Sleepy States

Anwar Shafi, MD, Discusses the Growing Problem of Sleepy Kids


By Rebecca Budde | Photos by Jason Johnson
Published in Aspects, 40-1, Winter 2017

Experts caution: Sleep is not a luxury; it’s a necessity for good health. It’s no secret that the sleep debt is growing like the national debt in American adults. Studies show that our children are walking in our sleepy footsteps, and it’s causing innumerable negative consequences. 

According to the Centers for Disease Control and Prevention, young children should get 11-12 hours of shuteye while school-aged children should sleep at least 10 hours. Though they’re notorious for staying up late, teens should be getting 9-10 hours of continuous sleep. 

But the statistics are waking people up.

As early as 2010, the American Academy of Sleep Medicine and the American Medical Associate passed a joint resolution stating insufficient sleep and sleepiness in adolescents is a public health issue. Nearly ninety percent of teens aged 13-18 reported not getting the minimum recommendation of nine hours of sleep per night, according to a 2011 poll by the National Sleep Foundation. Several other studies show comparable results for younger children. 

ShafiAnwar Shafi, MD, assistant professor of pediatrics at SIU School of Medicine, is working with families to help their children sleep easier and stay healthier. He is the only pediatrician in the region who is board certified in sleep medicine to evaluate and treat children with various sleep disorders and to interpret their sleep studies. He’s on a mission to get them back to a better night’s rest. 

Aspects talked with Dr. Shafi about this important health topic:

What are some of the medical reasons children aren’t getting the recommended amount of sleep?

Physical or neurological issues can lead to nighttime disruptions that don’t allow the child a full night of rest. Sleep apnea is likely the most common issue I see. Other sleep disorders that can adversely affect children and adolescents include night terrors, sleep talking, sleep walking and periodic limb movement disorder. Some children, mainly teens, have behaviorally induced sleep deprivation. 

For children who are 2 to 8 years old, sleep apnea is usually caused by restricted airflow due to enlarged adenoids and tonsils. A visit to the ENT for a tonsillectomy or adenoidectomy usually does the trick. Adolescents with sleep apnea may need the help of a CPAP machine. Sometimes children who have had their tonsils and adenoids removed in the past continue to have sleep apnea, and they may also need a CPAP machine.

Does environment or behavior play a role in sleep?

Definitely. Today’s children and adolescents are growing up in a world where stimulation doesn’t stop once the sun goes down. Activities like sports or band often take over the evenings, delaying homework time and pushing back bedtime. 

For adolescents especially, the most common culprit of stimulation is the screen. In fact, most sources cite that today’s youth spend 5-7 hours a day of screen time outside of educational purposes. This includes watching TV, using computers and other electronic devices and playing video games. 

Electronic devices actually have detrimental effects on sleep in two ways. First, your mind is actively engaged in what you’re doing, like checking email or playing a game. It’s hard to mentally wind down from those things. Second, these screens emit light, which alters the circadian rhythm that is responsible for helping us sleep.

Melatonin is a hormone excreted by the brain a couple hours before bedtime begins. As daylight fades, melatonin secretion is triggered. Light from the electronic devices suppresses the melatonin, making it harder to fall, and possibly, stay asleep. 

Is taking melatonin supplements safe for kids?

Melatonin can be safe for children, but it’s important to realize that it helps initiate sleep. It doesn’t help you stay asleep. 

What are some tell-tale signs that a child or adolescent isn’t getting enough sleep?

The symptoms of sleep deficiency can manifest differently in children than in adults. It makes sense that daytime sleepiness or falling asleep in school can also indicate sleep deprivation. But the contrary can also be true: Typically, children become hyperactive during the day and have problems with concentration and managing emotions. 

It’s sometimes hard to answer if tiredness is causing problematic behavior or the other way around. Some children who have been diagnosed with ADHD actually have sleep apnea. Addressing the sleep apnea can sometimes help the behavior concerns.

But if you flip the coin, children with behavior issues can have sleep problems. For example, medications used for behavior problems can interfere with sleep and children who have a harder time settling down at night might have later bedtimes. Psychological issues or stress can also interfere with sleep. A physician can help to figure out which is driving the other through a thorough examination and a sleep study. 

What types of health issues arise from lack of sleep?

Lack of sleep has been linked to many health problems, including obesity, heart disease, heart failure, depression, Attention-Deficit Hyperactivity Disorder, diabetes and high blood pressure. Young children who aren’t getting the proper amount of sleep often fail to thrive: They don’t gain enough weight, which can lead to health problems.

Does lack of sleep have other detrimental effects on children and adolescents?



The HSHS St. John's Hospital Sleep Center provides a child-friendly bedroom to evaluate childrens' sleep.

Like a sleepy adult, sleepy children have a harder time concentrating and learning. This can lead to taking longer to complete schoolwork, more frequent mistakes or trouble making decisions.

Sleep problems are family problems. A child who wakes in the night is likely to head to the parents’ room. The parent comforts the child and tries to go back to sleep. In some families, the process could be long enough that the parent has trouble falling back to sleep. Now everyone’s tired and likely grumpy.

How can a sleep study help parents with their child who is showing signs of lack of sleep?

A sleep study allows your doctor to measure how much and how well you sleep, whether you have sleep problems and how severe they are.

When should parents ask about a sleep study for their child?

It’s best to share your concerns with your pediatrician as soon as you notice an issue. I always do a thorough history and exam to try to determine the cause of the concern. 

What general recommendations do you have for parents to help their kids sleep better?

Stick to a consistent bedtime schedule, even on the weekends. 

While bedtime routines will help restless children ease into the night and fall asleep, for those with highly active children who take longer to unwind or those who have anxieties driving their mind, they may need a lengthier or different type of routine. 

Screens should be off an hour before bed. Keep the lights dim too. Remove all devices from the room: No TV, tablet, computer or phone. The bedroom should be for sleeping, not all these other activities like watching TV.