sleep to a person's health?

This article discusses why sleep is so critical to having good health. It also provides recommended sleep times dependent on a person's age.

Most people know when they don't get enough sleep: They're grumpier, have trouble concentrating and may even eat more. But too little shut-eye does more than affect your mood. It can wreak havoc on your health, research shows.

Sleep deprivation is associated with an increased risk of many serious health problems, including obesity, high blood pressure, type 2 diabetes, depression, heart attacks and strokes, as well as premature death and reduced quality of life and productivity, according to the Centers for Disease Control and Prevention. Add to those an increased risk of automobile crashes, industrial disasters and medical and other occupational errors. A recent mouse study found that chronic sleep loss can lead to the irreversible damage and loss of brain cells.

CDC data show that 28% of U.S. adults report sleeping six hours or less each night, and that's just not enough for most people, experts say. It's no wonder that the CDC calls insufficient sleep "a public health epidemic."

Sleep is so critical to good health that it should be thought of "as one of the components of a three-legged stool of wellness: nutrition, exercise and sleep," says Safwan Badr, a past president of the American Academy of Sleep Medicine and a sleep expert with Detroit Medical Center and Wayne State University.

"The three are synergistic," he says. "It's hard to lose weight if you are sleep deprived. It's hard to eat healthy if you are sleep deprived. It is hard to exercise if you're tired."

Although people's sleep needs vary, the sleep medicine group recommends that adults get about seven to nine hours a night for optimal health, productivity and daytime alertness.

But that's difficult for many people to do. An estimated 70 million Americans suffer from sleep problems, such as insomnia, sleep apnea, restless leg syndrome, shift-work sleep disorder or narcolepsy, as well as sleep disturbances associated with many diseases, mental illnesses and addictions, according to the National Center on Sleep Disorders Research, part of the National Heart, Lung and Blood Institute.

"That's a conservative estimate when it comes to the number of people with sleep disorders or those who have difficulty sleeping," says Michael Twery, director of the center. "There are more than 70 sleep disorders."

Sleep-deprived people may have schedules that don't fit well with the body's natural sleep cycle, such as shift workers or high school students who have to get up early but whose bodies are wired to get up late, Badr says.

They may have insomnia and not be able to fall or stay asleep at night. They may have sleep apnea, which is characterized by frequent pauses in breathing and brief interruptions in sleep.

Or people getting insufficient shut-eye simply may not value sleep. This is a culture where not sleeping very much or pulling an all-nighter is considered a "badge of honor," he says.

Anne Wheaton, a CDC epidemiologist, agrees that people just don't make it a priority. Many people think taking the time to get sufficient sleep is being lazy and a waste of time, but they could be performing so much better if they were well-rested, she says.

There are a lot of physiological changes that occur with sleep, says Timothy Morgenthaler, a consultant at the Mayo Clinic Center for Sleep Medicine in Rochester, Minn. "One of the main hypotheses is that one primary function of sleep is to help eliminate metabolic waste products of the mental processes in your brain. Sleep clears those waste products out and replenishes the energy inside brain cells."

There is a recent study that showed that "when we don't get enough sleep, we actually injure brain cells. The research was done in mice, but I think there is very little doubt that our cognition suffers, and our brain does not function as well when we don't get enough sleep."

New research shows that "another significant function of sleep is to prune out less important things we learn every day and solidify those signals that are more important to remember. This occurs every night," Morgenthaler says.

"When you miss out on sleep, you take out a loan from the sleep bank," he says. "You can never completely repay the debt — and decreased health is the interest on your loan."

Adds Twery: "Sleep is not only important for brain health, it's part of the biology of virtually every tissue and organ in our body. A lifestyle that doesn't provide for sleeping long enough on a regular schedule each night with good-quality sleep doesn't support the body's natural biological rhythm. Then the chemistry of these tissues and organs works inefficiently.

"The amount of sleep needed to support human biological rhythm is typically seven to eight hours during the night. Like naps, shorter periods of sleep at other times of day may reduce the feeling of sleepiness but do not help the biological rhythms associated with long-term health," he says.

Twery encourages individuals who frequently feel excessively sleepy during the day to discuss their symptoms with a physician.

New treatments for sleep disorders have been developed based on these research advances, and more are in the development pipeline, he says.

Badr says there are some steps you can take to get a better night's sleep: Go to bed at about the same time every night, get up at the same time in the morning, don't drink caffeine at all or in the afternoon, limit alcohol consumption, and exercise regularly.

"Sleep well, live well," he says.

Daily sleep needs vary by ages and individuals but here are some general guidelines:

Newborns (up to 2 months), 12-18 hours
Infants (3-11 months), 14-15 hours
Toddlers (1-3 years), 12-14 hours
Preschoolers (3-5 years), 11-13 hours
School-age children (5-10 years), 10-11 hours
Teens (11-17 years) 8.5-9.5 hours
Adults (18 and older), 7-9 hours

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Children eat more when they lose sleep

A new study from Pediatrics looks specifically at what effects adding and losing hours of sleep have on children, specifically regarding their caloric intake. In short, they found that the less sleep a child gets, the more they eat.

Many studies have shown that kids and adults who sleep less are more likely to be overweight or obese. This correlation doesn't prove that sleeplessness causes obesity: Obesity can lead to sleep problems, and lack of sleep might be associated with socioeconomic factors, less organized homes and other factors that affect weight gain.

But a new experimental sleep study, reported in Pediatrics, actually looked at what adding and subtracting sleep does to weight and caloric intake in kids, and its findings suggest that just changing sleep duration may impact kids' waistlines.

The less you sleep, the more you eat

The researchers asked 37 kids, aged 8-11 years, 27 percent of them overweight or obese, to sleep as usual for the first week of the study. During the second and third weeks the kids alternated between sleeping 1.5 hour more and 1.5 hour less per night for an entire week. Sleep duration was verified by an actigraph -- a device that is placed on the wrist and monitors activity level. On average, the actual sleep difference between the week with increased and decreased sleep was about 2.5 hours.

So what can 2.5 hours do? During the week the kids slept more they reported eating 134 fewer calories per day compared to their intake during the reduced sleep condition, and their measured weight was about half a pound less.

While you may frown upon the 134-calorie decrease, if such a reduction is maintained over a long period of time -- something further studies that last longer than three weeks will need to prove -- this would be enormous. Weight is usually gained slowly, by eating just a little more than necessary over long periods of time. The energy gap is the daily discrepancy between energy intake and energy expenditure, and for American kids, the average energy gap estimate is just 64 calories a day. Eliminating calories in just the double digits daily could prevent further weight gain and doing that in your sleep could be sweet!

The exact mechanism in which sleep affects weight is unclear. After a good night's sleep we might be more active and burn more calories, we might have reduced appetites, and craving for high-calorie foods might be curbed.

Getting a good night's sleep

Getting enough sleep helps kids grow, concentrate in school, feel good, and -- as this study further suggests -- keep a healthy weight.

And while getting enough sleep isn't always easy, one of the factors that affect sleep is in our hands. TV before bed has been shown time and time again to result in kids sleeping later, and having a screen in the bedroom not only reduces sleep -- it is correlates independently with overweight.

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Students going back to school need 9 hours of sleep

This article discusses how children going back to school need nine hours of sleep, but generally get much less.

Adopting healthy sleep habits before school is essential for students to get the rest they need to learn and to keep from gaining weight, a U.S. expert says.

Dr. Suresh Kotagal, a pediatric sleep expert at Mayo Clinic Children's Center in Rochester, Minn., suggests establishing a bedtime routine to help children fall asleep and get a good night's rest.

He says children rest better if they skip caffeine after dinner, get regular exercise, turn off electronic devices an hour before bedtime and silence phones so text messages or alerts don't disrupt sleep.

Imposing an early bedtime on weekends will make Monday mornings easier to deal with, he says.

Kids and adolescents ages 6-18 should get 9 hours of sleep nightly, but typically they average little more than 7 hours.

Sleep experts recommend maintaining strict bedtime rules because a lack of sleep increases the risk of being overweight.

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10 Reasons Babies Wake Up At Night

Most babies wake up at night, and this article discusses 10 common reasons why they do.

Most babies wake up at night. And although some superhero babies sleep 10-12 hours straight starting around 3-4 months of age, most infants wake up during the night and cry out for their parents. There are scientific reasons and some developmental and behavioral explanations for these awakenings. I spoke with my friend Dr. Maida Chen, a pediatric pulmonologist, mother to three and director of the Pediatric Sleep Disorders Center in Seattle. I put this list together regarding why babies wake up at night. I'll author a follow-up blog on ways you can help your baby when they wake up, too.

10 Reasons Babies Wake Up At Night:

1. Sleep Cycle: Babies wake up during the night primarily because their brain waves shift and change cycles as they move from REM (rapid eye movement) sleep to other stages of non-REM sleep. The different wave patterns our brains make during certain periods define these sleep cycles or "stages" of sleep. As babies move from one stage of sleep to another during the night, they transition. In that transition, many babies will awaken. Sometimes they call out or cry. Sometimes they wake hungry. It's normal for babies (and adults) to wake 4-5 times a night during these times of transition. However, most adults wake up and then fall back to sleep so rapidly that we rarely remember awakening. At 4 months of age, many parents notice awakenings after a first chunk of deeper sleep. This is normal, and often due to development of delta wave sleep (deep sleep). The trick for parents is to do less and less as each month of infancy unfolds during these awakenings; we want to help our babies self-soothe more and more independently (without our help) during these awakenings so that sleeping through the night becomes a reality.

2. Brain Waves: The majority of babies are really capable of sleeping for a prolonged 6+ hour period of time 1/2 way through infancy, around 6 months. As Dr. Chen explains, "When doing sleep studies we follow brain wave activity." After 6 months of age she says, "We see brain waves at 6 months of age and up that are similar in pattern to that of adults." Now that doesn't mean that babies that wake throughout the night have abnormal brain waves, but it does mean as they progress through infancy, they get more and more mature when it comes to sleep. Dr Chen says, "If you look at sleep studies on newborns and infants, they will look very different compared to older children. But by 6 months of age, the baby's brain wave patterns will look much like an 18-year-olds." That being said, unlike an 18-year-old, once some babies are awakened during transitions, they may call out for your help!

3. "Good Sleepers" Versus "Bad Sleepers": Some babies are just better sleepers right out of the gate. Dr Chen reminded me, "There are good sleepers and there are bad sleepers. Part of that is organically hard-wired. But there are also good sleepers with bad habits." Our job as parents is to do the best we can in creating good sleep habits. Most of that has to do with consistency from one night to the next. Some babies make habitual associations like always nursing to sleep, always being rocked to sleep or always being held to fall asleep. Then, when they have awakenings at night, they may cry out to have those associations (bottle, nursing or rocking to sleep) to get back to sleep. These associations can cause a good sleeper to have bad sleep, because of the habit.

4. Crying Is Part Of Being A Baby: There is a pretty serious ongoing debate and national dialogue between parents, psychologists, pediatricians, lactation consultants and scientists about letting babies cry-it-out versus not cry-it out. I'll not delve into much of the debate here, but if you're worried that letting your baby cry-it-out will damage them, try to relax. Dr Chen says, "We don't think that some crying is bad for a baby. The evidence to support long-term damage from crying at night is nil." Many pediatricians recommend letting your baby gradually learn to self-soothe or cry-it-out once they have self-soothing skills (turning over, sucking on fingers or hand, and more mobility) starting somewhere around 4-6 months of age.

5. Mom or Dad's Role At Night: Studies have evaluated how parents can change an infant's sleep. Studies have found that infant sleep disorders are affected by how many times a parent comforts them at night. The more parents camp out (remain in the room until baby is asleep), the more parents transfer the baby into the crib after asleep and the more they picked the baby up at night, the more likely the baby has sleep challenges. And although most studies have evaluated a mother's role in overnight awakenings, a2010 Tel Aviv study found that when fathers were more involved in infant care (day and night), in addition to mothers, their babies had fewer overnight awakenings. Take turns!

6. Development: Developmental milestones shift and change sleep. As described in the video, after 4 months of age, most babies have a prolonged period of sleep and then wake up every couple of hours because of sleep cycle changes. Sometimes they will wake up and roll over and then freak out and cry when they get stuck or move into a new position. The rolling milestone may translate into awakenings. At 6 months of age, babies are exploring the world, putting all sorts of objects and germs in their mouths, and subject to more infection. They're also learning to sit at 6 months of age and this milestones often triggers awakenings. At 9 months of age, babies learn how to pull themselves up in the crib and stand-up -- don't be surprised if they are awake more. Most parents are unpleasantly surprised to find their 9-month-old up and awake in the middle of the night standing up, ready to rock and roll.

7. Teething: There's no question that teething wakes children at night and disrupts sleep. Teething typically commences around 6 months of age but I hear about teething waking babies all the way through their toddlerhood. Acetaminophen is the only medication I recommend for teething.

8. Behavioral Changes: Many babies will have more frequent awakenings around 6 or 9 months of age due to advancing sense of independence and self-awareness. At 6 months of age, I often hear from parents their babies will wake up in the middle of the night and start talking, just go through their different sounds. No need to go to them if they are not fussing! When babies develop separation anxiety around 9 months of age, they will often change their sleep patterns. Often during those times of behavior change they will wake and scream out when they realize you're not at their side.

9. Infection: Infants and children typically have an upswing in infections after 6 months of age. This occurs primarily because once a baby reaches 6 months, they are capable of putting lots of new objects (including their hands) in their mouths, so their exposure to germs increases dramatically. Many babies who have colds or upper respiratory infections will wake due to congestion or coughing. Fever, vomiting and diarrhea will awaken babies at night, too. Hang on and support your baby with a little TLC. Sleep schedules typically go back to normal within a few weeks after the illness began, especially if you can keep up good sleep routines.

10. Pacifiers/Bottle: Many babies are conditioned to fall asleep (or fall back to sleep) while sucking on something. This starts just after birth, when newborns instantly fall asleep with breastfeeding or a bottle in their mouth. Many infants who use a pacifier will wake up between 6-12 months of age when the pacifier falls out. The easiest solution is to get rid of it all together! But remember, big habits die hard, if a baby learns to fall asleep sucking and does so for 6+ months, it can take awhile to unlearn the habit.

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Survey shows kids in the US are getting enough sleep

A survey shows that children in the United States do get enough sleep, despite concerns of the contrary.

"Our estimates are in line with the amount of sleep recommended for children by the [U.S.] Centers for Disease Control and Prevention, which suggests that children in the U.S. are getting an appropriate amount of sleep on average," said study author Jessica Williams, a doctoral candidate at the Fielding School of Public Health at the University of California, Los Angeles. 

The finding stems from an in-depth look at current sleep norms among infants and children, as reflected by data collected in 1997—with follow-ups in 2002 and 2007—by a large National Science Foundation survey that set out to assess behavioral and mental health development from birth through age 18. 

Williams and her colleagues report their findings in the Nov. 26 online issue of the Archives of Pediatrics & Adolescent Medicine. 

The authors noted that the CDC recommends that children between the ages of 1 and 3 years get roughly 12 to 14 hours of sleep per day, while those between ages 3 and 5 years should get 11 to 13 hours per day. By the time kids reach the ages of 5 to 10 years, 10 to 11 hours of sleep are deemed sufficient. By adolescence, 8.5 to 9.5 hours of sleep is considered enough. 

In the survey, childhood activities, including sleep time, were detailed in family diaries logged by survey participants, which initially included about 2,800 children, later dropping to about 1,400 children by the final follow-up. 

The investigators determined that infants were sleeping an average of 13-plus hours per day, a figure that slowly but continuously fell as they aged through adolescence. By the time teens were between 14 and 18 years old, the average amount of sleep hovered at about nine hours per day, with all the figures holding up regardless of race or ethnicity. 

Daytime sleep was much higher among infants, with a fall-off by the time children reached school age. The team further observed that older children tended to sleep more during the weekend than during the week.

The researchers concluded that American children do seem to be getting the recommended amount of age-appropriate sleep, contrary to what they suggested was mostly unsubstantiated anecdotal evidence that recent generations of infants, preteens and teens have been struggling with mounting sleep deprivation. 

That said, Williams cautioned that while her analysis shed some light on the normal patterns of sleep among American children—and how closely they matched current recommendations—it did not render any verdict as to whether or not such patterns are, in fact, healthy. 

But Williams nonetheless suggested that the norms observed in the study might "be used by clinicians and parents to determine when a child falls far from the median as a signal that that child's sleep patterns may need further assessment." 

For her part, Shelby Freedman Harris, director of the behavioral sleep medicine program and of the Sleep-Wake Disorders Center at Montefiore Medical Center in New York City, said that "this study stands out because it suggests something very different than previous reports of sleep averages in kids." 

She noted: "Many papers have found that kids are getting less sleep on average than this paper did. Others suggest different sleep averages based on racial/socioeconomic differences, and these researchers didn't. The averages that each age group [were] getting in this study was on par with the current sleep-need guidelines in the sleep field." 

However, added Freedman Harris, who is also an assistant professor of neurology and psychiatry at the Albert Einstein College of Medicine, "What is not surprising though, but consistent with pediatric sleep knowledge, is the gradual decrease of sleep-need as kids get older. Sleep helps kids' bodies grow at a rapid rate. It helps their brains develop. As they get older and drop naps, their total sleep times gradually decrease. In adolescence, it is thought that teens' melatonin levels drop off and delay, leading to later bed [times]." 

Melatonin is a hormone that helps regulate the body's sleep-wake cycles. 

Freedman Harris also stressed that the amounts of sleep found in the study aren't necessarily the ideal for kids' health. "It does help to guide treatment recommendations though, if a child is significantly higher or lower, sleep-wise, than the average," she said.

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