Study: Insomnia increases risk of stroke

A study shows that insomnia, especially as a young adult, can significantly increase a person's risk of stroke.

The risk of stroke may be much higher in people with insomnia compared to those who don't have trouble sleeping, according to new research in the American Heart Association journal Stroke.

The risk also seems to be far greater when insomnia occurs as a young adult compared to those who are older, said researchers who reviewed the randomly-selected health records of more than 21,000 people with insomnia and 64,000 non-insomniacs in Taiwan.

They found:

• Insomnia raised the likelihood of subsequent hospitalization for stroke by 54 percent over four years.
• The incidence of stroke¬ was eight times higher among those diagnosed with insomnia between 18-34 years old. Beyond age 35, the risk continually decreased.
• Diabetes also appeared to increase the risk of stroke in insomniacs.

"We feel strongly that individuals with chronic insomnia, particularly younger persons, see their physician to have stroke risk factors assessed and, when indicated, treated appropriately," said Ya-Wen Hsu, Ph.D., study author and an assistant professor at Chia Nan University of Pharmacy and Science and the Department of Medical Research at Chi-Mei Medical Center in Taiwan. "Our findings also highlight the clinical importance of screening for insomnia at younger ages. Treating insomnia is also very important, whether by medication or cognitive therapy."

The study is the first to try to quantify the risk in a large population group and the first to assess if the risk of stroke differs by insomnia subtypes, Hsu said.

Researchers divided participants -- none of whom had a previous diagnosis of stroke or sleep apnea -- into different types of insomnia. In general, insomnia included difficulty initiating or maintaining sleep; chronic or persistent insomnia lasted one to six months; relapse insomnia was a return of insomnia after being diagnosed free of disease for more than six months at any assessment point during the four-year study; and remission was a change from a diagnosis of insomnia to non-insomnia at the subsequent time point.

During the four-year follow-up, 583 insomniacs and 962 non-insomniacs were admitted for stroke. Persistent insomniacs had a higher three-year cumulative incidence of stroke compared to the other participants in the remission group.

The mechanism linking insomnia to stroke is not fully understood, but evidence shows that insomnia may alter cardiovascular health via systematic inflammation, impaired glucose tolerance, increased blood pressure or sympathetic hyperactivity. Some behavioral factors (e.g., physical activity, diet, alcohol use and smoking) and psychological factors like stress might affect the observed relationship.

The researchers said it's unclear if the findings also apply to people in other nations, but studies in other countries have also pointed to a relationship between insomnia and stroke.

"Individuals should not simply accept insomnia as a benign, although difficult, condition that carries no major health risks," Hsu said. "They should seek medical evaluation of other possible risk factors that might contribute to stroke."

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Sleep disorders in children can hurt their development

This article discusses how detrimental sleep disorders can be to children and their development.

Sleep behaviors are one of the most common concerns parents of young children discuss with their pediatricians. In infancy and early childhood, the developing brain requires more time asleep than it does awake.As a result, sleep quality is extremely important in the overall well-being of a child. Children suffering from lack of quality sleep or sleep-related disorders can jeopardize their cognitive, emotional and physical development. Pediatric sleep problems don’t just affect the child - they often have a negative impact on other siblings’ quality of sleep and the entire family dynamic.

Sleep disturbances are diagnosed in 25 to 30 percent of infants and children. Causes can include an inconsistent bedtime routine, sleepwalking, sleep apnea, narcolepsy and epilepsy. Not surprisingly, pediatric sleep disorders are often overlooked because presenting symptoms of negative behavior, moodiness, irritability, lack of motivation, inability to focus, lethargy are misdiagnosed as behavioral or emotional problems, not a physical, medical condition. Severe or chronic sleep disorders can even cause adverse cardiovascular and metabolic effects as well as failure to thrive.

Common pediatric symptoms

Symptoms of sleep disorders in children can be obvious or subtle and often present with one or more of these symptoms on a regular basis:

 ongoing bedtime resistance

 nightly awakenings

 sleepwalking

 nightmares

 bedwetting

 insomnia

 chronic snoring/breathing difficulties

How to proceed if you suspect a sleep disorder

First, consult with your pediatrician to rule out any acute or chronic medical conditions. Once medically cleared, it may be helpful to clinically observe and monitor your child in a sleep center that offers pediatric diagnosis and treatment services. These centers offer comfortable bedroom like settings where sleep patterns are evaluated and diagnosed during an overnight stay.A parent accompanies the child during the stay to provide comfort and alleviate anxiety.A sleep technologist applies small painless sensors designed to monitor your child’s brainwaves, muscle activity, heart rhythms, respiratory activity and oxygen saturation levels throughout the night. The results are then analyzed by a pediatric sleep medicine physician, who will determine a diagnosis and recommend the most appropriate treatment for your child, if necessary. Once properly diagnosed, this and other sleep-related medical conditions can be successfully treated to restore and continue the child’s normal development process. If you suspect your child may have a sleep issue, see your pediatrician and discuss a sleep study evaluation.

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Causes and Cures for Insomnia

This article discusses symptoms of insomnia as well as what could be causing it, and how to cure it.

We have all had nights when sleep will not come, but for some people not being able to sleep is a chronic condition — they suffer from insomnia.

People with insomnia may have a hard time falling asleep even though they are tired, or they may wake up in the middle of the night and then lie awake for hours, unable to return to sleep. Sometimes insomniacs do sleep, but the sleep is unrefreshing and they wake up feeling as drowsy and fatigued as if they had experienced no sleep.

Understanding insomnia

Insomnia is not about failing to get eight hours of sleep at night. Rather, it is the inability to get the amount of sleep you need to feel rested. We all need different amounts of sleep, so insomnia is defined by the quality of your sleep and how you feel after sleeping — not by how many hours of sleep you get, or even by how quickly you fall asleep. If you only sleep five hours but feel great you do not have insomnia.

Insomnia usually is not just a sleep disorder; typically, there are other causes at the root of the problem. Insomnia is often the symptom of other issues that are interfering with your ability to sleep. These issues may range from having too much caffeine during the day to medical conditions to psychological issues.

Symptoms

• Difficulty falling asleep even if you are tired
• Waking up repeatedly during the night
• Difficulty falling back to sleep once you have woken up
• Not feeling rested after sleeping
• Needing to rely on sleeping pills or alcohol to fall asleep
• Waking up too early
• Feeling drowsy, tired and irritable during the day
• Having trouble concentrating during the day

Common causes

Many of us experience temporary insomnia — the kind that lasts just for a few days and then goes away. Usually this type is due to nerves over something at work, a relationship issue that is later resolved, jet lag, or some other brief hiccup in our routine.

But when insomnia continues for weeks and months, then it is time to talk with your doctor.

• Psychological causes: Depression, anxiety, chronic stress, bipolar disorder, post-traumatic stress disorder.
• Medications: Antidepressants, cold and flu medications with alcohol, pain relievers with caffeine, diuretics, corticosteroids, thyroid hormone, high blood pressure medications
• Medical causes: Asthma, allergies, Parkinson's disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain and others.
• Sleep disorders: Sleep apnea, narcolepsy, restless leg syndrome

Cures for simple causes of insomnia

• Look at your behavior — are you consuming too much caffeine (soda, coffee, energy drinks)? Try cutting back.
• If you are using alcohol or sleep aids to fall asleep, cut back. These actually disrupt sleep over the long term. Try warm milk to soothe you.
• Shut off your brain at least an hour before bed — no Internet, no TV, no computer, and no vigorous exercise within two hours of bedtime. Unwind with a relaxing book, meditation, etc.
• Keep your bedroom dark, cool and quiet. Try white noise machines, sleep masks or earplugs if need be.
• Do not smoke, especially at night. Nicotine will keep you awake.
• Keep your bedroom only for sleep and sex — not work or other activities.
• Make sure you get good exposure to natural light during the day, but minimize your exposure to artificial light at night. Maintaining this balance will help your body's natural wake/sleep cycle.

When the cause is psychological

If you answer "yes" to any of these questions, it may be helpful to see a psychiatrist regarding your insomnia issues.

• Am I under a lot of stress?
• Am I depressed? Do I feel devoid of emotion and hopeless?
• Do I have chronic feelings of anxiety or worry?
• Have I experienced panic attacks?
• Have I undergone a traumatic experience?

If the cause is chronic anxiety, depression, chronic stress, post-traumatic stress disorder, and the like, then you should consult a psychiatrist. These conditions can be treated with consultations, medication, or other therapies.

A therapist can also instruct you in relaxation techniques that can help you cope better during the day and unwind at night.

When to get help

If you answered "yes," to the questions listed under "When the cause is psychological," then you should consult with a psychiatrist. Professional insomnia treatment is also advised if you experience the following:

• Your insomnia is causing problems at work, home or school.
• Your insomnia hasn't responded to self-help tips like those listed under "Cures for simple causes of insomnia"
• Your insomnia is getting worse, occurring almost every night

Nature intended our minds and bodies to rest. If you are chronically unable to get restful sleep, get help. A good night's sleep can be an amazing restorative to your mental and physical health.

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Sleep Disorders in College - Highly Prevalent

An interesting article discussing the severity of sleep disorders for students as well as the prevalence throughout the US. JR

Brittany Barnhill had been awake for three days.

A University of Georgia senior from Thomson, Barnhill has struggled with insomnia since entering college.

Her condition is cyclical, meaning she is sporadically unable to sleep. But one of her worst experiences came during her sophomore year, when a night of studying for organic chemistry turned into a three-day sleepwalk.

“I had a lot of trouble with organic chemistry. It was the bane of my existence for a very long time,” Barnhill said. “I had an exam coming up for it and so one night I stayed up to study for it and pulled an all-nighter. That was Monday night.”

Monday night bled into Tuesday morning, and Barnhill planned to sleep that night, but found herself unable.

“I couldn’t get to sleep because I was stressed out about the exam the next day,” she said. 

Though she passed the test, Barnhill said the erratic sleep schedule of a college insomniac is hardly healthy.

“My roommates thought I was dead,” Barnhill said. “[Being tired is] like I’m walking through a haze. I won’t recognize people, things. I definitely shouldn’t drive. It feels like I’m swimming.”

Barnhill’s tale, while extreme, is familiar for college-aged students, who are more likely to experience sleep disorders than other age groups. The average college student gets 6-6.9 hours of sleep a night, much less than the recommended eight hours. Less sleep can cause increased weight gain, mental illness and automobile accidents, while resulting in decreased academic performance, according to the University Health Center. 

Students with sleep problems can find relief at the health center. If a student’s insomnia is cyclical, an assigned physician may prescribe sleep aids or advise altered sleep habits. But if the condition has psychological roots, the student may also seek aid from Counseling and Psychiatric Services.

“Sleep is probably one of the number one problems on campus, so it’s something a lot of students come in for,” said Liz Cheely, the case manager at the health center. “They need to do a phone screening, which takes about 15 minutes, where they tell us what is going on...after that, we get them scheduled for an intake [counseling session], which takes about an hour.”

A psychologist might then write a prescription for sleep aids or offer further psychiatric sessions.

Alexis Havrilla, a sophomore from Cumming, said her experiences with chronic (long-term) insomnia led to a lost scholarship and disappointing class results.

“I lost [the HOPE scholarship] because I got two C+ grades in classes because of my sleep habits,” said Havrilla, who is working with CAPS to address her condition. “I didn’t get enough sleep. It affected study habits. I just felt like doing other things because I don’t like to sleep — I do have a sleep fear.”

Insomnia leaves students searching for limited answers. Insomniacs are advised by most physicians to avoid caffeine, maintain a regular sleep schedule and develop other sleep-friendly habits. But students report habit-changing techniques as only marginally effective.

When the techniques work, they seem to only work for a short time. Even then, it’s difficult to change unhealthy habits while meeting the demands of college life.

Potent sedatives and antidepressants, such as Ambien and Trazodone, provide a quick fix for sleeplessness, but their addictive nature deters some students.

“It just seems like with the medicines and choices that are there, they aren’t very long term,” Barnhill said. “It’s all habit forming and you get dependent on it, and I don’t want to be stuck on that for the rest of my life.”

There is another option for students. 

The Athens Sleep & Wellness Center, located on Prince Avenue, conducts overnight sleep tests to diagnose common sleep ailments. The test, which costs about $150 for patients with insurance, provides answers to the uncertainty surrounding sleep deprivation.

Meredith Petry, the Sleep Lab Administrator at the center, said it was important to diagnose the root of insomnia, rather than mask symptoms.

“The actual true, true insomnias are much more rare than you think of,” Petry said. “Most students should not go on sleep aids, because it’s usually pretty clear that they have bad habits and that they can be corrected. You don’t want to just give them a sleep aid to knock them out when they want to go to sleep or try to go to sleep because it’s not that simple.”

The Southeast in particular struggles with insomnia, with 13.1 percent to 19.3 percent of adults reporting insufficient rest in the past 30 days, according to a study done by the Centers for Disease Control and Prevention in Atlanta.

The region’s higher reported rates of insufficient sleep could be traced to higher obesity rates.

“If you look at that map, with obesity and weight, it’s going to be very close,” Petry said. “There is much more of a weight issue in the Southeast than there is in the West. The more of a weight issue there is, it’s probably highly correlated.”

Petry said students make up a low percentage of the center’s patient base because most students don’t prioritize sleep.

“Maybe five percent would be students, if that,” Petry said. “But what it should be is at least 20 to 25 percent. There are a lot of students with these issues, but sleep gets put so low on the priorities.”

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Sleepless Nights May Put The Aging Brain At Risk Of Dementia

 Memo to doctor self: good advice to help initiating sleep. JR

Copyright ©2012 National Public Radio. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

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Heard on Morning Edition

August 27, 2012 - DAVID GREENE, HOST:

Sleepwalking is not the only form of disrupted sleep. As we age, our sleep patterns change and many people have problems falling and staying asleep. Now researchers have found a link between disrupted sleep and dementia, as NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE: Psychiatrist Kristine Yaffe runs a clinic for people at risk of developing dementia. She's at the University of California, San Francisco. She says many of her older patients say they just don't sleep well.

DR. KRISTINE YAFFE: Either have difficulty falling asleep, waking up on and off throughout the night, feeling tired in the day or, you know, having to nap a lot in the day. Those kind of things are very common....NEIGHMOND: First step, control outside stimulation.

ANCOLI-ISRAEL: And what this therapy says is you're not allowed to do anything in bed but sleep. Sleep and sex, but nothing else. You can't pay your bills in bed, you don't take your computer or your iPhone or your iPad to bed with you, you don't watch television in bed, you don't read in bed.

NEIGHMOND: And if you don't fall asleep in about 20 minutes, get out of bed. Watch or read something relaxing, and after 20 minutes, try again. And the clock, get rid of it.

ANCOLI-ISRAEL: You know, the first thing you do when you wake up at night is you look at the clock. In order to look at the clock, you have to open your eyes, maybe lift your head, but what's worse is you have to take yourself from transitional sleep to full awakening to comprehend that it's 1:10 in the morning and you want to be asleep.

NEIGHMOND: If you need the alarm, cover the clock or put it under the bed. You'll still hear it go off.

Now, there's another sleep difficulty faced by older adults. Natural body rhythms change.

ANCOLI-ISRAEL: Sleep is controlled in part by our core body temperature. Body drops at night - that's when we get sleepy, it rises in the morning hours, and that's when we wake up.

NEIGHMOND: And that changes at different times of our lives. Teenagers' body temperature drops late in the evening, so they don't get tired till around midnight and don't naturally wake up till late morning.

ANCOLI-ISRAEL: For older adults, it's the opposite. Their body temperature drops really early in the evening, around 8 o'clock and rises really early in the morning, about four. So, if your lifestyle allows it, go to bed early and when you wake up, get up.

NEIGHMOND: For those who don't want to do that, Ancoli-Israel suggests get lots of light.

ANCOLI-ISRAEL: Light is the strongest cue that our body has to know when to go to sleep and when to get up. And lots of light exposure during the day helps us have a strong biological clock.

NEIGHMOND: And the best source of light? The sun. A late afternoon or early evening walk, when the sun is still out, is the best. That delays the circadian rhythm and helps people stay alert later on in the evening and sleep longer in the morning.

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Yoga can help some sleep issues

Research looks into how yoga can help those who suffer from chronic insomnia and other sleep problems.

According to the U.S. Centers for Disease Control and Prevention (CDC) and the National Sleep Foundation, millions of Americans suffer from sleep problems. Sleep deprivation is reported to affect two-thirds of American adults and is considered an important public health concern. Sleep experts recommend adults get 7 to 9 hours of sleep a night for good health and optimum performance, yet the majority of adults get considerably less.

No doubt the epidemic proportions of this problem stem from our nonstop society, where millions of people trade off quality sleep time for more work time. Stress, anxiety, and depression are also important causes of sleep problems, such as insomnia, sleep apnea, restless legs syndrome, and narcolepsy.

Chronic sleep deprivation can increase the risk of serious health problems, including heart disease, strokeand breast cancer.

Research reports that yoga practice can help to alleviate sleep problems. For a natural, drug-free way to promote restful sleep, try yoga for sweet dreams.

Yoga Can Help Relieve Chronic Insomnia

A study published in Applied Psychophysiology and Biofeedback found yoga helped relieve chronic insomnia.

Researchers at Harvard Medical School in Boston taught 20 study participants yoga breathing, meditation and mantra (sacred sound recitation) in one training session.

The participants practiced the yoga treatment before bedtime on their own and with brief in-person and telephone follow ups for eight weeks. The subjects maintained a sleep-wake diary for two weeks prior to treatment and for eight weeks during the treatment period.

The participants' sleep efficiency, total sleep time, total wake time, sleep onset latency, wake time after sleep onset, number of awakenings, and sleep quality measures were assessed from their sleep-wake diary entries.

Researchers found that the participants had significantly improved sleep efficiency, total sleep time, total wake time, sleep onset latency, and wake time after sleep onset at the end of treatment compared with before the treatment.

"Yoga is an effective treatment because it addresses insomnia's physical and psychological aspects," says study author Sat Bir Khalsa, Ph.D., assistant professor of medicine at Harvard Medical School and associate neuroscientist at Brigham and Women's Hospital, in a statement.

Yoga Helps Ease Sleep Problems

A 2012 randomized study, published in the journal Menopause, found yoga helps ease sleep problems and menopausal symptoms in postmenopausal women. All the participants were not on hormone therapy and were diagnosed with insomnia.

Brazilian researchers assigned 44 menopausal women with insomnia to yoga, physical therapy stretches, or no treatment for four months. Questionnaires evaluating insomnia, menopause symptoms, anxiety and depression symptoms, stress, and quality of life were obtained from the participants.

The yoga and physical therapy groups participated in sessions two times per week. The yoga program included yoga stretches and Tibetan yoga breathing.

The researchers found that the yoga participants had significantly reduced insomnia severity and menopause symptoms and improved quality of life and stress resistance compared to the control group. In addition, the yoga group had significantly fewer sleep problems than the physical therapy group.

"This study showed that a specific sequence of yoga might be effective in reducing insomnia and menopausal symptoms as well as improving quality of life in postmenopausal women with insomnia," the study authors conclude.

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Poor evidence for natural treatments for insomnia

New study shows over the counter or herbal remedies may not help insomnia or other sleeping issues.

What do we know already?

Insomnia, or poor sleep, is a common problem that can make it difficult to live life normally. It's estimated that, at any time, around 1 person in 4 in the UK has problems getting to sleep.

For most people, their sleeping problems go away in time. But if you have sleep problems on at least three nights a week for one month or more, and these problems aren't caused by an illness, then you may have chronic primary insomnia. Insomnia has been linked to other problems such as heart disease, and can increase your risk of accidents.

There are treatments your doctor can prescribe you to help insomnia. But some of these treatments can only be prescribed for a few weeks because of the risk that people may become dependent on them. Some of them may also cause bothersome side effects such as headaches. Some people find the treatments can make them feel less clear-headed, and they struggle to think and remember things.

So there's an interest in over-the-counter, herbal remedies. But it's unclear whether these work and if they are safe. To see what the evidence says, researchers reviewed published studies of different herbal remedies for managing insomnia, and looked closely at 18 studies.

What does the new study say?

The researchers found very little evidence that the herbal medicines most often included in studies are helpful for treating insomnia.

• Valerian. A large review of good-quality studies found that although valerian is safe to take, it doesn't help you sleep longer. However, there is some evidence that it can improve the quality of sleep. Studies that have compared people who were randomly assigned to take either valerian or a dummy pill found that people who took valerian didn't sleep more than people who took a dummy pill. There have also been some reports that people who took valerian had liver problems, but these have been extremely rare.
• Valerian with hops. Studies showed that these herbal medicines in combination worked better than valerian on its own. But the trials have been small and short term.
• Chamomile. There have only been a few studies of chamomile as a treatment for insomnia. There does seem to be some improvement in sleep for people who take chamomile, but the difference is slight.
• St John's wort. Most of the studies have looked at using St. John's wort as a treatment for sleeping problems in people who have other illnesses, such asdepression. We don't know if the results of these studies apply to people with primary insomnia.

The researchers also looked for evidence for other popular herbal medicines, such as lavender, but didn't find any studies where these have been used as a treatment for insomnia.

How reliable is the research?

This was a review of good-quality studies. However, many of the studies were small and lasted only a few weeks. This can make them less reliable.

What does this mean for me?

This review of the literature highlights the need for more research into whether herbal remedies are useful for insomnia. But of all the herbal remedies looked at, the combination of valerian and hops showed the most promise as a treatment forinsomnia symptoms.

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Prevalence of Sleep Disorders in Autistic Children

Possible reasoning behind an association between children with Autism and sleep disturbances

Doctors who treat autistic children said that there is a high prevalence of sleep disorders among their patients. Autism spectrum disorders are developmental brain disorders. These could include a wide range of symptoms such as difficulty in social communication, expressing emotions or obsessive behaviour traits. Some children are mildly impaired by their symptoms, while others are severely disabled.

An ongoing study that started last year at Jaslok Hospital with nine autistic children in the age group of three to eight years has shown that there is a strong association between sleep disorders and autism. Of the nine children, seven suffered from sleep disturbances such as bed-wetting, insomnia and disturbed sleep among others.

The study done by Dr Preeti Devnani also included a detailed polysomnography of these children where their sleep pattern was studied all night. Polysomnography measures rapid eye movement (REM) sleep, snoring episodes, leg movement, airflow and choking. Last month, Dr Devnani presented the study at a conference at the American Academy of Sleep Medicine, Boston.

“We found that higher the spectrum of autism, the more the sleep disturbance. These children also had less REM sleep or active sleep or deep sleep. REM sleep helps form memory,” said Dr Devnani, who runs a sleep disorder clinic at Jaslok Hospital.

“Many parents also suffer a lot after a stressful day with children who have to be given occupational and other forms of therapy,” said Dr Samir Dalwai, a developmental paediatrician, who runs New Horizons Child Development Centre at Goregaon, which treats autistic children including Ayana.

Autistic children do not respond to stimuli such as day and night and follow their own pattern of behaviour. “These children do not follow the schedules that other children follow. Some are hyperactive and refuse to sleep,” said Dr Malay Dave, consultant psychiatrist who practices at Ghatkopar.

Dr Devnani said it was important to be aware of sleep disorders in these children and treat them.

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Doctors claim sleeplessness eroding public health

Emergency room doctors helped implement seatbelt use, lung specialists led the charge to reduce cigarette smoking. Now, a group of sleep specialists meeting in Montreal is agitating for a sleep policy.

That's right. A good night sleep is so important for physical and mental well-being that its lack poses a grave risk to public health, experts say.

If science has yet to unravel the mystery of why we need to sleep, the toll of inadequate slumber is well-documented in studies linking bad sleep to obesity, cancer, cardiovascular diseases and metabolic disorders. Lack of sleep weakens the immune system.

Look at the numbers: 25 per cent of adults don't get enough sleep or have chronic insomnia, said psychologist Reut Gruber, director of the attention, behaviour and sleep lab at the Douglas Mental Health University Institute in Montreal.

But the worst group for sleeplessness is adolescents: up to 80 per cent of Canadian students come to school extremely sleep-deprived, while the portrait of school age children "isn't pretty . . . 43 per cent are going to bed at a very, very late time."

Robust evidence on sleep deprivation and health consequences led most medical schools in North America, including Montreal's McGill University, to abolish 24-hour shifts for medical residents. Not only do sleepless nights impede students' ability to learn, they can lead to medical errors that put patients at risk.

Fatigue is cumulative, and crashing on weekends to play catch-up doesn't work, said Gruber, who is bringing together about 40 sleep scientists from across Canada and the United States to discuss how to translate sleep medicine research, specifically pediatric sleep, into educational and public policies and lifestyle changes.

Some people suffer from sleep apnea or other medical problems that interfere with slumber, but for many, the chief culprit is the mistaken belief that sleep is a waste of time.

"Sleep feels like it's something we can give up when we have other competing priorities," said Gruber, who is chair of the pediatric interest group, Canadian Sleep Society. "Our choices are going to affect many things that are important to us."

In fact, sleep should be a high health priority, along with eating well and exercising, she said.

Children, for example, need at least nine hours of sleep, Gruber said. Among other functions, sleep allows the brain to do its "executive actions", consolidating learning and memory, something that is imperative for academic performance, she said.

Working guidelines on good sleep hygiene would mean, for example, that sports and cultural activities would not be scheduled late on school nights.

"I'm very excited to hear presentations from the (Quebec) institute of public health on this topic. It's a great step forward," Gruber said. "My request to each presenter was to identify barriers to integrating pediatric sleep into public health and the education systems.

"We have the knowledge. We have the evidence. Why can't we integrate it and overcome the barriers?"

Five common myths about sleep.

- Sleep is a time when your body and brain shut down for rest and relaxation.

False. Our bodies and brains actually do a lot of work while we sleep, which helps us to refuel and to stay healthy and happy. Sleep also plays an important role in memory and learning; as we sleep, we consolidate all the information we learned during the day.

- Sleep is less important than some of our other important basic needs, such as eating.

False. Even cutting our sleep by one hour one night has a serious impact on our health, mood, and behaviour the following day. Furthermore, a single night of partial sleep deprivation is enough to impair our immune functioning, which heightens our risk for acquiring a virus or illness.

- Adolescents need less sleep than younger children.

False. While it is true that adolescents tend to get less sleep than younger children and may have a harder time falling asleep, getting an adequate amount of sleep is still just as important for their development and well-being as it is for younger people.

- Sleeping in on weekends compensates for lack of sleep throughout the week.

False. Having a consistent bedtime and wake time throughout the week is important to ensure we maintain healthy sleep habits. Waking up early throughout the week and then sleeping in on the weekends creates an irregular sleeping schedule and confuses our bodies. If we do not get enough sleep one night, a better way to compensate for this is a short nap in the afternoon.

- Alcohol and other sedatives help us to sleep.

False. While alcohol may help us to fall asleep easily and quickly, it actually disrupts our sleep and prevents us from achieving a deep, restful sleep. Sleeping pills can be problematic. If we use them regularly and then stop, it becomes difficult to fall asleep without their use, thus starting a vicious cycle of dependence.

Read more: http://www.montrealgazette.com/health/Sleeplessness+eroding+public+health+docs/6562402/story.html#ixzz1uOMCgZWb

Sleep Guidance for Kids and Teens Is Based on Sound Science

Dr. Rotenberg, among other other sleep specialists, signed on to this letter regarding recent articles in Pediatrics. - JR

Sleep Guidance for Kids and Teens Is Based on Sound Science

Posted: 03/16/2012 8:31 am

Representing scores of scientists who study sleep's role in the health and welfare of children, we need to be clear: Current expert recommendations for the sleep needs of children may not be perfect or immutable, but they are based on sound and rigorous science. For the sake of children whose parents, pediatricians and teachers may have seen recent media reports on two papers that call this into question, we're compelled to offer the context of what decades of research has produced.

Perhaps the best service is to describe current recommendations for healthy child sleep and then to describe why the pediatric sleep community of health care professionals is concerned that parents and other stakeholders have become misinformed about how well research supports these recommendations.

First of all, abundant research shows that sleep is a vital component of physical and mental health in children and adolescents. That and other research provides solid scientific grounding for current recommendations. Experts acknowledge that there is some individual variability in sleep needs, and therefore these recommendations are offered as guidelines for parents. They should be viewed in the context of potential signs of insufficient sleep in children and teens (difficulty waking in the morning, daytime sleepiness, sleeping longer on weekends and school vacations). Also, the recommendations for sleep amounts, such as those posted by the National Sleep Foundation (NSF), should always be applied in conjunction with other healthy sleep practices (such as regular bedtimes and wake times and bedtime routines).

As much as we care about children ourselves, we know we owe it to their parents to make (and defend) any recommendations on the basis of research, rather than intuition. We also need to be clear about the health effects of inadequate sleep, given the outward appearance that sleep cuts into "productive" time. Many lay people may not know that sleep is an enormously productive time -- especially for the developing brain -- when the brain organizes itself and consolidates the day's learning.

Here are the stakes. A large number of studies have shown associations between insufficient sleep and adverse health outcomes in teens and younger children. These include increased obesity risk, higher rates of motor vehicle accidents and accidental injuries, reduced cardiovascular health, and increased risk of depression and suicidal ideation. Many other studies have demonstrated the negative outcomes of sleep restriction and the positive impact of sleep extension on cognitive function of children and teens.

In a recent paper in the Eastern Economic Journal, two Brigham Young University economists dismiss such serious medical findings when they purport to determine an "optimal" amount of sleep for kids based on one question -- "How many hours of sleep do you usually get a night?" -- and a small set of standardized test scores. They report that that teens who got less sleep than experts recommend got better scores. We take issue with aspects of their methodology, but even if their paper were technically unassailable, as health professionals we would still be compelled to ask why a narrow set of test scores should be any parent's benchmark for optimal sleep when so many vital health conditions are endangered by too little sleep.

Ultimately, the key issue is to define how much sleep kids and teens need. That's long been a priority of our field because parents and health care professionals have always worried about this question and have needed science to provide answers. What has changed over time has been the increasing quantity and quality of science we've been able to apply. Many rigorous pediatric sleep research studies have done much to help address the issue of optimal sleep duration and healthy sleep practices in children and adolescents. These studies include large epidemiologic approaches as well as rigorous field tests and in-lab brain wave monitoring.We've posted a selected list of these studies and those referenced above, as well as more than 70 co-signers among our colleagues to this essay, on our website.

For all these reasons, we feel we should put in context a recent paper in Pediatrics that gained substantial and unduly credulous media attention. By looking at historical recommendations for sleep and measured sleep durations, the authors claimed that "there is almost no empirical evidence for the optimal sleep duration for children," and that "no matter how much sleep children are getting, it has always been assumed that they need more."

A careful look at the paper shows that almost all of their findings are driven by data in infants, for whom recommendations around the turn of the last century were hugely different from those around the turn of this century. Meanwhile, the sleep recommendations at other ages are pretty much on par across the century. Fundamentally, by ignoring many strong studies that provide a quantitative basis for current sleep recommendations, the authors do a serious disservice to parents, pediatricians, other health professionals, educators and, ultimately, to children. 

The scientific literature shows that children and adolescents experience better learning and academic success and greater physical and mental health when their sleep is protected and supported to levels recommended by a consensus of experts, such as those posted on the NSF website. Our hope is that by understanding the scientific record and context beyond these two recent splashes in the literature, the pediatric sleep community's service to parents and health professionals can be restored.

Mary A. Carskadon, PhD Judith Owens, MD MPH

Professor, Psychiatry and Human Behavior Director of Sleep Medicine

EP Bradley Hospital Children's National Medical Center

Alpert Medical School of Brown University Washington DC 20010-2970

Providence, RI 02906

                                           

1

 A list of references is provided after the list of sleep professionals endorsing the essay.3

Links to Media Coverage

Stories based on the original articles

Challenging 100 Years of Sleep Guidelines for Children - WSJ.com

Children are sleep-deprived, experts have fretted for 100 years - latimes.com

No science, just expert guesses on how much sleep kids need - USATODAY.com

Kids and Sleep Through History: They Have Never Gotten Enough, but Who's to Say How Much They 

Really Need? | Healthland | TIME.com

Scientists say kids throughout history have never had enough sleep | Mom Houston | a Chron.com blog

Responses to media coverage

How Much Sleep Do Kids Need? Not Such A Mystery After All : Shots - Health Blog : NPR

Sleep Expert Stands By Current Sleep Advice for Kids | Parents News Now, by Holly Lebowitz Rossi

Articles

Articles Referred to Directly in the Essay

• Eide, ER & Showalter MH.  Sleep and student achievement.  Eastern Econ J 2012; 1-13.  

Doi:10.1057/33j.2011.33

• Matricciani LA, Olds TS, Blunden S, Rigney G, Williams MT. Never Enough Sleep: A Brief 

History of Sleep Recommendations for Children. Pediatrics. 2012;129:548-556.

Selected Additional Articles on Childhood & Adolescent Sleep

1. Iglowstein I, Jenni OG, Molinari L, Largo RH. Sleep duration from infancy to adolescence: 

reference values and generational trends. Pediatrics. 2003;111:302-7.

2. Iglowstein I, Latal Hajnal B, Molinari L, Largo RH, Jenni OG. Sleep behaviour in preterm children

from birth to age 10 years: a longitudinal study. Acta Paediatr. 2006;95:1691-3.

3. Eaton DK, McKnight-Eily LR, Lowry R, Perry GS, Presley-Cantrell L, Croft JB. Prevalence of

insufficient, borderline, and optimal hours of sleep among high school students - United States, 

2007. J Adolesc Health. 2010;46:399-401.

4. Galland BC, Taylor BJ, Elder DE, Herbison P. Normal sleep patterns in infants and children: A

systematic review of observational studies. [published online ahead of print July 23, 2011]. Sleep 

Med Rev 2011. http://www.sciencedirect.com/science/article/pii/S1087079211000682. Accessed 

February17, 2012

5. Wolfson AR, Carskadon MA. Understanding adolescents' sleep patterns and school performance: a

critical appraisal. Sleep Med Rev. 2003;7:491-506.

6. Beebe DW. Cognitive, behavioral, and functional consequences of inadequate sleep in children and4

adolescents. Pediatr Clin North Am. 2011;58:649-65.

7. Berger RH, Miller AL, Seifer R, Cares SR, Lebourgeois MK. Acute sleep restriction effects 

onemotion responses in 30- to 36-month-old children. [published online ahead of print October 11, 

2011]. J Sleep Res. 2011. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2011.00962.x/full. 

Accessed February 17, 2012

8. Arman AR, Ay P, Fis NP, Ersu R, Topuzoglu A, Isik U, et al. Association of sleep duration with

socio-economic status and behavioural problems among schoolchildren. Acta Paediatr. 

2011;100:420-4.

9. Gruber R, Laviolette R, Deluca P, Monson E, Cornish K, Carrier J. Short sleep duration is associated 

with poor performance on IQ measures in healthy school-age children. Sleep Med. 2010;11:289-94.

10. Feinberg I, Campbell IG. Sleep EEG changes during adolescence: an index of a fundamental brain

reorganization. Brain Cogn. 2010;72:56-65.

11. Nevarez MD, Rifas-Shiman SL, Kleinman KP, Gillman MW, Taveras EM. Associations of early life

risk factors with infant sleep duration. Acad Pediatr. 2010;10:187-93.

12. Spilsbury JC, Storfer-Isser A, Drotar D, Rosen CL, Kirchner LH, Benham H, et al. Sleep behavior in

an urban US sample of school-aged children. Arch Pediatr Adolesc Med. 2004;158:988-94.

13. Magee L, Hale L. Longitudinal associations between sleep duration and subsequent weight gain: A

systematic review. [published online ahead of print July 23, 2011]. Sleep Med Rev. 2011.

http://www.sciencedirect.com/science/article/pii/S1087079211000608. Accessed February 17, 2012.

14. Vorona RD, Szklo-Coxe M, Wu A, Dubik M, Zhao Y, Ware JC. Dissimilar teen crash rates in two

neighboring southeastern Virginia cities with different high school start times. J Clin Sleep Med.

2011;7:145-51.

15. Boto LR, Crispim JN, de Melo IS, Juvandes C, Rodrigues T, Azeredo P, et al. Sleep deprivation and

accidental fall risk in children. Sleep Med. 2012;13:88-95.

16. Gangwisch JE, Malaspina D, Babiss LA, Opler MG, Posner K, Shen S, et al. Short sleep duration as 

a risk factor for hypercholesterolemia: analyses of the National Longitudinal Study of Adolescent

Health. Sleep. 2010;33:956-61.

17. Lin JD, Tung HJ, Hsieh YH, Lin FG. Interactive effects of delayed bedtime and family-associated

factors on depression in elementary school children. Res Dev Disabil. 2011;32:2036-44.

18. Fitzgerald CT, Messias E, Buysse DJ. Teen sleep and suicidality: results from the youth risk

behavior surveys of 2007 and 2009. J Clin Sleep Med. 2011;7:351-6.

19. Gruber R, Wiebe S, Montecalvo L, Brunetti B, Amsel R, Carrier J. Impact of sleep restriction on

neurobehavioral functioning of children with attention deficit hyperactivity disorder. Sleep.

2011;34:315-

20. Beebe DW, Rose D, Amin R. Attention, learning, and arousal of experimentally sleep-restricted

adolescents in a simulated classroom. J Adolesc Health. 2010;47:523-5.

21. Randazzo AC, Muehlbach MJ, Schweitzer PK, Walsh JK. Cognitive function following acute sleep

restriction in children ages 10-14. Sleep. 1998;21:861-8.

22. Sadeh A, Gruber R, Raviv A. The effects of sleep restriction and extension on school-age children:

what a difference an hour makes. Child Dev. 2003;74:444-55.

23. Van den Bulck J. The effects of media on sleep. Adolesc Med State Art Rev. 2010;21:418-29, vii.

24. Bryant Ludden A, Wolfson AR. Understanding adolescent caffeine use: connecting use patterns with 

expectancies, reasons, and sleep. Health Educ Behav. 2010;37:330-42.

25. Hale L, Berger LM, LeBourgeois MK, Brooks-Gunn J. A longitudinal study of preschoolers'

language-based bedtime routines, sleep duration, and well-being. J Fam Psychol. 2011;25:423-33.

26. Mindell JA, Telofski LS, Wiegand B, Kurtz ES. A nightly bedtime routine: impact on sleep in young

children and maternal mood. Sleep. 2009;32:599-606.

27. Mindell JA, Meltzer LJ, Carskadon MA, Chervin RD. Developmental aspects of sleep hygiene:  

findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Med. 2009;10:771-5

9.

28. Wolfson, A.R. and Carskadon, M.A.  Sleep schedules and daytime functioning in adolescents.  Child 

Development 1998;69(4):875-887.  PMID: 9768476

29. Carskadon, M.A., Harvey, K., Duke, P., Anders, T.F., Litt, I.F., and Dement, W.C.  Pubertal changes 

in daytime sleepiness.  Sleep  1980; 2: 453-460.  PMID: 7403744  PMID: 12224838

30. Carskadon, M.A., Wolfson, A.R., Acebo, C., Tzischinsky, O., and Seifer, R.  Adolescent sleep 

patterns, circadian timing, and sleepiness at a transition to early school days.  Sleep 1998; 21(8):871-

881.  PMID: 9871949

31. Carskadon, M.A., Harvey, K., and Dement, W.C.  Acute restriction of nocturnal sleep in children.  

Percept. Motor Skills  1981; 53: 103-112.

32. Fallone, G., Acebo, C., Arnedt, J.T., Seifer, R., and Carskadon, M.A.  Effects of acute sleep 

restriction on behavior, sustained attention, and response inhibition in children.  Percept. Motor 

Skills 2001; 93:213-229.  PMID: 11693688

33. Ohayon, M.M., Carskadon, M.A., Guilleminault, C., and Vitiello, M.  Meta-analysis of quatitative 

sleep parameters from childhood to old age in healthy individuals:  Developing normative sleep 

values across the human lifespan.  Sleep 2004; 27(7):1255-1273.  PMID: 15586779

34. Fallone, G., Acebo, C., Seifer, R., Carskadon, M.A.  Experimental restriction of sleep opportunity in 

children:  Effects on teacher ratings.  Sleep 2005; 28 (12): 1561-1567.  PMID: 16408416

35. Carskadon, M.A., Harvey, K., and Dement, W.C.  Sleep loss in young adolescents.  Sleep  1981; 4:  

299-312.  PMID: 7302461

36. Carskadon, M.A.  Adolescent sleepiness:  Increased risk in a high-risk population.  Alcohol Drugs 

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Link to Essay here

Huffingotn post published  here

The sentiments expressed in the essay were endorsed by the following individuals:

Full Name Affiliation

Candice A. Alfano, Ph.D. University Of Houston

Rosana Alves, MD, PhD Department of Neurology, Sao Paulo Medical 

School, University of Sao Paulo, Sao Paulo, Brazil

Strahil Atanasov, MD 

Kristin T. Avis, Ph.D, CBSM University of Alabama at Birmingham Dept of 

Pediatrics

Robert Beckerman, MD Section Chief, Pediatric Pulmonary and Sleep 

Medicine, Children’s Mercy Hospital, University of 

Missouri in Kansas City School of Medicine

Dean W. Beebe, Ph.D. Cincinnati Children’s Hospital Medical Center and 

University of Cincinnati College of Medicine

Julie Boergers, PhD Alpert Medical School of Brown University, 

Bradley-Hasbro Children’s Research Center

Lee J. Brooks, MD Children’s Hospital of Philadelphia, University of 

Pennsylvania

Tyish S. Hall Brown, Ph.D Assistant Professor, Department of Psychiatry, 

Howard University College of Medicine

Oliviero Bruni, MD Department of Pediatrics and Developmental 

Neurology, Tel-Aviv University

Joseph A. Buckhalt, Ph.D. Auburn University

Margaret A. Cashman, MD, 

FAASM

Harborview Medical Center; Department of 

Psychiatry and Behavioral Sciences, University of 

Washington School of Medicine

Mary Cataletto, MD Director, Children’s Sleep Services, Winthrop 

University Hospital, Mineola, NY

Sangeeta Chakravorty MD Director, Pediatric Sleep Evaluation Center, 

Children’s Hospital of Pittsburgh of UPMC

S.P.Chan MBBS Director of Pediatric Pulmonology, Staten Island 

University Hospital, New York

Barry A. Cohen, MD Pediatric Sleep Specialist, Saint Barnabas Medical 

Center, Livingston, NJ

Heidi V. Connolly, MD Chief, Division of Pediatric Sleep Medicine, 

Associate Professor of Pediatrics and Psychiatry,  

University of Rochester

Penny Corkum, PhD Departments of Psychology, Psychiatry & 

Pediatrics, Dalhousie University, Halifax, Nova 

Scotia, Canada

Flavia Cortesi MD Dept Pediatrics & Child Neuropsychiatry University 

of Rome “La Sapienza”, Italy 

Stephanie Crowley, PhD Assistant Professor, Department of Behavioral 

Sciences, Rush University Medical Center, ChicagoGary Feldman, M.D. Medical Director, Pediatric Sleep Disorders Center, 

Miller Children's Hospital Long Beach, Long 

Beach, CA 

Karyn Gail France, PhD, 

DipClinPsyc

Associate Professor, Programme Coordinator, Child 

and Family Psychology Programme, University of 

Canterbury, Christchurch, New Zealand

Dominic Gault, M.D. Medical Director, Division of Pediatric Sleep 

Medicine, Greenville Hospital System Children's 

Hospital 

Peter Glusker, MD-PhD, FAAN, 

FASM, FACP

Retired Adjunct Clinical Assistant Professor, 

Department of Neurosciences, Stanford Medical 

Center, Texas Childrens Hospital

Roger Godbout, Ph.D., 

psychologist

Professor of Psychiatry, University de Montréal, 

Montreal, Canada and Director of the Sleep 

Laboratory & Clinic, Riviere-des-Prairies, Montreal, 

Canada

David Gozal, MD  The Herbert T. Abelson Professor and Chair, 

Department of Pediatrics, The University of 

Chicago; Physician-in-Chief, Comer Children's 

Hospital 

Michael Gradisar, PhD, 

M.Psyc.(Clin.)

Flinders University, Australia

Madeleine Grigg-Damberger, MD Professor of Neurology, Medical Director of 

Pediatric Sleep Services, Associate Medical 

Director of the Clinical Neurophysiology 

Laboratory, University of New Mexico School of 

Medicine

Jim Halsey, R.R.T., RPSGT, RST Department of Respiratory Care, Stephens County 

Hospital, Toccoa, GA

Allison Harvey, PhD Professor of Clinical Psychology, University of 

California, Berkeley.

Jacqueline MT Henderson, PhD Canterbury Sleep Programme, Department of 

Psychology, University of Canterbury, Cristchurch, 

New Zealand

 Ibrahim MD Cleveland Clinic, Cleveland OH

Kyle P. Johnson, MD Associate Professor, Departments of Pediatrics and 

Psychiatry, Oregon Health & Science University

Lewis J. Kass, MD Westchester Pediatric Pulmonology and Sleep 

Medicine, Mt. Kisco, NY; Pediatric Sleep Disorders 

Center at Norwalk Hospital, Norwalk, CT

Sharon A. Keenan, Ph.D., 

REEGT, RPSGT

Diplomate of The American Board of Sleep 

Medicine and Director, The School of Sleep 

Medicine, Inc., Palo Alto, CA 

Amit Khanna, MD Adult & Pediatric Sleep Center, Lawrence & 

Memorial Hospital

Suresh Kotagal, M.D. Consultant, Neurology, Pediatrics and the Center for 

Sleep Medicine, Mayo Clinic, Rochester, MinnesotaAndrea M. Landis, PhD, RN Assistant Professor, Family & Child Nursing, 

University of Washington School of Nursing, 

Seattle, WA

Albin Leong, MD Chief, Pediatric Pulmonology, Roseville Kaiser 

Medical Center, The Permanente Medical Group, 

Inc.

Robin M. Lloyd, M.D. Mayo Clinic Center for Sleep Medicine

 Mark W. Maholwald, MD Professor, Department of Neurology, University of 

Minnesota Medical School and Visiting Professor, 

Department of Psychiatry and Behavioral Sciences, 

Stanford University

Cami Matthews, MD General Pediatric and Adolescent Medicine, UW 

Health Pediatric East Clinic, Madison, WI

Lisa J. Meltzer, Ph.D. Assistant Professor of Pediatrics, National Jewish 

Health

Richard P. Millman, MD Professor and Vice Chair of Medicine, Division of 

Biology and Medicine, Alpert Medical School, 

Brown University

Paul Montgomery Professor of Psycho-Social Intervention, University 

of Oxford, Oxford. UK

Cynthia D. Nichols, PhD, 

FAASM, CBSM

Neuropsychologist, Munson Healthcare Sleep 

Disorders Center

Camilo Ortiz, Ph.D. Doctoral Program in Clinical Psychology, Long 

Island University, CW Post

Phillip L. Pearl, M.D. Division Chief, Child Neurology, Children’s 

National Medical Center; Professor of Neurology, 

Pediatrics, and Music, The George Washington 

University School of Medicine and Columbian 

College of Arts and Sciences, Washington, D.C.

Rafael Pelayo, MD Stanford University School of Medicine

Rosa Peraita-Adrados, MD, PhD  Sleep Disorders Unit – Clinical Neurophysiology 

Department, Univeristy Hospital Gregorio Marañón, 

Madrid, Spain

Judi Profant, PhD, CBSM Kaiser Permanente, University of California, Irvine

Brandy M. Roane, Ph.D. Sleep for Science Research Laboratory of Brown 

University

Dominic Roca, MD PhD Stamford Hospital, Stamford CT

Mary Rose, PsyD, CBSM Assistant Professor, Director, Psycho-Oncology, 

Lester & Sue Smith Breast Center, Baylor College 

of Medicine

Carol L. Rosen, MD Professor, Department of Pediatrics, Case Western 

Reserve University, University Hospitals of 

Cleveland, Case Medical Center, Rainbow Babies & 

Children's Hospital

Mark Rosenblum, Psy D, LP, 

CBSM

Director, Insomnia Program, Minnesota Sleep 

Institute

Joshua Rotenberg, MD, Diplomate American Board of Psychiatry & Neurology, Child Neurology, & Sleep Medicine, Texas Medical & Sleep Specialists, Houston TX and San Antonio, TX.

Paul A. Rothenberg, Ph.D. Long Island Jewish Medical Center and Greenwich 

Hospital Sleep Disorder Centers

John Saito, MD FAAP FCCP Diplomate in the American Board of Sleep 

Medicine; President, Pulmonary & Sleep Disorder 

Consultants, Irvine, California. 

John N. Schuen, MD Chief, Pediatric Pulmonary and Sleep Medicine, 

Michigan State University-College of Human 

Medicine, Grand Rapids, MI

David C. Schwebel, PhD Professor of Psychology and Associate Dean for 

Research in the Sciences, University of Alabama at 

Birmingham

Yakov Sivan, MD Dana Children's Hospital, Tel Aviv University 

Faculty of Medicine,Tel Aviv Medical Center, Israel

George F. Slade

Kevin C. Smith, PhD University of Missouri -- Kansas City School of 

Medicine, Pediatric Psychologist, Section of 

Developmental and Behavioral Sciences, Section of 

Pediatric Pulmonary and Sleep Medicine, Children's 

Mercy Hospitals and Clinics

Jim Spilsbury, PhD, MPH Assistant Professor & Director, Academic 

Development Core, Center for Clinical 

Investigation,  Case School of Medicine

Kingman P. Strohl MD Case Western reserve University, Cleveland OH

Lisa Talbot, Ph.D. San Francisco VA Medical Center and University of 

California, San Francisco

Douglas M. Teti, Ph.D. Associate Director, Social Science Research 

Institute; Professor of Human Development, 

Psychology, and Pediatrics, The Pennsylvania State 

University; Lead Faculty, Parenting-at-Risk Faculty 

Research Initiative; Associate Editor, Infancy

Amy Walker, PhD, RN Assistant Professor, University of Washington, 

Department of Family & Child Nursing, Seattle

Teresa Ward, RN, Ph Assistant Professor,  Family & Child Nursing, 

University of Washington, Seattle

Shelly Weiss, MD FRCPC Associate Professor, University of Toronto; 

President, Canadian Sleep Society

Luci Wiggs, PhD Reader in Psychology, Oxford Brookes University, 

Oxford, UK

Mark C. Wilson, MD Children’s Hospital and Medical Center, UNMC, 

Omaha, NE

Amy Wolfson, PhD Professor of Psychology, College of the Holy Cross


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