Are Hong Kong kids sleeping enough? Solutions for better sleep

The early months of waking in the night to feed your baby and enduring sleep regression may be in the rearview, but as your child develops, new sleeping problems arise. From nightmares, to resisting bedtime, not sleeping through the night and the distraction of screen time, welcome to the new era of bedtime battles.

Sleep directly affects your health and due to their rapid physical and mental development, kids need more sleep than adults, so their body can rest, repair and process information.

During sleep, kids consolidate motor and cognitive skills and they process the information they’ve been exposed to during the day, as well as their emotions. Sleep also helps them grow big and strong – it’s when growth hormones are released and their immune system strengthens itself.

How big a problem is poor sleep among Hong Kong children?

90% of your child’s development occurs during the first 5 years of their life. Despite this, a 2022 Hong Kong study shows a consistent downward trend in sleep duration among preschoolers.

The American Academy of Pediatrics says that approximately 25% to 50% of children experience some sort of sleeping problem.

A longer term review of over a century of children’s sleep data shows that children 5-18 have lost 0.75 minutes of sleep each year. This means that kids in 2008 got over an hour less of sleep each night than their 1905 counterparts did.

In fact, 89% of Hong Kong preschoolers don’t get the recommended minimum 11 hours of sleep, with studies linking lower sleep duration to hyperactivity, inattention, behavioural problems, academic performance and being overweight.

“Children need plenty of sleep to support their growth and immune system, without it, they might be more likely to fall ill, or develop slower. Many of the kids I see in clinic don’t meet their sleep requirements - between bedtime resistance, the demands of homework and the many things parents have to attend to in the evening, it can be difficult to get kids to bed on time,” says naturopath and medical herbalist Tej BG. 

“Tiredness may present counterintuitively in kids – often as hyperactivity, or an inability to manage their impulses,” he adds. Other signals they’re not sleeping enough include how well they’re able to focus, how defiant they are, and mood swings. Their emotional response might skyrocket into sudden crying or anger. 

How much sleep do children need?

Child sleep requirements vary depending on their age and individual needs. According to the UK’s NHS:
-          toddlers 1-2 years old need 12 to 16 hours.
-          children 3-5 need 11 to 14 hours.
-          children 6-12 need 9-12 hours.
-          teenagers need 8-10 hours.

“Just like we have a natural variety in sleep requirements among adults, some children need more hours of sleep than others. Their sleep needs may increase during phases of brain development, or when experiencing growth spurts. Stress and neurodiversity may also increase their sleep needs. Highly sensitive children may need more time sleeping at night to process the extra information they absorb throughout the day and regulate their nervous systems,” says Tej.

Common sleeping problems among children and their causes

Bedtime resistance

Studies have shown that 61% of toddlers engage in bedtime resistance. As a result, these toddlers had later bedtimes, took longer to fall asleep and slept for shorter periods, leading to daytime sleepiness.

“Bedtime resistance is often less about not wanting to sleep and more about what bedtime represents. For younger children, it may mean separating from their parents or ending an enjoyable day. Separation anxiety at bedtime is a common developmental experience, particularly in younger children. The goal is not to eliminate the child's need for reassurance but to help them gradually build confidence in falling asleep independently,” says IMI counsellor Victoria Tam.

Bedtime resistance is very common among kids with autism, with studies reporting between 60% and 80% prevalence. In fact, sleep disorders in general are. A 2021 survey on over 2000 kids showed that sleep disorders were prevalent in 67% of Chinese children with ASD.

There’s a clear link between sleeping problems and neurodiversity. Alongside bedtime resistance, kids with autism tend to take longer to fall asleep and are more likely than neurotypical peers to experience sleepiness during the daytime.

Kids with ADHD experience similar challenges, and may additionally struggle to stay asleep, waking during the night and finding it hard to fall asleep again. You might find that getting them to wake up in the morning presents an equal challenge.

When separation anxiety is at play, Victoria suggests that parents can support their kids by establishing a predictable bedtime routine, providing reassurance and avoiding introducing sleep habits that parents are unable to maintain long-term, like staying beside your child until they fall asleep. “Gradual steps towards independence, combined with warmth and patience often helps children feel more secure over time,” she says.

Nightmares and night terrors

If the phrase ‘Mummy, I’ve had a bad dream,’ is a familiar occurrence, then we’d hazard a guess that your little one is between 3 and 6 – the age when nightmares are most common. Kids are vulnerable in a world which often feels scary, and the prevalence of their nightmares reflects this. Nightmares occur as periods of REM (dreaming sleep) lengthen during the night – usually around halfway through sleep.

“Nightmares are a normal way to process new experiences, worries and emotions through dreams, so periods of stress, change, or major life events can sometimes lead to more frequent nightmares,” says Victoria. 

“Rather than trying to convince a child that their fears aren't real, it is often more helpful to acknowledge how frightening the experience felt. Saying "there's nothing to be scared of" may unintentionally make children feel misunderstood. Instead, acknowledge their feelings by saying something like, "That sounds really scary," before gently reassuring them that they are safe,” she adds.

Night terrors on the other hand, usually occur within the first few hours of sleep and are most common between the ages of 3 and 8. They happen when transitioning from one phase of sleep to another, during non-REM sleep. If your child is experiencing a night terror, they may shout and thrash around. Their eyes may be open, but they are not awake. Night terrors can cause a lingering sense of fear, but often go unremembered, whereas your child will most likely be able to recollect the narrative of a nightmare, as they occur on the cusp of waking and dreaming.

Night terrors tend to run in families – if a family member has night terrors, or sleepwalks, then your child may be more likely to experience them. If your child is experiencing a night terror you may want to wake them – but you shouldn’t. Allow the terror to pass – and don’t try to prevent them from moving, unless they could harm themselves or others. Waking them could be more distressing.

Nightmares may be a natural part of your child’s emotional processing. But frequent nightmares could indicate something’s going on with your child’s mental health – stress, anxiety, depression and PTSD are all linked with nightmares.

“If nightmares become persistent, significantly disrupt sleep, or are linked to traumatic experiences, seeking professional support can help identify and address the underlying cause,” says Victoria.

Five year old Sam was struggling with chronic nightmares. He was brought by his mother to see homeopathic doctor, Manisha Khiani.

His Mum had recently had a medical emergency, and he was left in the care of a nanny for a week. “Though he was well cared for, to his developing mind, his mother had vanished overnight. Even when she returned, the trauma of her disappearance remained. He was plagued by relentless, vivid nightmares, terrified that if he fell asleep, she might disappear again. He was trying to process an overwhelming fear of abandonment,” says Dr Manisha.

In these contexts, Dr Manisha often reaches for homeopathic remedies like phosphorus and calcarea carbonica. “After carefully assessing Sam’s symptoms, I prescribed him a remedy to address his emotional shock. His response was remarkable. Within a short period, his nervous system settled and his sleep was restored,” she adds.

Poor quality sleep

A large population study in China has shown that exposure to pollutants during a child’s early life is linked to sleeping problems which primarily affect breathing, and a child’s ability to stay awake during the day. Researchers have theorised that the effect toxins have on the respiratory system affects brain health, leading to worse sleep.

Though toddlers and children spend nearly half their time asleep (or are recommended to) studies have shown that there are high levels of SVOCs (semi volatile organic compounds) found in their bedrooms, originating from their mattresses and toys. Their vulnerability to pollutants is higher, as their breathing rate is around 10 times faster than an adult’s and they have a higher skin: body mass ratio, leaving more surface area susceptible to environmental toxins.

Kids with neurodiversity are more susceptible to the effects of toxins, which place strain on a nervous system which may already struggle to regulate, exacerbating sleeping problems.

A 2022 study on the relationship between gut health and sleep among pre-school age children shows that kids who had higher levels of good bacteria like Bifidobacterium scored higher on their total sleep time. Higher levels of the Bacteriodes species, another good gut bacteria, were prevalent in kids who had better sleep efficiency – those who spend the most time in bed actually asleep, rather than tossing or turning.

The bad bacteria species, Lachnospiraceae, was connected to shorter sleep durations.

Screen time and nervous system dysregulation

Studies have linked screen time to an overactive nervous system, or HPA axis dysregulation. A 2015 sleep study on Hong Kong preschoolers showed that kids who used electronic devices for more than 3 hours each day shortened their sleep duration, demonstrating the negative impact of screen time.

The limit recommended by experts for recreational screen time is a maximum of 2 hours per day, but the reality is that not only do we exceed this as adults, our kids do too – and the negative impact is clear.

Research shows that kids who have higher levels of screen time sleep less, delay going to bed, have poor quality sleep and are more tired during the day.

Addiction to screens can cause more activation of the sympathetic nervous system response, which can prevent kids from being able to relax enough at night to switch off.

What helps children sleep at night?

When it comes to bedtime, consistency and patience is key. Preparation for bedtime starts during the day, and limiting naps to 20 minutes in the afternoon can help ensure they’re actually sleepy when bedtime rolls around. 

“Creating opportunities for children to talk about their worries during the day, and helping them practise calming strategies before bed can all reduce nighttime anxiety,” Victoria says.

Co-create your child’s wind down routine before bed, giving them some freedom over the choices they have. Do they want to cuddle, or read a book? Have their back stroked? Make sure the options you give them aren’t stimulating – and end screen time at least an hour before their bedtime.

Make sure their routine has clear limits – we read one story, then cuddle for 5 minutes.

If your child is hungry before bed, include snack time as part of their wind down routine, around 30-45 minutes before bed.

 Kiwis, tart cherries and bananas contain serotonin, melatonin and tryptophan respectively, all of which support sleep. Oatmeal provides a blend of melatonin, magnesium and tryptophan, and as a complex carb, it stabilises blood sugar to help prevent night time awakenings. Pistachios, pumpkin seeds, walnuts and almonds also contain nutrients which support better sleep at night. If you have the time on a Sunday, you could prepare a batch of overnight oats with a blend of these ingredients as an easy evening snack that will help support better sleep.

“Getting enough nutrients for children is important for the synthesis of serotonin and melatonin, which may support their moods, ability to relax and sleep. Magnesium and certain B vitamins can be helpful. Keep an eye on foods and drinks that are high in sugar content as these can present a block at bedtime. Remember that sleep is multifactorial, and that all physical and emotional aspects have to be taken into consideration,” says Tej.

If your kids are afraid of the dark, a nightlight can help ease bedtime fears. “Parents can also help children develop coping tools, such as practising slow breathing, visualising a safe place or comfort items like blankets or stuffed animals” says Victoria.

Give the routine as much space as is required for them to go to bed on time – between 30 minutes and an hour before their bedtime. If your child currently goes to sleep late, bring their bedtime forwards by a set amount each week.

If your child gets out of bed, take them back to bed calmly. Don’t scold them, as this can excite their nervous system. Equally, don’t give them too much attention. Be boring, so being out of bed for your child becomes less appealing.

“Parents should consider seeking professional support if sleep difficulties persist for several weeks, regularly interfere with the child's daytime functioning, or cause significant distress for either the child or the family,” says Victoria. 

“Frequent nightmares, intense bedtime anxiety, ongoing refusal to sleep alone beyond what is developmentally expected, or sudden changes in sleep following a stressful or traumatic event are all signs that additional support may be beneficial,” she adds.

Early intervention when your child is experiencing sleep issues can help identify emotional or physical aspects contributing to bedtime battles. If you need some help – whether it’s using naturopathy to optimise their physical health and improve sleep quality, homeopathy for nightmares, or taking them to see a counsellor or psychologist to ease their bedtime fears, our practitioners have got your back.

References
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