Signs of sleep deprivation in children and adults:

A parent's evidence-based guide

© 2008 Gwen Dewar, all rights reserved

You may be very familiar with some of your own signs of sleep deprivation. Besides the really obvious stuff--feeling tired or drowsy--you may also show the following signs (Dement and Vaughan 1999):

• Being slow to wake up in the morning; needing caffeine or other aids to “get going”

• Having difficulty paying attention

• Being quick to fall asleep (healthy sleepers may take 20 minutes or more to fall asleep)

• Poor reaction times

In addition, you may become more emotional in response to disturbing images or events (Yoo et al 2007).

But what about your children? Like you, they show behavioral changes when they are sleep-deprived. But the signs of sleep deprivation can be harder to recognize. Babies can’t articulate their feelings, and, as I note below, some signs in older children may look deceptively like symptoms of hyperactivity attention deficit disorder.

Here I provide a guide to identifying signs of sleep deprivation for the whole family. Because adult signs are often the easiest to recognize, I start with an overview of adult signs of sleep deprivation. Then I cover babies and older kids.

For more help determining your children's sleep needs, see these articles on the sleep requirements of babies and older children.

Understanding your own sleep needs: Signs of sleep deprivation in adults

According to world-renowned sleep researcher William Dement, the best way to understand your sleep needs is to keep a sleep diary. To do that, you rate yourself using the Stanford Sleepiness Scale (quoted here from Dement and Vaughan 1999):

1. Feeling active, vital, alert, wide awake

2. Functioning at a high level, not at peak

3. Relaxed, not full alertness, responsive

4. A little foggy, not at peak, let down

5. Tired, losing interest, slowed down

6. Drowsy, prefer to be lying down

7. Almost in a reverie, hard to stay awake

Dement recommends that you rate yourself every two hours during your waking day for several days in a row. This will help you track your circadian rhythms--when during the day you are at peak alertness, and when you feel less wakeful.

According to Dement’s research (which has focused on American subjects), well-slept adults should feel alert after waking in the morning. They shouldn’t need special aids (like persistent wake-up alarms, cold showers, caffeine etc.) to get going.

How alert should you be? You can test your alertness level—and other signs of sleep deprivation--with this amusing (and valid) experiment online.

After awakening, alertness should gradually decline for the next 6 hours or so, and then increase again until it reaches a second peak in the evening (about 15 hours after awakening). After this peak is reached, healthy adults should experience a sharp decline in alertness as they become progressively more drowsy (Dement and Vaughan 1999)

If your own pattern deviates from this norm, you might be sleep deprived. In particular, feeling sleepy during the morning hours--and feeling as if you could easily drowse off during times that are typically associated with alertness--are classic signs of sleep deprivation.

Another sign of trouble is feeling too restless or “wired” to sleep at bedtime. There is evidence sleep deprivation causes elevated levels of cortisol (the stress hormone) in the afternoon and evening (Copinschi 2005). In addition, people suffering from insomnia have abnormally high levels of cortisol at night (Rodenbeck and Hajak 2001).

Signs of sleep deprivation in babies

Babies may be pretty good at regulating their own sleep if they are given plenty of opportunities for quiet time. But it’s possible for things to go wrong. Read more about it in my article about signs of sleep deprivation in babies.

Signs of sleep deprivation in children

Kids are notoriously bad judges of their own sleepiness. In experiments where 8-10 year olds were not permitted to sleep more than 4 hours at night, kids performed worse on cognitive tests. But (no surprises here!) these same kids insisted that they were not sleepy (Dement and Vaughan 1999).

Signs of sleep deprivation in kids include many of the same signs we see in adults. For instance, kids may

• be harder to awaken in the morning

• show greater difficulty concentrating

• fall asleep spontaneously during the day (inadvertent napping)

• “sleep in” on weekends (which suggests that they are making up for sleep lost during the school week)

Interestingly, lack of concentration and inadvertent napping are also considered symptoms of attention deficit hyperactivity disorder (ADHD).

Other signs of sleep deprivation are also consistent with ADHD, including

• Hyperactivity (Kuhn et al 1999; Shur-Fen Gau 2006)

• Defiant behavior (Lavigne 1999; Shur-Fen Gau)

There is a growing body of research to suggest that some kids who have been diagnosed with ADHD are really just sleep-deprived (Shur-Fen Gau 2006). But sleep restriction doesn’t always lead to ADHD symptoms (Fallone et al 2001), and it’s possible that ADHD causes sleep disturbances.

Children may also become more moody when sleep-deprived. A recent study of healthy American elementary school students links more intense emotionality with sleep problems (El Sheikh and Buckhalt 2005).

Researchers monitored kids’ sleep with wrist actigraphs (which can detect the physiological signs of sleep) and parental reports. They found that the most emotional kids got the least amount of sleep and had the highest number of night wakings (El Sheikh and Buckhalt 2005).

Results like these seem to confirm our everyday experience. But, as noted above, it’s not yet clear if sleep problems are the cause or the effect of intense emotionality. Both may be true, which case emotional kids may be prone to fall into a vicious circle--emotional intensity making it hard to sleep, and sleeplessness promoting greater emotional intensity.

Chronic sleep loss: When sleeplessness continues over the long-term

As these signs of sleep deprivation illustrate, poor sleep makes life unpleasant. More worrying, however, are long-term problems for behavior, health, and cognition.

As noted above, kids who get less sleep are more likely to show symptoms associated with ADHD. In addition, they are more likely to be diagnosed with behavioral problems in general (Lavigne et al 1999).

Sleep restriction is associated with impaired memory (Hairston et al 2005), poor academic performance (Fallone et al 2005), and obesity (Lumeng et al 2007; Bell and Zimmerman 2010).

Perhaps most alarming is the idea that sleep deprivation in early childhood could impair cognitive performance later on.

A recent prospective study tracked Canadian children from age 2.5 to 6 years (Touchette et al 2007). Researchers found that kids who got less sleep overall—especially before 41 months—had higher rates of hyperactivity and impulsivity at 6 years of age.

They also performed lower on neurodevelopmental tests. Kids who were poor sleepers at the beginning of the study performed worse at age 6, even if their sleep times improved after age 3. This led the researchers to speculate that there is a “critical period” in early childhood, when the effects of sleep restriction are especially harmful (Touchette et al 2007).

Sleepless kids may not always show clear signs of sleep deprivation

In many cases, it’s pretty easy to identify kids with sleep problems. But parents may have trouble recognizing the signs of sleep deprivation in their kids. And it appears that many kids go undiagnosed.

An experimental study of school-aged kids has shown that even kids who had no reported sleep difficulties performed better on neurobehavioral tests after they were given an extra hour of sleep (Sadeh et al 2003).

For this reason, it makes sense to examine your child’s sleep schedule--even if he doesn’t show obvious signs of sleep deprivation. Good sleep practices will help ensure that your child gets the sleep he needs. These practices include

• Waking up at the same time each morning

• Avoiding artificial lighting before bedtime

• Avoiding stimulating activities—including TV and video games—before bedtime

• Going to bed “early” if your child feels sleepy

For more information, check out these articles on sleep requirements in babies and older children.



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References: What scientific studies say about the signs of sleep deprivation

Anders TF. 2003. Sleep-wake states and problems and child psychosocial development. In: RE Tremblay, RG Barr, and RDeV Peters (eds). Encylopedia on Early Childhood Development [online]. Montreal, Quebec: Centre of Excellence for Early Childhood Development 2003: 1-6. Available at http//www.child encyclopedia.com/documents/AndersANGxp.pdf. Accessed 1.6.08.

Bell JF and Zimmerman FJ. 2010. Shortened Nighttime Sleep Duration in Early Life and Subsequent Childhood Obesity. Arch Pediatr Adolesc Med. 164(9):840-845.

Copinschi G. 2005. Metabolic and endocrine effects of sleep deprivation. Essent Psychopharmacol 6(6): 341-347.

Dahl RE. 1996. The impact of inadequate sleep on children’s daytime cognitive function. Semin Pediatr Neurol. 3(1): 44-50.

Dement W and Vaughan C. 1999. The promise of sleep. New York: Random House.

El-Sheikh, M., & Buckhalt, J. (2005). Vagal regulation and emotional intensity predict children's sleep problems. Developmental Psychobiology, 46, 307-317.

Fallone G, Acebo C, Seifer R and Carskadon M. 2005. Experimental restriction of sleep opportunity in children: effects on teacher ratings. Sleep 28 (12):1561-1567.

Franco P, Seret N, Van Hees JN, Scaillet S, Vermeulen F, Grosswasser J, and Kahn A. 2004. Decreased arousals among healthy infants after short-term sleep deprivation. Pediatrics 114: 192-197.

Hairston IS, Little, MTM, Scanlon MD, Barakat MT, Palmer TD, Sapolsky RM, and Heller, HC. 2005. Sleep restriction suppresses neurogenesis induced by hippocampus-dependent learning. J Neurophyiol 94: 4224-4233.

Jenni OG, Borbely AA, and Achermann P. 2004. Development of the Nocturnal Sleep Electroencephalogram In Human Infants. Journal of Physiology - Regulatory, Integrative and Comparative Physiology 286: R528-R538.

Kuhn BR, Mayfield JW, and Kuhn RI. 1999. Clinical assessment of child and adolescent sleep disturbance. Journal of Counseling and Development 77: 359-368.

Lavigne JV, Arend R, Rosenbaum D et al. 1999. Sleep and behavior problems among preschoolers. Journal of Dev Behav Pediatr. 20: 164-169.

Lumeng JC, Somashekar D, Appulgliese D, Kaciroti N, Corwyn RF, and Bradley RH. 2007. Shorter sleep duration is associated with increased risk for being overweight at ages 9 to 12 years. Pediatrics 120: 1020-1020.

Montgomery-Downs HE and Gozal D. 2006. Toddler behavior following polysomnography: effects of unintended sleep disturbance. Sleep 29: 1282-1287.

Rodenbeck A and Hajak G. 2001. Neuroendrocrine dysregulation in primary insomnia. Rev Neurol. (Paris) 157: S57-61.

Sadeh A., Gruber R, and Raviv A. (2003) The effects of sleep restriction and extension on school-age children: What a difference an hour makes. Child Development, 74, 444-455.

Shur-Fen Gau S. 2006. Prevalence of sleep problems and their association with inattention / hyperactivity among children aged 6-15 in Taiwan. Journal of Sleep Research 5(4): 403-414.

Thomas DA, Poole K, McArdle EK, Goodenough PC, Thompson J, Beardsmore CS, and Simpson H. 1996. The effect of sleep deprivation on sleep states, breathing events, peripheral chemoresponsiveness and arousal propensity in healthy 2 month old infants. European Respiratory Journal 9: 932-938.

Touchette E, Petit D, Seguin JR, Boivin M, Tremblay RE and Montplaisir JY. 2007. Associations between sleep duration patterns and behavioral/cognitive functioning at school entry. Sleep 30(9): 1213-1219.

Yoo SS, Gujar N, Hu, Jolesz FA, and Walker MP. 2007. The human emotional brain without sleep—a prefrontal amygdale disconnect. Current Biology 17(20): 877-878.

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