Sleep and adolescence

Sleep deficit in adolescence has been recognised and commented on for some time. It is well recognised that sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents.

Earlier this year, a study looked at this school population and their experience of sleep and sleep quality.

General education classes were randomly selected from a convenience sample of three high schools in the American Midwest. Three hundred eighty-four ninth- to twelfth-grade students (57%) completed a self-administered valid and reliable questionnaire on sleep behaviours and perceptions of sleep.

The findings showed that most respondents, (91.9%) obtained inadequate sleep. In many ways this is unsurprising as most adolescents seem to live in a "twilight" zone.

How much is due to poor sleep hyigene and bad habits around sleep is not explored. Nor is there any investigation of what type of sleep disturbance is most common in this group. Other studies suggest that school activities, jobs after school and other hobbies and responsibilities may impact on the sleep schedules of adolescents. One can only hope that in highlighting the difficulties some measures were put in place to address the sleep deficit that these individuals experience.

Australian study of sleep in primary school children.

It has long been recognised that adequate sleep optimizes children's learning and behavior. However, the natural history and impact of sleep problems during school transition is unknown.

This study was set up to determine
(1) the natural history of sleep problems over the 2-year period spanning school entry and
(2) associations of children's health-related quality of life, language, behavior, learning, and cognition at ages 6.5 to 7.5 years with (a) timing and (b) severity of sleep problems.

To acheive this data was drawn from the Longitudinal Study of Australian Children. Children were aged 4 to 5 years at wave 1 and 6 to 7 years at wave 2.
Parent-reported predictors included (1) timing (none, persistent, resolved, incident) of moderate/severe sleep problems over the 2 waves and
(2) severity (none, mild, moderate/severe) of sleep problems at wave 2.

Outcomes included parent-reported health-related quality of life and language, parent- and teacher-reported behavior, teacher-reported learning, and directly assessed nonverbal (matrix reasoning) and verbal (receptive vocabulary) cognition. Linear regression, adjusted for child age, gender, and social demographic variables, was used to quantify associations of outcomes with sleep-problem timing and severity.

Sleep data was available at both waves for 4460 (89.5%) children, of whom 22.6% (17.0% mild, 5.7% moderate/severe) had sleep problems at wave 2. From wave 1, 2.9% persisted and 2.8% developed a moderate/severe problem, whereas 10.1% resolved.

Compared with no sleep problems, persistent and incidental sleep problems predicted poorest health-related quality of life, behavior, language, and learning scores, whereas resolving problems showed intermediate outcomes. These outcomes also showed a dose-response relationship with severity at wave 2, with effect sizes for moderate/severe sleep problems ranging from -0.25 to -1.04 SDs. Cognitive outcomes were unaffected.

The final conclusion was that sleep problems during school transition are common and associated with poorer child outcomes.

(QUACH J, HISCOCK H, CANTERFORD L, WAKE M.
Pediatrics 2009;123(5):1287-1292.)

Sleep and behaviour in 2-3 year olds

This year in the Reid Hong and Wade, of the Department of Psychology in the University of Western Ontario, completed a study reviewing the relationship between common sleep problems and emotional and behavioural problems among 2- and 3-year-olds.

The contribution of sleep problems to emotional and behavioural problems among young children within the context of known risk factors for psychopathology was examined. Data on 2- and 3-year-olds, representative of Canadian children without a chronic illness, from three cross-sectional cohorts of the Canadian National Longitudinal Study of Child and Youth were analysed (n = 2996, 2822, and 3050).

The person most knowledgeable, usually the mother, provided information about her child, herself, and her family. Predictors included: child health status and temperament; parenting and any symptoms od maternal depression; family demographics (e.g., marital status, income) and functioning. Child sleep problems included night waking and bedtime resistance. Both internalizing/emotional (i.e., anxiety) and externalizing/behavioral problems (i.e., hyperactivity, aggression) were examined.

Adjusting for other known risk factors, child sleep problems accounted for a small, but significant, independent proportion of the variance in internalizing and externalizing problems. Structural equation models examining the pathways linking risk factors to sleep problems and emotional and behavioral problems were a good fit of the data. Results were replicated on two additional cross-sectional samples.

The relationship between sleep problems and emotional and behavioural problems is independent of other commonly identified risk factors. Among young children, sleep problems are as strong a correlate of child emotional and behavioural problems as symptoms of depression in mothers, a well-established risk factor for child psychopathology. Adverse parenting and depression in mums, along with difficult temperament all contribute to both sleep problems and emotional and behavioural problems.

Children's sleep problems appear to exacerbate emotional and behavioural problems.

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Sleep in children starting school

Sleep disorders in children starting school are associated with impaired performance and behavioural difficulties. This is not at all unusual and a recent study by Lehmkul G Fricke-Okermann L, Wiater A and Mitchke decided to look at the causes and effects of sleep disorders in this group. It is already recognised that these disorders manifest themselves highly variably among children of any given age, and even in an individual affected child, they need an appropriate diagnostic evaluation so that the many environmental and background factors that may be relevant to the further course of the problem can be assessed.

In order to look more closely at this extensive data was obtained on approximately 1400 children who were tested before beginning school in 2005. This was accomplished using a special sleep questionnaire and another screening instrument that is used to assess behavioral strengths and difficulties (the SDQ, Strengths and Difficulties Questionnaire).

Five percent of the children were found to have difficulty falling asleep, difficulty staying asleep, or nocturnal awakening. Less frequent problems included parasomnias such as pavor nocturnus (0.5%), sleepwalking (0.1%), and frequent nightmares (1.7%).

This study showed that sleep disorders increase the risk of daytime fatigue and of psychological problems in general, including both hyperactivity and excessive emotional stress.

These results imply that sleep problems and emotional disturbances are intimately connected and underscore the importance of diagnosing sleep problems in young children.

If you are aware that your child is having sleep difficulties contact Dream-Angus.com for support and advice.

Parasomnias

Parasomnias are unusual behaviours or strange experiences, which occur mainly or only when going to sleep, during sleep or when waking up. Parents are often very concerned about these events, however they do not mean that the child is psychologically disturbed or medically ill in any way. Very often these events will stop after some time and without any intervention but sometimes safety measures must be taken to protect the child. For example in sleep walking it is useful to ensure that the child does not injure themselves.

There are currently over 30 types of recognised Parasomnias in two main groups.

Primary Parasomnias can be grouped according to the time of night when they occur.

Secondary Parasomnias are the expression of underlying medical, behavioural or psychiatric conditions. Nocturnal epilepsy, nocturnal panic attacks

Parasomnias occur at all ages but are more common in children than in adults. Children may have more than one type of parasomnia as they may also have more than one type of sleep disorder. Sleep apnoea can be associated with sleep walking for example.

It is very important that the parasomnias are correctly identified as the treatment and interventions required are dependant on this. Accurate identification depends on a detailed account of the experiences both from a subjective and objective sequence of events, the timing of the event and the cicumstances in which the event occured. Audio visual recording, in the form of home video can be very helpful in this.

Specific medication is usually only required in a minority of primary parasomnias but may be required to treat the underlying problem in secondary parasomnias.
Research information on Parasomnias is quite limited at the moment.

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