Articles & News

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About Sleep

AUTHOR: Danielle Clarke

To help your child to develop healthy sleep habits it is important to have some understanding of how we sleep and sleeping patterns.

Humans spend one-third of their life asleep. It is not known yet why we need so much sleep and what happens while we sleep, but we do know the consequences of sleep deprivation.

Sleep is extremely important for the brain and body to develop. And that is why it is so important to start healthy sleeping habits as early as possible.

Normal sleep phases

Active and quiet sleep

In active sleep, babies breathe irregularly and shallowly, twitch their arms and legs, and display rapid eye movements under closed lids. In fact, limb muscles become temporarily paralysed. Heart rate increases, and blood pressure rises.

In adolescence and the adult years, active sleep is called rapid eye movement (REM) sleep. Active sleep is a form of light sleep. It is believed that REM is the time when we process what we have experienced throughout the day. Scientist think that is why new borns spend most of their time asleep in REM sleep.

In quiet sleep, babies lie still and breathe deeply. They’ll occasionally jerk or ‘startle’. Quiet sleep is similar to non-REM sleep in older children and grown-ups. It can be light or deep.

Light and deep sleep

Light sleep can be very light – sometimes you might not even realise you’re asleep. We can be easily woken from light sleep.

Someone in deep sleep is hard to wake. Deep sleep is a lot more peaceful and restful. It’s thought that deep sleep is the time when we grow and heal. Someone in deep sleep might feel quite drowsy if woken.

Sleep cycles

In the course of one night, grown-ups and children move through repeating cycles of quiet and active sleep.

Typically, more of our sleep in the early part of the night is quiet sleep (about 80%). Then, about halfway through our normal-length sleep, our sleep cycle flips. By morning, about 80% of our sleep is active sleep.

This is why it’s easier to be disturbed towards the end of a sleep.

Sleep cycles in babies and children

Cycles of quiet and active sleep last 30-50 minutes in babies, then gradually increase in length across childhood.

Some babies and children fall deeply asleep very quickly. Others sleep lightly, fidgeting and muttering for up to 20 minutes, before getting into deep sleep.

Children usually wake briefly at the end of each sleep cycle. This is a normal part of healthy sleep – all children do it. Some children call out when they wake and need help settling again, but independent sleepers put themselves back to sleep. And that is why it so important to teach children to be independent sleepers.

An independent sleeper might take a few seconds or minutes to put themselves back to sleep giving them the chance to have a better quality sleep. A child who depends on props to go back to sleep will be wasting valuable time seeking the same conditions that put him to sleep in the first place such as feeding, rocking, pacifier.

Sleep cycles in adolescence and adulthood

In adolescence and during the adult years, each cycle of active and quiet sleep lasts about 90 minutes.

Each cycle ends in a brief awakening, and these can happen several times throughout the night. These awakenings don’t normally disrupt our sleep, and we usually aren’t even aware of them. If things haven’t changed, we’ll normally go straight back to sleep – but if things have changed around us, we’re uncomfortable or anxious, our pillow is missing, or we’re disturbed by a noise, we might wake fully.

How sleep cycles change over time

The amount of time we spend in each type of sleep varies depending on our age.

At birth, full-term infants spend about half their sleeping time in active sleep. Each sleep cycle lasts only 40 minutes (compared to 90 minutes for a grown-up). This means that, biologically, infants are programmed to sleep more lightly and have more awakenings than grown-ups.

The amount of active sleep in our sleep cycle decreases with age. By three years of age, 33% of sleep is active.

By the time we’re around 13 years old, only about 20% of our sleeping time is active sleep.

When we sleep

It takes time to consolidate most of our sleep into the night-time. Babies and children vary in their sleep habits and sleep requirements, just like adults. It can be a good idea to have routine sleep times to stop your child getting overtired or sleepy during the day – see what works best for your child.

Under six months

Newborns sleep on and off through the day and night.

Babies aged 3-6 months might start moving towards a pattern of 2-3 daytime sleeps of up to two hours each. They might still wake at least once at night.

From 6-12 months

From about six months, babies have their longest sleep at night.

Between six and 12 months, most babies are in bed between 6 pm and 10 pm (latest 8pm bedtime recommended). They usually take less than 30 minutes to get to sleep (but about 10% of babies take longer).

Most babies can sleep for a period of six hours or more at night and are waking less. About 60% will wake only once during the night and need a grown-up to settle them back to sleep. About one in 10 will call out 3-4 times a night. More than a third of parents report problems with their baby’s sleep at this age.

Around 85-90% of infants aged 6-12 months are still having daytime naps. These naps usually last 1-2 hours. Some infants will sleep longer, but up to a quarter nap for less than an hour.

From 12 months

From this age, children tend to sleep better. Some toddlers start to resist going to sleep at night, preferring to stay up with the family – this is the most common sleep problem reported by parents. It peaks around 18 months and improves with age.

Less than 5% of two-year-olds wake three or more times overnight.

From 3 years

Children aged 3-5 years need around 11-13 hours of sleep a night. Some might also have a day nap that lasts for about an hour.

Children aged 6-9 need 10-11 hours sleep a night. They’re usually tired after school and might look forward to bedtime from about 7.30 pm.

From 10 years

Children entering puberty generally need about 9¼ hours of sleep a night to maintain the best level of alertness during the day.

Changes to the internal body clock or circadian rhythm during adolescence means it’s normal for teenagers to want to go to bed later at night – often around 11 pm or later – then get up later in the morning.

Over 90% of adolescent children don’t get the recommended amount of sleep on school nights. Getting enough good-quality sleep is important during this period, because sleep is vital for thinking, learning and concentration skills.

Parents can help children get enough sleep by encouraging a set bed time on school nights, then allowing kids to stay up a bit later on the weekends. To prevent Monday morning blues and early week tiredness, it can be a good idea for teenagers not to get up too late on weekends.

Reference

Raising Children. (2013, February 27). About Sleep. Retrieved http://raisingchildren.net.au/articles/sleep_the_hows_and_whys.html/context/731

 

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By Kate Murphy
April 16, 2012 6:15 pm April 16, 2012 6:15 pm

Diagnoses of attention hyperactivity disorder among children have increased dramatically in recent years, rising 22 percent from 2003 to 2007, according to the Centers for Disease Control and Prevention. But many experts believe that this may not be the epidemic it appears to be.

Many children are given a diagnosis of A.D.H.D., researchers say, when in fact they have another problem: a sleep disorder, like sleep apnea. The confusion may account for a significant number of A.D.H.D. cases in children, and the drugs used to treat them may only be exacerbating the problem.

“No one is saying A.D.H.D. does not exist, but there’s a strong feeling now that we need to rule out sleep issues first,” said Dr. Merrill Wise, a pediatric neurologist and sleep medicine specialist at the Methodist Healthcare Sleep Disorders Center in Memphis.

The symptoms of sleep deprivation in children resemble those of A.D.H.D. While adults experience sleep deprivation as drowsiness and sluggishness, sleepless children often become wired, moody and obstinate; they may have trouble focusing, sitting still and getting along with peers.

The latest study suggesting a link between inadequate sleep and A.D.H.D. symptoms appeared last month in the journal Pediatrics. Researchers followed 11,000 British children for six years, starting when they were 6 months old. The children whose sleep was affected by breathing problems like snoring, mouth breathing or apnea were 40 percent to 100 percent more likely than normal breathers to develop behavioral problems resembling A.D.H.D.

Children at highest risk of developing A.D.H.D.-like behaviors had sleep-disordered breathing that persisted throughout the study but was most severe at age 2 1/2.

“Lack of sleep is an insult to a child’s developing body and mind that can have a huge impact,” said Karen Bonuck, the study’s lead author and a professor of family and social medicine at Albert Einstein College of Medicine in New York. “It’s incredible that we don’t screen for sleep problems the way we screen for vision and hearing problems.”

Her research builds on earlier, smaller studies showing that children with nighttime breathing problems did better with cognitive and attention-directed tasks and had fewer behavioral issues after their adenoids and tonsils were removed. The children were significantly less likely than untreated children with sleep-disordered breathing to be given an A.D.H.D. diagnosis in the ensuing months and years.

Most important, perhaps, those already found to have A.D.H.D. before surgery subsequently behaved so much better in many cases that they no longer fit the criteria. The National Institutes of Health has begun a study, called the Childhood Adenotonsillectomy Study, to understand the effect of surgically removing adenoids and tonsils on the health and behavior of 400 children. Results are expected this year.

“We’re getting closer and closer to a causal claim” between breathing problems during sleep and A.D.H.D. symptoms in children, said Dr. Ronald Chervin, a neurologist and director of University of Michigan Sleep Disorders Center in Ann Arbor.

In his view, behavioral problems linked to nighttime breathing difficulties are more likely a result of inadequate sleep than possible oxygen deprivation. “We see the same types of behavioral symptoms in children with other kinds of sleep disruptions,” he said.

Indeed, sleep experts note that children who lose as little as half an hour of needed sleep per night — whether because of a sleep disorder or just staying up too late texting or playing video games — can exhibit behaviors typical of A.D.H.D.

Not only is a misdiagnosis stigmatizing, but treatment of A.D.H.D. can exacerbate sleeplessness, the real problem. The drugs used to treat A.D.H.D., like Ritalin, Adderall or Concerta, can cause insomnia.

“It can become a vicious, compounding cycle,” said Dr. David Gozal, chairman of the department of pediatrics at the University of Chicago Pritzker School of Medicine, whose clinical practice focuses on children with sleep disorders.

Sleep deprivation is difficult to spot in children. Of the 10,000 members of the American Academy of Sleep Medicine, only 500 have specialty training in pediatric sleep issues. And pediatricians may not even know to make a referral, because they often depend on parents to bring up their children’s sleep problems during checkups.

But parents themselves often are uninformed about healthy sleep habits. A study conducted last year by researchers at Penn State University-Harrisburg and published in The Journal of Sleep Research showed that of 170 participating parents, fewer than 10 percent could correctly answer basic questions like the number of hours of sleep a child needs.

“Parents didn’t know what was normal sleep behavior,” said Kimberly Anne Schreck, a psychologist and behavioral analyst at Penn State who was the study’s lead author. “Many thought snoring was cute and meant their child was sleeping deeply and soundly.”

Reference

Murphy, K. (2012 April 16). Attention Problem May Be Sleep-Related [Web log post]. Retrieved February 4, 2015, http://well.blogs.nytimes.com/2012/04/16/attention-problems-may-be-sleep-related/

 

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Bedtime battles can be reduced if you introduce a routine to ease your child to sleep. Children like predictability and feeling in control of what is happening next. You may think your baby is too young to understand what you are saying, but good communication is the key for raising a happy and healthy child. Explain to your baby what you are doing and what is coming next.

If you introduce a pleasant routine 5-10 minutes before you put your child in bed you can help her switch into quiet mode and be ready for sleep.

Choosing the right bedtime routine for your family

A bedtime routine can include a number of activities. Usually it involves hygiene tasks (bath, brushing teeth), as well as enjoyable quiet activities (playing peekaboo, read a story and cuddles). It is important that the activities you choose are performed in the same order each night so your child comes to know what comes next and is prepared for when sleep time arrives.

An example could be:

  • Bath
  • Breastfeed or bottle-feed
  • Quiet play (story or peekaboo)
  • Cuddles
  • Bed

When choosing activities, think about what your child likes and what you enjoy as well. If your child likes being read stories, but you don’t, you might feel tempted to skip this. If your child dislikes having a bath, don’t include this task to the bedtime routine (bath your child earlier in the day to avoid crying and fuss at bedtime).

At the end of the routine you should place your child awake in the cot and say goodnight. Newborns can feel a lot of discomfort caused by gas when laying down. Make sure to burp your child as much as possible before placing her in the cot. If you think your child is still uncomfortable you can pick her up and burp her more, but make sure she is awake when you put her down.

Introducing a bedtime routine

Let your child know that play time will be over soon and announce that you are going to start the bedtime routine. Your child won’t have a full understanding of time, but she will pick up the idea, which will assist make your job easier later when she gets older. You can start the routine 5-10 minutes before the desired bed time (somewhere around 6pm and 8pm is ideal).

Research has shown that children who follow a routine and develop healthy sleep habits are more able to improve general behaviours, cognitive development, control of emotions and relationships.

APR
15

Bedtime battles can be reduced by introducing a routine to ease your child to sleep. Children like predictability and having a sense of knowing what is happening next. A routine that eases them toward sleep can reduce the shock that it is time for bed, and hence assist them accept it more readily.

In the absence of a routine, your child may be happily playing an exciting energetic game, then suddenly she is picked up and told its bedtime. In this scenario, she is much likelier to make a fuss.

By introducing a pleasant routine 20-30 minutes before you put your child in bed you can help her transition to quiet mode and be ready for sleep.

Choosing the right bedtime routine for your family

A bedtime routine can include a number of activities. Usually it involves hygiene tasks (bath, brushing teeth), as well as quiet activities (read a story, talk about the day and cuddles). It is important that the activities you choose to incorporate are performed in the same order every night so your child knows what comes next and is prepared when sleep time comes.

An example could be:

  • Bath
  • Breastfeed or bottle-feed
  • Quiet play (story or talking time)
  • Cuddles
  • Bed

When choosing the activities think about what your child likes and what you enjoy as well. If your child likes reading stories, but you don’t, you might want to consider something else (although reading is a very important developmental tool). If your child doesn’t like having a bath, you shouldn’t include this task to the bedtime routine (bath your child earlier in the day to avoid a fuss at bedtime).

At the end of the routine you should place your child in bed and say goodnight. If the child protests you should maintain calm, yet be firm and be clear that it is time to sleep now and leave the room.

Introducing a bedtime routine

Incorporating a transition period in the bedtime routine is important.

Let your child know that play time will be over soon by announcing that in 10 minutes you are going to start the bedtime routine. Remind her when there is 5, 2 and 1 minute left. Your child won’t have a full understanding of time, but she will soon understand the idea of the countdown. You can start the routine 20-30 minutes before the desired bed time (somewhere around 6pm and 8pm is ideal).

However, if your child is older and you wish to move to an earlier bedtime, you will need to change the time gradually. For example, if your child is used to going to asleep at 9 pm, set this as a temporary bedtime and start moving bedtime forward 10 minutes every few days until you reach the desired bedtime.

For example:

  • Start routine at 8:40, put child in bed at 9 for the first week
  • Move routine to 8:30, put child in bed at 8:50 for a few nights (3 is a good number)
  • Continue moving bedtime until desired time is achieved.

Research indicates that children who follow a routine and develop healthy sleep habits are more able to improve general behaviours, cognitive development, control of emotions and relationships.

By Pam Belluck
February 2, 2015 6:05 pm February 2, 2015 6:05 pm

A large new study has documented unexpected links in the timing and severity of symptoms of maternal depression, which could help mothers and doctors better anticipate and treat the condition.

The study of more than 8,200 women from 19 centers in seven countries, published last month in Lancet Psychiatry, found that in those with the severest symptoms — suicidal thoughts, panic, frequent crying — depression most often began during pregnancy, not after giving birth, as is often assumed.

Moderately depressed women often developed their symptoms postpartum, and were more likely than severely depressed women to have experienced complications during pregnancy like pre-eclampsia, gestational diabetes or hypertension.

Severely depressed women, however, more often reported complications during delivery.

“This is the largest study to date on postpartum depressive symptoms,” said Leah Rubin, an assistant professor in the Women’s Mental Health Research Program at University of Illinois at Chicago, a co-author of a commentary about the study. “This is definitely a first step in the right direction, knowing that depression isn’t one-size-fits-all.”

Ten to 20 percent of mothers experience depression, anxiety, bipolar disorder or other symptoms at some point from pregnancy to a year after giving birth. The study could aid efforts to find causes and treatments.

The study participants were all mothers. Some had been found to have postpartum depression by clinicians, while others were assessed via a widely used questionnaire. (Some participants fell into both groups.)

Each group could be separated into three subgroups representing women with severe, moderate, and either mild or clinically insignificant depression, said Dr. Samantha Meltzer-Brody, the director of University of North Carolina’s perinatal psychiatry program and the study’s corresponding author.

Dr. Meltzer-Brody said the finding that two-thirds of severe depression began during pregnancy raised scientific questions. The biological factors at work could differ from those affecting women with classic postpartum depression, which scientists think may be linked to plummeting hormone levels after delivery.

She also wondered whether the finding that 60 percent of moderately depressed women reported issues like diabetes suggested that immune system problems might underlie their symptoms.

Dr. Meltzer-Brody and her colleagues will begin seeking answers this year by collecting DNA from thousands of women through an international online registry.

“Ideally, you could determine who’s at risk,” she said. “What we do now is wait for people to get sick.”

Reference

Belluck, P. (2015 February 2). Maternal Depression Often Starts Before Giving Birth, Study Says [Web log post]. Retrieved February 4, 2015, http://well.blogs.nytimes.com/2015/02/02/maternal-depression-often-starts-before-giving-birth-study-says/?action=click&contentCollection=Health&region=Footer&module=MoreInSection&pgtype=Blogs