Too little sleep impairs children's health

This article explains how getting too little sleep impairs a child's health.

In a new study, children who regularly got too little sleep had worse physical, emotional and social health than those who slept the average amount.

"Sleep is important for a lot of reasons, and can influence health and well-being and cognitive functioning," said lead author Christopher A. Magee. "The typical sleep pattern appeared to have the best outcomes as measured in this paper," he told Reuters Health in an email.

But since this is a relatively new area of research, the researchers can't say for sure that this pattern of sleep causes better health and wellbeing, said Magee, of the University of Wollongong in Australia.

Genetics do influence the regulation of sleep, but the results suggest that environmental and social factors, like household financial hardship, may play a role as well, he said.

The researchers used Medicare Australia data from a group of almost 3,000 children to track the kids' health and quality of life at four points between birth and seven years of age.

Parents completed sleep journals and answered interview questions about their children's sleep patterns, and included how often their children had experienced problems like difficulty waking, feeling sad, problems socializing or missing school due to illness, which were meant to rate the child's overall quality of life.

Researchers divided the kids into four groups based on their sleep patterns: "typical sleepers" slept the most as infants, about 14 hours, and gradually decreased their sleep duration until age seven, when they got an average of almost 11 hours per night.

"Persistent short sleepers" showed a similar decline in sleep hours over time, but they always got about an hour less sleep than the typical sleepers. Only 11 percent of kids fell into this group.

"Initially short sleepers" started out like the short sleepers, but by age five or six were getting as much sleep as typical sleepers. This group included 45 percent of the kids, followed by typical sleepers, who made up 40 percent.

Less than three percent of kids had the most unusual sleep pattern, which started short, with sleeps of less than 10 hours in infancy, gradually increasing with time. Researchers called this group the "poor sleepers."

Poor and initially short sleepers tended to have a lower physical functioning score on the quality of life scale than typical sleepers. Persistent short sleepers also had the physical disadvantage, as well as lower emotional and social functioning scores, according to the results published in Pediatrics.

Following one group of kids for seven years helps to focus on the problem of too little sleep as a chronic issue, not just one bad night, said Dr. Elsie M. Taveras, director of Pediatric Population Health Management at Massachusetts General Hospital in Boston.

Taveras worked on a similar study published in the same issue of the journal, following 1,000 kids from age six months to seven years, and found that kids who chronically slept too little tended to have more body fat at age seven than longer sleepers.

Kids who had shortened sleep most often were more than twice as likely to be obese than kids who rarely or never had short sleep duration. That's a significant increase in risk, she said.

"Two times the odds of obesity for any risk factor for obesity is very rare," she said.

In Taveras' study, short sleepers not only had more fat, but more abdominal fat than longer sleepers.

"Abdominal fat is particularly hazardous for later cardiometabolic diseases," like diabetes and heart disease, she told Reuters Health by phone.

Taking the results of her study with the results of the Australian quality of life study, the amount of sleep kids get seems to be linked to a huge number of areas of health, she said.

According to recommendations from the National Sleep Foundation and the National Heart, Lung and Blood Institute, toddlers need more than 12 hours of sleep per day, children up to four years old need between 10 and 11 hours and up to age seven kids should get at least 10 hours, Taveras said.

"For many children, good sleep could be promoted by having regular bedtimes, limiting household noise, and limiting TV viewing and electronic media near bedtime," Magee said, but some sleep problems like sleep apnea or primary insomnia may need specialized treatment.

"If a child has persistent problems sleeping and this is impacting on their normal daily activities, then it may be a good idea to seek some advice," he said. "A general practitioner could be a good starting point."

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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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Overcoming Sleep Disturbances in Children

Helping children get over their sleep issues requires finding the source of the issue according to the following article.

Annie was having a tough time. While her five-year-old son Paul would sleep through the night, her two-year-old daughter Nina would wake every few hours, meaning Annie was exhausted. “My little girl had extremely interrupted sleep patterns and would rarely sleep for more than three hours at a time,’’ says Annie, a Dubai HR officer. “She’d wake up crying as if she’d had a nightmare and it would take a lot of comforting before she’d go back to sleep.’’

Her husband Mathew helped her to soothe Nina and put her back to bed, and the lack of sleep was taking its toll on both parents. “I was finding it difficult to concentrate at work and my husband said that he once even dozed off at the wheel,’’ says Annie. “I realised then I needed to do something before a disaster happened. The lack of sleep was becoming dangerous.”

She took the toddler to her doctor for a check-up, but there was nothing physically wrong with her. “We tried all kinds of things like rubbing her back, cuddling her and putting her to bed at fixed times,” says Annie. “It took nearly a year before she fell into a regular sleep pattern.’’ Annie’s not sure what caused the problems, but suspects it was a stage her daughter eventually grew out of.

Nothing that can’t be tackled

Battling through months of disturbed sleep is to be expected when you’ve got a new baby. But when your child is older and still not sleeping through the night, it can be a huge family problem. However, there are very few issues that can’t be tackled, promises Dr Richard Ferber, director of the Centre for Pediatric Sleep Disorders at Boston Children’s Hospital.

He stresses that while children’s sleep problems vary widely (common issues include being unable to fall asleep without help, getting up repeatedly during the night, waking early, being hard to wake up, bed-wetting and sleep apnoea) they are rarely the result of poor parenting.

A revised version of Dr Ferber’s book, Solve Your Child’s Sleep Problems, was published recently, and he hopes parents of children of any age will read it to help them understand sleep so they can prevent problems occurring. “Pretty much all children have the ability to sleep fairly normally,” he says. “But there are many ways sleep patterns can be disrupted and that’s when it’s worth trying to sort it out.”

Stop it at the source

Dr Ferber says that one of the most common problems is children not being able to go to sleep easily or stay asleep. This is often due to schedules (the timing of sleep and how it’s controlled) and habits related to sleep (what they’re used to doing before sleep) such as feeding. As a child gets older, there may be issues around limit setting (sticking to strict rules on sleep-delaying tactics), and night-time fears may also cause problems.

He explains that solutions will differ depending on the child, and says that while trying something such as controlled crying – where babies older than six months are left to cry but checked regularly and reassured without being picked up – may help in particular situations, it’s often not appropriate.

It shouldn’t be used if children are in pain or discomfort, if their sleep schedule isn’t correct (if parents think the child should be sleeping for longer than he or she is capable) or if they’re frightened. If a child has night-time fears, it’s important to identify the source of the fears and deal with it so the problem can be resolved. “The first question is ‘why is a child crying?’” stresses Dr Ferber.

He says that it’s to do with some sort of association, for example if they have to have their back rubbed to fall asleep, then if they wake up in the middle of the night, which is a normal part of the sleep cycle, someone can’t be there to rub their back all night. “If they learn how to go to sleep without back rubbing, there’s no problem, so withdrawing it is appropriate,” says Dr Ferber. “If the child is upset, you may want to check them at increasing intervals to show you haven’t disappeared, but without reinstating the back rubbing or the habit related to them getting to sleep.”

According to Dubai-based Dr Onita Nakra, educational psychologist and counsellor, American School of Dubai, poor sleep can impact a child negatively. “The child’s health, safety, development, learning and behaviour can be affected,” she has said. “A common complaint is difficulty concentrating or poor retention at school. A tired child also has difficulties focusing in the classroom.”

Dr Ferber points out that children often have a combination of more than one sleep problem, and parents need to be aware that if they deal with one problem such as a sleep association and the child still has sleep difficulties, it may be because there’s an another issue. This may be an incorrect sleep schedule. “Parents may come to the conclusion that their child is just a bad sleeper, but if they fix the schedule as well, they may find the child’s actually a great sleeper,” he says.

Another sleep problem is a child not getting enough sleep. While Ferber stresses there’s no way of telling from numbers alone, a general guide for how much children should be getting is around 14-18 hours for a baby, around 12-14 hours for a toddler and around 11-13 hours for primary school-aged children.

A bedtime routine is very important. A child put to bed straight after watching TV without any transition period can cause problems. “Establishing a routine the child looks forward to, such as a song or a story, makes the process more pleasurable,” says Dr Ferber. “It’s also a chance for parents to get away from other distractions and interact with their child. It can be as special a time for parents as it is for children. We’re not talking about much time, but it’s time well spent.”

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Sleep Tips for Teenagers and Young Adults

Many teenagers don't get enough sleep per night and this results in negative health outcomes. This article discusses how teenagers and young adults can get better sleep patterns to avoid the negative health consequences.

Getting less than four hours of sleep every night and waking up early the next day almost seems to be the norm for many Singapore teenagers. Sleep problems can dampen your mood, zap your energy and reduce your concentration in school. Some gain weight or become depressed.

"Studies have shown that people who sleep less than four hours have higher mortality rates than those with seven-eight hours of sleep," says Dr Toh Song Tar, Consultant ENT Surgeon, Department ofOtolaryngology and Sleep Disorder Unit, Singapore General Hospital (SGH).

During sleep, the body releases a growth hormone that is important for physical growth in children and teens. Teenagers should get eight to nine hours of sleep every night, adds Dr Toh. Otherwise their physical growth may be affected.

So what causes teenagers to lose sleep?

Youths generally cite the following causes for their sleep problems:

• Worrying over unfinished business (school work, tests and exams)
• Playing video games late at night
• Online chats with friends
• Difficulty falling asleep (insomnia)
• Watching late-night television
• Stress

But there is also a biological explanation for the "sleep late, wake up early" syndrome in teenagers. The onset of puberty and a teenager's penchant for late nights may cause the body to delay melatonin production, a hormone which induces sleepiness and regulates sleep patterns.

Myths about sleep

• Loss of sleep can be compensated

Sleep debt cannot be compensated and chronic sleep deprivation can lead to obesity, hypertension and heart disease.

• Drinking alcohol can make you sleep better

Drinking alcohol at night may make you feel drowsy and sleepy, making it easier for you to fall asleep. But it will reduce REM sleep or deep sleep and cause multiple awakenings at night, thus affecting your overall sleep time and sleep quality. Over time, one would also need more and more alcohol to get to sleep.

• Exercising can overcome sleep problems

Depends on what time you exercise. Late-night exercising may not help with insomnia. At night, body temperatures normally fall as you prepare to sleep, while rigorous exercise temporarily raises your body temperature and keeps you wide awake. Avoid exercising at least four hours before bedtime.

6 tips to overcome sleep problems

1. Stay away from bright lights at night

This means stop watching television and playing computer games by a certain time. Avoid brightly lit objects such as mobile phones and iPads because light sends false messages to the brain that it is still day, and causes a delay in melatonin production.

2. Keep your computer or laptop away from your bedroom or bed

This may reduce the temptation to start playing computer games, watch videos, chat with friends or surf the Internet.

3. Keep a to-do list

Make a list of things you have not done before going to bed. This will ease your mind and stop you from thinking about unfinished business. An overactive mind can cause sleep problems.

Related article: 16 tips to cope with stress

4. Develop a regular sleep pattern

Try to sleep and wake up at about the same time every day. A regular sleep pattern helps you sleep better.

5. Avoid coffee and caffeinated drinks up to 14 hours before bedtime.

Caffeine is a stimulant which can stay in your body for up to 14 hours. If you are sensitive to caffeine, don't drink coffee after breakfast or caffeinated drinks after lunch to avoid sleep problems.

6. Drink a glass of warm milk

Drinking a glass of warm milk is relaxing. An amino acid called tryptophan, found in milk and banana, may help to induce sleep.

"Make small lifestyle changes such as watching less late-night television and refraining from playing computer games late into the night. Sleeping pills are best avoided as they can create a dependency. Only take them if they're prescribed by a doctor," says Dr Toh.

If you suffer from snoring and persistent sleep problems, do see a sleep specialist to rule out any underlying medical causes such as sleep apnoea, a condition in which the person doesn't breathe normally during sleep.

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Disrupted Internal Clock Means Higher Risk of Diabetes and Obesity

A study by researchers at Brigham and Women's Hospital (BWH) reinforces the finding that too little sleep or sleep patterns that are inconsistent with our body's "internal biological clock" may lead to increased risk of diabetes and obesity. This finding has been seen in short-term lab studies and when observing human subjects via epidemiological studies. However, unlike epidemiological studies, this new study provides support by examining humans in a controlled lab environment over a prolonged period, and altering the timing of sleep, mimicking shift work or recurrent jet lag.

The study will be electronically published on April 11, 2012 inScience Translational Medicine.

Researchers hosted 21 healthy participants in a completely controlled environment for nearly six weeks. The researchers controlled how many hours of sleep participants got, as well as when they slept, and other factors such as activities and diet. Participants started with getting optimal sleep (approximately 10 hours per night). This was followed by three weeks of 5.6 hours of sleep per 24-hour period and with sleep occurring at all times of day and night, thereby simulating the schedule of rotating shift workers. Thus, during this period, there were many days when participants were trying to sleep at unusual times within their internal circadian cycle-the body's "internal biological clock" that regulates sleep-wake and many other processes within our bodies. The study closed with the participants having nine nights of recovery sleep at the usual time.

The researchers saw that prolonged sleep restriction with simultaneous circadian disruption decreased the participants' resting metabolic rate. Moreover, during this period, glucose concentrations in the blood increased after meals, because of poor insulin secretion by the pancreas.

According to the researchers, a decreased resting metabolic rate could translate into a yearly weight gain of over 10 pounds if diet and activity are unchanged. Increased glucose concentration and poor insulin secretion could lead to an increased risk for diabetes.

"We think these results support the findings from studies showing that, in people with a pre-diabetic condition, shift workers who stay awake at night are much more likely to progress to full-on diabetes than day workers," said Orfeu M. Buxton, PhD, BWH neuroscientist and lead study author. "Since night workers often have a hard time sleeping during the day, they can face both circadian disruption working at night and insufficient sleep during the day. The evidence is clear that getting enough sleep is important for health, and that sleep should be at night for best effect."

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