Sleep and Its Disorders in Children

Timothy F. Hoban, MD

Disclosures

Semin Neurol. 2004;24(3) 

In This Article

Normal Sleep in Older Children and Adolescents

The sleep of older children continues to evolve with advancing age but at a more modest pace compared with the dramatic changes seen during the first years of life. During the early school-age and preadolescent years, average nighttime sleep requirements decline from 11.1 hours at 5 years of age to 10.2 hours by age 9.[2] Sleep architecture continues to mature as well, with gradually declining amounts of deep NREM sleep, increasing proportion of stage 2 sleep, and constant proportions of stage REM between the ages of 6 and 11.[33]

Healthy preadolescent children are typically highly alert, with little or no daytime sleepiness as measured by multiple sleep latency testing (MSLT). Indeed, mean sleep latency on the MSLT for preadolescent children averages 19 ± 1.6 minutes[34,35] in contrast to the 10- to 20-minute range considered normal for healthy adults.[36] Significant daytime sleepiness is highly unusual in healthy preadolescents, and chronic or recurrent sleepiness at this age is usually strongly indicative of a serious underlying sleep disorder.

During the adolescent years, average nighttime sleep declines from an average of 9.0 hours at age 13 years to 7.9 hours at age 16.[2] Sleep architecture completes its transition to a mature adult form with a 40% decrease in the amount of slow-wave sleep between the ages of 10 and 20 years and modest increases in light NREM sleep.[35,37] Daytime sleepiness increases significantly during adolescence even when total sleep time remains constant, suggesting that the need for sleep does not decline at this age and may in fact increase.[38] Finally, a tendency toward delayed circadian phase becomes evident during adolescence, with both bedtime and waking time usually being later on non-school nights compared with school nights.

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