According to Peg Dawson of the Seaport Coast Mental Health Center, as many as 30% of children suffer from sleep disorders. For the math-challenged, this amounts to three in ten children who suffer from a lack of restful and restorative sleep or do not sleep well.
Much research has been done to indicate that getting enough sleep is critical for the daily restoration of chemicals in our brains, in specific, and our bodies, in general, as well as for healthy brain development in young people. The idea that three in ten children may not develop as quickly or normally due to a sleep disorder is appalling and certainly deserves our attention in this column.
Before talking about pathology and sleep problems, let us begin by talking about what happens when we sleep well. Without some definition of what is normal, it profits us not to discuss what is abnormal.
Most sleep research has been done on adults. The seminal work in this area was done by James Dement, who is still recognized as the father of sleep research. Dement has made several films that are commercially available (see Dement and Vaughn (1999) The Promise of Sleep for details) and provide insight into what goes on inside our brains at night when we sleep. Basically, Dement found that the brain’s electrical activity undergoes important changes at various “stages” of sleep during the night. However, these stages may be assigned to one of two basic kinds of sleep: Rapid Eye Movement (REM) and Non-Rapid Eye Movement Sleep (Non-REM). The former occurs during dreaming, and the latter occurs during non-dream sleep time.
One of the early Dement (1999) experiments consisted of monitoring subjects’ brain waves and awakening the subjects when they began to go into REM sleep. Upon awakening, all of the subjects reported that they were dreaming. However, when asked about it the next morning, one crusty guy, who had reported prior to the study that he never dreamt, still denied that he ever dreamt, and he did not remember having reported that he was dreaming when they awakened him. Dement found in this early work that, no matter how many hours people spent sleeping, they still felt tired and sleep-deprived if they did not go through the essential amount of time in REM. Some of the subjects even began to report symptoms of a pain disorder, fibrositis, if their REM sleep were interrupted for a few nights (see, e.g., Wright, David (1993) Manual of the Newport Beach Pain Treatment Center). There were many implications for our understanding of sleep and the importance of the various stages of sleep. It was noteworthy that many subjects had to be dismissed from the study because their need for REM sleep was so great that they began to go into REM so quickly after being awakened a few times.
It is well-accepted that adults go through four to six cycles of REM sleep per night, and that each of these cycles lasts from five to ten minutes. Thus, a “dreamer” who spends a large amount of time in REM sleep with brief periods of Non-REM sleep might require only three or four hours of sleep per night, while a person who spends a great deal of time in non-REM sleep might require ten hours. Hence, the idea that some of us need more sleep than others is now well-accepted (Connor, Steve, The Independent, August, 2009).
A second well-accepted fact about sleep research is that infants sleep a great deal and spend the most time of any age group in REM sleep. (They are probably dreaming about milk?) Newborns sleep almost continuously. By the time they are six months old, most infants have reduced their need for sleep to 13 hours per day, and naps are a regular part of life. Colic and other issues come to the fore here, and a first look at sleep disorders versus changing parental anxiety about the problem is in order. Many parents, especially first-time parents, read books and want to stick to rigid schedules about sleep, and the child is not ready to have the same pattern. Other parents make it so unpredictable that a routine is never established, and the child’s sleep may suffer. If the child’s sleep suffers, the family may also suffer. Pediatricians can be of great assistance at this time. If a pediatrician does find that the parents need guidance, referral to a psychologist who specializes in sleep hygiene is recommended (lomalindahealth.org).
Most children need around ten hours of sleep until they are in adolescence. When the hormonal changes occur, sleep patterns often change as well. This is, again, due to chemical changes in the brain. Sleep onset is triggered by a hormone called Melatonin, and awakening is correlated with an increase in another hormone, Cortisol. Research has shown that adolescents experience increasingly later release of melatonin subsequent to puberty, and thus their wanting to stay up later may actually be biologically-based. Some schools have begun to take this into account and experimented with later start times, such as beginning at 9:00 instead of 8:00 a.m. (see, for example, “Later School Times and Zzzzs to A’s,” Emily Sohn, LA Times, 8/23/2010). The results of this pattern have yet to be fully realized. We also need to realize that most of our adolescents are going to have to buckle down and continue to get up and get ready for school at 8:00. This is a good spot to tell about one of my more successful results with a sleep problem.
Parents brought their thirteen-year-old son in because he was showing signs of anxiety, not getting to sleep as easily as he once did, having a hard time staying awake in class, and growing increasingly irritable. Since many of my clients are referred to me because of school problems, I began by assessing the boy’s intellectual ability, academic achievement, and attention and concentration. In short, we found no significant problems in any of the areas that were tested. I had my client do the hand temperature monitoring that I have described elsewhere (see blog on Biofeedback and Neurofeedback, for example), and his hands were almost always cold. I also had him start to track some dietary and exercise habits.
Long story short, caffeine turned out to be the culprit. Unbeknownst to the parents, the client had been consuming a 64-oz soda on a daily basis. When we stopped the soda, the sleep problems went away. Therefore, in spite of the above-mentioned biological changes at puberty, some other reason may be operating. Do not overlook the high amount of sugar and caffeine that your child may be ingesting when you are faced with a sleep issue.
Future columns will be devoted to the serious issues of Sleepwalking and Night Terrors. This writer will also welcome questions about sleep problems that your child might be experiencing or suggestions for further topics in this area.
Until then, good night, everyone!