Why should millions of people have so much trouble with a natural bodily process like sleep? It is a normal function for all mammals-- one that we spend a third of our lives doing.
As I describe in my new book- “Mending the Body with the Mind: Harnessing Kids' Superpowers to Heal and Stay Healthy,” sleep is essential for having a healthy immune system, healing from illness, and, of course, being alert during the day. Kids who do not get enough sleep suffer from mood and conduct problems, get lower grades, suffer more sickness, and are prone to obesity and drug addiction. Sleep deprivation has even been shown to shrink the brain!
The reasons kids do not get enough sleep are many: Too much homework, (sometimes), too much time spent on phones and tablets (most of the time).
Any stress at school or problem at home can make it tough to fall asleep and stay asleep: bullying, an unrecognized learning disability, a mean teacher, test anxiety,
a crush, worry about school violence, a recent move, homelessness, food insecurity, an unsafe neighborhood, parental fighting, divorce, or drug abuse. (Of course young people who abuse drugs or alcohol are all prone to insomnia.)
Simple environmental factors, like too much light, or a TV in the room, or too much noise at home, outside, or from a bedroom sharing sib may be the problem.
Lack of exposure to sunlight, and a deficiency of fresh air or exercise may be the issue. And caffeine or other stimulants after 12 noon may keep children, and adults awake.
Finally, kids with ADHD, anxiety, depression, and phobias (to the dark, for example), are all prone to sleep problems. And the medicines young people are given for ADHD may themselves cause troubles falling asleep.
The challenge that I faced in my pediatric practice is this: Health care providers, and society too often looks to drugs for the answer to problems sleeping. That's despite the fact that experts agree that changing habits around sleep, and other behavioral methods are the proven solution to sleep disorders.
In my parents' day, barbiturates were commonly used to bring on sleep. They were addictive and had side effects. Then the sedative hypnotic class called the diazepam’s gained popularity. Valium is used less than the short acting drug Ativan. It's used for short term issues with sleep like a death in the family, but I've also seen children who were prescribed doses of this addictive drug for years.
Then there are the over-the-counter drugs that are pushed in glossy commercials on TV, often with attractive women, or couples fretting about sleep before the magic pill has them waking up refreshed and ready to go. What is mentioned only in the rapid-fire list of side effects at the end of the ad is that the meds all can have side effects like daytime drowsiness, that may make driving hazardous; side effects may affect 2/3 of sleeping pill users.
And, according to published studies, medicines for sleep not only do nothing to improve the amount of important REM (or dream) sleep, they only increase the amount of total sleep by 20-30 minutes a day!
Parents and many doctors view melatonin as "natural" so safe, and it is prescribed or suggested so widely, that in my book I call melatonin "Vitamin M" But herbs are not regulated by the FDA in the U.S. so they may be adulterated with other substances and not have the amount of the active herb the label says it does.
Melatonin itself may have side effects like daytime drowsiness, dizziness and headache.
This herb does help adjust the circadian cycle, as when we get jet lag crossing time zones, or when adults have to adjust to working a different shift, or when teens have to learn to adjust their bedtime from the ridiculous 3 or 4am I've seen too often to be able to wake up for school. But as a rule, it does not help most kids sleep better all night (with one exception I discuss in my book.)
The antihistamine diphenhydramine (Benadryl) was the only medicine we'd used for kids who couldn't sleep back in the twentieth century--for the side effect of drowsiness. It is harmless, for the most part, but can cause dry mouth, sleepiness (the reason for its use) and wears off in 4-6 hours. In addition, studies of adults who use the drug chronically shows that it might contribute to dementia.
Finally, may adults swear by the now legal drug derived from cannabis--cannabidiol (CBD). It can help with sleep, as well as with chronic pain. But it too can have side effects like diarrhea, appetite loss, and other gastrointestinal issues.
CBD is processed by the same liver enzymes that metabolize many other drugs, so taking both together can cause liver damage.
Not surprisingly, sleep experts agree that the best prevention against, and treatment for sleep problems are behavioral: Don't talk about stressful things or have screens on within an hour before bed. Bedrooms should be absolutely dark and quiet. Beds should be used only for sleep, (for adults) sex, and perhaps some mellow reading.
Just as we all need good hand hygiene, we need good sleep hygiene. Kids, especially need a regular bedtime routine--lasting no more than a half hour--with a bath or shower (it helps them relax), snack, toothbrushing, story and bed.
If kids hop out of bed after the goodnight kiss--what the sleep pro's call curtain calls, a parent can say, "I'll come back in 5 minutes for a second goodnight;" it's back to bed for the little one, parent leading the silently, calmly, without emotion.
For those with active sympathetic nervous system, slow relaxation breathing has been proven to help. For those whose thoughts will not just leave them alone, learning a version of mindful meditation can work like a charm. It did for me, when I was going through a tough period in my life, years ago. It took me six months of practice during the day before I overcame my insomnia. Children, with their more active imaginations, learn much faster. Now, if I awaken at night, I practice lovingkindness meditation which I learned from the wise, and kind Buddhist teacher and author Sharon Salzburg. It's as if I took a sleeping pill:
I'm asleep as soon as I finish, then in dreamland until morning.
I taught many young people how to examine their thoughts and let them go, by comparing them to clouds in the sky, or floats at a parade; for those recurrent thoughts, they can visualize a merry go round. Those bobbing painted horses just keep going round and around, but you can just notice them then see them go, just resting, (never "trying" to go to sleep) until the sand man comes to visit.
Doesn't this sound a lot cheaper, safer, and less artificial than using sleeping pills? Sleep is a natural biological process. Shouldn't treatment be natural too?