• Suzanne Axelsson

The BIG Sleep


This post is a collection of posts from my previous blog site... now put together as one... this makes a long read but I have divided them as chapters here, so you can have a break if you wish...

I am a mother, an early years teacher/consultant and also a wife of a professor of sleep research .My husband sent me an article - I have found some of my own - and so I am going to try and piece together some science and some experience in the preschool world together in the effort to make some sleeping and resting sense for preschool teachers and parents.

At preschool nap time and rest time should not be viewed as a time for staff to take breaks because fewer staff are needed - that is not the reason for nap and rest time. It should be viewed as a pedagogical part of the day - the part of the day where the children are able to sort through their thoughts and the sleepers can transfer short term memories to their long term memory and therefore aiding their ability to learn.

"Attention can be maintained at a maximum level only for a

limited duration. It typically waxes and wanes, and so does activity

in brain networks regulating arousal and attention. Sleep deprivation

aggravates this “state instability” of interleaved periods of

normal versus attenuated performance and activation of attention

networks "

.Sleep, Cognition, and Behavioral Problems in School-Age Children: A Century of Research Meta-Analyzed. Rebecca G. Astill, Kristiaan B. Van der Heijden, Marinus H. Van IJzendoorn, and Eus J. W. Van Someren

Online First Publication, April 30, 2012. doi: 10.1037/a0028204

We can hardly expect children to have full focus for a whole day at preschool/kindergarten, they NEED down time either sleep or a rest, not only from a cognitive perspective but also from an emotional perspective. All parents and teachers can vouch how children are far more grumpy and tend to have emotional responses to things they would, normally, be able to deal with after a late night.

Most sleep research is carried out on adults, or children with sleep problems, there is not the same amount of research on healthy young-and-school aged children. My husband has wanted to do research to find out more about the sleep needs and the importance of sleep for preschoolers but there is not the same financial interest in backing research in children...

"..sleep duration in healthy children shows

considerable interindividual variability. This variability is associated

with variability in cognitive functioning and behavioral problems.

Cross-sectional studies in community samples suggest relations

of the quality or duration of sleep with cognitive measures,

such as executive functioning (Sadeh, Gruber, & Raviv, 2002),

intelligence (Busby & Pivik, 1983), and academic grades (Buckhalt,

El-Sheikh, Keller, & Kelly, 2009; El-Sheikh, Buckhalt,

Keller, Cummings, & Acebo, 2007). Short sleep duration has also

been linked to behavioral problems (Aronen, Paavonen, Fjallberg,

Soininen, & Torronen, 2000; Lavigne et al., 1999; Paavonen,

Porkka-Heiskanen, & Lahikainen, 2009). Some studies, however,

did not find any associations of sleep quantity or quality with behavioral problems

or cognitive outcomes such as academic achievements

(Eliasson, Eliasson, King, Gould & Eliasson, 2002;

Loessl et al., 2008; Mayes, Calhoun, Bixler, & Vgontzas, 2008;

Terman & Hocking, 1913).

.Sleep, Cognition, and Behavioral Problems in School-Age Children: A Century of Research Meta-Analyzed. Rebecca G. Astill, Kristiaan B. Van der Heijden, Marinus H. Van IJzendoorn, and Eus J. W. Van Someren

Online First Publication, April 30, 2012. doi: 10.1037/a0028204

There is also a need for more studies to look into children's sleep quantity and sleep efficiency (how much of the time in bed is spent sleeping). The article does go on to say that as far as all the studies and research show that sleep DOES influence a child's day -

"The results show conclusively that shorter sleep

is associated with worse cognitive functioning and more behavioral

problems.

In particular, shorter sleep is associated with

worse school performance and executive and multiple-domain

cognitive functioning, as well as with more internalizing and

externalizing behavioral problems. Sustained attention, intelligence,

and performance on explicit and implicit memory tasks

were not significantly associated with sleep duration."

So what this all implies is that getting enough sleep is important to not only a child's cognitive development but also their emotional stability. Many preschool teachers will have seen that by the end of a long day emotions tend to run higher among the children.

Age Nighttime Sleep Daytime SleepAverage Total Sleep

2 years 10.5 to 12.5 hours 1 to 3 hours (1 nap) 11.5 to 15.5 hours

3 years 10.5 to 12.5 hours 1 to 3 hours (1 nap) 11 to 14 hours

4 years 10 to 12 hours 0 to 2.5 hours (1 or no nap) 10 to 13 hours

5 years 10 to 12 hours 0 to 2.5 hours (1 or no nap) 10 to 12.5 hours

• Note: The two sets of numbers don't always add up because children who take longer naps tend to sleep fewer hours at night, and vice versa.

How much sleep does your preschooler need?

Most sites recommend more or less the same amount of sleep as what is suggested above. Although, I can imagine that there will be some reactions about 2 and 3 year olds needing naps - as I know I have parents coming to me asking me not to allow their children to sleep during the day as it affects their night sleep. After seeing many children struggle to keep awake during rest time I felt like the meanest person on the planet prodding and poking them trying to keep them awake - that is when I have had the great fortune to have a sleep researcher husband to turn to. He has recommended that these children should have a 10 minute power nap to help them over come their tiredness but also not to interfere with the parents' wishes for the night sleep to be prioritised. It does make a difference - and parents have found this to be a good idea, but sometimes it has been hard to wake up these children after 10 minutes. But a proper nap of at least 30 minutes is what he would recommend.

Children today probably have a much more stimulating life that what was on offer to children in my day and before that. Children are having to prepare for school at an ever younger age in many countries (thank goodness I live and work in Sweden where school starts at 7, although the final year preschool is now found in schools...). The size of groups in preschools are tending to increase which means that children need more negotiation tools, do not have the same access to teachers on an individual level and it is harder to find a quiet corner for some down time when needed - so naps and rests will have more importance to support a child's needs to deal with the social side of preschool. Of course naps and rest is not always so flexible in an institution - and preschool is a kind of institution (even though it doesn't seem to have the most positive ring to the word). How can a teacher allow a child to rest or sleep when they need in a day of schedules? How can we offer a child the need to rest indoors when its an excursion day and everyone is supposed to be outdoors? No matter how flexible we want to be in a preschool we can never be as flexible to the needs of individual children as in their homes - where they can go into their own room to play quietly for a moment of relaxation, or find a corner to read for a while before joining the family again. The maximum fee policy for preschools in Sweden has also resulted in a greater number of children having longer days at preschool - we, as teachers and parents, need to be aware how this affects the children's need for sleep. We also have to consider that volume of preschools has an effect on children and also the fact that the amount of viruses and other sicknesses that are easily spread when many young children meet will also exact their toll on a young body - maybe your child does not get visibly sick, but they may be still fighting off the sickness. So what can we do? There are studies that massage has an important calming effect, allowing rest and helping the emotional climate of a preschool, classical guitar music has been suggested to aid falling sleep faster, we can become better at reading the individual needs of children - are they crying and shouting because they are angry - or do they need some down time? Are children getting enough physical contact during the day - hugs, sitting on knees etc does not compromise a child's independence but it can contribute to allowing the child feel secure and less stressed in a busy and stimulating environment. Do we, as preschool teachers, need to consider the fact that a second rest time needs to be introduced into the daily routine so that children with long days have access to enough downtime throughout the day - as over-tired children often find it harder to fall asleep (and then if they cannot fall asleep they then start the next day with a sleep deficit and all the grumpiness that can come with that - and so the vicious circle begins...). Should teachers know about the bedtime routines of children at home? Would this help to explain how a day should be adjusted for a child - for example if we know a child stays up late every night in order to say goodnight to a parent who comes home late (or because the child wants to and the parents have not established a routine for early nights) then maybe a preschool could offer this child more opportunities to down-time during the day if a nap is not an option (parents have requested no naps). This is one of those areas that blurs - there should be a home and preschool cooperation but sometimes one feels that this is one-sided and that it is about bringing the parents into what we do in the preschool and that we as teachers have no business in the lives of the children in their homes (unless a parent asks for advice) - how can we best support the children and their sleep needs when we as teachers don't really see their sleep but do deal with the results of lack of sleep? As a teacher to parent readers - how can we better collaborate in this area? Below are a few articles in Swedish I have looked at as well. I found the one by Catarine Wahlgren very useful and for you readers without Swedish, I apologise and hope that you can translate it as it was a worthwhile read, long, yes, but accessible and not full of name of brain parts and other scientific jargon found in the papers and articles my husband sends me (I know they make sense to him - but sometimes they are just a bunch of letters to me - lol)

Förskolan - nödvändighet eller möjlighet?: Behovet av förskolan och dess konsekvenser för barnet sett ur ett föräldraperspektiv - Johansson, Jessica; Lindh, Emelie http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5487 Stress hos barn i förskolan: En studie om förebyggande arbete mot stress hos barn i förskolan - Giang, Kim Huong; Kavand, Ulla http://lnu.diva-portal.org/smash/record.jsf?pid=diva2:560421 Det kompetenta barnet i behov av kompetent omsorg för återhämtning i förskolans vardagsarbete: Att "bara vara" och "göra ingenting" - Wahlgren, Catarina http://hig.diva-portal.org/smash/record.jsf?pid=diva2:532620

PART TWO

Many years ago I read a research conducted over three years called Kidscape where preschools in Malmö, Stockholm, Sweden and preschools in North Carolina, USA participated. The researchers, Boldemann, Söderström, Mårtensson, Dal, Blennow, Pagels, Raustorp, Wester, Cosco, Moore and Bieber have looked into how the design of outdoor environments effect children's well-being, including sleep. The links that I had for this are now broken... and finding the same text is proving difficult... but if you want to find out more, use the names as a search tool.. It was noticed that in the outdoor environments that were classified as high quality - a stimulating area with plenty of opportunities for play as well as having natural elements such as bushes and trees which offer shade as well as variation that children slept better. Cecilia Boldemann is quoted "we can conclude that children are more active, receive less harmful UV radiation, are slimmer and sleep better due to a good outdoor environment" The researchers have gathered facts about how long the preschool children have slept, how many steps per minute they took and how much daylight they received. The weather was better in North Carolina than in Sweden, but routines in the USA tended to limit how much time was spent outdoors. Some questions arise from their study

  • whether children are less active on rainy days or outdoors less.

  • why staff mobility did not increase in the higher quality outdoor environments

  • why are boys allowed to move more than girls

Some tips for outdoor environments - to make yards richer

  • GRASS: Take away the asphalt, in with grass and other material

  • NATURE: take nature in and bring the wild into the yard

  • NATURAL MATERIALS: use tree stumps and natural material

  • BUSHES: replace fences with bushes and vegetation

  • MORE SHADE: Save trees and bushes which give shade and play possibilities.

PART THREE

So now I return to yesterday's post about outdoor environments being an important part to health and sleep quality in preschool children. In Sweden 97% of all 3-5 year olds attend a preschool setting (referred to as a DCC in the research article - Day Care Centre) this means that in Sweden the time spent at preschool covers a large proportion of a preschooler's life.

The article points out that microbes and the spread of infections may be slower due to the expanded outdoor spaces compared to the indoor environments, but there is research that can show both sides of the coin - that infections spread equally fast and that outdoor preschools and "indoor" preschools tend to have the same number of absences as each other - obviously more research needs to be made into this area...

"Today, overweight, craving appetite, a lack of sleep, restlessness

and medicalization to calm the parents’ worries are

important health issues for the child population even in a

welfare country such as Sweden" (1)

The article goes on to describe how a good outdoor environment can have a positive impact on the above mentioned quote. The quality of the outdoor environment at each preschool was assessed by the Outdoor Play Environment Categories (OPEC) scoring tool.

"Vegetation gives protection from excessive ultraviolet radiation

known to affect the occurrence of skin cancer.

Green outdoor environments are also known to buffer the

impact of life stress in young individuals, especially if they

grow up in deprived areas compared to the impact on

children from affluent areas. Preschool children

areas including woodlands had better attention capacity,

were calmer and appeared less stressed than did children

who attended urban DCCs in a more dense and barren

environment." (1)

OK, so far not a whole load about sleep - so I will not go into the details about weight, stress and health so much and will focus on what the article has to say about sleep. As I mentioned yesterday the children playing in preschool yards that rated high on the OPEC rating system tended to sleep longer, and since sleep has a positive impact on health one can deduce that the affects of a good outdoor environment has a double positive impact on the preschoolers health.

"Important for children′s health is the length of sleep per

24 h. This study indicates that the quality of the outdoor

environment in combination with long outdoor stay

resulted in longer night sleep. Physical activity was less

important as an explanatory variable, with the effect of

OPEC and outdoor stay removed. " (1)

This means that being physically active indoors does not have the same effect as being outdoors for long periods of time. It is the time spent outdoors in a good quality environment that is important. This can be tricky when weather is extreme - either extremely hot or extremely cold and therefore limiting time that can be spent outdoors, but does indicate that it is important that we think about HOW we can lengthen time spent outdoors - appropriate clothing, shade, shelter etc. There was no more mention about routines in USA restricting outdoor play - this is something I will have to look elsewhere to find out more...

The article points out that children's night time sleep has decreased in many countries around the world in the last 10 years. Iglowstein et al (2) write that bedtime resistance has decreased significantly between 1974 and 2001 - could it be that our parenting techniques are in fact hindering children from getting enough sleep? Are we making a decision NOT to enter the whole bedtime resistance fight scenario and allowing our children to stay up longer (rather than deal with the tantrum) - since children still have to get up to go to preschool/school in the morning, parental wishes to avoid bedtime arguments could in fact be having a detrimental effect on our children's health through lack of sleep over 24hrs.? Lack of sleep, so I read, increases children's appetite and weight and occurrence of infections (1).

"However, many parents experience

difficulties to put the child to bed for the night if the nap is

too long at DCC. At the preschools studied in United

States, the mid-day nap was mandatory for the

children. These children were much alerter at pick-up

time compared to their peers in Malmo¨ , as experienced by

the research team. We could be criticized for not including

the nap on the way home in the night sleep variable.

Children from high-quality outdoor environment had

however, even though they napped on their way home,

longer night sleep." (1)

Interesting to read that napping is mandatory in the preschools in USA, I would be VERY interested to find out more about how the napping effects the night sleep - but there was no more information about this in the article... But I interpret these words to mean that napping does not seem to impact night sleep as much as lack of outdoor play in a good quality environment.

"Studies from United States show that children

from very poor areas benefit more from high-quality

environment compared to better off peers. Thus,

the relation between environment and health found in this

study would be even more pronounced with participants

from low socio-economic groups. " (1)

The more ECE research I read the more it seems apparent that children from very poor areas always seem to be the ones that benefit the most from good quality settings which means that there needs to be investments made in all preschool settings, and not just the ones that can afford them.

Söderström et al have written several articles based on this research, I have included another one on the reference list here (3) where there is more information about how a good outdoor environment helps support children's attention levels. In this article it does go on to describe the "outdoor preschool" (UR och Skur/Forest School) as positive for most children as they are outside for long periods of time BUT that the long days for some children means that these children remain stressed - as "children cannot restore their cognitive capacity beyond restoration" (3) - as a nature-like environment or environments with nature elements added to it, helps with restoration.

So I end this post with

  • we need to play outdoors in a good quality, nature like, environments to aid longer sleep

  • we need to make sure we adults take up the bedtime fight and ensure our children are getting enough sleep

  • it would be good to find out how long we should be playing outside for the children to benefit from the positive effects mentioned

  • I want to find out more about how napping and night sleep impact each other

References

(1) The quality of the outdoor environment influences childrens health – a

cross-sectional study of preschools

M Söderström (masod@sund.ku.dk)1,2, C Boldemann3, U Sahlin4, F Mårtensson5, A Raustorp6,7, M Blennow8 October 2012 Acta Pædiatrica ISSN 0803-5253

(2) Pediatrics 2005;115;233

H. Largo

Oskar G. Jenni, Heidi Zinggeler Fuhrer, Ivo Iglowstein, Luciano Molinari and Remo

in the First 10 Years of Life

A Longitudinal Study of Bed Sharing and Sleep Problems Among Swiss Children

(3) Outdoor environmental assessment of attention promoting settings for preschool children

F.Ma ̊rtenssona,C.Boldemannb,􏰀,M.So ̈derstro ̈mc,d,M.Blennowe,J.-E.Englundf,P.Grahna

http://www.nynashamnsnaturskola.se/spring/pdfHtm/Martensson_et_at2009.pdf

PART FOUR

Here are some notes I took when my sleep researcher husband, John Axelsson, talked to parents of young children about sleep and napping

  • the brain has 5-6 arousal systems (light, activity, stress etc) that need to be switched off before falling asleep - which means if it is too bright, or the brain is too active or stressed then it will be impossible to sleep. Some people are better at switching off these arousal systems than others and can thus fall asleep faster.

  • Deep sleep reflects what we have been doing during the day. The parts of the brain that have been activated during the day sleep deeper during the night to help recovery and plasticity.

  • stressed people may fall asleep later, but they will get the same amount of deep sleep - its just their sleep patterns will look different. Problems ocurr for people who wake up during the night unable to fall back asleep.

  • when we sleep we block stress signals to the brain.

  • teenagers are more evening people and not morning people

  • sleep is important for filling up the energy level in the brain which makes focussing on activities easier. People with low brain energy (ie lack of sleep) need to change activity more often to help maintain focus (this can be seen in night shift workers who need to change their job activity more frequently).

  • sleep supports the immune system.

  • sleep helps learning - synapses levels are reduced during sleep so that they are more receptive to learn/connect

  • when the brain is tired, the part that is feeling over used/tired can actually locally sleep!!!

  • REPEAT - SLEEP - the best way to learn

  • sleep allows memories to move from short term to long term

  • Sleep helps process the emotions that you have experienced during the day - this allows you to react less strongly/more appropriately next time

  • with a lack of sleep it is not only harder to create long term memories but also harder to keep control of your emotions - much more likely to swing between emotions - angry is more angry, sad is more sad and happy is more happy and you have the chance of experiencing them all in a short period of time...

  • sleep shortages - short term risks are accidents. Long term risks are health problems.

  • Those who have too little sleep will have problems with their hunger regulation - they will feel MORE hungry - this means that overweight is also connected to lack of sleep - and the health problems that come with being overweight.

  • Tips for good sleep hygiene - physical activity, being outside in the morning ( as if you are exposed to light in the evening it can stimulate you and keep you awake), wind down before bedtime, routine sleep times, don't go to bed hungry (eat regular meals), warm socks - its harder to fall asleep if your feet are cold (and from personal experience I can vouch for this as I have problems keeping my feet warm - I have great cozy socks now). In the room where you sleep - a calm sleeping environment, cool and well ventilated, dark, good bedclothes that are breathable. Understand and accept that occasional disturbed sleep will happen.

  • low music can help collect thoughts and reduce stress and thus help the falling asleep process

  • night terrors are harder on the parents than on the child

  • In sweden we stop giving our children naps earlier than any other country in the world - its a modern invention to stop napping at a young age. If a child falls asleep after lunch they should be allowed.

  • rest time (ie lying still but not sleeping) is valuable as even though it does not allow the brain to recover as sleep would, it does allow for stress reduction.

  • people with insomnia should not nap

  • if a child does not nap during the day as usual and falls asleep around 5pm instead, allow the child to sleep for 20 minutes... if the child does not wake easily after 20 minutes try 10 minutes later - as deep sleep lasts about 30 minutes.

  • Children with a lack of sleep are at risk of reduced emotional control, hyperactivity, cognitive disturbance and risk for overweight.

  • If your child snores it is worth getting them checked out by a doctor - to rule out sleep apnea and increase sleep effectivity

  • when it is the parents that are in control of bed times the children tend to have better sleep and perform better in school than children who control their own bedtimes.

  • Children with many out of school activities have less sleep - due to a combination of stress and evening activities stimulating the brain.

  • blue light (screens) stimulate the brain making it harder to fall asleep, so its a good idea to avoid TV and screen time before going to bed

On my computer I use f.lux so that it reduces the blue light the later it gets, which makes the screen quite reddish... but the idea is, of course, to help reduce brain stimulation before bedtime...

#sleep #outsideplay

Interaction Imagination

© 2017 Suzanne Axelsson. Interaction Imagination. Stockholm, Sweden.
suzanne@interactionimagination.com 

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