Deirdre Budd’s Blog

Archive for September 2009

In 2003 a study in Finland looked at 60 children aged 6-13 years. Measurements of sleep and activity were reviewed over 72 hours in a normal school week. This study included working memory experiments, to test the functions of auditory and visual memory. Information about the children’s sleep during that period was also  collected and collated. 

The results showed lower sleep efficiency and longer delay in getting to sleep were associated with a higher percentage of incorrect responses in working memory tasks at all memory load levels. Shorter sleep duration was associated with performing tasks at the highest load level only.

The study concluded that sleep quality and quantity affect performance of working memory tasks in school-age children. In children with learning difficulties the possibility of underlying sleep problems should be excluded.

It has long been recognised that good learning outcomes are achieved where there is a good sleep pattern and where restful sleep is a regular occurence.  This study again demonstrates the importance of sound sleep. In order for our children to learn efficiently they require the opportunity and the ability to have a full nights sleep. Setting regular bed and wake times, developing and maintaining a good pre bed routine will assist in achieving this.

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Pregnancy is divided into three stages of three months but the first three months after delivery are also very important. Some regard this as a “Fourth Trimester”.  In the first few weeks of life baby has not sorted out the difference between night and day so for many new families sleep is a rare commodity which occurs in short snaps between feeding baby.  While it is not possible to create a definate routine out of this there is usually the begining of a pattern emerging and it is worthwhile starting to work towards creating a sleep/wake regime.

Many babies will start to lengthen their sleep time once they reach the “magic” figure of 12 weeks. Others will find little difference but this is an excellent time to start making a pre bed routine for baby and maintaining that routine will make baby feel secure. Giving signals that become part of the learning process baby learns that these activities are a prelude to night sleep. There is no such thing as a “no cry” solution to sleep disturbances. Babies cry, it is their only method of communicating. Until they achieve language all expression is read on babies face, babies eyes and the babies cry.

Babies cry has been likened to natures’ smoke alarm. This cry can reach 100 decibels,   about as loud as a lawnmower but with deep emotional responses stirred in parents. Nature has done this to ensure that babies are cared for. It is very difficult to listen to your child when they are distressed and crying.  As baby grows and develops the relationship with mum grows too. Learning to distinguish between a hungry or a sleepy cry or a cry of protest comes with experience of one’s own baby.

Ferber looked at children’s sleep and came up with an effective way to resolve some of the disturbances using a technique today recognised as “Cry it out” , where a child is allowed to cry for a time limited period before a parent checks on the child. The period of crying is allowed to become progressively longer before parents intervene and at some stage baby stops crying. While this is an effective solution for some babies/children in some situations it is not an easy method to use. It can be comparatively quick and effective but the emotional cost to the parents and child have never been fully researched. This is not a method which should be considered for children under 3 years of age as it contributes to feelings of abandonment and insecurity.

While there are a variety of sleep disturbances and disorders which affect children between birth and 4 years there are an equal variety of ways to resolve these. Some crying is expected because the child has become used to one way of doing and is being expected to alter that behaviour. Of course there is protest but it is reassuring to both parents and child if this protest can be minimal and the resolution achieved by more gentle means.

If you would like help and support to resolve your child’s sleep disturbances contact Dream-Angus.com

Through the ages there have been a number of people who have been very aware and concerned about sleep disorders in children. In 1545 Thomas Phaire drew attention to the importance of sleep to young children and, to some of the more serious sleep disorders such as nightmares, infantile colic and bed wetting. In 1892 noisy breathing was noted to be symptomatic of obstructive sleep apnoea. William Osler was concerned about the dulling of reactions in daytime which he attributed to obstructive sleep apnoea.  Clement Dukes, 1905, was very concerned about the various serious effects of sleep deficit on young and growing children. In the 1970’s Anders and colleagues at Stamford were chiding colleagues in the medical profession for not taking more interest in the sleep patterns of children until their academic performance was badly affected.

There has been a considerable increase in the amount of research done on the various topics of children’s sleep disorders and sleep patterns. Despite this, there is still a deficit of awareness and of knowledge amongst the medical profession on this important topic. A great deal of knowledge is available but to this day, many opportunities to address sleep disorders in children are not taken, and it is unfortunate that the myth that as a parent one should expect to have sleepless nights for a prolonged period (some say the first four months others the first four years!)  Life is difficult enough, and it is certainly not necessary to parent while coping with this degree of sleep deficit. 

 Some sleep disorders can be relatively easily resolved by behavioural means. There are few occasions when medication is the only effective answer. The International Classification of Sleep Disorders is the current “bible” of these conditions but refers mainly to sleep disturbances in adults. While new research shows that some sleep disorders can be successfully treated the same way in both adults and children there are distinct differences.

As parents we have a responsibility to our children to help them to be all that they can be. We teach them to live in society and to accept the rules and social mores of that society. We should also teach them good sleep habits and be prepared to support them with appropriate interventions when they struggle with sleep disturbances and disorders.  There is no need to struggle to get to sleep, to stay asleep or to cope with sleep disturbance and sleep disorders when there are resources available which can effectively resolve these issues.  We cannot live without sleep and occasionally we all need a little help.

If you would like some help in addressing your child’s sleep disturbance contact Dream-Angus.com

Around the time of puberty onset the previous sleep wake cycle is known to be physiologically delayed by about 2 hours. This later sleep onset and wake time than in middle childhood is a result of the pubertal hormonal influences on the circadian sleep wake cycle and on the secretions of melatonin.
The child’s sleep needs do not differ dramatically, this should still be 9-9.5 hours, but many children at this stage only have 7-7.25 hours of sleep. This results in a considerable sleep deficit. Adolescents are recognised as having a decreased daytime awareness and some studies suggest that many teens function for a good part of the day in a “twilight zone”. This is not dissimilar from an individual with Narcolepsy.

External factors which impact on this sleep include;-

  • Early school start time
  • Homework
  • After school jobs
  • Extracurricular activities

High achievers and children with chronic medical issues or psychiatric problems such as depression, are at particularly high risk of developing sleep disorders. It is suggested that the prevalence of sleep disorders in this group may be as high as 20%. Chronic sleep deficit in this age group leads to significant negative neurobehavioural consequenses such as;-

  • Negative impact on mood
  • Vigilance
  • Motivation
  • Reaction time
  • Memory
  • Attention

It is very important that at this critical time children maintain good sleep hyigene and regular sleep wake times which will strengthen the circadian rhythm

Most of us experience no problems when the clock goes back an hour or forward an hour. Unfortunately, there is a group of individuals who find this simple event to be a very difficult experience and find that their sleep pattern is disturbed by this event for a good few weeks, following on after the event.

This leaves these individuals struggling with all the associated symptoms of sleep deficit and makes life for the other family members much more difficult. That’s assuming that the other members of the family do not have the same issues. However, take heart, with a little planning and some good sound advice, these difficulties can be avoided.

If you know how long it takes to “recover” from the clock change then you can anticipate and plan a strategy that will avoid the process of sleep deficit and sleep disturbances. The clock goes forward or back at a set calander date and you know when this will happen.

If you know, for example, that it will take three weeks to catch up with this change then you can avoid the problems altogether by simply dividing the 60 minute change into 3 segments of 20 minutes.

Three weeks before the clock changes start to adjust pre bedtime routine by a few minutes so that by the end of the first week a 20 minute delay in bedtime routine (or an earlier start to this routine) is accepted.

Continue this over the following three weeks and by the time the clock has moved the brain and body will be in sync with this altered sleep/wake time. This can be further enhanced by altering the supper snack before bed to ensure that it is rich in the chemicals which encourage the release of sleep hormones.

If you would like further advice about sleep disorders Contact us at Dream-Angus.com