Tuesday, September 03, 2002

By CARA HALSTEAD

Sleep problems are believed by some to be the number one health issue in the United States, resulting in lack of focus, irritability, frustration and impulsive behavior, not to mention sleepiness. According to the CNN Web site, nearly half of all Americans have difficulty sleeping.

There are many reasons adults have trouble sleeping, but for parents of young children there is often one specific reason: their child isn’t sleeping through the night. The American Academy of Pediatrics (AAP) reports that sleep problems are common among children during the first few years of life.

The parents of these children are concerned and rightly so. Most want their children to learn as much about good sleep habits, or sleep hygiene, as they do about good nutrition or physical fitness.

In an informal survey conducted for this article, 24 out of 31 local parents said that their pre-school age children sleep through the night. What about the other 25 percent?

Ranging from mild problems, such as bedtime resistance and occasional bedwetting, to more serious ones such as sleep apnea, there is a wide range of sleeping difficulties that can affect the young.

Common sleep problems

According to the American Academy of Child and Adolescent Psychiatry, signs that children are having sleep problems include: frequent waking; night talking; difficulty falling asleep; waking up early and/or crying; daytime sleepiness; nightmares; bedwetting; and teeth grinding.

Nightmares are said to be common among young children, who have difficulty distinguishing between imagination and reality. Limiting television with scary images and relieving certain stresses, such as those associated with toilet training, may help lead to a peaceful night. Allowing children to express fears by talking or artwork may also help.

In most children, nightmares occur only occasionally. If they occur frequently, a physician should be consulted.

Sleep talking is characterized by unintelligible speaking in a monotone voice. Treatment is rarely needed unless sleep talking occurs in combination with other disorders.

Other sleep problems include sleep walking and night terrors. Sleep walking rarely begins before age 6, however, and tends to run in families.

Children who experience night terrors may suddenly sit up in bed with their eyes open and scream, gasp, moan, mumble, thrash, and remain in a confused, agitated state for 30 to 60 minutes before returning to a peaceful sleep. They are unresponsive to attempts at comforting and remember nothing the next morning.

Night terrors occur in only 1 to 5 percent of children and are not an indication of psychological disturbance. Physical exhaustion can contribute to night terrors. There is no treatment, but most children outgrow them.

Turn off TV

A report published in the September 1999 issue of the Journal of the American Academy of Pediatrics recommends that health care practitioners question parents about television viewing when diagnosing health disorders. Over 70 percent of 495 children studied watched television over two hours a day. Most of the television viewing practices examined were associated with at least one type of sleep disturbance.

The study found that having television in the bedroom affected the quality of sleep. Television viewing at bedtime caused children to resist going to bed, have trouble falling asleep, and sleep less than recommended. Nine percent of the children experienced nightmares at least once a week after watching disturbing programming.

The report concluded that television viewing and increased sleepiness may lead to persistent sleep problems that become difficult to change as the child grows older.

More advisable than television at bedtime are relaxing and consistent routines that may include a bath and book.

Sleep strategies

The AAP has published a “Guide to Your Child’s Sleep,” that offers many approaches to developing good sleep habits. The guide recommends that sleep strategies be tailored to individual children and families, but should generally include limiting stress and establishing a regular bedtime routine. The guide suggests neither responding immediately to every complaint, nor letting a baby cry for longer than 10 minutes.

Consistency and limits for young children at bedtime are necessary for developing good habits. Toddlers tend to be comforted by bedtime routine. Change in routine may cause difficulty sleeping.

However, some children between the ages of 2 and 3 may resist going to sleep in an attempt to assert power or due to separation anxiety.

Letting children make choices within reason at bedtime, for example what to wear, what story to read, and which stuffed animal to sleep with, may help. Leaving a night-light on and allowing your child to sleep with security objects may help reduce separation anxiety.

The AAP suggests keeping a sleep diary for your child before discussing sleep issues with a pediatrician. They recommend including the following: where the child sleeps and for how long; bed time; objects the child needs in bed (favorite toy, blanket, etc.); time it takes to fall asleep; time parent goes to bed; times awakened during the night; how long it takes to fall asleep again; methods of comforting and consoling; time child wakes up in the morning; time and length of naps; changes or stresses in the home.

The AAP encourages parents to be understanding despite the stress a sleep problem can cause. Negative responses can worsen a sleep problem, especially if it is associated with a stressful situation in the child‘s life.

Ferberizing

Dr. Richard Ferber has become the sleep authority in recent years with his popular method of getting children to sleep through the night. His method, detailed in his book, “Solving Your Child’s Sleep Problems,” calls for a progressive technique of separation beginning with short periods and eventually longer and longer periods during which there is neither scolding nor rewarding.

Dr. Steven Kanengiser, the pediatric sleep specialist at Pascack Valley Hospital, echoes Ferber in his philosophy that if general difficulties in sleeping through the night are not a problem for the family, they are not a problem.

Donna Yantsos of Suffern, NY feels that although her 2-year-old daughter still wakes up in the middle of the night (around 2 a.m.) and ends up in her parents’ bed, it could be worse. “She’s healthy, she’s beautiful,” says Yantsos. “The time will come when we’ll miss it. If this is our biggest obstacle, we are lucky.”

Many parents have an open-door policy, where children are allowed into the parents’ bed if they ask. But a growing number of parents feel the best way to nurture children is a return to traditional bed sharing and many experts agree. Sleeping with parents often helps an otherwise poor sleeper sleep through the night.

Behavior disorders and sleep

According to Dr. Carl Hunt, director of the National Center on Sleep Disorders Research, sleep disorders are often not recognized in children, and symptoms related to sleep deprivation may be wrongly attributed to hyperactivity and behavior disorders.

Kanengiser feels that some, but not most, cases of hyperactivity may be the result of a sleep disorder.

Sleep issues become a problem if they cause behavioral difficulties, lack of concentration, sleepiness and irritability, or if they are part of a more serious health problem. Physiological problems that can interfere with sleep in small children include sleep apnea and gastro esophageal reflux or heartburn.

Sleep apnea

The most common sleep disorder that requires professional attention and often surgery, is sleep apnea. According to Kanengiser, the most effective treatment for sleep apnea is the removal of the tonsils and adenoids by a surgeon.

Those with sleep apnea briefly stop breathing many times a night and awaken, often due to an obstruction in the respiratory tract related to enlarged tonsils or adenoids. Parents should seek the help of a sleep specialist if they are unsure whether their children are simply snoring or have an obstructive sleep apnea. The AAP advises seeking professional advice if your child snores habitually.

Sleep apnea occurs in all age groups, both sexes, and seems to run in families. It is estimated that as many as 18 million Americans have sleep apnea.

Early treatment for sleep apnea is advisable as it may lead to more serious health problems and complicated treatment in adults.

Kanengiser feels that sleep apnea is under recognized in both children and adults, but stresses the importance of professional evaluation in the form of a sleep study before surgery is recommended. “Normal parental concern about sleep habits and snoring is not proof of a serious condition in a child,” says Kanengiser. “A sleep study is performed in one night and it is painless. They sleep, wake up, and go home.” He assures that children during a sleep study are made to feel comfortable.

Sleep problems are usually occasional occurrences. Frequent episodes that interfere with daytime activities and behavior, however, may be an indication of physical or emotional difficulties. An evaluation by a doctor specializing in sleep disorders is advisable in some cases.

Cara Halstead of Suffern is a writer and mother.

A branch of the National Institutes of Health, the National Heart Lung and Blood Institute (NLHBI) in Washington, D.C., has begun a five-year educational program to promote healthy sleep habits in children. The initiative, co-sponsored by Garfield creator Jim Davis, will target parents, teachers, and health-care providers.

The mission of the National Center on Sleep Disorders Research (NCSDR) is to support research, training and education about sleep disorders. The center is located within the NHLBI of the National Institutes of Health.

Information about sleep disorders research can be obtained from the NCSDR and the NLHBI.

National Center on Sleep Disorders Research

Two Rockledge Centre, Suite 7024

6701 Rockledge Drive MSC 7920

Bethesda, MD 20892-7920

301/435-0199

NHLBI Information Center

P.O. Box 30105

Bethesda, MD 20824-0105

301/592-8573

Web Sites:

njsleephelp.com/

www.medem.com/MedLB/articleslb.cfm?sub_cat=14

www.stanford.edu/~dement/children.html

www.athealth.com/Consumer/newsletter/FPN_6_4.html

www.intelihealth.com/IH/ihtIH/WSIHW000/24597/24597.html

www.fpnotebook.com/PSY123.htm

www.nvo.com/isleepless/sleepproblemsinbabieschildren/

www.sleep-clinic.com/html/children.htm

www.sleepnet.com/links.htm

www.sleepnet.com/news.htm

www.cnn.com/HEALTH/indepth.health/sleeping.conditions/

www.nhlbi.nih.gov/about/ncsdr/index.htm

www.sleepfoundation.org

www.mattress.com

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