Helping Our School-Age Children Sleep Better when 23% have sleep problems!

Revisiting the importance of  healthy sleep habits in school-age children.
Common sleep problems and some strategies for resolving them... -JR

Helping Our School-Age Children Sleep Better
By Peri Klass, M.D.

"Everyone knows that getting a baby to sleep through the night can be a big challenge for parents. But sleep problems are common among preschool and school-age children, too. As we ask children to function in school, academically and socially, fatigue can affect their achievement and behavior.

Australian research on sleep problems in children has included work aimed at the “school transition” year in which children adjust to a school schedule. In a study of 4,460 children, 22.6 percent had sleep problems, according to their parents, at that transition age of 6 to 7 years. “We were surprised, we thought it was all baby sleep” that was the problem, said Dr. Harriet Hiscock, a pediatrician who is a senior research fellow at the Murdoch Childrens Research Institute at the Royal Children’s Hospital in Melbourne who was one of the authors of the study.

The most common sleep issues for children around the age of school entry, Dr. Hiscock said, definitely include limit-setting issues — that is, some of them need their parents to make the rules and routines clear. But there are also children with what sleep specialists call “sleep onset association disorder,” in which a child has become habituated to falling asleep only in a certain context, requiring the presence of a parent, or needing to have the TV on, to cite two common examples. Very anxious children are also often problem sleepers. And then there are children beset by nightmares, night terrors and early morning waking.

Many parts of the brain work less well when children are tired. “The prefrontal cortex is very sensitive to sleep deprivation, and it is key to the brain mechanisms which underlie executive function and some of the attention  processes,” she said. “The amygdala is affected by sleep deprivation and is essential for emotional processes.”"

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Is melatonin safe for children?

This article discusses the research that has been done on melatonin and children.

Melatonin hormone should be made easily available according to some sleep experts despite the conflict of interest among researchers as to whether it is safe for inducing sleep in children or not, reports The Sydney Morning Herald.

Melatonin is a natural hormone secreted by the pineal gland of the body. The small pea-sized gland which is located just above the middle of the brain is inactive during the day and gets turned on by the suprachiasmatic nucleus (SCN) located in the hypothalamus when it gets dark. It then secretes the melatonin in the blood which is responsible for inducing sleep naturally.

Sleep plays a vital part during the early development of brain in the newborns. The Circadian rhythm or the sleep-wake cycle in the body is regulated by the light and dark and it takes time to develop, resulting in the irregular sleep schedules of newborns. The rhythms begin to develop at about six weeks, and by three to six months most infants have a regular sleep-wake cycle.

However, 30 percent of children aged under three suffer from sleep problems, with the most common causes which are either behavioral or medical, according to a Monash University study.

Pediatric sleep specialist Dr Chris Seton, Woolcock Institute of Medical Research says, melatonin is a better alternative to the antidepressants and blood pressure medication that is commonly used by the parents which cause severe side effects.

But the medical experts do not seem to be readily accepting the claim as some of the research reveals that melatonin could adversely affect development during adolescence. They also have raised concern over the increasing trend of use of the hormone for treating sleep related issues in children.

There are reports which say that children with epilepsy and cerebral palsy were prescribed with melatonin way back since 1991. But it is now believed children with behavioural issues, such as ADHD, are more likely to be given melatonin now.

A senior research fellow at The University of Adelaide, David Kennaway says that the studies done on adults and animals have linked melatonin to a negative impact on reproductive, immune, cardiovascular and metabolic systems. In a research article published in the Journal of Paediatrics and Child Health, he says “It is not registered for use in children anywhere in the world and it has not undergone the formal safety testing expected for a new drug, especially long-term in children.”

But Dr Chris Seton, feels otherwise and says,”There is no evidence that it’s anything but a very safe drug. In the contexts of drugs given to kids, it’s at the top in terms of safety”.

The Sleep Health Foundation has cautiously approved the use of melatonin in children, stating it “appears to be safe and works well in the short term”.

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Young kids' sleep and obesity

Young kids not getting enough sleep could lead to obesity later in life.

Lack of sleep and sleep-related breathing problems appear to boost children's risk of obesity, a new study finds.

What isn't clear from the study, however, is whether the sleep issues actually cause obesity, or if something else might explain the association between sleep problems and obesity.

Researchers analyzed data from about 1,900 youngsters in England. The researchers had about 15 years of follow-up on the children. Those who got the least amount of sleep at ages 5 and 6 had between a 60 percent and 100 percent increased risk of being obese at age 15. (For children aged 5 or 6, fewer than 10.5 hours of sleep a night is considered too little, according to the researchers.)

Children who got too little sleep at other ages were not at increased risk for obesity, according to the study.

The researchers also found that one-quarter of the children were at increased risk of obesity due to sleep-related breathing problems such as snoring and sleep apnea. Those with the most severe sleep-related breathing problems were twice as likely to become obese by ages 7, 10 and 15.

The risk was slightly lower in children whose sleep-related breathing problems peaked at ages 5 or 6, but was still 60 percent to 80 percent higher than among those without sleep-related breathing problems.

The researchers didn't look at whether children with both these risk factors had a higher risk of obesity than those with just one of the risk factors.

"In recent years, lack of sleep has become a well-recognized risk for childhood obesity," study author Karen Bonuck, a professor of family and social medicine, and obstetrics, gynecology and women's health at Albert Einstein College of Medicine in New York City, said in a college news release.

"We know that the road to obesity often begins early in life. Our research strengthens the case that insufficient sleep and SDB (sleep-disordered breathing) -- especially when present early in childhood -- increase the risk for becoming obese later in childhood," she added.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented. With childhood obesity hovering at 17 percent in the United States, we're hopeful that efforts to address both of these risk factors could have a tremendous public health impact," Bonuck concluded.

A common cause of sleep-related breathing problems in children is enlarged tonsils or adenoids. If these are a problem, they can be removed through surgery. Another possible cause is misalignment of the jaws and teeth. This problem can be treated with a night guard or orthodontics.

Learning good sleep habits can help children get adequate sleep, Bonuck said.

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Sleep issues in children with mental health diagnoses

Sleep issues are common among children with mental health diagnoses, and may go undiagnosed due to the co-existing conditions.

Sleep difficulties, particularly problems falling asleep, are common among toddlers and preschoolers with mental health issues, according to a new study.

"Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschool adjustment, and problems of irritability, hyperactivity and attention," said the study's leader, John Boekamp, clinical director of the pediatric partial hospital program at Bradley Hospital in Providence, R.I.

However, he said, sleep disorders may be unrecognized and underdiagnosed in young children, particularly when behavioral or emotional problems are present.

The study, published online in Child Psychiatry & Human Development, involved 183 children aged 6 years or younger receiving outpatient treatment for psychiatric problems. The researchers examined the prevalence of sleep disorders among these children and the nature of the sleep problems.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings. Collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp in a hospital news release.

Recognized sleep disorders, particularly sleep onset insomnia, were more common than expected, the researchers found. Overall, 41 percent of children in the study met the criteria to diagnose a sleep disorder.

Sleep problems were most common in kids with disruptive behavior, and attention, anxiety and mood problems, the researchers found.

Early sleep problems could not only be the result of behavioral and emotional problems, but could also contribute to them, the researchers noted.

"Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms, and psychiatric symptoms affecting their sleep-wake organization," said Boekamp. "It is important for families to be aware of how important sleep is to the behavioral adjustment and well-being of young children."

Sleep problems can complicate treatment for challenging behaviors, such as aggression and attention and mood problems. Daytime sleepiness and fatigue can make these problems even worse, the study's authors noted.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp.

"Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment," he explained.

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Study: Children with ADHD benefit from treating sleep problems

A study shows that children with ADHD benefit from treating underlying sleep problems.

Addressing sleep problems often improves psychiatric symptoms in children and teens, including those with attention-deficit/hyperactivity disorder and chronic pain.

Sleep-focused treatment improves mood and quality of life in children with attention-deficit/hyperactivity disorder (ADHD), asthma, chronic pain, and cancer, according to speakers at symposium on sleep in children with chronic health conditions at the annual meeting of the American Academy of Sleep Medicine and Sleep Research Society in Minneapolis in June.

Children with ADHD are two to three times more likely to have trouble sleeping than children without the disorder, said Penny Corkum, Ph.D., a professor of psychology and neuroscience at Dalhousie University in Halifax, Nova Scotia. Their sleep problems may undermine daytime performance, said Corkum, who directs research and training at Colchester Regional Hospital’s ADHD Clinic.

In research reported at the meeting, she and colleagues assessed sleep in 30 children newly diagnosed with ADHD and 30 age- and sex-matched typically developing controls. The children’s mean age was about 8.5. At baseline, children with ADHD took 47 minutes to fall asleep in the sleep laboratory, while controls took 24 minutes. Children with ADHD slept about 30 minutes less than controls.

In a four-week medication trial, the researchers gave the 30 children with ADHD either a standard single daily morning dose of methylphenidate or a placebo, in random order for two weeks. While children took longer to fall asleep and slept less when taking the stimulant than when taking the placebo, parents and teachers said their behavior improved.

Children being evaluated for problems with attention, Corkum said, should also be screened for sleep disorders. Consequences of sleep disorders such as obstructive sleep apnea, insomnia, and periodic limb movement disorder/restless leg syndrome may mimic symptoms of ADHD.

Children with and without ADHD, she added, benefit from having a consistent bedtime, learning to fall asleep on their own, sleeping in a dark room, and avoiding television, computers, telephones, and other electronic devices near bedtime.

Children and adolescents with persistent pain commonly report difficulty falling or staying asleep or complain of poor quality sleep, said symposium speaker Tonya Palermo, Ph.D., a professor of anesthesiology and pain medicine at the University of Washington, Seattle.

About 5 percent to 8 percent of children and adolescents in community samples experience moderate to severe disability from persistent pain, most often in the head, abdomen, or limbs, she noted. Common causes include headache disorders, juvenile arthritis, and sickle-cell disease.

Some have depression. Their pain medications may be sedating. These youngsters often say, “I’m always tired,” Palermo noted. Many take frequent and often long naps that may interfere with school or social activities. Concerned parents may allow children to stay in bed late in the morning.

Engaging children and adolescents in self-assessment, Palermo said, may foster improved sleep habits. She asks them to abstain from watching television in their bedroom for a week, for example, to see how that affects their sleep. She also encourages them to use an alarm clock and get up on their own and to maintain a consistent weekday/weekend schedule.

Palermo and colleagues also found that poor sleep diminishes the effectiveness of cognitive-behavioral therapy for chronic pain. She said sleep-specific intervention may need to be delivered before pain-focused behavioral therapy starts.

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Children with autism face more health complications when obese

Children who have autism and are obese are more likely to suffer from other health complications, such as anxiety, depression, and sleep problems.

Adding to the complications of autism, overweight and obese children with the disorder are prone to a host of other troubles, including depression, anxiety and sleep problems, reports a study published 2 February in the Journal of Autism and Developmental Disorders.

The findings suggest that excess weight can signal, or even trigger, less obvious conditions in autism, and that variations in weight may affect results about the prevalence of sleep, mood and anxiety problems in behavioral research studies.

In the new study, researchers calculated the body mass index (BMI), a measure of body fat based on weight and height, of 376 children with autism living in Oregon. (The healthy range for a BMI is between 18 and 25.) The participants, ranging in age from 2 to 18 years, are part of the Autism Treatment Network, a group of collaborating hospitals organized by the research and advocacy group Autism Speaks.

The researchers then analyzed the relationship between parent and clinician reports and the children’s BMI. The reports documented the children’s behavior and other conditions.

Roughly 18 percent of the children in the study were overweight — with a BMI between 25 and 30 — and 17 percent were obese, with a BMI above 30. For comparison, about 32 percent of typically developing children are overweight or obese.

Among teenagers with developmental disabilities, those with autism are the most likely to be obese, according to a study published 20 February in Maternal and Child Health Journal. The study found that 32 percent of adolescents with autism are obese, compared with 20 percent of those with developmental disabilities such as intellectual disability and attention deficit hyperactivity disorder. In contrast, 13 percent of typical teenagers are obese.

Studies have suggested that depressive symptoms may be both a cause and a consequence of childhood obesity. The Oregon study found that obese children younger than 6 years are more likely to suffer from anxiety and mood problems, such as depression, than are children who weigh less.

Obese children older than 6 years do not show this trend, but that may be because their version of the test poses different questions.  

Roughly 85 percent of overweight and obese children with autism under 11 years also struggle with sleep. Children with the disorder tend not to sleep well in general.

The new study found that roughly 75 percent of the children with autism under 11 years of age with a healthy weight don’t sleep well.

Possibly as a consequence, one in three obese children with autism take the sleep-promoting hormone melatonin, compared with one in five children with autism who have a healthy BMI.

Interestingly, however, some symptoms of autism are less severe among children carrying extra weight. The study found that children with the disorder who are overweight, but not those who are obese, have lower levels of repetitive behaviorsthan their slender peers do.

This relationship is difficult to interpret, the researchers note. It’s possible that repetitive behaviors burn many calories, contributing a healthy BMI, but that does not explain the severity of the behavior among obese children with autism. The researchers also suggest that children with severe repetitive behaviors may take medications, such as risperidone, that cause them to gain weight.

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No technology helps kids get healthy sleep

This article explains why having no technology in a child's bedroom is pivotal to ensure the child gets healthy and quality sleep.

Here's the scenario: A child is glued to his Xbox, or maybe his iPhone or iPad and won't go to bed. Frustrated, mom or dad gives up the fight and walks away, letting the kid play just a little longer -- even though it's a school night.

But an expert on children's sleep says parents need to buck-up.

Dr. Daniel Lewin, associate director of Pediatric Sleep Medicine at Children's Medical Center, says he too has a child who wants to be on the computer constantly.

"It's simply modeling and limit setting, which is critical," Lewin says.

It comes down to parents limiting their own exposure to electronics, especially while in front of children. This helps show the behavior they'd like their kids to mimic.

Lewin says in a culture with constant access to electronic media, there's a lot of pressure to perform.

But "those kids who are on media devices to do their homework and when that's done right before bedtime they're impacting their sleep," says Lewin.

When it comes to kids, Lewin recommends making sure the electronics are off at least an hour before bedtime. That's because the light actually shuts down the biological process that initiates sleep.

"Sleeping with a dim light in the bedroom is fine. But sleeping with electronics on in the bedroom is really not optimal," Lewin says.

For children who take ADHD medication, Lewin says it's extra important to make sure he or she is getting a good night's sleep.

"Getting enough sleep at night is critical for attention, for regulation of emotion," says Lewin. He says it's really important to be able to recognize the signs of sleep disorder and to recognize the signs of inadequate sleep.

"We have a lot of kids who are on ADHD medications. We could start by optimizing sleep before putting kids on medications. Some certainly need it," Lewin says.

There's also a relationship between sleep deprivation and mood, including suicidal thoughts. Chronic sleep deprivation can lead to high blood pressure, strokes and Type 2 diabetes.

Children around the ages of 12 and 13 should get 9.5 to 10 hours of sleep. Older children and adolescents should get about 9.5 hours of sleep.

And, Lewin adds, "The American Academy of Pediatrics has been very clear: no TVs in the bedroom and no electronics in the bedroom absolutely critical."

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Autistic boys get less sleep with media in bedrooms

A study shows that media screens in the bedroom of autistic boys resulted in them getting significantly less sleep.

For boys with autism, having easy access to media in the bedroom is linked to significantly less sleep, according to researchers from the University of Missouri.

“Previous research has shown that bedroom access to screen-based media is associated with less time spent sleeping in the general population,” said Christopher Engelhardt, Ph.D., a postdoctoral research fellow at the MU Thompson Center for Autism and Developmental Disorders and the MU School of Health Professions.

“We found that this relationship is stronger among boys with autism.

“Our current results were cross-sectional, meaning that we are not able to determine whether pre-bedtime media exposure causes some children with autism to sleep less,” he said.

“However, the relationship between bedroom media access and sleep was particularly large among boys with autism, suggesting that we should continue to carefully research this possibility.”

For the study, researchers looked at the relationship between media use and sleep among boys with autism compared to typically developing boys or boys with attention-deficit/hyperactivity disorder (ADHD).

Parents of the boys in each group were surveyed regarding the child’s hours of media use each day, bedroom access to media and the average hours of sleep they received per night. The findings revealed a link between bedroom access to a television or computer and reduced sleep among boys with autism.

Furthermore, average video-game exposure was connected to less time spent sleeping among the boys with ASD.

“Even though our findings are preliminary, parents should be aware that media use may have an effect on sleep, especially for children with autism,” Engelhardt said. “If children are having sleep problems, parents might consider monitoring and possibly limiting their children’s media use, especially around bedtime.”

Engelhardt says future research should investigate the processes by which bedroom access to media could contribute to sleep disturbances in children with autism spectrum disorder (ASD).

“It is also important to note that some media use may also be beneficial for children with autism,” Engelhardt said. “Future research is also needed to determine how video games and other technologies may be helpful in teaching and reinforcing skills and behaviors.”

It is estimated that about one in 88 children have ASD, which is characterized by social and communication difficulties as well as repetitive behaviors.

Sleep problems are very common in children with autism, and this may be due to a variety of underlying causes. Media use may worsen some of these underlying factors, and it appears to be an area for future research, Engelhardt said.

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The importance of bedtimes for toddlers

A study on the natural sleep cycle of toddlers shows that toddlers have trouble falling asleep if their natural melatonin release is later than their bedtime.

The bedtime you select for your toddler may be out of sync with his or her internal body clock, which can contribute to difficulties for youngsters attempting to settle in for the night, according to a new University of Colorado Boulder study.

The study pinpointed the time when thehormone melatonin increased in the evening, indicating the start of the biological night, in a group of 14 toddlers whose sleep also was studied over the course of six days. The study showed that toddlers with later melatonin rise times took longer to fall asleep after being put to bed, said CU-Boulder Assistant Professor Monique LeBourgeois.

"There is relatively little research out there on how the physiology of toddlers may contribute to the emergence of sleep problems," said LeBourgeois, a faculty member in the integrative physiology department who led the new study. "Sleeping at the wrong 'biological clock' time leads to sleep difficulties, like insomnia, in adults."

While adults get to choose their own bedtime, toddlers rarely have this option, said LeBourgeois. "This study is the first to show that a poor fit between bedtimes selected by the parents of toddlers and the rise in their evening melatonin production increases their likelihood of nighttime settling difficulties," said LeBourgeois.

The findings are important because about 25 percent of toddlers and preschoolers have problems settling after bedtime, said LeBourgeois. Evening sleep disturbance can include difficulties falling asleep, bedtime resistance, tantrums, and episodes known as "curtain calls" that manifest themselves as calling out from bed or coming out of the bedroom, often repeatedly, for another story, glass of water or bathroom trip, she said.

Toddlers with longer intervals between the onset of nightly melatonin release and their subsequent bedtimes were shown to fall asleep more quickly and had decreased bedtime resistance as reported by their parents, according to the study.

A paper on the subject was published this month in the journal Mind, Brain and Education. Co-authors included University Children's Hospital Zurich Director of Child Development Oskar Jenni and CU-Boulder Associate Professor Kenneth Wright Jr. The National Institute of Mental Health funded the study.

Sleep problems in early childhood are predictive of later emotional and behavioral problems, as well as poor cognitive function, that can persist into later childhood and adolescence. In addition, parents of young children with sleep problems often report increased difficulties in their own sleep patterns, which can cause chronic fatigue and even marital discord, she said.

"A natural next step is to optimize our knowledge of the interactions between physiology and the environment to further understand how problems like bedtime resistance first develop and how they are maintained," LeBourgeois said.

Research in adolescents and adults has shown that exposure to light in the evening can delay the timing onset of melatonin. Whether the later rise of melatonin in some toddlers can be pushed to an earlier time by restricting evening light or by increasing morning light exposure is a question still to be answered, she said.

"We believe that arming parents with knowledge about the biological clock can help them make optimal choices about their child's activities before bedtime, at bedtime, and his or her sleeping environment," LeBourgeois said.

For the study, the research team recruited 14 families in Providence, R.I., each of which had a child between 30 and 36 months old who slept at least 10.5 hours nightly and took a daytime nap of at least 45 minutes. Saliva samples containing the children's melatonin levels were collected every 30 minutes over a six-hour period on one evening before bedtime.

Melatonin onset times varied among the 14 toddlers studied, which means the "hands" on the individual body clocks told each to be prepared to sleep at different times in the evening, she said.

Saliva was collected by having toddlers chew on dry dental cotton rolls, which were then "spun" onsite in a small centrifuge. The task of getting numerous saliva samples from a child during a single evening requires a team of three researchers called "sleep fairies" experienced at make-believe games, reading and crafts.

Because light suppresses melatonin levels, saliva samples were collected in families' homes after they were converted into "caves" of sorts by covering the windows with dark plastic, installing dimmer switches and using low-watt light bulbs.

The average evening melatonin onset for the toddlers occurred at roughly 7:40 p.m., which occurred about 30 minutes before parent-selected bedtimes, said LeBourgeois. On average, the toddlers fell asleep about 30 minutes after bedtime. "It's not practical to assess melatonin levels in every child," LeBourgeois said. "But if your child is resisting bedtime or having problems falling asleep, it is likely he or she is not physiologically ready for sleep at that time."

The study showed several toddlers who were put to bed before their rise in melatonin took 40-60 minutes to fall asleep. "For these toddlers, laying in bed awake for such a long time can lead to the association of bed with arousal, not sleep," she said. "This type of response may increase children's lifelong risk for insomnia over time."

The toddlers wore special wristwatches to measure activity, allowing the researchers to objectively assess their sleep. They also collected subjective data from parents on their toddlers' bedtime resistance and ease or difficulty falling asleep.

A 2012 study led by LeBourgeois indicated toddlers show more anxiety, less joy and interest, and a poorer understanding of how to solve problems when they missed their regular afternoon nap versus when they napped. These results suggested that children who miss out on needed sleep don't benefit from positive life experiences and have problems coping with day-to-day challenges.

LeBourgeois currently has 10 undergraduates working in her CU-Boulder lab. "The contributions of students to the research done in my lab are enormous," she said. "They not only perform the majority of data collection, but also participate in analyzing, interpreting and presenting our results to the scientific and lay communities. Their love of science, discovery and working together as a team continually inspires me."

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Random Bedtimes Breed Bad Behavior In Kids

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Parents learn the hard way that late bedtimes make for cranky kids the next day. But inconsistent bedtimes may have a greater effect on children's behavior, a study says.

Kids who didn't go to bed on a regular schedule had more behavior problems at home and at school. When those children were put to bed at the same time each night, their behavior improved.

That data came from an ongoing study of 10,230 British schoolchildren. Mothers were asked if their child had a regular bedtime during the school week. That information was collected when the children were ages 3, 5 and 7.

The mothers were also asked to complete a standardized test that measures behavior, including conduct problems, hyperactivity, emotional symptoms, problems with peers and positive behavior.

Children who went to bed after 9 p.m. were rated as having more behavior problems than children who went to bed earlier. That's no surprise; there's abundant evidence on the effects of lack of sleep on children's school performance and behavior.

But irregular bedtimes actually caused worse behavior than short sleep.

Teachers were asked to rate some of the children's behavior at age 7. They too reported more behavior problems in children with irregular bedtimes.

The good news is that the behavior problems improved when children were shifted to a more regular schedule. The scientists call that a "clear dose-response pattern." And behavior deteriorated in children who had regular bedtimes at age 5 and were on a more random plan by age 7, the parents said.

The sleep issues could affect behavior in two ways, according to the researchers at University College London. It could mess up children's circadian rhythms, which are slow to change. And it could affect maturing brain regions involved in regulation of behavior.

Pediatricians should ask about irregular bedtimes, the researchers say, not just how many hours a kid is logging.

This study has shortcomings. It doesn't report how much the children actually slept, but rather how much their mothers said they slept. And it could be that the families with random bedtimes had other problems that affected the child's behavior.

Lack of sleep causes health problems in children and adults, including weight gain and insulin resistance.

And regular bedtimes are recommended for adults too, because maintaining a regular circadian rhythmmakes it easier to fall asleep and wake up on time. No word if it makes grownups less cranky. But it probably couldn't hurt.

Autistic children's sleep patterns

A study shows that autistic children sleep for shorter periods of time and wake more easily than non-autistic children.

Sleep problems are common in children with Autism. Studies have revealed that 50 to 80% of children with autism experience sleep difficulties at some time. Past research has focused on disrupted sleep patterns linked to Autism however; the quality of the evidence accumulated to date has often been compromised by small sample size, lack of agreed definitions, and poor comparability of study participants.

In this new study researchers examined longitudinal sleep patterns in children with autistic spectrum disorders (ASDs) by using long term data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a cohort study of children born in Avon, England during 1991 and 1992. The study tracked the health and development of more than 14,000 children.

Parents were asked about their children's sleeping patterns when their kids were 6, 18, 30, 42, 69, 81, 115 and 140 months old, including when their children routinely went to bed and woke up on week days, and how much time they spent sleeping during the daytime.

Researchers also took into account other key information that included the results of the validated The Social Communications Disorders Check List (SCDC) a questionnaire completed by parents which measures social reciprocity and verbal/non-verbal characteristics similar to those found in Autism. The Wechsler Intelligence Scale for Children (WISC-III) was administered at age seven years. TheWISC-III considers a variety of constructs in determining the Full Scale Intelligence Quotient.

Eighty six of the children had been diagnosed with autistic spectrum disorders by the time they were 11 years old. Thirty had classic autism; 15 had atypical autism; and 23 had Asperger's syndrome.

The final analysis was based on 39 children with autistic spectrum disorders and 7043 typical children for who complete data across all time points were available.

Before the age of 30 months (2.6 yrs.) there was no major difference in sleep patterns between the two groups. However, from 30 months onwards, children with autistic spectrum disorders tended to sleep less in total, with the greatest discrepancy (43 minutes) persisting up to 140 months of age, a difference that remained significant after adjusting for sex, ethnicity, high parity and epilepsy.

The reduction in total sleep was wholly due to changes in night rather than daytimesleep duration. Night-time sleep duration was shortened by later bedtimes and earlierwaking times. Frequent waking (3 or more times a night) was also evident among the children with ASD from 30 months of age.

When it comes to disturbed sleep patterns the authors suggested that an increasing body of data suggests that production of the sleep hormone melatonin may be impaired in some children with autistic spectrum disorders.

The authors acknowledge it is unclear just what impact this shortened sleep pattern may have, however they point out that other researchers have suggested that sleep loss may have impact on neuronal development.

"If this hypothesis of cumulative sleep reduction resulting in neuronal loss is confirmed, then clinically [children with autism] might gain from even a small consistent increase in total sleep time," write the team.

In their conclusion the researchers write “Sleep duration in children with ASD is reduced from 30 months of age and persists until adolescence.”

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Childhood sleep issues could signal eating disorders

A study that looked at what may signal a child may eventually develop an eating disorder found that sleep problems during early childhood was the only signal found.

Researchers, clinicians, and sufferers are often interested in finding out what leads to eating disorders, what causes them, and how we can predict them (if at all). A recent research study done in Norway and published by the Journal of Eating Disorders sought to do just that.

Researchers used results from a 15-year-long longitudinal community study to investigate risk factors from early childhood (before age 5) for adolescent eating problems. The study began with 921 mothers completing questionnaires regarding their 1 ½ year old child. 784 mothers completed questionnaires at age 2 ½ and 737 at age 4 ½. When the children were 16 years old, 373 mothers also completed a questionnaire about eating problems called the Eating Attitudes Test.

The study looked at several possible risk factors from early childhood including picky eating in early childhood, sleep problems, internalizing problems, shyness, and emotionality. Interestingly, the only risk factor that was associated with the development of eating problems in adolescent was early childhood sleep problems.

Although this does not mean that sleep problems cause eating disorders, it may mean that there is some type of psychological or biological problem that results in both sleep problems in early childhood and eating problems in adolescence. However, given that this is the only study to show a such a correlation, the results must be duplicated before anyone begins to worry about a sleepless two-year-old developing an eating disorder at age 16.

Interestingly, picky eating in early childhood was not correlated with the development of eating disorders late in life (much to the relief of toddler parents everywhere).

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Sleep and academic success in children

This article discusses how important sleep is to academic success for young children.

CHILDREN who have trouble sleeping tend to do worse in school than their peers who get a good night’s sleep, a new study suggests.

Researchers in Brazil looked at children aged seven to 10 who attended São Paulo public schools. They found children with symptoms of sleep disorders or sleep breathing disorders earned lower grades than those without problems sleeping, on average.

Thirteen percent of children with difficulty sleeping had failing grades in Portuguese, compared with 9% of those without sleep problems. Likewise, 25% of children with disrupted sleep had failing maths grades, versus 8% of children without trouble sleeping.

"Because (symptoms of sleep disorders) and particularly (sleep breathing disorders) are highly prevalent, we suggest that all health professionals and educators become aware of this striking effect and take appropriate actions to solve or mitigate what could very well constitute a public health issue," researchers led by Dr Luciane Bizari Coin de Carvalho from the Universidade Federal de São Paulo write.

In the US, experts estimate that roughly a quarter of children have disrupted sleep at some point during childhood. There are no definitive statistics on how many South African children have disrupted sleep patterns, but experts say rates are likely to be as high, if not slightly higher in this country, for a variety of socioeconomic reasons.

Erratic bedtime hours and anxiety, either at school or at home, may contribute.

Sleep disorders

Other children may have unrecognised sleep disorders, such as sleep walking, nightmares or insomnia, or sleep breathing disorders such as sleep apnea. Some medications, including those for asthma or attention-deficit/hyperactivity disorder, can affect sleep. The underlying medical problems may also cause sleep disturbances.

Poor sleep among children has been tied to obesity, which over the long term increases the risk of heart disease and diabetes. And poor school performance has been linked to early dropout rates, so the new findings may have implications beyond getting a good night’s sleep, researchers say.

From 1999 to 2001, the researchers distributed 5,400 questionnaires asking about symptoms of sleep disorders and sleep breathing disorders to children in São Paulo public schools.

Then they looked at the Portuguese and maths grades of 2,384 children whose parents filled out and returned the questionnaire.

The study team found about 31% of the children had symptoms of sleep disorders — such as difficulty falling or staying asleep, or feeling sleepy all the time — and close to 27% had sleep breathing disorders. Those students’ grades were significantly lower than the grades of children without sleep disorder symptoms.

In Brazil, grades are based on a scale of 0 to 10, with 5 considered passing. Average Portuguese grades were 6.6 for children with sleep problems, compared with 7.1 among those with no sleeping trouble.

Likewise, children with symptoms of sleep disorders or sleep breathing disorders earned an average grade of 6.3 in maths, compared with 7.1 for other children, according to findings published in the journal Sleep Medicine.

Dr Carl Bazil, a neurologist and director of the division of epilepsy and sleep at New York-Presbyterian/Columbia University Medical Centre in New York City, notes that this study fills a research void.

Learning information

"There’s growing information, mainly in adults, that you need good quality sleep to process and learn new information," Dr Bazil says.

"It stands to reason that, if anything, sleep would be more important in children, but there’s very little information in children about sleep disturbance and learning."

Research has shown that sleep deprivation might affect certain parts of the brain, especially the frontal lobes. The frontal lobes control executive function, which is the ability to make decisions, form memories, plan for the future and inhibit socially undesirable behaviour, such as fighting with a classmate.

However, the new study cannot say definitively that sleep problems were to blame for poor grades, researchers say.

"This study doesn’t prove that a sleep disturbance causes decreased academic performance," Dr Bazil says, "but it shows an association. Basically every category of sleep disturbance the authors looked at correlated with decreased academic performance."

The researchers relied on parents’ reports of their children’s sleep, rather than bringing children into a sleep lab overnight, for example.

The study is "far from perfect", Dr Bazil says. But, "it’s a first step in emphasising that sleep in children is something that’s important, not only to prevent them from being sleepy but to make sure that they learn.

"I think this study will help raise awareness that sleep is particularly important in children."

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Sleep problems and heart function in children

A study of blood pressure and sleep problems in children found that there was no association between the two conditions.

The study aims to assess the associations of sleep problems with 24–hour ambulatory blood pressure and cardiovascular reactivity in children. The results suggest that in a healthy community sample of prepubertal children, sleep problems are not associated with an unhealthy cardiovascular phenotype at this age. However, associations may be underestimated because of the low prevalence of sleep breathing disorders in this sample and may not generalize to older populations.

Methods

• Sleep problems in 285 term-born, healthy 8-year-olds (mean [standard deviation]=8.1 [0.3]years) were measured with a parent-rated Sleep Disturbance Scale for Children.
• Ambulatory blood pressure (n=241) was measured for 24hours (41% nonschool days) with an oscillometric device.
• The children (n=274) underwent the Trier Social Stress Test for Children during which blood pressure, electrocardiography, and thoracic impedance were recorded and processed offline to give measures of cardiovascular and autonomic function.

Results

• No associations were found between sleep problems and 24-hour ambulatory blood pressure.
• Children with sleep breathing disorders (n=5) had higher baseline sympathetic vascular activity (p=.014) and higher heart rate (p=.044) and sympathetic cardiac activity (p=.031) in reaction to stress.
• Children with disorders of excessive somnolence (n=55) had higher baseline parasympathetic activity (p=.016).
• None of the associations remained significant after controlling for multiple testing.

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Tips for sleeping in the summer

This article gives tips for sleeping during summer nights when days are longer.

Those extra hours of daylight in the summer contribute to sleep problems experienced by many Americans, experts say.

The Loyola University Health System team offers tips on how to get a good night's sleep.

At least an hour before bedtime, start quieting down and relaxing. Don't exercise or do any other vigorous activities. Turn off handheld devices and remove them from the room. Darken the room and create a comfortable environment in terms of temperature, bedding, mattress and sleepwear.

Try to go to bed at the same time every night. Don't have any food and beverages for several hours before bedtime. This will reduce the chances that you'll have to get up in the night to go to the bathroom.

Make a list of worries, future errands and other things that are on your mind before you go to bed. This can help reduce anxiety, organize your thoughts and prepare you for sleep. Think twice about allowing pets to sleep with you. If they move in the night and make noise, they disturb sleep.

Some people who take medications before bed may do better to take them in the morning or the other way around, according to a Loyola news release. If you think this is an issue, talk to your doctor about changing your medication schedule.

Train your mind and body to associate the bedroom with relaxation and sleep, not exercising, playing games or watching TV. Discuss good sleep strategies with your partner. You need their cooperation for your efforts to succeed.

If your sleep problems persist, you may have a sleep disorder such as sleep apnea, the Loyola experts say. Talk to your doctor about undergoing a sleep study.

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