Deirdre Budd’s Blog

Reviewing recent sleep research, particularly relating to teenagers and college students, the following interesting studies  came to light.

First, a Swedish study looked at the effects of regular mobile phone use on otherwise healthy 14-20 year old students. Dr. Badre of Sahlgrens Academy, in Gothenburg,  reviewed the use of mobile phones in students without reported sleep problems. Using questionnaires and noting the level of mobile phone use Dr Badre found that addiction to mobile phone use is becoming common. “youngsters feel a pressure to be interconnected and reachable round the clock. There seems to be a connection between the intensive use of cell phones and health compromising behaviour such as smoking and the use of alcohol.”

The subjects formed two separate groups. One group made 5 or less calls or  text messages a day. The second group made 15 or more calls and/or texts a day. When compared, the group which made the most frequent use of mobile telephones, demonstrated increased restlessness with more careless lifestyles. They consumed more stimulating beverages, and experienced more difficulty in falling asleep, more disrupted sleep, and  were more susceptible to stress and fatigue.  Their behaviour became more like the behaviour demonstrated when ones’ biological clock is delayed.

Dr. Badre stressed “It is necessary to increase the awareness amongst youngsters of the negative effects of excessive mobile phone use on their sleep wake patterns, with serious health risks and cognitive problems.” Adolescents should get nine hours of sleep every night. Although in this study the sample size was small the results certainly give food for thought.

The second study was much larger, and conducted on students in North Texas.

People are either owls or larks. This recognised phenomenon describes those of us who do our best work in the morning (Larks) and those who perform better in late afternoon, or evening (Owls). In the University of  North Texas, a study of psychology students was undertaken by K.Clay. In this study 824 undergraduate students completed a health survey which included questions about sleep habits and daytime functioning.

According to the results, the students who achieved the best grades were the larks. D.J. Taylor PhD, Ms. Clay’s co author, who developed the concept for this study, stated that “these results suggest that it might be possible to improve academic performance by using chronotherapy to help students entrain their biological clocks (circadian rhythms) to become more morning types.”

 It is well recognised that puberty can affect circadian rhythm. Perhaps it is time to consider the lifestyle of our teens and the effects of our reliance on technology on sleep patterns too!

 

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Data from 700 children between the age of 5 and 12 years was collected for the study  which looked at parent reported insomnia in children. Assistant professor R.Singareddy from the department of Psychiatry at Penn State college of medicine believes that children who have insomnia symptoms should be screened by their own family doctor for underlying medical conditions.

All the children in this study had a full medical and psychiatric examination, overnight polysomnography and neuropsychological testing. Children with sleep disturbances had significantly more complaints of gastrointestinal symptoms and it was found that gastrointestinal regurgitation and headaches remained significantly associated with insomnia symptoms.

Parent reported insomnia (having trouble falling asleep and/or waking frequently in the night)  was identified in 19% of those reported. Gastrointestinal regurgitation was reported in 7.5%  children with insomnia and 2% of children who did not have insomnia. Headaches were reported in 24.4%  children with insomnia and 13.2% of children who did not have insomnia.

Insomnia symptoms may have resulted in the medical complaints as there are significant recognised physiological changes in the respiratory,cardiovascular and gastrointestinal systems during sleep. Activation of the stress response system in association with hyperarousal could have been responsible for both sleep complaints and medical problems in these children.

This study suggests that further should explore whether treatment of sleep complaints improve the medical problems and vice versa.

Behavioural treatment approaches to bed time struggles and sleep disorders have a well documented basis and remain the mainstay of treatment. 94% of studies to date, report that behavioural interventions as a whole produce clinically significant improvements in both bed time resistance and night waking.

If you have concerns about your child’s sleep, contact Dream-Angus.com we can help you to improve your child’s sleep.

Researchers at the University of Chicago have discovered a technique which is able to determine if a child habitually snores or has obstructive sleep apnoea by screening their urine. The study results are published in the December 15th issue of the American Thoracic Society’s journal of Critical Care Medicine. Professor and chairman of the Pediatrics department, David Gozal, who was lead author of the study, hopes to validate the findings in urine samples and develop a single colour based test that could be done by the parents or the family doctor.  

It is estimated that one to three percent of children up to age 9 may suffer from obstructive sleep apnoea, many more, an estimated twelve percent experience habitual snoring. Differentiating between habitual snoring and obstructive sleep apnoea is important.  Obstructive sleep apnoea can lead to cognitive, behavioural, cardiovascular and metabolic consequences in children and is often resolved by removing enlarged tonsils and adenoids, although some children may require further treatment after surgery.

 The researchers studied 90 children who had been referred to the sleep clinic for evaluation. 30 healthy non snoring children from the community were recruited to act as a control. All underwent standard overnight sleep polysomnography and the results categorised in three groups. Non snoring children, habitual snoring and obstructive  sleep apnoeic children.

These children’s urine, sample taken from the morning after the sleep study, was screened using a sophisticated electrophoresis technique which screens for hundreds of proteins simultaneously. It was noted that a number of these proteins were expressed differently in the three different groups. This was unexpected. Since the field of biomarkers is expanding there is hope that in the future this test can be simplified and available to family doctors and to parents.

Gerard CM, Harris KA, Thach BT are quoted in the Journal of Pediatrics in 2002 following two studies on swaddling. One was entitled ” Spontaneous Arousal in Supine Infants while Swaddled and Unswaddled During REM and Quiet Sleep” This study examined 26 infants swaddled and put to sleep on their backs. Over all this study demonstrated that swaddled babies slept for longer periods and had shorter arousals during REM sleep. They woke less during deep sleep than unswaddled babies. This study concluded that swaddled babies sleep longer and their parents also sleep longer as baby is safe, warm and sleeping better.

The second study “Physiological Studies on Swaddling” involved 37 infants introduced to swaddling at an older age and examined their acceptance of sleeping on their backs. This study demonstrated that the majority of infants, including 78% who normally slept on their tummies (prone), accepted sleeping this supine position. The authors concluded that it is never too late to swaddle, and even older babies can be helped to sleep on their backs and stay asleep longer when swaddled.

Then in 2005 a research project titled “The influence of Swaddling on Sleep and Arousal Characteristics of Healthy Infants “by Franco Patricia MD, PhD et al. Which was reported in Pediatrics Vol 115: 1317-131, examined the arousal threshold for auditory stress in swaddled sleeping infants. This study demonstrated that swaddling promoted sleep continuity, and decreased spontaneous arousal. This was also associated with increased responses to environmental auditory stress. Concluding that swaddling makes babies sleep longer but also makes them more alert to dangerous situations.

Despite  a popular misconception that swaddling is detrimental to a childs motor development, there appears to be no evidence to substantiate this. As long as babies are swaddled for naps and night sleep, but are allowed freedom of limb movement during wake periods, there is no reason to believe that swaddling is anything other than positive. Swaddling a child in a cotton or other breathable material, provides deep pressure, a feeling of being held without physical contact, security, comfort and safe warmth as there are no loose blankets which could cover baby’s head and face. Some babies will wriggle free of swaddling and as baby grows and develops this is a natural progression.

Overall there are far more benefits to swaddling a child, than to leaving a child who has not yet developed good limb co-ordination skills, with limbs free and likely to strike themselves when startled.

Recent articles in the UK press were concerned with the abuse of children in a day care centre. A member of staff, who had been “security cleared” was found guilty of abusing a child, photographs were taken and posted to other abusers and the internet.

While the whole incident has rocked the lives of parents who use such facilities to help them maintian their lifestyles. Mobile phones are now equipped with the technology to take stills or video footage. Taking photographs of any child without the express permission of the parents, even when without malicious intent, is a breach of trust. One wonders why employees in childrens care centres are still allowed to keep their mobiles on their persons.

Previously, if there was a need to contact a member of staff in a child day care facility, that contact was acheived via a central office. Perhaps there is a need to return to this practice as a step to improve child safety. If mobile phones were not accepted in the workplace then at least one opportunity to abuse parental trust would be removed.

Perhaps this is something parents should ask about when choosing a care centre for their child, what are the centre’s policies regarding mobile phones in the workplace?

After learning something new, the brain initiates a complex set of post-learning processing that facilitates recall (i.e., consolidation). Evidence points to sleep as one of the determinants of that change. But whenever a behavioral study of episodic memory shows a benefit of sleep, critics assert that sleep only leads to a temporary shelter from the damaging effects of interference that would otherwise accrue during wakefulness.

To evaluate the potentially active role of sleep for verbal memory, a study compared memory recall after sleep, with and without interference before testing. It was demonstrated that recall performance for verbal memory was greater after sleep than after wakefulness. And when using interference testing, that difference was even more pronounced. By introducing interference after sleep, this study confirms the active role of sleep in consolidating memory, and unmasks the large magnitude of that benefit.

This is particularly important for our children who are growing and learning on a daily basis. If we want them to accomplish all that they can we need to ensure that they have a regular wake sleep pattern and occasional “power naps” may be very useful to a growing mind.

There has long been an association between headaches and migraines and sleep disorders in childhood. Last year a group decided to look at polysomnographic readings,(this is a brain wave reading taken during sleep) of children who complain of headaches and migraines. This study looked at 90 children with migraine (60), chronic migraine (11), tension headache (6), and nonspecific headache (13) indicated that sleep-disordered breathing was more frequent among children with migraine (56.6%) and nonspecific headache (54%) vs chronic migraine (27%). Tension headache was not associated with sleep-disordered breathing. In the nonspecific headache group, children with sleep-disordered breathing had higher body mass indexes.

Severe migraine and chronic migraine were associated with shorter sleep time, taking longer to get to sleep, and shorter rapid eye movement and slow-wave sleep. Fifty percent of children with tension headache ground their teeth, vs 2.4% of children with nontension headache. These results support an association between migraine and sleep-disordered breathing, and between tension headache and bruxism, in children. This suggests that disrupted sleep architecture with reduced rapid eye movement and slow-wave sleep in severe and chronic migraine headaches may support an intrinsic relationship between sleep and headache disorders.

This study was carried out in Pennsylvania, USA and reported in Pediatric Neurology.