How Children’s Sleep Habits Have Changed in the Pandemic

So how are you sleeping these days? Some children — and adolescents — may actually be getting more sleep, or better sleep, while others are struggling with disrupted routines, anxiety and electronics, sometimes all at the same time. And even for those who have settled into new schedules that leave them reasonably well rested, back-to-school season may mean a possibly problematic reset.

Two sleep specialists, in Cincinnati and London, published an editorial, “Perils and promise for child and adolescent sleep and associated psychopathology during the Covid-19 pandemic,” at the end of May in the Journal of Child Psychology and Psychiatry. Stephen P. Becker and Alice M. Gregory discussed possible impacts of the Covid-19 pandemic on children’s sleep, arguing that because of the importance of sleep for many aspects of children’s well-being, ranging from mental health to immunological well-being and disease resistance, it would be important to look closely at how sleep might be changing, for children and for adolescents, at whether those changes are problematic when children have to return to school, and at which factors are associated with better — and worse — sleep.

In a study published in late July in the Journal of Sleep Research, researchers looked at how 1,619 children in China were doing in terms of sleep. The children, ages 4, 5 and 6, were recruited from 11 preschools in the province of Guizhou, in the city of Zunyi, about 650 miles from Wuhan. Parents and caregivers completed a questionnaire about how the children were sleeping during their time “sheltering at home” in February, after the children had been confined at home for nearly a month. The reported sleep patterns were compared to a similar group in 2018.

Dr. Zhijun Liu, an associate professor in the department of applied psychology at Zunyi Medical University who was the lead author on the study, said in an email that the expectation had been that the confinement would have a negative effect on children’s sleep: “Here in China, most families underwent days of confinement to cope with the pandemic, which means much less outdoor activities, less face-to-face interpersonal communications and even less sunlight for some of them than usual.” Both parents and children spent more time on electronic devices and less time moving around. He continued, “Living in a limited room is usually no good for one’s mood either.”

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The results of the study showed that kids at home in the pandemic were going to sleep later — 57 minutes later, on average, than 2018 weekday bedtimes, and 30 minutes later than weekends — and they were also waking up later, and the differences in wake-up times were larger: They were waking an hour and 52 minutes later than on weekdays in 2018, and an hour later than on weekends. Tellingly, the researchers did not distinguish between weekdays and weekends in the 2020 sample, concluding that the children were essentially on “holiday schedule.”

In other words, they were sleeping longer at night than the children in 2018 and, perhaps not surprisingly, sleeping less during the day; only 27.5 percent routinely took daytime naps, compared with 79.8 percent in 2018 (69.4 percent on weekends). It added up to about the same amount of sleep in a 24-hour period, and, interestingly, “somewhat unexpectedly,” as the researchers noted, the caregivers in 2020 reported fewer sleep disturbances. Daytime sleepiness, night wakings, bedtime resistance and sleep anxiety were all lower in the pandemic sample than in the 2018 group.

Dr. Judith Owens, the co-director of sleep medicine at Boston Children’s Hospital, said that in her own patient population, which includes many children with neurodevelopmental disorders, she has seen both positive and negative effects from the changes in sleep patterns during the pandemic.

For many adolescents in the United States, she said, especially those whose schools start early, “they are able to sleep much more in concert with their circadian rhythms.” Like the Chinese preschoolers, they are staying up later and sleeping later — often much later — but may be getting, she said, “more sleep and more aligned sleep” than they did when they were attending school. On the other hand, of course, they are missing out on in-person education, social interactions, sports, extracurricular activities.

In the Chinese study, the researchers speculated that more flexible schedules, increased parental attention and responsiveness, and reduced academic burden on the children may all have helped reduce stress, leading to fewer sleep problems. Sleep disturbances were lower in those families reporting regular diet, more harmonious family atmosphere, and increased parent-child communication. They were higher in children who were bed-sharing, or who had increased time using electronic devices.

Dr. Adiaha Spinks-Franklin, a developmental behavioral pediatrician at Texas Children’s Hospital and an associate professor at Baylor, called those devices “the No. 1 sleep enemy,” and said they had become a huge issue for many of her patients, home for months, often with limits relaxed on computer time, YouTube and other screen exposures. She emphasized the need for an hour of screen-free time before bed: “It takes an hour for the brain to calm down,” she said.

Resist any arguments to let the phone into a child’s bedroom at night, Dr. Spinks-Franklin said; buy an alarm clock, if a child needs an alarm clock, rather than using the phone. “Put bells on your doorknob, lock the electronics in a drawer in your room, sleep with a key around your neck,” she said. “Parents are in charge, not children, parents have jobs that pay for the electronics, the internet, the electricity, the apps.”

Dr. Owens, who was a co-author on the Chinese study, said she was struck by the ways that many parents had been able to be more involved than usual with their children, and that this had been helpful with regard to sleep. “When children sense their caregivers are engaged, addressing fears, setting appropriate limits,” sleep gets better, she said. “It’s not just what you do at night that helps with your circadian rhythms, it’s having regular mealtimes, having things you do at a certain time during the day every day,” she said. Natural light exposure and exercise are also important in underscoring natural circadian rhythms, she said.

For children who are sleeping without problems, but on a different schedule because of the pandemic, August is a time when parents can try and help them recalibrate for school in the fall, whether in-person, remote or “hybrid.” Dr. Spinks-Franklin suggested waking children earlier and earlier on successive days. “If they’re not sleepy, then putting them to bed early is not going to work,” she said. “You actually have to rob them of sleep.”

Dr. Owens said, “Start by moving wake time earlier in increments for a couple of days, then move sleep time so they fall asleep earlier in the evening,” No napping during the day. And along with avoiding screens in the period before bed, try for natural light exposure in the morning, as soon as the child wakes up.

With younger children, enforce a regular bedtime, and don’t vary it on weekends. With older children and adolescents, Dr. Owens said, don’t let them spend the day in bed, whether they’re online or working on their homework: “That’s a recipe for the development of insomnia, they start to associate being in bed with being awake.”

There will be much more research coming in, on preschoolers, school-age children and adolescents, in countries around the world, as schools open up and as schools teach remotely. Dr. Owens said: “The jury is still very much out in terms of the potential impact of different learning platforms on sleep and mental health.”

Dr. Perri Klass is the author of the forthcoming book “A Good Time to Be Born: How Science and Public Health Gave Children a Future,” on how our world has been transformed by the radical decline of infant and child mortality.