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March 4, 2021

The Importance of Sleep and How Anxiety Affects Kids and Teens

By Luis Ortiz, M.D., pediatric sleep physician at Johns Hopkins All Children’s Hospital

Sleep plays a vital role in good health and well-being throughout your child’s life. Quality sleep can help protect children’s mental and physical health, quality of life and safety. During National Sleep Awareness Week this March, learn about the importance of sleep, how anxiety impacts it and warning signs that your child may be having sleep problems.

Why is sleep so important?

While your kids are sleeping, their brains are preparing for the next day and forming new pathways to help them learn and remember information. Sleep helps children pay attention better, make decisions and be creative. In studies evaluating the importance of sleep in kids, lack of sleep in children and teens is associated with increased symptoms of ADHD, anxiety and depression, as well as worse grades in school.

Sleep is also involved in healing and repair of heart and blood vessels, hormonal regulation of weight and energy and modulation of the immune system. Over a lifetime, ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes and stroke.

What are the symptoms of sleep problems?

Difficulty going to sleep, frequent night awakenings, nightmares and sleep terrors are some of the symptoms of trouble sleeping at night. When a child does not sleep enough, they are more likely to feel tired and sluggish during the day, have difficulty focusing on their school work and potential problems getting along with others.

Other symptoms may include:

  • Feeling angry and impulsive
  • Mood swings
  • Feeling sad, anxious or depressed, or lacking motivation
  • Being irritable or emotional
How is anxiety related to sleep?

The COVID-19 pandemic has created new anxieties and caused inconsistent sleep schedules. Anxiety and sleep problems feed each other and create a cycle. If a child is anxious, they may not be able to fall asleep. Poor sleep means they are more likely to be anxious. Creating the best sleep environment and schedule is one way to reduce anxiety.

How can we reduce anxiety-related sleep problems?
  • Ensure a set bedtime and wake time, allowing the child to have an age-appropriate amount of time to sleep (i.e., a 10-year-old should get about 10 hours of sleep). Older kids may need less and younger kids need more sleep.
  • Limit electronics an hour before bedtime. TV programs, video games and social media can result in anxiety by raising concerns regarding job security or life and death in family members, or may contain fanciful scary content.
  • Eliminate caffeine, as this can interfere with a child’s ability to go to sleep. Caffeine is found in teas, coffee and soda.
  • A child with anxiety should be given an opportunity to express their concerns earlier during the day or before bed by talking to their parent and/or writing them down.
  • Try deep breathing and progressive muscle relaxation exercises before sleep. There are many apps available that help relax our brains.
Should children with anxiety take medications to help them go to sleep?

Some children may benefit from medications, but this should be paired with a strict bedtime and wake time schedule, learning meditation and excellent sleep hygiene. Ideally, the child should be evaluated by a physician familiar with both medications as well as cognitive behavior therapy for insomnia first.

For more information about sleep issues or to schedule an appointment, visit HopkinsAllChildrens.org/SleepClinic.

About the Author: Luis Ortiz, M.D., is a physician in the Sleep Center at Johns Hopkins All Children’s Hospital. He joined the medical staff in 2018. He sees patients at the main campus in St. Petersburg, Florida, as well as at Johns Hopkins All Children’s Outpatient Care, East Lake. 

Dr. Ortiz earned his medical degree from the University of Rochester. He completed his residency in internal medicine and pediatrics at the Charleston Area Medical Center. He also completed a fellowship in pediatric pulmonology at the Johns Hopkins University School of Medicine in Baltimore, Maryland. He also completed a fellowship in sleep medicine at the Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania in Philadelphia.

His clinical interests include narcolepsy, hypersomnia, obstructive sleep apnea, and skeletal dysplasias. His research interests include examining the interaction of sleep disorders on chronic pediatric diseases such bronchopulmonary dysphasia, asthma, and developmental delay. He has worked extensively in creating educational content for people with narcolepsy as well as advocating for patients with rare diseases.

Originally published in March 2021

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