Night Waking

Waking in the night is one of the most common difficulties that beset children. Recent studies looking at the age and stage of children who have difficulty in sustaining sleep show that 25-50% of 6-12month olds, 30% of 1year old children and 15-20% of toddlers 1-3 years old continue to have night wakings.

These night wakings occur for a variety of different reasons but persistent problematic night wakings are often due to inappropriate sleep onset associations. For some these wakings occur as regularly as every 45-90 minutes. This is of great concern to parents who are also deprived of sleep in order to settle the child.

There is often considerable variation in the night to night and week to week patterns and neither infants, nor parents, are consistent in the way they behave and interact at these wake times. Of course what one parent sees as a difficulty another parent or family accept as "normal" so night wakings are seldom addressed in the same fashion across the population.

Children or adolescents who experience persistant night wakings that are extermely disruptive to the family as well as the complainant should be seen by a sleep specialist. There are very effective ways to alter this night waking behaviour and to improve the night sleep.

If you are experiencing this difficulty within your family Contact Dream-Angus.com we can help you to resolve this issue and improve your night sleep.

Nightmares

Nightmares are frightening dreams that occur during Rapid Eye Movement (REM) sleep, which usually result in waking from sleep and seeking reassurance. The content of nightmares varies with the age and developmental stage of the child. They may coincide with a frightening event, trauma or stress. They are more prevelant when there is sleep deficit. On average 75% of children experience at least one nightmare and 10-50% of young children require parental intervention to reassure them in the night. Chronic nightmares are nightmares which occur regularly over 3 months or longer. One study shows that 24% of children aged 2-5 years and 41% of children aged 6-10 years experience chronic nightmares.

If a child has experienced frequent nightmares then this can make the child afraid to go to bed (bed time resistance) because they anticipate frightening dreams.

Children remember the scary content of the dream and they awake with feelings of impending harm and anxiety. Return to sleep following this experience is delayed. The child has this experience in the later part of the night whereas Night terrors usually occur within the first few hours of settling to sleep, do not result in a full awakening and return to sleep is much more rapid.

There are a variety of strategies which can be successfully used to reduce and eliminate nightmares. Where behavioural strategies fail or the nightmares are extremely disruptive and persistant referral to a mental health specialist for evaluation and treatment are worthwhile.

If you would like help to reduce your child's nightmares contact Dream-Angus.com.

Bed Wetting/Nocturnal Enuresis

Bed wetting or nocturnal enuresis, remains a common issue for parents and children.

Nocturnal Enuresis is defined as spontaneous emptying of the bladder during sleep occuring in children 5 years of age or older. In the USA this affects 5-7million children.

Restricting the amount of fluids given before bed,and/or toileting the child before the parents retire has little or no effect on this.

Medications are rarely appropriate before the age of 7 years and generally if the child is not distressed it is wise to wait and see if this does resolve over time. For many children resolution is a matter of maturity and by the time they have reached 7 years there is no problem.

If the child is 5 years old and distressed by wetting the bed then it is possible to look at methods of training the bladder. Studies show that the use of Enuretic alarms combined with behavioural therapies are effective when the child is motivated. Children should not be made to feel guilty about this problem and they should be reassured that it can be resolved.

There are a variety of theories about the cause of bedwetting and these are probably the most familiar;-

1) That there is a difference between the bladder's capacity and the production of urine overnight.

2)That the child sleeps so deeply that the normal "alert" of a full bladder is not disturbing.

3) That the child's bladder is smaller and with maturity this will change.

Various factors can potentially influence the balance between nocturnal urine production and functional bladder capacity. Different types of bladder dysfunction, resulting in a small nocturnal bladder capacity, probably contribute significantly. As different clinical subgroups may have different responses to treatment, it is necessary to distinguish these subgroups before a decision on the specific treatment protocol can be made. New insights have an important bearing in our future management strategy for bedwetting

If you would like help and advice in dealing with this problem,

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Babies and circadian rythm.

The hormone Melatonin produced in the pineal gland regulates sleep. It does so using the initial building block of tryptophan which is an omega 3 fatty acid. This initial and important building block is present in breast milk. Mum's circadian rythm is usually well established and it is interesting that a study looking at the levels of this important omega 3 in breast milk has found that mum's circadian rythm has an effect on the amount of "sleep related hormone" secreted in breast milk.
Sleep efficiency in babies of 12 weeks, both only breast fed and those who were formula fed was measured over a week and it was found that assumed sleep, actual sleep and sleep efficiency was significantly better in exclusively breast fed babies.
It follows that breast fed babies are already learning to develop a circadian rythm which is parallel to that of mum. The levels of tryptophan which fluctuate to follow mum's rythm are starting to "train" baby.

Another study investigated the relationship between exposure to light and 24-h patterns of sleep and crying in young, healthy, full-term babies living at home and following a normal domestic routine. Babies were monitored across three consecutive days at 6, 9 and 12 weeks of age. There was an early evening peak in crying which was associated with reduced sleep at 6 weeks. Across the trials there was a gradual shift towards a greater proportion of sleep occurring at night. Sleeping well at 6 weeks was a good indication of more night-time sleep at 9 and 12 weeks. Babies who slept well at night were exposed to significantly more light in the early afternoon period. These data suggest that light in the normal domestic setting influences the development of the circadian system.

Both of these studies demonstrate the ability of babies to "learn" a circadian rythm and confirm that encouraging naps in normal daylight will improve infants night sleep patterns.

If you would like information and advice on training your baby to sleep
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Research and Narcolepsy

In May of this year groundbreaking research about the key role the immune system plays in Narcolepsy was published. A team of international researchers led by Emmanuel Mignot, MD, PhD, and Director of Stanford’s Center for Narcolepsy found a tight association between narcolepsy and a genetic mutation in T cells, the immune system’s vehicle for identifying and attacking foreign bodies.

Although further research is needed to determine exactly how this mutation leads to narcolepsy, the research behind this highly technical article, titled, “Narcolepsy is strongly associated with the T-cell receptor alpha locus” is based on a study of the analysis of DNA samples from over 800 patients with narcolepsy and cataplexy. Dr Mignot stated that this is opening the door for preventive therapies. The implications of this research go well beyond the narcolepsy field. As the first of its kind to link a disorder associated with the immune system to the T cell alpha locus, it provides a model for the study of over 100 other similarly associated disorders including juvenile diabetes and multiple sclerosis.

Generally children with narcolepsy have a completely normal development although secondary narcolepsy is associated with underlying neurological disorders such as Nieman-Pick disease where there is developmental delay. In first degree relatives 10% may also have narcolepsy and up to 40% of narcoleptic patients may have a family member who has excessive daytime sleepiness.

Narcolepsy is fortunately one of the less common sleep disorders but has long been recognised as having a definate genetic link. Most sufferers are diagnosed in late teens although some younger children have also been identified as narcoleptic.

Narcolepsy is a lifelong chronic disorder that will always require management. The aims of "treatment" are adaptation to living with this disorder and improving quality of life.

Sensory integration and sleep.

What does it take to make your child comfortable? For some children light touch is irritating. They prefer firm contact. These children often have difficulty settling to sleep when the bed covers are light but offer a weighted blanket and they settle much more easily.
Our perception of touch, sound, colour and texture is part of what makes us who and what we are. Children who have difficulties with their sensory information often also have difficulties in other areas of their lives. When we recognise this we can address it and provide the comfort that the child needs to feel secure in their environment.

Some children who require "deep stimulation" like to be held firmly and this will also assist in settling them to sleep. Using a sleeping bag or a weighted blanket is comforting because there seems to be a defined place in the bed for them, they feel as if they are being held, without any danger of "falling out" or being left loose.

Small babies enjoy being swaddled because it replicates the space they came out of and being swaddled is like being held without mum or dad having to hold them. Most children grow out of the need for this but some do not.

Settling to sleep is a behaviour that we want our children to acomplish by themselves, without the need for our intervention. Looking at each child as an individual and identifying the measures that make that child feel secure can help in assisting that child to relax and go to sleep.

Sleep disturbances are much more common in children with sensory difficulties than in the rest of the population. This is well recognised, but it is also possible to alter their sleep behaviour. It may present more difficulties and may take longer but it is certainly possible.

If you would like help and support in altering your child's sleep behaviour,
Contact Dream-Angus.com

Relaxation before sleep (1)

Some older children have problems getting to sleep. They may already have a short pre bed routine, getting washed and toileted, brushing their teeth, getting dressed for bed and lying down ready for sleep, but it seems difficult for them to get over to sleep.

This can be for a whole variety of reasons. Their minds may still be busy, perhaps there is something special happening or the day has been exciting and they are still reveiwing the events. For others there may be concerns about tomorrow, a school exam, a big event or it may just be perceived as "normal" for that particular child to have this difficulty.

Ensuring that the hour before bed time is unstimulating, that the bedroom is seen as a safe place and that the pre bed routine is maintianed will all help but some children need a little more.

There are two basic relaxation techniques that are helpful, not just for children but also for adults.

The first is a visualisation technique which requires that the child close their eyes and breathe deeply. Keeping one hand on the diaphragm, to feel the movement of the chest during breathing, close the eyes and picture a wall of velvet. The velvet is black or navy blue and the true colour is only seen in the deep folds as it flows down from the ceiling.

In a corner above the velvet is a bright white light. As breathing in occurs the light gets brighter, on breathing out this light gets dimmer. After watching the light for five breaths, watch the velvet and the effect of the light on the surface.
Observe the deep colour and the softness of the fabric.

This exercise calms the mind and offers a different focus for intrusive thoughts. For some this offers a speedy relapse into the gentle arms of sleep. This is so simple that it can be used at any time and requires no other intervention. Learning to use this method offers a solution to some of the distractions which make sleep so difficult to obtain. It can be used to start a nap or a deep overnight sleep.

If your child has difficulty settling to sleep or staying asleep they are not alone. It is estimated that 37% of children aged 4-11 have difficulties with this. When these difficulties are not addressed they can become chronic.
For help and support, contact Dream-Angus.com