What do I do when my baby won't sleep??

This article addresses what action parents should take when their baby won't sleep, and warning signs that could require further attention.

The quest for a good night’s sleep is one of the main reasons parents take their children to a pediatrician.

But doctors familiar with sleep disorders say the issue is often more about behaviour than it is about medicine.

“In my private practice it’s a very common concern, ‘My child doesn’t sleep,’ ” said pediatrician Dr. Wilma Arruda, Island Health medical director of childhood and family health.

“It can start at a very young age and it can cause a fair bit of trouble for a family,” Arruda said in an interview. “As parents, we also need our sleep.”

She said it is entirely appropriate for parents to take their sleep concerns to a doctor. Family doctors are typically the first to be consulted. If further expertise is required, a referral can be made.

Parents should be aware, however, there is likely no easy, medical answer.

“[Doctors] can’t just give them a pill and all of a sudden the kids are falling asleep every night and it’s all perfect,” Arruda said.

“In many cases it is a behavioural situation,” she said. “A lot of things around sleep are related to certain behavioural adaptations that kids will make. And it takes some effort to a manage those behaviours into something that might be more suitable for a family.”

She and other doctors say concerns about children’s sleep appear to be increasing. One suspected reason is the increase in the rates of childhood obesity. Fat in the neck can obstruct the airway, causing snoring and often a cessation of breathing.

Another reason may be the reluctance of parents and doctors in recent decades to remove tonsils. If tonsils become enlarged, they can obstruct the airway.

There is also an increased awareness of the neurobiological disorder of ADHD, attention deficit hyperactivity disorder. Children with ADHD often say they have trouble sleeping — and the lack of sleep aggravates the challenge of their disorder.

Dr. Atul Khullar, medical director of the Northern Alberta Sleep Clinic in Edmonton, said any parent seeking help for a child with a sleep problem should consider keeping a log.

“It’s extraordinarily helpful,” Khullar said. “You can start to see the triggers yourself and that’s really helpful to a doctor.”

He said in his practice, where he treats mostly teens but also some young children, the No. 1 reason for sleep trouble is anxiety.

“We see a lot of kids with the first onset of an anxiety disorder,” Khullar said. “It doesn’t necessarily require medication, but some sort of acknowledgment of the anxiety, perhaps getting them into some sort of therapy or group, is helpful.”

Khullar also said a growing realization is dawning of the medical importance of sleep. An entire family needs to recognize and work to ensure everyone gets a good night’s sleep, he said. Parents and children should acknowledge and speak to its importance and develop good sleep habits.

“Kids tend to model what their parents are doing,” Khullar said. “A kid starts out OK, but they start imitating the maladapted behaviour of their parents.

“The parents, if they have sleep problems, they tend to pass them along to their children — subconsciously, but they do.”

Warning signs

Snoring. Children who struggle to breathe, noisily pause, gasp or choke at night are at risk for obstructive sleep apnea, a treatable condition.
Difficulty falling or staying asleep. Everyone, adults included, has occasional problems falling asleep. But chronic insomnia can make it difficult for children to stay focused and alert during the day.
Sleepwalking, night terrors or other nighttime activities. Many children walk, talk or cry out during sleep. If these incidents become frequent, parents should seek help to learn potential triggers.
Sleeping too much. Children who have trouble waking up in the morning, getting to school on time or fall asleep in class have clear signs of a sleep problem.

Snoring. Children who struggle to breathe, noisily pause, gasp or choke at night are at risk for obstructive sleep apnea, a treatable condition.
Difficulty falling or staying asleep. Everyone, adults included, has occasional problems falling asleep. But chronic insomnia can make it difficult for children to stay focused and alert during the day.
Sleepwalking, night terrors or other nighttime activities. Many children walk, talk or cry out during sleep. If these incidents become frequent, parents should seek help to learn potential triggers.
Sleeping too much. Children who have trouble waking up in the morning, getting to school on time or fall asleep in class have clear signs of a sleep problem.

Tips for sleeping

Make sleep a priority. Without a good night’s sleep, kids will have trouble participating fully in school, homework, sports or play.
Develop a bedtime routine. Everyone needs a short period of calm time before bed.
Keep schedules consistent between weekdays and weekends. Sleeping in a bit on Saturdays or staying up a little bit late is OK. But try to keep the flex to 45 minutes.
In fact, keep schedules consistent every day. Going to bed and getting up around the same time trains the brain to account for the hours needed for regular activities.
Make the bedroom restful. TVs and videogames are distracting and can produce a bright light that signals the brain to wakefulness.
Sleep in the same place every night. Children who sleep on the couch, on the floor, or in different beds have more trouble developing good sleep habits.
Avoid caffeine. Soft drinks, coffee, tea or energy drinks can keep children and adults awake.
Put your child to bed when they are sleepy, but not fully asleep. Self-soothing and relaxation are good skills for children to learn. Putting them to bed before they are fully asleep gives them a chance to develop them.
Address anxiety. Anxiety makes sleep difficult for everyone.

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When you should talk to a doctor about sleep issues

This article discusses signs that indicate you should talk to a doctor about sleep issues.

According to the Centers for Disease Control (CDC), about 70 million Americans suffer from chronic sleep problems. Unfortunately, we live in a fast-paced society where sleep is not always a priority. We often overlook feeling tired and sleep deprived, chalking it up to a necessary part of a busy life. But besides the obvious impact on quality of life, sleep issues have also been linked to injuries, chronic diseases, mental illnesses, increased health care costs, and lost work productivity.

If you regularly have trouble falling or staying asleep (insomnia), are tired during the day (even after getting seven or more hours of sleep the night before), or notice that your abilities to perform daily functions are reduced, you may have a sleep disorder. Start by keeping track of your sleeping patterns. Record what time you go to sleep, how many times you wake up during the night, what time you wake up, and how you feel during the day. Take note of clues like the following:

• nodding off while driving
• struggling to stay awake when inactive, such as when watching television or reading
• difficulty paying attention or concentrating at work, school, or home
• performance problems at work or school
• getting told by others that you look sleepy often
• difficulty with your memory
• slowed responses
• difficulty controlling your emotions
• needing to take naps almost every day

If you experience one or more of the symptoms above, you should seek the help of a professional who can determine what is preventing you from experiencing quality sleep and help to address the problem. In some cases, disturbed sleep can be caused by sleep apnea, a chronic condition in which you have one or more pauses in breathing or shallow breaths while you sleep. Many people don’t even know they suffer from this condition, but it’s important to find out what’s causing it because it can lead to an increased risk of more serious health conditions like heart attack, diabetes, stroke, and obesity.

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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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Children, like adults, are affected by sleep disorders

A good night's sleep is eluding an increasing number of people, and children are not immune.

The Centers for Disease Control has labeled "insufficient sleep" a public health epidemic. From bedwetting to loud snoring, a host of symptoms can indicate an underlying sleep problem in children. Many children suffer with disorders but are undiagnosed or misdiagnosed, says Dr. Larry Salberg, clinical associate professor of medicine at the Indiana University School of Medicine Northwest. "Approximately 2 percent of children have sleep apnea, and most of the kids are going undiagnosed," he says.

In some cases, children diagnosed with attention problems, such as ADD/ADHD, actually have a sleep disorder. Some of the symptoms are the same, such as changes in behavior and attention. "There are studies that show that up to 38 percent of our children who are on stimulant medication for ADD/ADHD do not have ADD/ADHD," Salberg says. "They have sleep deprivation or poor sleep, most of which is due to sleep apnea."

Any child that visits a doctor for possible ADD/ADHD should be screened for apnea or another disorder, says Salberg, founder of Neurological Institute and Specialty Centers in Merrillville.

People with sleep apnea have breathing that repeatedly stops and starts as they sleep, according to the Mayo Clinic. Common signs are loud snoring or feeling tired after a full night's sleep. Obese adults have an increased risk of sleep apnea, and the same rings true with children. "It's a common pathological problem," Salberg says. "It's easy to diagnose and it's easy to treat."

Left untreated, it can lead to serious health problems, such as high blood pressure. In adults, it can result in heart attacks, stroke, congestive heart failure and other maladies.

Good sleep helps reduce weight, but obesity causes poor sleep. "It's a vicious cycle," says Salberg, who has been practicing sleep medicine since 1978.

Dr. Muhammad Najjar, medical director for the Sleep Disorders Center of Franciscan Physicians Hospital in Munster, says sleep disorders in children are not new, but medical technology has improved. "Now we have the tools to treat them," he says.

The Munster center treats children, but the majority of its patients are adults. The facility just started accepting pediatric patients in February. "To the best of my knowledge, no one offers this in Northwest Indiana," Najjar says.

Aside from sleep apnea, children are susceptible to other sleep-related disorders, such as sleepwalking, insomnia, loud snoring and bedwetting. When a doctor recognizes symptoms of a sleep disorder in a child, the child may be recommended for a sleep study.

At Sleep Disorders Center, two rooms are designated for pediatrics. Designed to have a feel that's comfortable for children, it has toys, pictures on the wall and smaller beds. During a sleep study, a child spends the night in a sleep center, hooked to machines that monitor brain waves, eye movement, flow of air in the nose and mouth, heart and oxygen levels and more, Najjar says. The data are recorded and analyzed. It takes a few days to process the results and another appointment to discuss the best course of treatment.

In adults, prescribing a continuous positive airway pressure (CPAP) machine, which is a breathing mask worn at night, is a common treatment for sleep apnea.

For children with sleep apnea, a possible first step is to remove their tonsils and adenoids. If that does not correct the problem, then a doctor can explore nasal or orthodontic treatments or address a child's weight, if he is overweight, Najjar says. If fixing those issues does not work, then a CPAP machine is an option.

Salberg says children have to be re-studied in a sleep center after various treatments are tried, to ensure what appears to be working truly is working. "You have to prove that you've treated it. The only way you can document and make a diagnosis is by going through a sleep test."

If someone quits snoring, that does not mean the sleep apnea is gone. "One does not beget the other, necessarily," Salberg says.

Parents who think their child may have a sleep disorder should talk to the child's doctor. If the doctor ignores the concern or does not seem to know, parents should not be afraid to ask for a consultation with a board certified sleep specialist, Salberg says.

"We spend a third of our life sleeping," he says. "What we do during sleep has a lot to do with the day."

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What is narcolepsy?

Narcolepsy is a very serious disease. Information on narcolepsy and ways to treat it.

Narcolepsy: Definition and Treatment

Narcolepsy is a chronic, rare sleep disorder. It is a disease of the central nervous system. When one suffers from narcolepsy they experience bouts of sleepiness throughout the day. Although it is rare the disease is the second most common sleep disorder affecting about every 1 in 2,000 Americans. It usually starts in the adolescent or teenage years and all races and sexes are equally likely to suffer from the disease.

Narcolepsy is caused by a lack of hypocretin chemicals in the brain. The chemical is release by cells and those who suffer from narcolepsy have a minimal amount of cells that carry the chemical. The chemicals are produced by the hypothalamus and have to do with the secretin hormone.

Most who suffer from narcolepsy are unaware and it goes untreated. It is estimated that several thousand people suffer from the disease but are unaware of it. The disease is very severe and can disable one’s daily life.

Narcolepsy is companioned by several serious symptoms such as sleep paralysis, which leaves a person unable to move, hallucinations, and cataplexy which is a sudden onset of muscle weakness. Cataplexy can cause a person to fall down or not be able to hold up their head and it is believed that it is triggered by emotions.

Narcolepsy is treated by using a combination of several medications. Stimulants are used to help control the fatigue while some of the other symptoms are treated with medications similar to anti-depressants. Since there can be some adverse reactions to these medications most patients are only given the stimulants. If the fatigue can be controlled it helps in controlling the other symptoms.

There are also non-medicated treatments that are used less frequently. Educating a person with narcolepsy and it being completely understood by the patient and their family has shown to help reduce the symptoms. Another treatment is to set up scheduled sleep and nap times and try to keep awake as much as possible in between times. This can cause your body to get used to sleeping when it’s supposed to and being awake at other times.

For each person a different form of treatment is going to be more effective. Treatments are designed on a very personal basis. Sometimes a combination of medication and behavioral treatments are used.

Currently there are no cures for narcolepsy. However, scientists are currently working on finding a way to replace the missing molecules that carry the hypocretin. If these molecules could be replaced narcolepsy could be cured. The procedure, unfortunately, is going to be very difficult. The molecules cannot be inserted or ingested because they would be broken down by the body before reaching the brain. Artificial drugs will have to be invented that will allow the molecules/chemicals to get to the brain to do their job. Scientists do not believe that replacing this molecule would necessarily lead to a cure of the disease. It is commonly believed that there is a possibility that the body destroys the molecule and that is why it is not present in those who suffer from narcolepsy.

Narcolepsy is constantly being studied and more discoveries are being made. It is hoped that within 10 years there will be some more effective and longer lasting treatments for the disease.

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What is good 'sleep hygiene'?

According to the Centers for Disease Control and Prevention, about 75 million Americans — more than one-quarter of the population — say they don't get enough sleep. Almost 30 million say they suffer from chronicinsomnia.

This restlessness, the CDC warns, can lead to a number of chronic illnesses and conditions, including diabetes,cardiovascular disease, obesity and depression.

It can also take an economic toll as productivity lags and workplace safety comes into question. Lack of slumber results in an average of 11.3 days, or $2,280, in lost productivity per worker each year, and the total cost to the nation is more than $63 billion annually, according to a recent study by Harvard Medical School.

"Sleeplessness has become an epidemic in the United States," said Dr. Douglas Prisco, director of sleep medicine at Keck Hospital of USC. "People are having an extremely hard time turning off."

This is National Sleep Awareness Month, so it's a good time to focus on what all the experts say is a problem that's getting bigger. But before we get to possible solutions for the sleep-deprived, let's look more closely at the reasons for our sleeplessness.

Dr. Ronald Popper, who runs the Southern California Pulmonary & Sleep Disorders Medical Center in Thousand Oaks, said he's seen a roughly 30% increase in patients since the economy tanked a few years ago.

"People have more on their minds," he said. "They have a hard time shutting down when they go to bed."

And it's not just anxiety about our jobs, homes and future keeping us awake at night. Popper and USC's Prisco also cited busier lifestyles, a culture of 24-hour news and entertainment and the ubiquity of gadgets like smartphones and iPads that can keep people gazing at electronic screens well into the wee hours.

"Bright lights suppress melatonin secretion," Popper observed. "That makes it harder to fall asleep."

The nonprofit National Sleep Foundation reported last year that nearly all of the more than 1,500 people surveyed interacted with some sort of electronic device within an hour of bedtime. That included watching TV or going online.

By the same token, the poll found that 43% of respondents ages 13 to 64 said they rarely or never get enough rest on weeknights. Most said they would like about 71/2 hours of shut-eye, but typically get fewer than seven hours.

About 15% of adults 19 to 64, and 7% of young people 13 to 18, reported sleeping fewer than six hours on weeknights.

"We're particularly having a problem with teenagers, who end up being overly sleepy in school," said Dr. George LaBrot, a sleep specialist at Santa Monica-UCLA Medical Center and Orthopaedic Hospital. "The best solution is to remove all the electronic devices from their room."

Easier said than done, as any parent will attest.

Meanwhile, people are doing everything they can to keep pace with a faster world. We schedule activities early in the morning or late at night. We skip meals when they interfere with other stuff. We keep ourselves heavily stimulated with regular doses of caffeine.

In 1987, Starbucks had just nine outlets, all in the Seattle area. Now it has more than 19,000 worldwide.

So what's a would-be sleeper to do?

Many people turn to quick fixes like Ambien, Lunesta or other prescription drugs. The research firm Global Industry Analysts estimated in a report last month that the worldwide market for sleeping pills will be worth $9 billion by 2015.

But sleep experts say this merely places a Band-Aid on the problem. To achieve lasting results, they say, you have to address the causes of sleeplessness and change your behavior accordingly.

In the sleep trade, this is known as having good sleep hygiene.

The CDC recommends avoiding caffeine, alcohol and nicotine anywhere near bedtime. It also advises skipping large meals and vigorous exercise as rock-a-bye time approaches.

A key element of good sleep hygiene is acclimating your body to a regular schedule. That means trying to go to bed and wake up around the same time every day.

The National Sleep Foundation recommends turning your bedroom into "a cool, comfortable sleeping environment that is free of distractions."

The foundation also advises keeping a "worry book" next to the bed. If anxiety is keeping you up, write down what's on your mind, jot down a few ideas about how to cope with things, and then forget about everything until morning.

There's also a technique called "sleep restriction" that's worth considering (It worked for me). If you get into bed and often toss and turn for an hour or more, start going to bed later at night, while still getting up at the same hour each morning.

That may sound counterintuitive for someone who wants more sleep — and it certainly wipes you out for a while — but the idea is to provide deeper, more restful sleep by limiting your time under the covers to the hours you're actually catching z's.

As you become more proficient at staying down, you gradually try to lengthen the amount of time in bed until you get closer to the seven or eight hours most experts say is preferable.

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Why are Americans Having Trouble Sleeping?

Why are 70 million Americans having trouble getting a good night's sleep? Let us count the ways:

We are over-caffeinated (coffee, soft drinks, energy drinks, snacks) and over-medicated (prescription and over-the-counter drugs, including alcohol), wreaking havoc with slumber patterns.

We are over-wired (video games, Web browsing, social media, texting) and overstressed (money, work, relationships, overloaded schedules), making us too restless to doze off when we should.

We are overworked (longer hours, night shifts incompatible with our biological clocks) and overweight (perhaps a chicken-or-egg deal, as different studies have found that one leads to the other).

And then there's societal pressure, what nationally recognized sleep expert Dr. Mark Mahowald calls "the pervasive, erroneous attitude that sleep is not a biological imperative, that it is negotiable. We have raised sleep deprivation to a badge of honor."

The effects might outnumber the causes, and are hardly as benign as many of us might think. "Any degree of sleep deprivation will impair performance: behind the wheel, in the classroom or workplace," Mahowald said.

He added that the Bhopal, Challenger, Exxon Valdez and Three Mile Island disasters "all are officially attributed to problems from sleep deprivation. But the biggest risk of sleep deprivation is car crashes, period."

No wonder the number of accredited sleep centers has risen nationwide by 630 percent in just 15 years. And while sleep study results have been all over the map and sometimes contradictory, experts such as local doctors Mahowald and Michael Schmitz know a lot more than researchers did even a decade ago.

The lowdown

• Insomnia victims have trouble falling or staying asleep in a setting with adequate conditions for sleep; this becomes chronic insomniaif it lasts more than three weeks. Sleep deprivation is caused by behavioral or situational factors that curtail or mitigate the ability to get enough sleep time.

• Most adults need seven to nine hours of sleep a night. The amount a person needs is genetically determined, Mahowald said. "Some people might need four hours on the short end, up to 10 on the high end. We have absolutely no control over this."

• Anyone who uses an alarm clock "is by definition sleep-deprived," Mahowald said, "because if the brain had received the amount of sleep it wanted, you would have woken up before the alarm went off."

• Melatonin is a hormone, secreted daily by the brain's pineal gland, that helps maintain the body's sleeping cycle. A nonprescription synthetic melatonin pill is sold in the United States and is widely used. The FDA does not test or regulate melatonin because it doesn't consider it a drug.

• Larks and owls: "Some people are early to bed, early to rise; others late to bed, late to rise. We have very little control over that," Mahowald said. "So you see a lot of problems when an owl marries a lark and each one thinks the other is being stubborn."

EFFECTS

• With sleep deprivation, some glucose metabolism problems might predispose one to diabetes. And if so, a consequence could be heart disease and stroke.

• With insomnia, there is no evidence of long-term physical problems or links to other diseases. But insomnia results in poorer quality of life and work absences and can lead to depression.

• There is some evidence that severe sleep apnea can lead to hypertension, heart problems and a higher risk of strokes.

SOLUTIONS

• Improving sleep hygiene -- avoiding late eating and drinking, keeping the room cool and dark, winding down before bedtime -- can improve or resolve transient or acute insomnia but probably not chronic insomnia.

• For chronic insomnia, cognitive behavioral therapy is equally as or more effective than medications. Medication often is useful for acute insomnia.

• Naps can help -- except when they don't. "We discourage napping when anyone has problems falling or staying asleep at night, which might be an untreated sleep disorder," said behavioral sleep specialist Schmitz. "We encourage power naps, 30 minutes or less, when folks can't stay awake or will have late-night events."

• See your doctor if: You have had difficulty falling and staying asleep for more than a week. Or if you snore, have frequent awakenings and are reporting sleepiness during the day. Anyone with apnea symptoms should seek treatment.

BY THE NUMBERS

One third of Americans suffer from insomnia at some point in their lives.

14 to 15 hours of sleep a night is recommended by the Mayo Clinic for infants, 12 to 14 hours for toddlers and 10 to 11 for school-age children.

84 classifications of sleep disorders have been found.

2,365 U.S. sleep centers are accredited by the American Academy of Sleep Medicine. In 1997, there were 374; in 2006, there were 1,000.

2 million U.S. children suffer from sleep disorders.

18 million Americans probably suffer from sleep apnea, with more than half of them undiagnosed.

$15.9 billion is added to national health care costs by sleep problems, according to the National Commission on Sleep Disorders.

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Attention night-owls! What time is it? Dont forget to Spring forward and be careful...

Attention night-owls! What time is it? Dont forget to Spring forward and be careful. Accidents increase after the time change. JR

Transitions into and out of daylight saving time compromise sleep and the rest-activity cycles

Background

The aim of this study was to analyze the effects of transition out of and into daylight saving time on the rest-activity cycles and sleep. Rest-activity cycles of nine healthy participants aged 20 to 40 years were measured around transitions out of and into daylight saving time on fall 2005 and spring 2006 respectively. Rest-activity cycles were measured using wrist-worn accelerometers. The participants filled in the Morningness-Eveningness and Seasonal Pattern Assessment Questionnaires before starting the study and kept a sleep diary during the study.

Results

Fall transition was more disturbing for the more morning type and spring transition for the more evening type of persons. Individuals having a higher global seasonality score suffered more from the transitions.

Conclusion

Transitions out of and into daylight saving time enhanced night-time restlessness and thereby compromised the quality of sleep.

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