Caffeine therapy, preemies, and sleep trouble

A study found that preemies are at risk for having sleep issues and sleep disorders later in life, regardless of any caffeine therapy they may have had in the NICU.

Using caffeine to treat premature newborns for apnea - dangerous pauses in breathing during sleep - does not have long-term harmful effects on their sleep or breathing patterns, according to research led by Children's Hospital of Philadelphia. 

But the new study also found that prematurity itself is a risk factor for sleep disorders years later. Children born preterm had high rates of obstructive sleep apnea and periodic limb movement during sleep, whether or not they had caffeine therapy in the neonatal intensive care unit.

The very idea of caffeinating fragile preemies may sound misguided. But eight years ago, an international study that compared the stimulant to a placebo found it had benefits, including relieving sleep apnea.

Still, there were lingering concerns. Caffeine works in the brain, blocking a molecule that promotes sleep. Animal studies suggest that such early biochemical tinkering can lead to permanent sleep and breathing abnormalities.

"I think we all know from daily life the effect that caffeine has on us," said lead author Carole L. Marcus, a pediatric pulmonologist and director of the sleep center at Children's Hospital. "We give the equivalent of six cups of coffee a day for a week or more - and these are little babies whose brains are still developing."

The new study, published Friday in the American Journal of Respiratory and Critical Care Medicine, tracked down 201 of the original 2006 premature babies, now ages 5 to 12. Half had gotten caffeine therapy, the other half a placebo.

For two weeks, the children wore a noninvasive sensor at night to monitor their sleep. The parents also filled out questionnaires.

There were no differences in the children's sleep patterns, including how long they took to fall asleep and how soundly they slept.

But both caffeine and placebo groups had high rates of sleep disorders. Overall, about 10 percent had periodic limb movement disorder (episodes of involuntary movement, usually of the legs), and 14 percent had obstructive sleep apnea. In general, less than 4 percent of school-age children have apnea, and 5 percent to 8 percent have the limb movement disorder.

Obstructive sleep apnea is different from the apnea of prematurity. In the obstructive form, the throat airway collapses or becomes blocked. In preemies, breathing stops because their immature nervous systems cannot yet enable continuous respiration.

Obstructive apnea can lead to daytime sleepiness, learning problems, high blood pressure, and heart disease. Limb movement disorder is less understood but has been linked to attention deficit hyperactivity disorder and a serious sleep problem called restless leg syndrome.

If caffeine isn't a culprit, why are sleep disorders common in former premature babies?

One possibility, the researchers noted, is enlarged tonsils. About a quarter of the children had already undergone tonsillectomies, the primary treatment for childhood obstructive sleep apnea.

"We're thinking the rate of apnea would have been even higher if not for the tonsillectomies," Marcus said.

The limb movement may be related, at least partly, to iron deficiency. Low blood iron levels were found in the children with the movement disorder who underwent testing.

All the children with apnea or limb movement disorder were referred for more testing and treatment, but most former preemies are not even checked for such problems. The study suggests that should change.

"We should be screening these children," Marcus said. "Then we could prevent problems, or treat them earlier."

Read more here

What price new parents pay for interrupted sleep

This article discusses what happens to parents of newborns after one night of interrupted sleep, such as being in a bad mood and other consequences of interrupted sleep.

The familiar cry in the night, followed by a blind shuffle to the crib, a feeding, a diaper change, and a final retreat back into oblivion—every hour on the hour. Such is the sleep pattern of most new parents, who report feeling more exhausted in the morning than when they went to bed the night before.

Now, in the first study of its kind, Prof. Avi Sadeh and a team of researchers from Tel Aviv University's School of Psychological Sciences explain why interrupted sleep can be as physically detrimental as no sleep at all. In the study, published in the journal Sleep Medicine, Prof. Sadeh and his colleagues Michal Kahn, Shimrit Fridenson, Reut Lerer and Yair Ben-Haim establish a causal link between interrupted sleep patterns and compromised cognitive abilities, shortened attention spans, and negative moods. The researchers discovered that interrupted sleep is equivalent to no more than four consecutive hours of sleep.

"The sleep of many parents is often disrupted by external sources such as a crying baby demanding care during the night. Doctors on call, who may receive several phone calls a night, also experience disruptions," said Prof. Sadeh. "These night wakings could be relatively short – only five to ten minutes – but they disrupt the natural sleep rhythm. The impact of such night wakings on an individual's daytime alertness, mood, and cognitive abilities had never been studied. Our study is the first to demonstrate seriously deleterious cognitive and emotional effects."

Putting Mom and Dad in a bad mood

"In the process of advising these parents, it struck me that the role of multiple night wakings had never been systematically assessed," said Prof. Sadeh, who directs asleep clinic at TAU, where he advises exhausted and desperate parents on how to cope with their children's persistent night wakings. "Many previous studies had shown an association, but none had established a causal link. Our study demonstrates that induced night wakings, in otherwise normal individuals, clearly lead to compromised attention and negative mood."

The study was conducted on student volunteers at TAU's School of Psychological Sciences. Their sleep patterns were monitored at home using wristwatch-like devices that detected when they were asleep and when they were awake. The students slept a normal eight-hour night, then experienced a night in which they were awakened four times by phone calls and told to complete a short computer task before going back to sleep after 10-15 minutes of wakefulness. The students were asked each following morning to complete certain computer tasks to assess alertness and attention, as well as to fill out questionnaires to determine their mood. The experiment showed a direct link between compromised attention, negative mood, and disrupted sleep—after only one night of frequent interruptions.

Paying a high price

"Our study shows the impact of only one disrupted night," said Prof. Sadeh. "But we know that these effects accumulate and therefore the functional price new parents—who awaken three to ten times a night for months on end—pay for common infant sleep disturbance is enormous. Besides the physical effects of interrupted sleep, parents often develop feelings of anger toward their infants and then feel guilty about these negative feelings.

"Sleep research has focused in the last 50 years on sleep deprivation, and practically ignored the impact of night-wakings, which is a pervasive phenomenon for people from many walks of life. I hope that our study will bring this to the attention of scientists and clinicians, who should recognize the price paid by individuals who have to endure frequent night-wakings."

Prof. Sadeh is currently researching interventions for infant sleep disturbances to reduce the detrimental effects of disrupted sleep on parents.

Read more here

Snoring in Children

This article discusses what is important to know about snoring in children.

Snoring in children is a common event, with estimates placing it at about 12 to 15 percent. Most of these children are healthy, show no symptoms and have primary snoring. Snoring happens during sleep due to a blockage of air when breathing as it passes through the back of the mouth. The loudness is affected by how much air passes through and how fast the throat tissue is vibrating. Snoring can be due to an upper respiratory infection, allergies, or it can be a sign of obstructive sleep apnea (OSA).

Infants and toddlers spend over half of their lives sleeping and, by adolescence, greater than on third of our lives are spent sleeping. Quality sleep is essential for proper development and daily functioning. Proper sleep helps with learning, consolidating memories, physical growth, recharging the body and helping our bodies fight infections.

Approximately 2 to 3 percent of children have OSA, which occurs when the posterior air collapses and blocks the throat. Frequent pauses in breathing, lasting from several seconds to a minute, often lead to the brain briefly waking up and causing us to breathe. This leads to gasping or snorting, waking us up and re-breathing. This can occur all through out the night.

Interrupted sleep can lead to behavioral issues, problems with social function, poor school performance and poor growth. These children are also more likely to be hyperactive and have trouble paying attention in school, mimicking signs of attention-deficit hyperactivity disorder (ADHD).

Studies also show that children with OSA are at risk of developing heart and lung problems which can lead to serious consequences later in life if it goes undetected. Untreated OSA, in the short term, often leads to daytime sleepiness, morning headaches, irritability, bed wetting and mouth breathing. The risk of apnea is higher in overweight children.

Other signs might include large tonsils and/or adenoids with frequent mouth breathing, restless sleep or sleep in abnormal positions, sleep in elevated position or with neck extended, excessive sweating during sleep, nasal speech, poor weight gain or being overweight, and high blood pressure. Even primary snoring (i.e. snoring without breathing pauses, frequent arousals, or drips in oxygen levels), which was once thought to be normal, still can lead to problems in school performance or behavior issues.

If you suspect your child may have symptoms of OSA don’t assume his or her snoring will go away on its own. Talk to your child’s doctor. The American Academy of Pediatrics has recognized this as a serious problem and has published recent guidelines for screening of obstructive sleep apnea, which will help doctors recognize, diagnose, and treat children with OSA.

Testing can be done if your child is suspected of having OSA, including an overnight sleep study. You may also videotape your child’s sleep to bring to the doctor for review. Night-time pulse oximetry to measure oxygen levels is also a useful tool. Your doctor may refer your child to a sleep specialist as well, as sometimes these tests are normal even when your child may still have OSA.

Once your child has been found to have obstructive sleep apnea syndrome, referral to doctors who specialize in treating OSA include pediatric otolaryngologists (ENT), pulmonologists and neurologists. Treatment options usually include removing enlarged tonsils and adenoids (T&A). Often removing the tonsils and adenoids stops the snoring and helps with improved appetite and growth in young children. It also improves academic performance and behavior in school-aged children as they get more uninterrupted, quality sleep. Other options include treating allergies or helping children lose weight. A night-time treatment called continuous positive airway pressure (CPAP) therapy is another option for children who can’t have surgery or have persistent OSA even after a T&A has been performed.

Remember to be suspicious that your child may have OSA if he or she regularly snores and has apnea, daytime sleepiness or school/behavior problems. If detected early, treatment of this problem may be reversible.

Read more here

Acupressure helps babies sleep!

This article reports that acupressure helps babies sleep, and can help with other issues that babies have.

Promoting better baby sleep from the perspective of Chinese medicine is very different from the standard American approach. 

Modern pediatric sleep advice is an incredibly contentious subject as any trip to the bookstore will demonstrate. There are books on the many different behavioral modification methods, from the cry-it-out approaches to the attachment-parenting styles. And if you go to any online parenting discussion board, there will be heated discussions among parents who defend their choice of sleep method for babies. 

Regardless of parenting style and culture, Chinese medicine techniques can help improve sleep because they alter the energetics of sleep and focus on physiology rather than behavior.

While a reliable sleep routine will be enough for most babies to establish a healthy sleep pattern, others may need additional support. This is when Chinese medicine and its attention to individual energetics can come to the rescue.

Causes of Poor Sleep 

In Chinese medicine, there are many different patterns of sleep disturbance, each with their own unique treatment. With babies, it is usually an excess of yang energy (fire) and a deficiency of yin energy (water), but it could also be due to a weak spleen (earth) and an excess liver (wood) or other elemental imbalance. 

Balancing these energies with acupressure can be done easily and effectively with the use of a good acupressure reference guide or the recommendations of a pediatric acupuncturist.

Better Digestion 

In Chinese medicine, the source of sound sleep is good digestion. A visit to a pediatric acupuncturist to treat sleep disturbances will always begin with an analysis of digestion. There can’t be good sleep if there is gas, bloating, constipation, or diarrhea. Regular abdominal massage can be incredibly beneficial to regulating the digestive processes.

To help digestion, you can massage in circles with medium pressure around the belly button, going counter-clockwise (against the flow of the intestines) to treat diarrhea and clockwise (with the course of the intestines) to treat gas, bloating, and constipation. 

To do a well-baby treatment, begin with 50 circles against the flow of the intestines and then finish with 50 circles going with the flow of the intestines. This is guaranteed to ease tummy troubles that interfere with good sleep.

Teething and Sleep Trouble 

Teething pain can disrupt even the best sleepers. Massaging acupressure points that have an energetic relationship to the gums helps to relieve the pain, heat, and swelling that accompany teething. In Chinese medicine, the primary channels that intersect the gums are the stomach and large-intestine meridians. 

To help ease teething discomfort, massage the point on the thumb-side of the index finger from the corner of the nail base to the nail tip (large intestine point), and the web between the second and third toe (stomach point) for two minutes per point as often as needed. This is very effective for improving sleep.

Deeper Relaxation 

Massaging between your baby’s eyes can also greatly improve sleep. This very relaxing acupressure point can induce sleep in even the most reluctant sleeper. This point is located above the bridge of the nose between the eyes. You can massage upward with medium strokes until the baby drifts off to dreamland. It is good for adults too.

Daily Massages 

A daily acupressure massage can also be used to promote good baby sleep. The entire body is crossed with energy channels that correspond to the internal organs. There are six channels that traverse the arms and six channels that traverse the legs. Regular massage along these energetic pathways will keep a baby’s immune system strong, improve digestion, and assist with good growth and development. 

For an easy massage that will benefit the whole body, begin by massaging one finger and follow that line all the way up to the shoulder. Continue with each finger until you’ve done the both hands and both sides of the body. 

Then do the same on the lower body by starting at each toe and massaging up each leg. Do both sides. Then continue with circular massage on the abdomen like the one to promote good digestion: Do 100–200 clockwise circles. 

Finish with a series of nine upward strokes on the back. Start these strokes at the base of the spine and finish them at the neck. Babies will love the attention and their health will benefit as a result of this tender care.

Parents should be persistent with their use of baby acupressure. Babies respond amazingly quickly to acupressure treatments, but if their parents’ efforts are not enough to work through sleep challenges, then a consultation with a pediatric acupuncturist may be necessary. They can do a more thorough evaluation and plan a comprehensive treatment strategy to put the baby on a better sleep track.

Babies benefit immensely from Chinese medicine’s unique perspective on pediatric sleep and its gentle and effective acupressure solutions. Regardless of parenting style and sleep philosophy, all families can utilize these simple and easy-to-implement strategies to improve their baby’s sleep. It just takes a little time and attention, and the result can be a better night’s sleep for both the baby and the parents.

Read more here