Child Sleep Debt: 3 Steps to Fix It Starting Tonight

Sleep is a basic human need, like breathing and eating. I think my husband would agree that sleep is at a premium in our home! The sleep deprivation and all that comes with is all too fresh for me. About 15 months ago, my youngest son was a newborn. Who remembers (or is currently going through) those newborn days? When anyone asks, I tell them without a doubt that sleep deprivation as a newborn mom is much more impactful than a very busy 24-hour call in the hospital as a pediatrician. You see for me, missing a few hours or even a night of sleep here and there is not what breaks me......it's doing it day in, day out over a period weeks and months. Chronic or prolonged reduced sleep like this leads to a 'sleep debt'. In children, particularly adolescents sleep debt is at epidemic levels. 

I am sure that like me, you wish there was a button or a switch that once turned on would guarantee a night of restful sleep that would leave me (and my kids) refreshed and restored. But we all know that getting good sleep requires prioritization, intention, and careful planning – not just for us but also for our kids.  

Sleep debt in children can adversely affects their mood, energy, academic performance, impulse control, risk-taking behavior, use of stimulants and concentration. There are direct brain effects as well specifically to the areas of the brain that regulate emotion, executive function, and reward-related behaviors. Studies have shown that the benefits of consistent adequate sleep include better attention, behavior, memory, emotional regulation, quality of life and mental and physical health. 

Today, there are so many demands on our kids, and we all know the saying - something has got to give; but let it not be their sleep! Electronic media use, academic and extracurricular demands and early school times for example can all contribute to sleep debt. In specific populations of children such as those with underlying chronic disease and neurodevelopmental conditions, sleep debt can be even more significantly impacted. 

The American Academy of Sleep Medicine published a consensus statement in 2016 that involved an expert panel review of hundreds of published scientific articles on sleep health in children. This led to recommendations on the amount of sleep in children for the promotion of optimal health (see below). Basically, adequate sleep is enough sleep to prevent the sequelae of inadequate sleep. It is important however to bear in mind that these recommendations vary based on age, race, underlying health issues and specific genetic and biologic factors. 

It is important to appreciate that sleep time does not equal the time your child is in bed while they try to fall asleep or are awake during overnight waking or early morning waking.

If you suspect that your child might have a sleep debt, here are three important steps to take:

1. Consider documenting sleep times

Consider completing a 2-week sleep diary documenting sleep and wake times. Include overnight waking (reasons for overnight waking, how long they last, what helps your child get back to sleep). 

2. Identify the barriers to and facilitators of sufficient sleep

These barriers could include electronic media use at bedtime or uncomfortable sleep environment (hot, brightly lit room) contributing to overnight waking or environmental noise in the morning for example

3. Implement a consistent plan to manage sleep issues 

This should focus on trying to remove barriers to adequate sleep and implementing facilitators to adequate sleep consistently, night in, night out.  

If you identify concerns or challenges to helping your child get adequate sleep, consider discussing further with your child’s primary care provider.

Recommended sleep times in children

From the American Academy of Sleep Medicine 2016 Consensus Statement  Link: https://jcsm.aasm.org/doi/10.5664/jcsm.6288

• 4-12 months: 12-16 hours in a 24-hour period (including naps)
• 1-2 years: 11-14 hours in a 24-hour period (including naps)
• 3-5 years: 10-13 hours in a 24-hour period (including naps)
• 6-12 years: 9-12 hours in a 24-hour period
• 13-18 years: 8-10 hours in a 24-hour period

Frequently asked questions about child sleep debt

What is sleep debt in children?
Sleep debt is the cumulative gap between how much sleep your child needs and how much they actually get. Unlike adults, children with sleep debt often appear hyperactive or irritable rather than tired.

Can sleep debt be reversed in children?
Yes. Most pediatric sleep debt resolves within one to two weeks of consistently meeting recommended sleep hours for the child's age. Severe or chronic sleep debt may take longer.

How do I know if my child has sleep debt?
Common signs include difficulty waking in the morning, mood changes, declining school performance, increased impulsivity, and falling asleep during the day. A two-week sleep diary is the most reliable way to confirm it.

Is sleep debt the same as insomnia?
No. Sleep debt is insufficient total sleep over time. Insomnia is difficulty falling or staying asleep when given the opportunity. A child can have sleep debt without insomnia (often due to late bedtimes or early school starts), and vice versa.

This article is educational and is not medical advice. Please discuss your child's specific sleep concerns with their healthcare provider. See our full Legal Disclaimer.