Circadian Rhythm Disturbances

Circadian Rhythm is the internal body clock and it is responsible for ensuring we sleep at night and wake in the day. Within this rythm, there are two well recognised disturbances, which can dramatically affect sleep patterns.

Delayed Sleep Phase Syndrome (DSPS) - This is a disorder that causes the sleep wake cycle to be delayed by 2 or more hours. This means that instead of falling asleep at 10pm and waking at 7am, an affected person will not fall asleep until 12 midnight and then has great difficulty waking at 7am for school or work. Approximately 7% of adolescents are known to have this problem. The cause is unknown but it is definitely not a deliberate behaviour. This syndrome causes other additional problems e.g. school absences and all the known problems associated with sleep deficit.

Early Sleep Phase Syndrome (ESPS) - This is the opposite of DSPS. Children with ESPS wake inappropriately early, e.g. 4am is not unusual. They cannot get back to sleep despite being able to self sooth and settle at a reasonable bedtime.

Both DSPS and ESPS are very difficult to treat because the whole family is affected by the disorders. Therefore the affected individual, and the whole family, have to be involved in, and make considerable effort to follow, a remedial behavioural treatment plan. The treatment plan to remedy these disorders is lengthy.

Duration of Treatment
Having worked to correct the circadian rhythm to a more acceptable state, the patient and family must continue to follow the prescribed course, even after positive results have been established. This means that the family must continue with the plan for the same length of time that it took to establish a positive outcome. e.g. is it took 3 months to correct the problem, it will take a further 3+ months to ensure that the "new" revised circadian rhythm becomes accepted by the body as "normal" for that person.

Setbacks
Deviations from the plan e.g. one late night, or one early morning, during the treatment can cause the body clock and therefore the plan, to require restarting from the beginning. Some children and adolescents who experience these problems are also affected by depression, which may co-exist with behavioural problems and excessive daytime sleepiness.

Detection
There is no definitive test for these disorders. They occur in children and adolescents and rarely occur after 30 years of age. They are recognised from clear history taking and in particularly complex situations may require overnight sleep studies to rule out other disorders.

If you think your child has a problem with circadian rhythm disturbance, contact Dream-Angus.com for advice and support.

Problem, What problem?

When is a sleep problem a problem? Well, that is really up to parents to decide. Some children will not settle before 9.30pm or later and this does not constitute a problem for the parents. Other parents think that their child should be settled asleep in bed much earlier. Both are right, as long as the child is getting enough sleep and is not over tired in the daytime or showing signs of sleep deficit.
What is acceptable in one family may not be quite so acceptable in another. This is why, when there are problems, the solutions need to be tailored to the lifestyle of the family.
Priorities in addressing sleep issues need to be discussed and agreed before any sleep management plan can be developed. There is no, "one size fits all" . Who would try to follow any plan that they felt unsuitable for their family?
For every child with a sleep problem there is usually more than one way to resolve the issues.

Dream-Angus.com works with parents, agreeing targets in creating a tailored management plan to improve your child's sleep. Contact us for advice and support.

Fussy babies

In the first few months of life babies have erratic sleep patterns. They learn through experience that they should be more active in daytime and sleep longer through the night. Babies have to sort through the incredible amount of stimulation that they are exposed to on a daily basis. They go from the quiet dim light of mothers womb into a world of noise, light and changing textures and levels of motion. This can be quite hard to sort through and some become overstimulated making it difficult for them to settle and resulting in prolonged crying and difficulty settling.
Fussy babies are often fussy because they have not had sufficient sleep and are overwhelmed by the experiences of the day. Prolonged sleep disturbance only exacerbates these problems. This is why naps are important. A babies nap is the first opportunity for them to learn to self settle. While night sleep is important for both mother and baby daytime naps are little top ups which help baby come to terms with all the stimulation of the environment.
As they grow and age the naps become fewer and night sleep increases but, if your child is "fussy" do not remove the opportunity for naps and think that by doing so you will gain a better night sleep. Naps are just as important to a growing child.

Night waking

Night waking is, as the title suggests a waking in the night when everyone should be sleeping. it is one of the most common problems parents face. Although babies of 6 months are physically capable of sleeping through the night and no longer require night feeds, a high percentage of them still wake.
In fact it is recognised that all children, regardless of age wake briefly four to six times during the night. Children who do not rouse their parents have learned to self soothe and return to sleep without any intervention. Children who have come to rely on set conditions being met before their initial sleep often require that the same situation is re created before they will resettle.
This is known as "sleep Associations". learning to sleep involves learning to sleep with the "right/good" associations so that further intervention is not required.

Sleep is a learned behaviour and we owe it to our children to teach them the best possible associations and behaviour patterns so that they can carry them throughout their lives and reap the benefits.


If your child has problems with night waking contact us at Dream-Angus.com for information and support.

Limit setting

We all need to set limits for our children, this makes them safe in an unsafe world and helps them to appreciate and live within, the social mores that make our society work. We know this but sometimes we do not enforce these limits.
When you decide it is bedtime and your child resists do you always reinforce the limit or do you occasionally cave, give in, because your child is so cute, you enjoy their company so much?
It is all very well to be "flexible" but, flexibility is not always the best option.
When adults are tired, have a sleep deficit, feel guilty about something, or are beset by other worries, we are more likely to take the easy way out. Children figure this out at an early stage and if we give in once, why not a second or third time, in fact is there really a limit at all?
Learning that boundaries may be tested but not set aside is a life lesson. Learning to be wise enough to enforce the boundaries which we have set for our children's security, or in their best interest, is a parental responsibility which we ignore at our peril.

Mothers song

Cooking and cleaning can wait till tomorrow,
Babies cannot as I've learned to my sorrow
so settle down cobwebs and dust go to sleep
I'm nursing my baby and babies don't keep!

Fussy eating.

The term "fussy eater", for diagnostic reasons, can really only be applied to children over 6 years of age. Until this stage in development the child is still learning about foods and textures. This does not mean that concerns, arising from eating behaviour before this, are invalid.

Children who have had reflux or colic lasting most of their infancy are not going to find the process of eating and being satisfied, at all comforting and may refuse foods for that reason.
Mealtimes can be the one time the child feels that they can have any control over their day and for that reason may take all the control that they can.

In general, no child will starve themselves. If you are concerned about your child's eating pattern then making a note of what and how much food they eat over a two week period is much more helpful than looking at amounts taken over a day. Children's appettites change over a day and over a week dependant on growth spurts, levels of activity, feelings of "wellness" and other factors. You may find that they do take in enough food over this period and are growing and gaining in height and weight although your initial perception was that your child wasn't a good eater.

If you have concerns about your child's eating habits it may be worthwhile having a proper feeding assessment done. This will give you a better idea of how to cope and, if another professional could be of assistance.
Dream-Angus.com offers exactly this service. Call for a free, no obligation consultation and then decide if you will take this further.

Co-Sleeping

Keeping a newborn baby in the parental bed is known as co-sleeping. There are a variety of views on this topic. In some countries children naturally sleep in the "family bed". In the west, traditionally babies have been put to sleep in a crib sometimes alongside mum's bed and sometimes in "baby's room".

It is very much a parental choice. Some people feel that baby sleeping with mum is more natural and that mum's breathing rate acts as a sort of pacemaker for baby. Certainly breast feeding is possibly less disruptive when mum doesn't have to get out of bed and "visit" baby in another room. Both may sleep lighter but feel the benefit of less anxiety and the mutual reward of the others presence. There is certainly a place for co-sleeping but it is, very much an individual choice.

Co-sleeping studies show that babies sleep on their backs and will feed with minimal disruption. Children, as they grow, often opt to leave the parental bed at anywhere between 18 months and 2 years. The maternal bond may be strengthened by co-sleeping and mums who have to return to work may feel that this time makes up for the time they have to spend apart from baby.

Parents who decide to co-sleep must make that decision together and decide when this arrangement should stop. Although traditionally in the West this was not a popular option more families do now co-sleep. As long as the parents are non smokers and are not retiring to bed in a drunken state there should be minimal risk for the child. There are also three sided bassinets available which can be attached to the parental bed, and allow the baby access to mum without the risk of falling out of the cot/bed.
As in all things parents have to be able to communicate their own feelings about this and if it is to work then both parents must be in agreement over the co-sleeping arrangement.

Baby should still be put down when showing signs of sleepiness, drowsy but awake. It should not be necessary for parental bedtime to be the same as that of baby although in the first few weeks mum may benefit from napping when her baby is sleeping. Co-sleeping ,with some thought given to sleep routines, should not constitute a sleep problem in itself and may not necessarily cause or contribute to sleep problems.