Sleep in the Developing Brain With Dr. Kristin Seaborg
Show notes
Sleep plays a critical role in brain development, learning, memory, and behavior throughout childhood and adolescence. In this episode, Dr. Kristin Seaborg discusses how sleep architecture changes across development, the impact of sleep disorders on attention, headaches, epilepsy, and neurodevelopmental conditions, and why neurologists should routinely assess sleep in pediatric patients. Learn practical approaches to recognizing sleep problems, including obstructive sleep apnea and insomnia, and how improving sleep can enhance neurologic and cognitive outcomes.
In this episode, Casey S. Albin, MD, FAAN, speaks with Kristin Seaborg, MD, author of the article "Sleep in the Developing Brain" in the Continuum® August 2026 Sleep Neurology issue.
Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia.
Dr. Seaborg is an Assistant Professor in the Department of Neurology at the University of Wisconsin–Madison in Madison, Wisconsin.
Additional Resources
Read the article: Sleep in the Developing Brain
Subscribe to Continuum®: shop.lww.com/Continuum
Earn CME (available only to AAN members): continpub.com/AudioCME
Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud
More about the American Academy of Neurology: aan.com
Social Media
Host: @caseyalbin
Guest: @KristinSeaborg
Full episode transcript available here
Dr Albin: In neurology and life, we are all looking for the secret to being attentive, focused, and engaged, and we certainly want that for our children. And what if the answer to all of that was just in sleep?
Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.
Dr Albin: Hello, this is Dr. Casey Albin. Today I'm interviewing Dr. Kristin Seaborg about her article on sleep in the developing brain. This article appears in the August 2026 Continuum issue on the neurology of sleep. Welcome to the podcast, Dr. Seaborg. Thank you so much for being here. I learned a lot from your article. Can you just briefly introduce yourself to the audience?
Dr Seaborg: Sure. Thank you for having me. I'm thrilled to be here. My name is Kristin Seaborg. I'm a pediatric neurologist and sleep neurologist at the University of Wisconsin Medicine. I also run the pediatric sleep neurology clinic at UW Madison.
Dr Albin: That is the perfect person to be writing this article. And every time I read an article about pediatric neurology, I am just so struck that like little tiny humans are not small adults, that they actually have a totally different neurobiology. They are in different stages of development. And this was really a topic that I was not familiar with, and probably for most of our listeners, they're not familiar with as well. And so, I thought we'd maybe just start with some of the basics. What is going on in terms of like pediatric sleep architecture, and how is that different than the adult architecture that we might be m- more familiar with?
Dr Seaborg: Sure. So, a lot of us think that sleep is the thing we do that when, when we're not doing other stuff. But actually, it's completely the opposite. During sleep, our brain is learning and consolidating memory and cleansing what's happened during the day, and that's especially important during infancy and early childhood development, and as a child gets older. If we take infants for an example, fifty percent of their sleep is in a precursor of REM sleep, which we call active sleep, which is much, much more than adults, as opposed to adults have about thirty percent of their sleep in REM sleep. And also, infants need sleep like fifteen to seventeen hours a day. Not all of that is consolidated in one continuous period. They usually sleep over the course of the day, fifteen to seventeen hours, and that sleep time decreases over the course of childhood and adolescence as well.
Dr Albin: Yeah, it's amazing that there's so much more going on. As someone who's had newborns, it feels like, oh my gosh, they're really just sleeping all day. They're not doing anything. But they're doing quite a lot, and that really is so much work for their developing brain. And then one of the things that also really struck me about the article is that as children move from infancy through adolescence, not only is the sleep architecture changing, but the time they go to sleep, the amount of sleep they need, some of the pathology that they may develop, it changes throughout these early years of their life. And so maybe when we are thinking about what patients might come to the clinic with, I assume a lot of parents are kind of concerned like, "Is my child getting enough sleep? Are they sleeping the normal amount? Are they sleeping in the timeframe that would be normal?" Walk us through just in broad strokes, like what is a normal amount of sleep as you go through that pediatric developmental phase?
Dr Seaborg: So that's not a one-sentence answer. And there's a table in the Continuum article.
Dr Albin: Love that.
Dr Seaborg: So, infants sleep like fifteen to seventeen hours, and it's chunked out over the course of the day. Usually they have one consolidated sleep period at night, but then two to three naps during the day. And as you move through early childhood, toddlers and adolescents usually need about fourteen hours of sleep around the time they're one year of age. As they get a little bit older, then they need like eleven to thirteen hours, depending on the child themselves. And then as we move toward like school age, like eight to ten hours of sleep is usually adequate, but especially younger school children need about ten hours of sleep at night. And then the interesting thing that happens in adolescence and early teenage years is that kids need just as much sleep, but they actually naturally fall asleep later because their melatonin is released later. So, it feels like they need to sleep all the time, but actually they just go to sleep later, and when school comes, it's not time or doesn't feel ready for them to wake up. So, adolescents and teens also need about eight to ten hours of sleep a night.
Dr Albin: Right. And I just was struck, you know, we think about it in this article and these issues, we've thought a lot about, I think it'll come up in other podcasts, the importance of daylight savings time and how that actually really is not good for our brains. And I feel so much for these teenagers who are really at a disadvantage because we make them get up early to participate in the world when it's not really aligned with how their natural sleep cycle is, and it feels unfair.
Dr Seaborg: It does. And there's so much to that. So, adolescents have school, and then a lot of time they have like after-school activities, whether that's sports or theater or music or whatever, but that usually happens after school. And then the reality of today's society is they come home, and at least my teenager disconnects or kind of decompresses by looking at her phone forever. And a lot of teenagers and adolescents bring their phone to bed. That exposure to light right up until the time when they want to go to sleep really can disrupt their circadian rhythm too. So they have the natural delayed circadian rhythm, and then they have these lifestyle exposures between activities after school and screens and everything else that really make sleep onset difficult. And so, waking up for school at 6:00 or 7:00 in the morning is really difficult for them.
Dr Albin: Gosh, I feel for that. And I suspect that many patients are coming into the sleep clinic with that exact sort of like my early teen, my preteen, my teenager. They're just exhausted all the time, but they won't fall asleep. They're developing insomnia. It sounds like there's a lot of behavioral changes that need to go along with that. Is that what you're seeing?
Dr Seaborg: Yeah. So, I'm also seeing an kind of a corollary, a lot of kids that come in with headaches because they're not sleeping enough, and they feel awful, or they're coming in with difficulty focusing in school or cognitive fog because they're not sleeping enough, and that they don't always know that that's the chief complaint. But often, as you start asking sleep-related questions, you figure out exactly what's going on. So, their amount they're sleeping and kind of their natural sleep cycle is affecting everything about their life.
Dr Albin: Yeah. It just-- it really struck me that, you know, one of the things that you talk about in the article is that there is, in patients who have neurodevelopmental differences and disorders, they may specifically have some sleep impairment, and they have a neurobiological reason for those sleep changes. But also, like you're saying, sometimes these inattentions or what's diagnosed as ADHD is actually just because they are not sleeping well, and they can't focus. And I imagine that's really hard to tease out. Like, is there something when you're trying to tease that out in the clinic that helps you figure out, is it the dog wagging the tail or the tail wagging the dog?
Dr Seaborg: Sure.
Dr Albin: Which is coming first? Is it, is it really a neurobiology problem where they have nerve developmental disorders and therefore sleep problems, or they have sleep problems causing the symptoms of a nerve developmental disorder?
Dr Seaborg: So, there's so many ways to answer that question. The very first part is you start at the beginning, not only asking the person's chief complaint, like, "Are you having trouble with attention?" But then also, uh, like I'll say, "Okay, what time do you go to sleep?" But not only that, "What are you doing before bedtime?" And then once they're asleep, are they snoring? Are they waking multiple times at night, you know, without trying to? And when they wake up in the morning, do they feel refreshed, or do they really still feel like they could fall asleep for a very, very long time? And then with regards to the neurodevelopmental disorders, it's fascinating. A lot of kids with neurodevelopmental disorders, whether that's ADHD or autism spectrum disorder or a genetic disorder that causes a developmental difference, often some of the pathophysiology of the actual neurodevelopmental difference also impacts the circadian rhythm and melatonin release and the brain's ability to initiate and maintain sleep. So, it's really important as a provider to be cognizant if you're seeing your patient with autism or ADHD to also ask about their sleep-related symptoms. And then eventually you'll ferret it out, but it takes a lot of sleuth work and investigation.
Dr Albin: So, what I'm hearing is actually when people come in with a chief complaint that probably is not like, "Hey, I'm having trouble sleeping," but maybe, "I can't focus" or, "I have headaches," or I have other problems that are being referred to a neurologist or pediatric neurologist, it really does behoove us to pause and take a good sleep history on all children coming in.
Dr Seaborg: Yes, and I'm gonna piggyback on that. Also, very, very important for our patients with epilepsy. There's a super high coincidence with epilepsy and sleep disorders, and there's actually been direct comparisons with children that-- typically developing children and children with epilepsy that's poorly controlled, and the amount of sleep-related complaints and sleep-related symptoms they have is astronomically higher. So, it's important as a neurologist to always have sleep kind of on our front burner, something we're paying attention to.
Dr Albin: No, it's so true. You know, I learned a lot about pediatric sleep and epilepsy through the article, and I think that obviously we wanna refer the listeners to checking out a little bit more. But there were a couple of things that were new terms to me that maybe others are not familiar with, and it does relate to like they are epilepsy, but they are more nocturnal, and they have more nocturnal epilepsies that we might need to really think and consciously consider. So, the new terms for me were SeLECTS, which I assume is actually just said as SeLECTS, but stands for... You tell me, what does it stand for?
Dr Seaborg: Self-limited epilepsy with central temporal spikes.
Dr Albin: Perfect. So okay. So, let's just start with that. Like, what is going on there? What do I need to know about it?
Dr Seaborg: So, SeLECTS was previously known as benign rolandic epilepsy 10 to 20 years ago, and then that, the term evolved to childhood epilepsy with central temporal spikes. But then it evolved again to SeLECTS, which is self-limited epilepsy with central temporal spikes. I think the primary motivation of changing the terminology, at least initially, was to acknowledge that even though this type of epilepsy occurs during childhood and it's self-limited, it is not benign always because seizures can cause some daytime dysfunction, and also there has been some association with ADHD-like symptoms or learning disability symptoms later in life. The other term you just mentioned, developmental epileptic encephalopathy with spike wave activation in sleep. That's a mouthful. That's the new terminology for what we used to call ESES or electrical status epilepticus of slow wave sleep. So, DEE-SWAS, developmental epileptic encephalopathy with spike wave activation in sleep is a broader term to encompass a bunch of epilepsy syndromes that have spike wave activation that during sleep, it is associated with developmental delay and per-perhaps developmental regression.
Dr Albin: And is that typically seen early childhood infancy? Like, I think of that as being something that you're gonna encounter really early in the life cycle. Am I correct?
Dr Seaborg: Not always. Sometimes, like school-aged children, one of the classic presentations is what it can be known as Landau-Kleffner syndrome, where you have spike wave activation during sleep in a, a school-aged child at like between the ages of six and 10, and then they have language regression, and you look at their EEG overnight and you see that they have epileptiform activity for up to 85 to 95% of the night.
Dr Albin: Wow. So, I wanna drill down on this. Since both of these things may come up, and probably are not something that the family is coming to you and saying, "Hey, I've seen these bizarre things happen in sleep," but are coming with daytime symptoms, how is it that you decide who is going to need a pediatric sleep study?
Dr Seaborg: Great question. So, if a child ever or a parent ever comes and complains or with concerns of developmental regression, and I guess I'm biased cause I'm a sleep doctor, but I would always do an EEG recording overnight if there were any concerns. And then if patients come and they just talk about rhythmic movements at night or waking up at night with some facial twitching, or the next day they're really acting tired, then I would order a sleep study. And of course, I would always ask the typical questions: Are they snoring? Are they waking up with a headache or not well refreshed? And ask a little bit more about a sleep history. But developmental regression and rhythmic movements at night definitely should be studied.
Dr Albin: And those questions about, you know, snoring at night, waking up with a headache, you're trying to get to pediatric obstructive sleep apnea. Is that right?
Dr Seaborg: Correct. Yes. Thank you for clarifying.
Dr Albin: Yeah. No, I just wanna make sure, like, because obviously that is a very common problem in the adult patient population. How frequently are you encountering that now in pediatric land?
Dr Seaborg: So actually, it's more common than you would think. So kids have, especially kids that I'm seeing in the pediatric neurology clinic, sometimes have some different facial anatomy or enlarged tonsils or enlarged adenoids, or they have a primary genetic disorder that gives them a little bit different facial anatomy, and they're at much higher risk for obstructive sleep apnea. Kids with different muscle tone, whether they have cerebral palsy or a different kind of hypotonia disorder, are at very high risk of obstructive sleep apnea. And then kids with epilepsy, for reasons that we don't fully understand, are at higher risk for obstructive sleep apnea. So, it's actually quite common in children. We see it a lot.
Dr Albin: Wow, that's fascinating. And then I wanna just in our little limited time together, there were two other sort of neurodevelopmental disorders that came up in the article and I think are at least worth previewing for the listeners. So, autism spectrum disorder, obviously a very large and a range of how patients can present, but sleep really does seem to be a manifestation. Walk us through the association there.
Dr Seaborg: Sure. So, we don't know 100%, but I can give you a few statistics. For instance, 20 to 75% of kids with autism spectrum disorder have some sort of sleep onset or sleep maintenance insomnia or some primary sleep disorder, which is astronomically high. We all know the etiology of autism is multifactorial, and there's not just one gene or one difference that leads to autism, but there are a fair amount of genetic differences that sometimes can lead to a diagnosis of autism spectrum disorder. We've found there's kind of coincidence of some differences in some of the circadian genes. Specifically, time and clock are two of the circadian rhythm genes that have been shown to have higher incidence of differences in kids with autism spectrum disorder. And then kids with autism spectrum disorder also sometimes have some underlying anxiety or hyperactivity in it that also compounds their difficulty falling asleep and sometimes their difficulty staying asleep at night. And so, there's multiple things that are playing in that can make sleep difficult, which in turn can affect their daytime performance and their daytime regulation. So, lots going on there.
Dr Albin: Absolutely. I mean, in reading this, I was struck by, oh gosh, there's a lot of both pharmacological and sort of behavioral therapy that has to go into like readjusting and, and setting normative patterns and expectations. It sounds like melatonin can, in some cases, be helpful here.
Dr Seaborg: Yes, melatonin. So, I know there's a lot of patients will come to me, they're like, "I don't wanna use melatonin 'cause my Facebook group told me it was terrible." There's a lot of literature and a lot of recently published literature to show the safety and efficacy in low-dose melatonin, especially in children with neurodevelopmental disorders and specifically in kids