Sleep Medicine Blog - Managing Insomnia, Restless Legs Syndrome, Obstructive Sleep Apnoea: August 2009

Sleep - Jet Lag and other circadian rhytm disorders

Other Circadian disorders

Shift work sleep disorder
circadian sleep-wake disorder of blindness

Symptoms

Disrupted female mestruation cycle - female flight attendents
Meals eaten out of phase - result in inappropriate pancreatic and metabolic responses and may be long term risk factors for heart disease
Life span can be shorterned by phase shifting

SWSD - shiftworkers - sleep problems, GIT problems, metabolic syndrome, heart disease and cancer

Suprachiasmic nucleus of the hypothalamus

Central pacemaker

Melatonin, light, body temperature

Management:
Sleep hygine

reduce noise, unwanted stimuli, earplugs, eye patches
avoid alcohol and caffine
jet leg diet - carbs at night for seratonin synthasis and protien in the day - thyrosine, catacholamine production
Naps
Hypnotic agents - short acting "Z" drugs
Light - Lab studies - 460 to 465 nm (Blue); field studies

Melatonin: produced at night for the duration of the night. ? effect on reproduction

Dr Yacoob Omar Carrim
zasleep@gmail.com

10 STEPS TO PEACEFUL BEDTIME

By Claire Marketos

“Sweet dreams, my darling, sleep well, is every parent’s wish for their child. Yet, bedtime can sometimes be a nightmare with youngsters throwing tantrums. If sleep is vital for all of us, why are there so many children who don’t want to go to bed and struggle to fall asleep?

Physical, emotional, and environmental factors all play a part in how easily your child goes to bed and how well she sleeps. You know your child better than anyone else and so it is important to tune into her needs not only at bedtime but during the day as well. Here are some simple guidelines based on what children need to help you make bedtime a pleasure.

DAY TIME AND NIGHT-TIME

In order for your child to develop good sleeping habits, “You must follow the biological forces of sleep. Sleep should happen during night- time hours (the circadian rhythm) and children need to be awake for long enough to be sleepy (homeostatic force),” says Dr. Alison Bentley of The Wits Dial-a- Bed Research Laboratory.

“It is not fair to insist on a specific bedtime unless your child has been awake long enough for her to get sleepy, emphasizes Dr. Bentley, “You have to take daytime sleep into account.” If your child needs a nap, it should happen early in the afternoon. Toddlers, who fall asleep in the car after 3pm in the afternoon, will not be able to sleep easily at night.

ROUTINE

“The key to getting your child to sleep is consistency, consistency, consistency,” stresses Dr.Irshaad Ebrahim of The Constantia Sleep Centre in Cape Town. “Children of all ages respond to rules and routine, as this provides them with an element of predictability in their life and hence security, and they need this especially when they are tired,” explains Ebrahim. “Bedtime should happen in the same way, at the same time every night, as long as day time naps finish early enough,” Bentley points out.

Children can go to bed later on the weekend and during the holidays, once a bedtime routine has been established, and “both parents clearly and consistently explain that this is a variation from the routine,” stresses Ebrahim. The bedtime ritual you use may vary to the one outlined below. Nevertheless, it should get them to bed calmly and quickly, so that they can sleep for at least 8-12 hours a night.

When the child begins slowing down and is tired, it is time to start the bedtime routine. Don’t wait too long, otherwise she may get a second wind and then it becomes difficult to get her to sleep. Announce in a firm matter of fact tone, that it’s bedtime. “Time to say goodnight to everyone, brush your teeth, and go to the toilet.” This should take 5-10 minutes. You can make bedtime more fun by telling your child that her favourite teddy is waiting for them to cuddle, or by describing how snug her bed is going to be. A positive tone from you will reassure her that bedtime can be enjoyable.

For the next 10 minutes you can read a story, and your child can have a drink of warm milk. Give her a favourite soft toy or blanket. The bed and its surroundings should be free of any stimulating toys or pictures. Then, sit with your little one and gently stroke her if necessary to help her relax. Do not engage in conversation, say, “We’ll chat tomorrow.” If she keeps chatting say, “Go to sleep now, I’m going to pack things away in the kitchen.” “Make a slight noise,” Ebrahim advises, “to let your child know that you are still there.” Leaving a bathroom light on also makes children feel safe.

If your child comes out of her bedroom, calmly return her to bed. Be firm and reassuring but don’t resort to hitting or shouting, as “this can arouse the child and make them excitable and alert – the exact opposite of what you are trying to achieve,” explains Ebrahim. Sit with her until she is asleep. If you are implementing this routine for the first time, you may have to return your child to bed several times in the first week. Be tenacious, especially if you have to undo bad habits.

REASON

“Why do I have to go to bed now?”

Giving children an explanation of why they need to go to bed helps them to understand the importance of caring for themselves and being healthy. Tell your child: “You are tired. Your body needs to rest so you can grow big and strong, and so you can have lots of energy to play with your friends tomorrow.” Even very young children will listen to your explanation although they may not understand everything you are saying.

Acknowledge their feelings of not wanting to go to bed. “I know you don’t want to go to bed. I know you want to play with your toys. Tomorrow you will have play time again. It is bed time now.” Doing this initially, will relax and reassure your child, and you won’t have to say it every night.

PEACE AND QUIET

In order to sleep well, children need a peaceful environment with positive, calm parents who are in control. Stick to the bedtime routine, and support the parent, who is carrying it out. If you have ideas to make bedtime easier, discuss them with your partner once the children are sleeping. Be creative, and devise a plan together that makes bedtime a joy, rather than a chore.

Stop all stimulating activity including TV, an hour before bedtime, to help your kids calm down. They cannot sleep if they are not calm.

PHYSICAL NEEDS

In order to sleep well, children’s physical needs have to be met. A warm bath and a healthy, sit down dinner, (not in front of the TV), should take place in the hour before bedtime. Avoid sugary and salty foods, or foods which may have colourants and caffeine in them. After dinner, chat, read, or listen to classical music. Rough-and-tumble games with Mom or Dad should take place earlier in the evening.

On the other hand, physical activity during the day is imperative for good rest at night. If your children are sitting in front of the TV all afternoon, they will have more problems falling asleep than if they’ve had a fun day outdoors.

Always check for symptoms of illness which may be preventing your child from resting peacefully. If your child has persistent nightmares and anxiety at bedtime, consult your family doctor, or a child psychologist as there may be underlying issues of which you are not aware.

SECURITY AND SAFETY

You play a significant role in making your child feel safe and secure, which is important if she is to rest peacefully. Be aware of what you say in front of your children, especially when talking about violence. Keep arguments and fights with your partner private where the children can’t hear you. Kids usually blame themselves if there is conflict in the home and may spend many hours at night worrying about how to fix the problem, rather than sleeping.

Talk to your children about concerns they may have, such as the birth of a new sibling, the beginning of a new school year, disputes with friends and exams. Sometimes you may have to initiate chats and bring up topics, even if your child doesn’t tell you what’s bothering her. These conversations should always make the child feel secure. It is counterproductive to create more issues for them to worry about at bedtime.

Take your child’s fears of monsters hiding in her room seriously. Pretend to fight them off “or give them a torch to make them feel a little in control,” recommends Dr. Bentley.

Children should feel comfortable going to bed, so let them help you make their room and bed an inviting sanctuary.

YOUR FEELINGS IMPACT YOUR CHILD’S ABILITY TO SLEEP

“Children are extremely sensitive to their parent’s feelings. They will know from the way you hug them, look at them, and the tone of your voice, how you are feeling.” Ebrahim explains. “If they sense you are anxious, they may cry at bedtime for reassurance. If you allow them to stay up when they cry, they could interpret you actions as caring for them, or that they are not safe in bed. It depends slightly on the emotional situation in which this happens as to how various messages will be interpreted. Not all of the signals from your children relate to how your child is feeling, but how they think you might be feeling as well,”clarifies Ebrahim.

Give yourself enough time to de-stress before bedtime, and to sit with your child in their bedroom.

MOTIVATION

Having a goal to work towards gives children a sense of accomplishment when they achieve it and it also enhances their self esteem. Find positive ways to motivate your children. Having incentives such as a sticker chart to get them started may help. However, they should learn that sometimes we do things because it is the right thing to do and because it’s good for us. Never reward youngsters with food.

If a child throws a tantrum and resists having to go to bed, understand that she is trying to express her frustration and anger at having to make the change from playtime to bedtime. Acknowledge her feelings with the same exuberance she is expressing them- “You’re cross! You don’t want to go to bed. I understand. Tomorrow you can play again,” while calmly continuing with the bedtime routine.

Praise your children by telling them how proud you are of them when they are successful at bedtime.

LOVE AND COMPASSION

Children need to feel love and acceptance to sleep calmly. Show them patience and compassion when they are tired, and especially if they have been through a life changing experience, such as the birth of a sibling, divorce or death.

During these times, children may need more assurance and attention from you during the day, to help them feel secure at night. In severe cases they may also need play therapy from a professional child psychologist, especially if anxiety persists.

A child often regresses during difficult times, especially if there is a newborn in the parent’s room, and then it may be necessary for a mattress to be placed in the parent’s room for your older child to sleep on. Give her what she needs and then after several weeks, slowly help her to make the transition back to her own bedroom.

Attention from you is essential for peaceful sleep. If you are away from your child all day, she will want to attach to you from the moment she sees you, and therefore may act out at bedtime to be close to you.

Feelings of guilt should not prevent you from being firm and doing what is best for your child.

FOLLOW YOUR INSTINCTS

Most children who wake at night can be soothed back to sleep quickly. However, Dr Bentley explains “Children who have a very disruptive sleep disorder can wake up to seven times a night and demand either milk or rocking to go back to sleep. This is usually not due to any physical need but rather a behavioural disorder for which you may need professional help.” (See essential signs of seep disorders.)

ESSENTIAL SIGNS OF SLEEP DISORDERS IN CHILDREN:

1. Snoring and associated hyperactivity or sleepiness in the daytime

2. Interrupted breathing while asleep

3. Excessive limb movements in sleep

4. Sleepwalking

5. Sleep/night terrors (not the same as nightmares)

6. Inability to fall asleep, despite adequate parenting

If you feel your child may have a sleep disorder, talk to your general practitioner or paediatrician.

Chat to your partner and come up with a plan for the middle of the night you both agree on. If junior can climb into your bed without waking you or your partner, it will provide an excellent opportunity for you to all bond and cuddle, especially if you are separated during the day. If you are unable to sleep with junior in your bed, a mattress next to it may be an alternative, or follow the same routine you used at bedtime. Ensure your little one’s room is warm enough. You may want to use a sleeping bag if she kicks her blankets off. Letting her have one of your T-shirts that smells like you to cuddle with can provide solace.

If she has a nightmare or wakes up afraid during the night, gently reassure her that she is safe and that you are there for her. If the nightmares continue speak to your family doctor or a child psychologist. When you say goodnight to your child, remember to always tell her you love her and say: “With a butterfly kiss and a ladybug hug, sleep tight little one like a bug in a rug." A good night to you all.

Useful Contacts: Dr Yacoob Omar Carrim http://zasleep.blogspot.com

Sleep Medicine Blog - Managing Insomnia, Restless Legs Syndrome, Obstructive Sleep Apnoea

Tuesday, August 25, 2009

Melatonin, Dr Yacoob Omar Carrim

Sleep - Jet Lag - Dr Yacoob Omar Carrim

Circadian Factors - Dr Yacoob Carrim

Circadian Factors

Friday, August 14, 2009

10 STEPS TO PEACEFUL BEDTIME By Claire Marketos