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Children with mental health disorders more sensitive to time change

Zoe Greszler • Mar 8, 2019 at 1:00 PM

Maintaining a healthy sleep schedule for a child or adolescent is part of a solid foundation for every family’s well-being.

For youngsters with mental or behavioral health problems, sleep is especially vital. Physicians at the Nationwide Children’s Hospital said they notice several changes in sleeping patterns around daylight saving time, which can particularly affect patients with a mental health diagnosis.

The next time change occurs at 2 a.m. Sunday, when clocks are moved ahead one hour.

“Sleep is a more complicated issue for patients with a mental health disorder,” said Dr. Robert Kowatch, child and adolescent psychiatrist and sleep medicine specialist at Nationwide Children’s. “Different conditions affect sleep differently, as do various medications for these conditions and their related side effects. These patients may be more sensitive to time changes than the typical child or teen.”

For example:

• Children and teens with bipolar disorder often sleep less when manic, or hypomanic. In certain instances, changes in the circadian rhythm of a person with bipolar disorder can cause a manic episode, and this can be triggered by the change in time.

• Depression may make it more difficult for a child to fall asleep and stay asleep.

• Teens with anxiety often struggle with insomnia because their innate anxiety makes it difficult to relax and fall asleep.

• Children with autism tend to sleep one to two hours less than other children their age and they also wake up earlier, although researchers currently do not know the cause of this trend.

• In some patients with attention deficit/hyperactivity disorder, stimulant medications can cause “rebound hyperactivity” close to bedtime, making it difficult for them to fall asleep.

“With many medications, an impact on sleep is a possible side effect, from interfering with falling asleep to resulting in next-day drowsiness,” Kowatch said. “Parents and patients should create a plan with their clinician and make sure dose schedules and amounts are properly followed, such as taking a longer-lasting dose earlier in the day followed by a shorter-lasting dose later in the day, so a stimulant can wear off — if necessary — in time for bed to allow for restful sleep.”

So what can parents and their children do?

Recommendations for better quality sleep are the same across age groups, regardless of whether a child or teen has a mental health disorder or not. Huron County Mental Health and Addiction Services executive director Kristen Cardone said Nationwide’s tips are “excellent” for parents to keep in mind. She also offered these additional suggestions:

• Go to bed on Saturday and get up on Sunday at the usual times. Stick to a strict routine of going to bed and getting up at the same time every day, especially in the weeks following the time change.

• Prepare for changes in daylight — make sure to draw bedroom blinds or add blinds and/or curtains to windows if you do not have any.

• Maintain the rest of your normal Sunday schedule, including mealtimes.

• Engage in self-care, including eating healthy, drinking plenty of water and incorporating exercise into your daily routine.

• Parents — pay close attention to your children in the weeks following the time change to monitor changes in mood and sleep patterns. If your child struggles with mental health issues, develop a plan with your child’s mental health provider or primary care physician ahead of time to help prepare.

• Reach out to your primary care physician or mental health provider as needed for additional guidance on how to address specific concerns.

Nationwide Children’s suggested turning off devices like phones, tablets or televisions, and even removing them from the bedroom, but instead have a playlist of calming sounds to listen to; not to eat heavy meals before bed; avoid caffeine eight hours before bedtime and to keep bedrooms dark and cool with comfortable bedding.

Anyone needing immediate help due to having suicidal thoughts, should go to the local emergency room immediately, call the Nationwide Suicide Prevention Lifeline at 1-800-273-TALK (8255) or reach out to the Crisis Text Line by texting START to 741-741.

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