Article Review Day 7: Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome is a dyssomnia.

Who: 2-3%, the highest prevalence is in preschool-aged children

What: It is "a disorder of breathing characterized by partial or complete upper airway obstruction during sleep. The obstruction can be intermittent or protracted and interferes with normal ventilation and normal sleep patterns."

When: During sleep.

Where: In bed.

What: "Symptoms include nightly snoring frequently accompanied by sporadic pauses, gasping, choking, disrupted sleep, and daytime attentional and/or behavioral problems. Associated problems include chronic rhinitis, nasal congestion, mouth breathing, otitis media, sore throats, halitosis, and frequent upper respiratory infections. Frequent complications include attention and behavioral difficulties, restless sleep, and growth impairment."

Why: The abnormal body functions that accompany this particular syndrome are an inadequate supply of oxygen to the tissues resulting from apneas (suspension of external breathing) and leads to numerous arousals from sleep.

How: How does a parent deal with this? First, if any of these symptoms seem familiar, you need to pay careful attention to your child's sleep. "Children with suspected OSAS symptoms should be referred to a pediatric otolaryngologist for evaluation, and a sleep study should be considered."

Sunday Sleep Dilemma

Q: My oldest child is going to be in first grade and gets out of school at 2:30pm, my youngest child usually takes a nap from 1:30 until 4pm. How can my youngest get his nap, and my oldest get picked up from school?

A: There may not be a perfect solution to this problem, but here are some ideas:
-Find someone to carpool with. You take the kids to school, and she can bring them home. Protecting the afternoon nap.
-Have a relative stay at the house while you go pick up your oldest. Again, protecting the afternoon nap.
-Try having your youngest take the nap earlier, and then wake him up to go to the pick-up. Or have him take it later, get there early, so you can get out of the parking lot back-up quickly and home to start the nap (this may push back bedtime too late, where the earlier nap may make bedtime earlier).
-Since sleep debt is cumulative, if he is missing sleep time during the week, make sure he has really good naps on the weekends... Try to make sure he gets the needed amount of sleep regardless.

Any other ideas? I am sure plenty of moms have had to deal with this one.

Article Review Day 6: Insufficient Sleep Syndrome

You struggled with your baby's sleep; you struggled with your toddler's sleep; you continue to struggle with your preschoolers sleep. "Insufficient sleep syndrome arises when a child regularly fails to get an adequate amount of sleep to maintain appropriate wakefulness during the day. The child's usual sleep period is shorter than predicted by age-based norms, and the child may experience daytime sleepiness or other behaviors indicative of sleep loss in child (e.g. problems with attention and concentration, irritability, and hyperactivity). Hmmm, could this have been the problem with some of my students all those years?

Besides the guidelines on the number of hours of sleep children need I often give which I find to be pretty accurate, (In general newborns should nap after 1-2 hours of being awake and then sleep for a large amount of time with a feeding or two mixed in. Infants will then transition to a three or maybe straight to a two nap a day schedule through 12-18 months. They should get 14-15 hours of sleep. Toddlers will have an afternoon nap and should get about 12-14 hours of sleep per day. Preschoolers may or may not have an afternoon nap and will continue with 11-13 hours of sleep per day. School age children should get 10-11 hours per day.) a few questions to consider in checking if your child is getting enough sleep are:

• Can he/she fall asleep easily at night (in less than 20 minutes)?
• Can he/she wake up easily at his/her normal wake time?
• Does he/she require a daytime nap? (if a nap is age appropriate please make sure they nap)

Some Tips for Addressing Insufficient Sleep Syndrome:

• Take inventory of your busy life- what can you cut out to allow for your child to get their needed sleep? What activities do you need to cut out or limit in your child's schedule?
  
• Check out your child's sleep environment- can something be changed to make it a more suitable sleep environment?
• Are you too tired to enforce bedtimes? What can you do to fix this problem?
• Do you need to subscribe to Lullaby Luna to stay up on sleep ideas? Do you need to read a sleep book? Do you need to come up with a consistent discipline plan with your children? Are you educated on the "importance of sleep to a child's health and well-being?"

"Many adults do not realize the pervasive and profound effects that even a small amount of sleep loss can have on a child's cognition and behavior."

Saturday Sleep Tip

Let's take a minute and look at our children's daily schedules. What do they look like? What is filling their time? Do we compromise our children's sleep to fit everything in (sports, ballet, exercise, errands, dinner, homework)?

"Overstimulated, overscheduled kids are getting at least an hour's less sleep than they need, a deficiency that, new research reveals, has the power to set their cognitive abilities back years." (Bronson, NYmag).

Have you asked your child/teen if they are tired? If they have daytime sleepiness? Do they fall asleep in class? Are they cranky and irritable (more than is age appropriate)?

"While parents obsess over babies' sleep, this concern falls off the priority list after preschool. Even kindergartners get 30 minutes less a night than they used to."

How much sleep does your child get? How much should they get? In general, newborns should nap after 1-2 hours of being awake and then sleep for a large amount of time with feedings mixed in. Infants will then transition to a three or maybe straight to a two nap a day schedule through 12-18 months. They should get 14-15 hours of sleep. Toddlers will have an afternoon nap and should get about 12-14 hours of sleep per day. Preschoolers may or may not have an afternoon nap and will continue with 11-13 hours of sleep per day. School age children should get 10-11 hours per day. Adolescents should get 8 1/2- 9 1/2 hours per day.

"There are many causes for this lost hours of sleep. Overscheduling of activities, burdensome homework, lax bedtimes, televisions and cell phones in the bedroom all contribute. So does guilt; home from work after dark, parents want time with their children..."

I would take a good look at all the activities that fill my child's time. What is necessary? What can be cut? How can time be used more efficiently and effectively so they can get the needed amount of sleep? When as a parent do I need to say no? What rules and boundaries need to be put into effect in my house?

"... sleep affects academic performance and emotional stability, as well as phenomena that we assumed to be entirely unrelated, such as the international obesity epidemic and the rise of Attention Deficit Hyperactivity Disorder. A few scientists theorize that sleep problems during formative years can cause permanent changes in a child's brain structure: damage that one can't sleep off... It's even possible that many of the hallmark characteristics of being a tweener and teen- moodiness, depression, and even binge eating- are actually symptoms of chronic sleep deprivation."

Even though these studies are not conclusive, you get the idea that the effects of poor sleep or sleep deprivation are serious. We all know that a well-rested Me is better than it's exhausted counter-part. We need sleep to function well, and our children need sleep as well. We have to be the authority that makes this happen.

Article Review Day 5: Inadequate Sleep Hygiene

Sleep hygiene? Yes, we try to work on our kids dental hygiene as much as they will cooperate, but sleep hygiene? Really?

We all want to create good dental habits in our children to maintain the integrity of their teeth, in the same way to want to create "habits and activities that promote the initiation and maintenance of effective sleep." Poor dental hygiene creates cavities that need fillings. Poor sleep hygiene creates habits that "enhance wakefulness and interrupt the sleep period, which can lead to a decrease in the quality and quantity of sleep and excessive daytime sleepiness."

Examples of Poor Sleep Hygiene:

• "engaging in stimulating activities near bedtime"- you should probably skip the before bedtime basketball game
  
• "using the bed for non-sleep-related-activities" (e.g. playing, watching tv, time out)
• "routine consumption of caffeine near bedtime" (Note: chocolate has caffeine. I recently read that it takes a child up to 6 hours for caffeine to completely leave their body)
• "allowing the bedroom to be uncomfortable to the sleeper (too cold, too hot, too noisy, too bright, etc.)"
• "inconsistent bedtimes and wake times with or without inappropriate napping"

Ways to Change Sleep Hygiene and Create Good Habits:

• "develop a consistent, calming bedtime routine" (bath and storytime are good items to have in your routine)
• "activities such as reading and singing lullabies also can foster sleep onset"
• be educated on poor sleep hygiene and avoid
• work with a sleep specialist/doctor or sleep consultant to create a plan that works with the family's schedule and lifestyle and gets the child the sleep they need.
  

Sunday Sleep Dilemma

Q: I need to run errands in the morning with my baby and my kindergartner. My baby really still needs a morning nap. How do I get my baby the sleep he needs and get my errands done?

A: You may not like my answer, but don't skip your baby's needed nap! Figuring out another plan...
Ideas:
-Go to the store at night if you have someone that can be at home when the kids are asleep.
-Shop online as much as you can.
-Bring lunch with you to the errands and go after your baby's nap time. Think less clean up too.
-Go after your baby's afternoon nap. More crowds, but it is usually a funky time for kids and may be nice to get out.
-Get a babysitter once a week for a few hours and get all your errands done sans kids. It is much quicker and may be some nice quiet time for you.
-Consolidate errands, so you can spend less time out during the week.

Article Review Day 4: Limit-Setting Sleep Disorder

Limit-Setting Sleep Disorder is a dysommnia.
Does anyone have a demanding preschooler? Does anyone has a preschooler who resists bedtime? Does anyone give into their preschooler? We all give into our kids at times- even the best parents have weak moments... consistent inconsitency can lead to this disorder.

The most common form of Limit-Setting Sleep Disorder is the preschooler who makes excessive (some requests may be normal but excessive is key) demands at bedtime to delay sleep. It looks pretty much the same in all homes: another story and another, water, potty again, another show, a parent going to sleep with the child or laying with them while they fall asleep. Whatever the demands may be, they make bedtime later, sleep time shorter, and bedtime and bedtime routine become inconsistent (ew! inconsistent).

"Bedtime resistance often leads to delayed sleep onset, which is classified as requiring longer than 20 minutes to fall asleep after going to bed. The degree of sleep loss depends on the actual length of time children require to fall asleep but is often enough to result in behavior and learning problems during the day."

How do I combat Limit-Setting Sleep Disorder you ask?:
-set up an appropriate bedtime where they get enough sleep. Figure out that appropriate bedtime based on how much your child's age needs.
-make sure your child is getting the needed amount of day sleep if that is appropriate for their age.
-create a bedtime routine. It may consist of: bath, book, PJs, teeth... What does your routine look like? I like to encourage a simple routine.
-help your child feel safe and secure in their sleep environment. You may also want to spend some fun time in their room during the day. You may also want to give children the chance to help arrange and decorate their own room. These things will help them feel comfortable being alone in their room.
-parental firmness- set limits and expectations and be consistent in them- both day and night.

Article Review Day 3: Sleep-Onset Association Disorder

Sleep-Onset Association Disorder is a dyssomnia (remember last Thursdays post?).

Night wakings are normal in infants and preschool children. They may wake up as many as 5 to 8 times a night. You may be thinking, my child sleeps all night (or at least most of the time). Or, you may be thinking, yep, they wake up about 5 to 8 times a night. Well, according to this article (I have been reviewing over the past few Thursdays) "the difference between children who are 'good sleepers' and sleep through the night and those who are 'poor sleepers' and wake frequently is their ability to self-soothe after awakening." So, even if you have a good sleeper that doesn't wake up they are probably just waking up and soothing themselves back to sleep. Self-soothing is wonderful and necessary. It sometimes means letting a child cry for a short period of time to discover how they will self-soothe. Many children are never given the opportunity to learn how to self-soothe. What does your child do to soothe themselves back to sleep? Do you soothe them back to sleep?

You may wonder why it is necessary for children to learn this skill. Well, if you soothe your child to sleep at bedtime with rocking or nursing or bottle feeding (this doesn't mean you skip a nighttime routine or if they fall asleep nursing they are going to be poor sleepers) they may learn to expect these as the way to go back to sleep when they wake during the night, and then you do these things to soothe them back to sleep during the night. "These children are unintentionally trained by their parents to expect these conditions and can experience many disruptions in their nighttime sleep leading to sleep loss. Parents also experience stress and a profound sleep deficit themselves because of night waking, resulting in potential for a negative impact on overall family functioning."

So, what do you do if your child has Sleep-Onset Association Disorder:
-Keep reading Lullaby Luna- informing yourself as a parent is a great way to help your kids get a new sleep routine.
-As a parent, you need to learn how "to help your children fall asleep in their cribs or beds and return to sleep during the night with minimal parental intervention."
-You may try "crying it out" or "graduated extinction" where you check on the child during episodes of nighttime crying- you make scheduled checks on the child and slowly increase the time between the checks. "During the checks, the parent should not hold or rock the child, as this will reinforce the crying and the need for parental intervention to return to sleep. By simply checking on the child, the child is reassured that his parents are still present but learns self-soothing techniques and often will accept that he is safe, his parents are near, and that he can fall asleep without the help from his parents."
Note: In my experience, crying will be part of this training, this training is necessary to create good sleepers, the younger the better (I like to do this by 5-6 months old), if your child is older it will take longer and probably be more difficult- not impossible, just more difficult.
-If you struggle to do this on your own or feel overwhelmed hire a sleep consultant.