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In order to discuss what happens when children do not get enough sleep, this essay will begin by examining Oswald’s (1966) restoration theory, in an attempt to understand why children need sleep and thus what can go wrong when they do not get enough. As per the United Nations Convention on the Rights of the Child (1989), this essay will define a child as anyone below the age of eighteen. Secondly, the effect a lack of sleep can have on emotional regulation and cognitive functioning will be evaluated, considering problems such as hyperactivity, misbehaviour and risk-taking. Thirdly, the effect sleep deprivation, particularly chronic sleep loss, has on a child’s physical health will be explored, with an emphasis placed on the link between sleep, obesity and related health problems. Then, the impact a child’s sleep problems can have on their family is discussed, with particular reference to parental and sibling sleep loss and its effects.  The essay then compares the impact of sleep loss on children who have neurodevelopmental disorders and those who are otherwise healthy, before concluding with an evaluation on the consequences a lack of sleep has on children.

 

According to Oswald’s (1966) Restoration theory, the primary function of sleep is to restore the body so that sufficient biological function is ensured. Oswald (1966) claims that sleep restores depleted sources of energy, repairs cells and removes waste from muscles. Oswald (1966) suggests that non REM sleep is when the body is replenished. It has been found that the body secretes greater levels of growth hormones during non-REM sleep (Kern et al, 1996), seeming to offer support to Oswald’s (1966) theory. Evidence in support of Oswald’s (1966) theory is also provided by the work of Shapiro (1981) who studied marathon runners and found that after they had completed a 57-mile run, non-REM sleep during the night after the run increased from 25% to 45%. This supports Oswald’s (1966) claims that the body uses sleep to restore and repair itself. Oswald (1980) built on his theory (1966) to include restoration of the brain during REM sleep. Evidence to support this theory is drawn from the significant amount of time young children spend in REM sleep (Ohayon, Carskadon and Guilleminault, 2004) and the significant amount of brain development that occurs in a child’s first five years of life (Kuzawa et al, 2013). Further support for Oswald’s (1980) theory is gathered from the findings that patients recovering from brain injuries or drug overdoses spend an increases amount of time asleep in REM sleep, for an average of six weeks (Imbach et al, 2015). This suggests that REM sleep is important in restoring proper cognitive function (Eugene and Masiak, 2015). Oswald (1980) claims that sleep deprivation can result in a lack of proper restoration of neurotransmitters in the brain and claims that this explains the problems with memory and attention found in those who are sleep deprived.

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However, Oswald’s theories (1966, 1980) have been criticised due to the negligible amount of additional sleep needed following periods of exertion (Horne and Millard, 1985). It was found that although people fell asleep quicker after periods of exertion, they did not usually sleep for longer (Horne and Millard, 1985), seeming to contradict the work of Oswald (1966). Furthermore, a study (Ryback and Lewis, 1971) found that when daytime activity is decreased via bed rest, the length of sleep does not decrease with it, suggesting that perhaps the primary function of sleep is not to restore or replenish as Oswald (1966; 1980) suggested as sleep did not decrease despite minimal daytime activity.  However, despite these criticisms there is a substantial amount of support (Xie et al, 2013) for Oswald’s theories (1966, 1980) and although it is not known exactly why we sleep, Oswald’s work has formed a basis for numerous studies (Xie et al, 2013).

 

Oswald’s theory of restoration (1966) is supported by studies that show a lack of sleep in children can negatively impact their behaviour (McLaughlin and Witcher, 2013). Aside from the physical manifestations of sleep loss such as tiredness or drowsiness, lack of sleep has been found to impact on cognitive functions, such as memory, attention and emotion (Alkadhi et al, 2013). For example, achievement on tests that require cognitive processes such as memory, reasoning or attention, has been shown to correlate with the quantity, quality and consistency of a child or adolescents sleep (Sadeh, 2007). One way in which psychologists measure daytime sleepiness is with the Epworth Sleepiness Scale, which is a short, self-administered questionnaire (Murray and Johns, 1991). A study of 3235 Canadian students who were assessed using this scale found that those who reported obtaining less sleep and feeling sleepier during the day were more likely to be late for school, feel tired in class, achieve poorer grades than their well-rested peers and struggle with social functioning (Gibson, Poles, Thabane et al, 2006). Therefore, it can be shown that when children do not get enough sleep, their ability to function effectively in school is impacted negatively (McLaughlin and Witcher, 2013).

 

 

Furthermore, younger children who were classified as poor sleepers by their parents – classified as at least three awakenings a night, or less than 90% sleep efficiency over five nights – had significantly higher parent-rated delinquent behaviour, emotional control and thought problems (Sadeh, Gruber and Raviv, 2002). These effects support Oswald’s (1966) theory that sleep helps ensure proper cognitive function as emotional control and function is shown to decrease with sleep loss. Children who do not get enough sleep can also exhibit hyperactive tendencies (McLaughlin and Witcher, 2013). For example, a sleep study which involved extending children’s sleep pattern by one hour a night for a week, showed that parents reported improvements in hyperactivity and anxiety levels (Crabtree, Dayyat, Millis et al, 2007). Furthermore, when teenagers had their sleep restricted from ten hours to six and a half hours for five nights, there was an increase in both parent-reported and self-reported negative emotions and moods, such as oppositionality and irritability (Beebe et al, 2008). It has been speculated that when children and young people do not get enough sleep, their ability to regulate their emotions is impaired (Dahl and Lewin, 2002). Therefore, it has been shown that a lack of sleep in children, results in poor emotional control, which can impact on a child’s ability to concentrate in school and have positive relationships with parents and peers (McLaughlin and Witcher, 2013). Therefore, it can be seen that there is mounting evidence linking sleep deprivation with a lack of control of emotion, behaviour and attention, all of which are critical in the development of a child’s social and academic ability (Dahl and Lewin, 2002).

 

Furthermore, for older adolescents, risk taking linked to lack of sleep is a concern (Moore and Meltzer, 2008). One of these risk-taking concerns is driving while drowsy or tired, due to the potential life threatening risk involved. In America, motor vehicle accidents are a leading cause of death for adolescents (Irwin, Burg and Uhler, 2002). Furthermore, a study (Lund et al, 2010) found that 60% of US youth aged between seventeen to twenty-four years old reported getting inadequate sleep and experiencing excessive daytime sleepiness. This is important as another study (National Sleep Foundation, 2006) in America, found that more than half of ten to twelfth grade drivers reported driving whilst tired in the past year and fifteen percent admitted driving drowsy at least once a week. Moreover, a study (Danner and Phillips, 2008) looking into the effect of delaying school times by an hour in one county in Kentucky, found that teenage motor vehicle crashes reduced by sixteen and a half percent across the county. This compares to the almost eight percent increase across the rest of the state in the same time period (Danner and Phillips, 2008). This study seems to show that a lack of sleep in adolescents may be an important factor in teen motor vehicle crashes and deaths. Additionally, a study (Mcartiniuk, Senserrick and Lo, 2013) in New South Wales, Australia, found that newly licenced drivers between seventeen to twenty four, who slept fewer than six hours a night had a significantly increased risk of crashing, compared to those who slept more than six hours, further emphasising the dangers teenagers who do not get enough sleep can face.

 

 Another risk-taking concern is the increased use of tobacco, marijuana and alcohol use found in adolescents who reported greater daytime sleepiness (Johnson and Breslau, 2001). It has been found (Mednick, Christakis and Fowler, 2010) that sleep loss can significantly increase the risk of substance misuse in teenagers and a lack of sleep can even impact on the amount of sleep a teenager’s friends are likely to have. It is not clear as to how drug taking is linked with a lack of sleep in teenagers (Mednick, Christakis and Fowler, 2010), but it has been suggested that perhaps a lack of sleep results in poor decision making skills, a decrease in emotional regulation and impulse control (Beebe et al, 2008). These reasons would appear to support Oswald’s (1966; 1980) theory, due to the impact a lack of sleep has on cognitive functioning and thus the concept of restoration of the brain. It can therefore be seen that when adolescents do not get enough sleep, the potential consequences can be serious (Moore and Meltzer, 2008). This is especially concerning as it has been found (Colten and Altevogt, 2006) that few adolescents obtain the optimal amount of sleep each night.

 

Having considered the effect a lack of sleep has on a child’s emotional and cognitive function, it is also important to evaluate the effect a lack of sleep can have on a child’s physical health. There is a considerable amount of evidence that links sleep deprivation in children with an increased risk of obesity, which in turn, can result in significant health implications, such as diabetes (Owens, 2014). Cross-sectional epidemiological studies such as Spiegel et al (1999) have examined the effect of recurrent partial sleep deprivation on hormonal and metabolic variables that are involved in appetite regulation. Spiegel et al (1999) concluded that sleep deprivation resulted in changes to metabolic and endocrine functions, of which have been recognised as risk factors for obesity. Furthermore, evidence gathered from epidemiological and laboratory studies have indicated that there is a link between chronic partial sleep loss and obesity and weight gain specifically in children (Van Cauter and Knutson, 2008). A study investigating this (Van Cauter and Knutson, 2008) concluded that this link was most likely due to hormonal responses that can cause increases in appetite, therefore potentially resulting in weight gain and obesity in the long term. Moreover, Patel and Hu (2008) reviewed numerous studies and experiments focusing on the impact of short sleep patterns and obesity and found the risk appeared greater in children than adults. Therefore, it is clear that when children do not get enough sleep, it can result in negative and long term health consequences, with particular links to weight gain and obesity (Colten and Altevogt, 2006).

 

Additionally, Obesity is also linked to problems such as type two diabetes, which is becoming increasingly common in children and young people (Pulgaron and Delamater, 2014). Obese children with type two diabetes are at an elevated risk of other health problems such high blood pressure, cardiovascular problems and death (Pulgaron and Delamater, 2014). Although these are not direct results of sleep loss, there is strong evidence of a link between sleep loss and obesity (Owens, 2014), and obesity can then lead to the above-mentioned problems. Therefore, when a child does not get enough sleep, especially if the problem is chronic, then it can pose a serious physical health risk, which can ultimately end in death (Pulgaron and Delamanter, 2014) thus showing the importance of having a healthy sleep cycle during childhood.

 

Moreover, when a child does not get enough sleep, not only can the child suffer ill effects, but the entire family can be impacted (Stores, 2009). It has been shown above that children who do not get enough sleep can have emotional control issues, resulting in irritable or hyperactive behaviour for example (McLaughlin and Witcher, 2013). These children can often be difficult to handle, causing frustration to their parents, and can severely impact or disrupt family life (Stores, 2009). Additionally, if these children are misdiagnosed as having Attention Deficit Hyperactivity Disorder rather than a primary sleep disorder, then stimulant drug medications can worsen the situation, causing further distress to a family (Stores, 2009). Furthermore, if children are experiencing sleep disorders such as nightmares or night terrors, then bedtime can become a distressing time for both the child and parent, resulting in further problems with getting the child to sleep and increasing sleep loss for all involved (Stores, 2009). The family may also lose sleep trying to deal with a child who may be waking frequently or not sleeping for long periods, and this can have a depressing effect, particularly in adolescence and adulthood, resulting in further potential family problems or tension (Stores, 2009).

 

Moreover, parents can have different ideas on how to deal with a child’s sleep problem, such as having the child share a parent’s bed, and this can cause relationships to become strained (Stores, 2009). Tension between parents can impact on the other children in the house, thus resulting in potentially more sleep loss due to the stress caused, exacerbating the problem further (Meltzer, 2011). Therefore it can be seen that when a child does not get enough sleep, especially if bed times become a stressful process, the impact can spread to the child’s parents and siblings (Stores, 2009). In severe cases, if a child’s lack of sleep results in the lack of sleep for the entire family, then mental health problems such as anxiety or depression can arise, particularly in older adolescent siblings (Meltzer, 2011). Moreover, if parental relationships become significantly strained, then divorce is a potential outcome, albeit severe, and this can result in further turmoil within a family, potentially exacerbating sleep problems (Colten and Altevogt, 2006). 

 

It has been found that when sleep disorders are treated, caregivers report improvement in the behaviour, intellectual functioning and health of their child (Carr et al, 2007). However, it has been suggested that chronic sleep deprivation, such as that caused by sleep disorders, could result in permanent loss of development potentials (Jan et al, 2010). It is thought that this is more likely to occur if the sleep deprivation is severe or occurs during critical developmental periods such as the first few years of life (Jan et al, 2010). However, it has been noted that most children who are otherwise health, are unlikely to suffer from these serious consequences as most sleep disorders are receptive to treatment (Jan and Freeman, 2004). Children who are most likely to suffer this permanent damage, are children who already have neurodevelopmental disabilities such as autism or cerebral palsy (Wiggs and Stores, 1996). Due to these children’s already impaired brain function, sleep deprivation can result in significant problems with attention, cognitive and motor functions (Meijer, 2008). Furthermore, children with neurodevelopmental disabilities are more likely to have treatment-resistant chronic or life-long sleep deprivation which can exacerbate problems with cognitive function such as issues with memory or attention (Durmer and Dingles, 2005). Therefore, it can be seen that although cognitive problems can occur when children do not get enough sleep, the consequences can be more severe and life-long if a child already has a coexisting neurodevelopmental disability (Jan et al, 2010). Most children can make up a sleep debt by resting more after a period of sleep deprivation (Oginska and Pokorski, 2006), however, the above research suggests that children with neurodevelopmental disabilities are more likely to suffer prolonged and adverse effects to sleep loss, with particular impacts on cognitive functions and behaviour (Durmer and Dingles, 2005).

 

To conclude, it is clear to see that there are numerous negative consequences associated with a child not getting enough sleep. Ranging from a single night’s loss of sleep to more chronic sleep deprivation and sleep disorders, the effects can be significant (McLaughlin and Witcher, 2013). Following the principles of Oswald’s (1966; 1980) theory of restoration, when a child does not get enough sleep, the brain and body can not restore and replenish itself. In animal studies, a lack of sleep has resulted in the animal’s death (Rechtschaffen et al, 1989) and in humans, the disorder fatal familial insomnia, which is a genetic disorder that stops sufferers of the illness from sleeping, ultimately leads to death, showing that total sleep deprivation in humans can kill (Redaelli, Tagliavini and Moda, 2017). Although this is the most severe consequence, it is extremely rare (Redaelli, Tagliavini and Moda, 2017). Usually, the behavioural and cognitive problems caused by a lack of sleep in children can be solved by treatment for any underlying sleep disorder (Carr et al, 2007), or by increasing the amount of sleep a child has each night (Crabtree, Dayyat, Millis et al, 2007). Therefore, simply put, when children do not get enough sleep, they become overtired, this tiredness can then impact on all aspects of their life, from emotional regulation (Sadeh, Gruber and Raviv, 2002), cognitive functioning (Eugene and Masiak, 2015), physical health (Owens, 2014), risk-taking behaviours (Moore and Meltzer, 2008) and family problems and tensions (Stores, 2009) as shown by the evidence above, although with treatment, it is thought that many of these problems are short-term and can be solved (Carr et al, 2007).