Child and Adolescent Psychiatry

Sleep Disorders 165

Box 20.2Good sleep hygiene

Daytime

Avoid naps, particularly late in the day.

Regular exercise (but not too close to bedtime).

Resolve worries and make plans for the next day (so these aren’t left for

bedtime).

Restrict caffeine-containing drinks (coffee, cola), particularly late in the day.

Tobacco, alcohol and drugs can also disrupt sleep, and may be used by

adolescents without their parents knowing.

Approaching bedtime

Finish any homework well before bedtime.

Gradual winding down without over-stimulation.

Avoid large meals late at night.

Choice of bedtime

Duration from bedtime to wake-up time should provide enough sleep for the

individual’s age and constitution.

Sending children or adolescents to bed too early conditions them to associate

lying in bed with being awake rather than asleep.

Go to bed

At a fairly consistent time.

When sufficiently tired to fall asleep relatively rapidly.

Without repeatedly getting out of bed again.

With soothing routines, for example, with a story or a tape; avoid frightening

stories or exciting TV while in bed.

Phasing out the need for a parent to be present equips an individual to get to

sleep (and get back to sleep) when alone.

Bedroom

Comfortable bed.

Temperature, light and noise controlled.

Neither aversive nor too exciting.

Wake-up

At a fairly consistent time (long lie-ins can reset the sleep–wake cycle).

Do not reward waking up too early, for example, by providing wonderful

videos.

Presentation

Sleep problems typically present in one (or more) of three ways:

problems getting to sleep or staying asleep;

excessive daytime sleepiness;

episodic disturbance at night, for example, nightmares, night terrors.