Bedtime is a time of day many parents dread. Kids not only make excuses, they flat-out refuse to go to their rooms, they cry and throw tantrums. The standoff can be dramatic. And so are the numbers.
A Canadian survey presented to the Canadian Pediatric Society last summer showed that 70% of children have a problem going to sleep. Of those children, 27% had been given over-the-counter (OTC) sleep aids such as the hormone melatonin or antihistamines. Put another way, that’s a bunch of little kids doing drugs.
Add to that the results of a study by Dr. Dirk Bock of Western University (he also conducted the survey), published in the July 2015 issue of the journal Sleep Medicine, which found that 30% of physicians prescribed OTCs for insomnia to otherwise healthy children. This despite the fact that there are no evidence-based guidelines for treating insomnia in kids.
As Bock told CTV News last fall: “Children may start getting used to the fact they need medication to have a good sleep.”
Penny Corkum, a professor in psychology and neuroscience at Dalhousie University in Halifax, points out that there is a large body of evidence that specific behavioural strategies such as changing the sleep environment and implementing healthy sleep habits can be highly effective.
“My concern is that people may go too quickly to medicine or the pill like melatonin without trying environmental strategies,” she says.
In a 2015 paper published in the Journal of Pediatrics and Child Health, sleep researcher David Kennaway from the University of Adelaide warned: “The word ‘safe’ is used very freely and loosely with this drug [melatonin], but there have been no rigorous, long-term safety studies of the use of melatonin to treat sleep disorders in children and adolescents."
For Canadian parents, there’s a new resource on the horizon – an alternative to melatonin – a groundbreaking Internet based sleep-intervention program for parents of children aged one to 10. The goal of the new website, Better Nights, Better Days, is to provide parents a path forward. The program consists of five sessions with interactive activities and videos that teach parents behavioural strategies that help children fall and stay asleep; details on the best sleep environment, and how to develop routines.
In March, researchers at Dalhousie will actively start to enlist 500 families nationwide to participate in a randomized clinical study of the project to determine its effectiveness, said Corkum, the study’s principal investigator. (You’ll be able to apply then and fill out a form on the website to determine your child’s eligibility for the study.)
“The truth is we don’t have a lot of easily accessible interventions. To go see a child psychologist or a sleep clinic is pretty difficult,” she says, pointing out that wait lists are long and it’s challenging for parents to take time off work.
With the online intervention program, parents will have 10 weeks to complete the five sessions at home. Researchers will check in with them after three, six, and nine months to measure the program’s effects.
The study was developed over three years and consists of a Canadian team of researchers from the University of Dalhousie, University of Montréal, McGill University, University of British Columbia, University of Western Ontario, University of Toronto, The Hospital for Sick Children in Toronto, and the University of Alberta.
Many lifestyle factors impact sleep, Corkum says. Parents place many demands on children, with numerous extracurricular activities. “Their busy schedules make it a challenge to settle at sleep time,” she says.
“We live in an electronic, 24-hour world. You can be plugged in and access information and stimulation any time of day,” she says. “Even young children have TVs, laptops, tablets, and phones in their bedrooms.” Artificial lights from electronics can interfere with a child’s sleep while lack of exposure to fresh air and natural light can disrupt circadian rhythms.
Corkum recommends consistent bedtimes and wake times. “Your child’s bedroom shouldn’t be an exciting place to play in. It’s just for sleeping,” she says. As it gets time to meet Mr. Sandman, keep things calm and dark. And get rid of electronics an hour or more before bed.
There’s no doubt that some children may require sleep aids such as melatonin, Corkum says; however, even in those situations, medication should be paired with healthy sleep habits so, in time, a child no longer needs pills.
“Sometimes things get worse before they get better,” she says. “It’s stressful and it’s hard work. There’s no doubt about it.”