Sleep problems, the epidemic affecting children and young people

BarcelonaWhile we sleep, the body recovers from the day's experiences. Restful sleep is therefore essential for physical and mental preparation to face the new day. However, the reality is that one in three children and adolescents do not get the necessary sleep, which impacts their physical, mental, and emotional health. According to the latest FAROS report from the School of Health at the San Juan de Dios Hospital in Barcelona, ​​17% of children go to school sleepy and 4% fall asleep in class. For adolescents, the figures are even more alarming, as 52% admit to going to school having slept less than 8 hours, and 84% have difficulty waking up.

Increased risk of low cognitive function

Lack of rest also hinders learning and impacts children's academic performance. "Sleep is a state of rest, which can lead us to think that the brain is on pause, but in reality, the opposite is true. While we sleep, we somehow recover brain function and reverse the damage caused during the day. That's why it's essential for learning, attention, and memory," said Dios, who participated in the presentation of the latest FAROS report on June 10.

Some studies show that sleeping less than ten hours until the age of three and a half carries a risk up to three times higher of having low cognitive function (less attention and memory) at the age of six. As for adolescents, they present the so-called social jet lag, which refers to the notable change in bedtime on weekends, more than two hours later than on other days, which translates into poorer academic performance for 24% of young people, especially during the first few days of the week. "Excessive daytime sleepiness is a major problem, causing hyperactivity in children and falling asleep in class in adolescents," warns Gonzalo Pin, coordinator of the sleep and chronobiology group at the Spanish Association of Pediatrics (AEP) and head of the comprehensive pediatrics unit - FAROS sleep unit.

Sleep problems or disorders

During his presentation, Pin sought to distinguish between two distinct things: "Although the consequences are often the same, having sleep problems is a matter of education and boundaries, while a sleep disorder is a pathology." The coordinator of the AEP's sleep and chronobiology group wanted to explicitly refer to the time poverty that children have been experiencing for some time: "They don't have enough time for their own interests, and the first thing we do when we don't have time is steal time from sleep. We're not protected from external factors."

"Sleep is to our body like oil is to an engine," Pin insists. Therefore, the consequences derived from sleep deprivation range from neurocognitive to learning, including behavioral, which are the first to appear. And the fact is that a lack of sleep also ends up triggering mental health problems. The good news, Pin points out, is that everything is preventable with a socio-educational intervention that affects school schedules, mealtimes, and physical activity.

Melatonin, the only drug approved by the EMA

The latest edition of the FAROS report details that insomnia is the most prevalent sleep disorder among children, affecting between 20% and 40% of them. In children, insomnia is often treated with cognitive-behavioral therapy, with which up to 80% of patients achieve improvement and 40% achieve complete remission. There are also sleep-related breathing disorders; central hypersomnias, which present with excessive sleepiness, such as narcolepsy, Kleine-Levin syndrome, or insufficient sleep syndrome; circadian rhythm sleep-wake disorders, such as delayed sleep phase syndrome, which primarily affects adolescents; parasomnias, or unpleasant motor or vocal manifestations that occur during the night, such as sleepwalking, awakenings, or night terrors; and sleep-related movement disorders, such as restless legs syndrome.

San Juan de Dios also emphasizes the few existing studies on the efficacy and safety of pharmacological treatment for insomnia in children. Only one drug, melatonin, is approved by the European Medicines Agency (EMA), indicated for the treatment of insomnia in children and adolescents diagnosed with autism spectrum disorder. However, the frequency of drug use for insomnia in children is similar to that of adults. "In Spain, there is a tendency to disregard sleep, and the treatment is not a pill, but a multimodal treatment, especially in pediatrics," says Òscar Sans, who points out that attention must be paid to biological factors, that is, when and how much we sleep, and also to external factors, such as exposure to sunlight, especially in the morning, and practice. "All of this influences circadian rhythms, and the fact is that the better I spend the day, the better I will sleep, and conversely, the better I sleep, the better I will spend the day," he points out.

Sans complains that we dedicate our efforts to things that perhaps shouldn't be so important, neglecting other fundamental aspects. "In pediatrics, we have a developing brain that won't reach its full potential if it doesn't sleep well," he says, while pointing out that between 20% and 24% of children and adolescents between 4 months and 17 years of age suffer from sleep deprivation. We can reverse this, but first, he emphasizes, "we must reflect on the sleep of the little ones," especially knowing that up to 80% of children with ASD and developmental disorders sleep poorly.