Thursday, December 9, 2010

Restless Legs Syndrome

Restless legs syndrome (RLS) is the third most common reported sleep disorder, and one of the most common causes of severe insomnia. Including its mild form, this irritating disorder affects between 10 and 15 percent of the population. Although its classified separately as a movement disorder  its important to note that all sleep related movement disorders are technically parasomnias.

Together they comprise the movement and behavioral disorders related to sleep. The way people describe their symptoms is often imprecise and can vary considerably, but the common denominator is an unpleasant sensation in the legs.

Sufferers may say they feel a "creepy, crawly" sensation in their legs when they trying to sleep or when they're just resting quietly. Or they describe extreme discomfort, pain, pulling, searing, boring, or deep itching sensations down the legs. Some patients have even described this sensation as 'electric ants' or bugs running up and down the legs.

The symptoms are typically relieved only by movement or stimulation of the legs. Doctors call this paresthesias -"abnormal sensations". For some people the feelings are a minor annoyance, and for others they're sheer torture. In all cases there's an urge to move the legs, getting the legs moving eases the symptoms temporarily.


WHO GETS RLS (Restless Legs Syndrome)

It can strike people of any age, RLS (Restless Legs Syndrome) is most commonly reported among people over the age of 40, and is classified as early onset if it strikes before the person is 45 years old. It's 1.5 to 2 times more common in women than in men. Many people who are later diagnosed with RLS ( Restless leg syndrome ) reporting having symptoms in childhood , and there's mounting evidence to suggest that its often misdiagnosed among children as attention deficit /  hyperactivity disorder or " growing pains."

In more than half cases,  primary RLS (  Restless legs syndrome ) runs in families. If you have an immediate family member with RLS ( Restless legs syndrome ), your risk is three to six times greater of developing the disorder.

Current  exciting research shows that there may  be a gene marker for RLS (Restless leg syndrome ) that explains this familial connection.

WHAT CAUSES RLS ( Resless legs syndrome ) ?

RLS ( Restless legs syndrome ) may be primary or secondary .  Primary RLS ( Restless legs syndrome ) means that there is no underlying disorder causing it , whereas secondary RLS ( Restless legs syndrome) means that another condition ( medical or neurological ) or a medication is really at the root of it . In the latter case, treating the underlying condition or stopping and offending medication should resolve the RLS ( Resless leg syndrome ). Although the majority of cases of  RLS ( Restless legs syndrome ) are primary ( with presumed problems with the brain's iron and dopamine systems), there are some known causes and associations with other conditions.


  • Iron deficiency and anemia are known to increase the risk of RLS (Restless legs syndrome ).
  • Several types of medications may bring on or aggravate RLS ( Restless legs syndrome ) , including many cold and allergy medications , antinausea  medications, antidepressants ( except Wellbutrin, a adopmine-enhancing  medication that may actually help ), antiseizure drugs, and antipsychotic drugs.
  • About 20-40 percent of those with chronic kidney failure on dialysis have RLS (Restess legs syndrome). The RLS (Restless leg syndrome ) symptoms disappear after a successful kidney transplant. The strong link between kidney disease and RLS ( Restless legs syndrome ) is still greatly under-recognised ,especially among kidney specialists.
  • Peripheral neuropathy , Parkason's disease, Lyme-disease myelitis,and diabetes mellitus have all been linked with RLS ( Restless legs syndrome )
  • Caffeine, tobacco, and nicotine can aggravate or trigger RLS ( Restless legs syndrome ) symptoms.
There is no evidence that RLS  ( Restless legs syndrome ) is linked with any sort of underlying psychological problems. nor does it signal the onset of any other neurological disorder. However, because the distressing symptoms and resulting sleep deprivation of RLS ( Restless legs syndrome ) can be chronic, it can induce depressive and anxiety disorders.

PREGNANT WOMEN AND RLS ( Restless legs syndrome )


About 26 percent of pregnant women get RLS ( Restless legs syndrome ), and it gets worse in the second and third trimesters. Ten percent of them already had th disorder before they got pregnant,but it generally gets much worse during pregnancy. The remaining 16 percent didn't have the disorder before, and some worry that its going to harm the baby,or that it is a sign of something wrong. It isn't RLS ( Restless legs syndrome )in the mother does not pose any known risk for the baby. The problem that requires treatment is when the mother is losing significant amounts of sleep most nights because of the RLS ( Restless legs syndrome ). Dopamine medications,which are the most-recommended treatments for RLS ( Restless legs syn

Tuesday, November 30, 2010

Narcolepsy and Excessive Daytime Sleepiness

Narcolepsy and Excessive Daytime Sleepiness
Narcolepsy is a serious, but relatively uncommon, disorder characterized by sudden and uncontrollable attacks of sleep. These attacks can be brief - lasting just 30 seconds - or longer, lasting as long as 30 minutes or more. Sometimes the attacks are accompanied by hallucinations and/or temporary paralysis. Narcolepsy can be quite debilitating, causing lack of muscle control and dream experiences occurring at inappropriate times.

Sufferers often unexpectedly fall asleep in the middle of important activities, including driving and while playing sports. This can be quite dangerous for themselves and others. In addition, they can fall asleep during conversations and at work, harming their personal and professional relationships.

Those with Narcolepsy often experience a temporary paralysis, which can be physically harmful if they fall down, and also very frightening when it occurs.

Research to date reveals that Narcolepsy appears to affect the part of the central nervous system that controls sleep and wakefulness and that it is not a psychological disorder. While there is no "cure" yet, recent advances in medicine, technology and pharmacology allow those with Narcolepsy to lead nearly normal lives. The finding that the Brain Protein called Orexin or Hypocretin is deficient in patients with Narcolepsy by leading researchers, including our own, is bringing hope of a cure. The doctors at the Sleep Medicine group of sleep centres are actively pursuing this research.

Diagnosing Narcolepsy needs to be done in a clinic that is familiar with sleep medicine. The patient's complete medical history is considered and the patient is given a thorough physical examination. Most often, patients are also given two tests, a polysomnogram and a multiple sleep latency test (MSLT) to confirm a suspected diagnosis and also to determine the extent of the Narcolepsy.

Excessive Daytime Sleepiness (EDS) is an essential part of the diagnosis of Narcolepsy but may have a variety of other causes including Obstructive Sleep Apnoea (OSA), Restless Legs Syndrome (RLS), Circadian Rhythm Disorder and the syndrome of Primary Hypersomnolence.

The symptom of EDS is important because it is associated with feeling drowsy and tired; having an overwhelming need to sleep during the day, being unable to stay awake in the daytime, even after getting a good night's sleep and falling asleep at times you need to be fully awake and alert.

It could mean ineffective work performance or dangerous levels of driving or other activities and, interference with a person's ability to concentrate or perform daily tasks or routines. Some people affected by EDS often feel frustration and anger about being misunderstood and being regarded as unintelligent or not interested in personal growth or learning. They often have low self-esteem and/or poor personal relationships as a result.

Narcolepsy

Narcolepsy

Narcolepsy is characterized by the classic tetrad of excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. Note that this tetrad is seen only rarely in children. The term "narcolepsy" is derived from Greek, "seized by somnolence." Gelineau was the first to delineate the syndrome in 1880.

Narcolepsy frequently is unrecognized, with a typical delay of 10 years between onset and diagnosis. Approximately 50% of adults with the disorder retrospectively report symptoms beginning in their teenage years. This disorder may lead to impairment of social and academic performance in otherwise intellectually normal children. The implications of the disease are often misunderstood by patients, parents, teachers, and health care professionals.


Narcolepsy is treatable. However, a multimodal approach is required for the most favourable outcome.

Narcolepsy is thought to result from genetic predisposition, abnormal neurotransmitter functioning and sensitivity, and abnormal immune modulation. Current data implicate certain human leukocyte antigen (HLA) subtypes and abnormalities in monoamine synaptic transmission, particularly in the pontine reticular activating system.

Understanding of the neurochemistry of narcolepsy stems primarily from research involving narcoleptic dogs (eg, special laboratory-bred Dobermans and Labradors). In these animal models, the disorder is transmitted in an autosomal recessive fashion with full penetrance and is characterized mainly by cataplexy.

Excessive daytime sleepiness (EDS) is the primary symptom of narcolepsy.

Sleepiness is a normal experience that cycles and invariably occurs after prolonged wakefulness. In healthy persons, mild sleepiness is apparent only during boring situations (eg, falling asleep while watching TV).
In patients with narcolepsy, severe EDS leads to involuntary somnolence during more active conditions such as eating and talking. Sleepiness in narcolepsy may be severe and constant, with paroxysms during which patients may fall asleep without warning (ie, sleep attacks).
Patients with narcolepsy tend to take short and refreshing naps (ie, REM type naps) during the day.
Several questionnaires evaluate sleepiness. The most commonly used is the 8-question Epworth Sleepiness Scale (1991).
Patients respond to each question on a scale from 0 (not at all likely to fall asleep) to 3 (very likely to fall asleep).
The resulting total score is between 0 and 24.
Although what score constitutes abnormal sleepiness is controversial, total scores above 10 generally warrant investigation.
Cataplexy (Latin, "to strike down with fear") is an abrupt attack of muscle weakness.

If severe and generalized, it may cause a fall.
More subtle forms exist with only partial loss of tone (eg, head nod).
The most characteristic feature of cataplexy is that it usually is triggered by emotions (usually laughter and anger).
Cataplexy is seen in about 70% of patients with narcolepsy, and its presence with EDS strongly suggests the diagnosis of narcolepsy. Specific historical questions concerning cataplexy are required.
Sleep paralysis is the inability to move upon falling asleep or awakening with consciousness intact.

It often is accompanied by hallucinations.
Sleep paralysis occurs during REM sleep in healthy subjects.
Sleep-related hallucinations may occur at sleep onset (ie, hypnagogic) or awakening (ie, hypnopompic) and are usually vivid (dreamlike) visual, auditory, or tactile in nature.

The classic picture of narcolepsy may be somewhat different in young children.

Children may deny EDS because of embarrassment.
Sometimes restlessness and motor overactivity may predominate.
Academic deterioration, inattentiveness, and emotional lability are common.
In one study of 51 prepubertal patients with narcolepsy, the following initial complaints were noted:
Children younger than 5 years presented with unexplained falls and "drop attacks," aggressive behavior, abrupt irritability, sleep terrors, and abrupt dropping of objects.
In children aged 5-10 years, the most common initial complaint was repetitive sleepiness, followed by difficulty with morning arousal associated with aggressive behavior and abrupt falls in school. These children often were misdiagnosed as having attention deficit hyperactivity disorder (ADHD), learning disability, or another neurologic disorder.
In children aged 10-12 years, poor academic performance was a common complaint. Other presenting symptoms included inappropriate low level of alertness, falling asleep in class, and inability to wake up in the morning.

Sleep Disorders


OVERVIEW

Excessive daytime sleepiness, difficulty sleeping, and abnormal sleep behaviors are common problems that can have large impacts on a person's overall health, safety and quality of life. With accurate diagnosis, however, most sleep disorders can be effectively treated.


Sleep Disorders Treated by Dr Yacoob Omar Carrim - Sleep Medicine Specialist

Sleep-related breathing disorders

Insomnia
Hypersomnias
Circadian rhythm disorders
Parasomnias
Sleep-related movement disorders

Narcolepsy TREATMENT

Narcolepsy
Overview

TREATMENT

Treatment plans for narcolepsy usually combine lifestyle modifications and medication. Plans need to be highly individualized and may require adjustment over time.

Lifestyle modifications
A patient's treatment team works with him or her to develop a daily plan to increase wakefulness. Elements of the plan may include:

Having a regular nighttime sleep schedule and adhering to it even on weekends
Taking naps at strategic times
Avoiding nicotine and alcohol
Getting regular exercise
Making changes at work or school to break up monotonous tasks. The Americans with Disabilities Act prohibits discrimination against workers with narcolepsy and requires employers to provide reasonable accommodation to qualified employees.
Avoiding driving if drowsy. If patients with narcolepsy must drive a long distance, they'll need to work with their treatment team to establish a medication schedule that ensures the greatest likelihood of wakefulness during the drive, and will need to stop for naps and exercise breaks whenever they feel drowsy. Patients should not drive if their sleepiness is not well controlled.

Medications
The best medication for a given patient depends on whether the patient experiences cataplexy, other medications being taking for other conditions, the patient's age, and response to particular drugs. Some medications often prescribed include:

Stimulants: Stimulate the central nervous system to help stay awake during the day. They include:
Modafinil (Provigil): Newer stimulant that isn't as addictive and doesn't produce the highs and lows often associated with older stimulants.

Methylphenidate (Ritalin)

Various amphetamines: Although effective, they may cause side effects, such as nervousness and heart palpitations.

Antidepressants: Suppress REM sleep to help alleviate the symptoms of cataplexy, hypnagogic (the boundary state between sleep and wakefulness) hallucinations, and sleep paralysis. Options include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants.

Sodium oxybate (Xyrem): Controls cataplexy, sleep paralysis and hallucinations, helps improve nighttime sleep, and in high doses may also help control daytime sleepiness (though taken only at night). Associated with possible serious side effects, however, such as trouble breathing during sleep, sleepwalking and bed-wetting, and therefore strictly regulated by the Food and Drug Administration.

Monday, August 2, 2010

Fatigue Causes

Fatigue Cause No. 1: Not Enough Sleep
Fatigue Cause No. 2: Sleep Apnea
Fatigue Cause No. 3: Not Enough Fuel
Fatigue Cause No. 4: Anemia
Fatigue Cause No. 5: Depression
Fatigue Cause No. 6: Hypothyroidism
Fatigue Cause No. 7: Caffeine Overload
Fatigue Cause No. 8: Hidden UTI
Fatigue Cause No. 9: Diabetes
Fatigue Cause No. 10: Dehydration
Fatigue Cause No. 11: Heart Disease
Fatigue Cause No. 12: Shift Work Sleep Disorder
atigue Cause No. 13: Food Allergies
Fatigue Cause No. 14: CFS and Fibromyalgia

Sleep Disorders and Fibromyalgia

Fibromyalgia syndrome causes symptoms of extreme pain in the muscles throughout the body. Sometimes the pain associated with the illness can be so intense that sufferers cannot continue with their daily tasks. But fibromyalgia isn’t just associated with pain. Fibromyalgia and sleep disorders also go hand in hand. In fact, it is thought that up to 80% of people with fibromyalgia experience some type of disordered sleep. Often, these sleep disorders leave people feeling tired, drained, and physically incapable of dealing with the stresses associated with fibromyalgia.
Alpha EEG Anomaly
An alarming percentage of fibromyalgia sufferers have a sleep disorder called alpha EEG anomaly. This sleep disorder may actually be a cause of fibromyalgia because so many sufferers have it. Alpha EEG anomaly affects deep sleep, preventing sufferers from getting a good night’s rest.
Alpha EEG anomaly occurs when sudden bursts of brain activity occur during a time when the brain should be in deep sleep. These periods of intense activity are measured as alpha waves on an EEG monitor. People with alpha EEG anomaly do not have difficulty falling asleep, but once they reach deep sleep, their brains begin to act like they are awake. This leaves sufferers feeling tired and drained.
Sleep Apnea
80% of people with fibromyalgia suffer from sleep apnea, a disorder that causes momentary stoppages in breathing. Sleep apnea only occurs when a person is sleeping, but it can affect some people so badly that they actually cause themselves to wake up. Many people who suffer from sleep apnea don’t even know that they have it - usually it is a partner that notices the sufferer waking up.
In apnea, there are gaps in breathing that can last for a few seconds or even as long as a minute. These gaps are often caused by a collapse in the airway due to snoring or being overweight. This is referred to as obstructive sleep apnea. However, there is also a much less common form of sleep apnea that appears to be caused by a defect in the central nervous system.
Referred to as central sleep apnea, this type of apnea is caused by a miscommunication from the brain. For some reason, the brain "forgets" to tell the lungs to breathe. People suffering from this type of apnea usually remember waking up.
Sleep apnea symptoms can affect a person’s sleep patterns. Some people with severe sleep apnea actually wake themselves up hundreds of times a night, if only for a few seconds. This prevents the body from benefiting from any restorative sleep. Sleep apnea can leave fibromyalgia sufferers feeling increasingly fatigued and even more subject to pain.
Restless Leg Syndrome (RLS)
Many people with fibromyalgia suffer from restless leg syndrome symptoms. RLS causes unpleasant sensations in the lower limbs, so much so that the limbs have to be moved in order to reduce the pain. RLS occurs mostly at night, between the hours of 10:00 pm and 4:00 am, though it can also occur throughout the day in severe cases. 
In a 2008 study, 64% of participants with FMS also had RLS.

RLS is exacerbated by long periods of rest, particularly nighttime sleeping, long car rides, or airplane travel. People with RLS describe crawling, itching, burning, or aching sensations beneath the skin in their legs. These sensations are so uncomfortable that they must move their legs, either by getting out of bed, or by exercising orstretching. Many find that if they do not move around, their legs will twitch involuntarily. Typically, RLS affects the calves and lower legs, though it can also affect the thighs, feet, and arms.
RLS causes major disturbances to sleep patterns. Because you are constantly being woken up or forced out of bed, many FM sufferers find that they just cannot get adequate rest. Many feel drained and sleepy during the day.
RLS is a neurological condition, but we don't yet know what causes it. Some cases may have a genetic cause, while others are believed to be related to:

Diagnostic criteria for RLS include:
  • A desire to move limbs, often linked to odd sensations
  • Symptoms that are present (or worse) when you rest; movement provides some temporary relief
  • Motor restlessness
  • Worsening symptoms at night

Symptoms of Restless Legs Syndrome and Fibromyalgia

Fibromyalgia and RLS share these symptoms:
  • Excessive daytime sleepiness
  • Problems with concentration
The primary symptom of RLS is odd sensations (parethesias) or unpleasant sensations (dysesthesias) in the legs and an uncontrollable urge to move to relieve these sensations. This phenomenon is not associated with FMS and requires different treatment.

Restless Legs Syndrome Treatment

RLS treatments can include medications and lifestyle changes.
For mild-to-moderate symptoms, your doctor may suggest you cut down or eliminate use of caffeine, alcohol and tobacco. If you have nutritional deficiencies, especially iron, folate or magnesium, your doctor may suggest supplements.
Other lifestyle management techniques include:
  • Maintaining a regular sleep schedule
  • Regular, moderate exercise
  • Avoiding excessive exercise
  • Hot baths
  • Leg massages
  • Applying heat or ice
These measures, however, don't generally provide complete symptom relief.
Your doctor may suggest medication to treat RLS. The more common types include:
  • Dopaminergics: (Examples are RequipMirapex) These drugs act like dopamine, which is a neurotransmitter that regulates muscle movement.
  • Benzodiazepines: (Examples are ValiumXanax) These are central nervous system depressants, generally used as anti-anxiety medicines, that also suppress muscle contractions.
  • Opiates: (Examples are DarvonPercodan) These pain killers also relax you and can suppress RLS in some people.
  • Anticonvulsants: (Examples are NeurontinTegretol) These are normally for preventing seizures but sometimes help relieve muscle contractions.
Some medications may make RLS symptoms worse, including antinausea, anticonvulsant and antipsychotic drugs and some cold or allergy medicines. If you're taking any of these, you may want to talk with your doctor about changing to drugs that are less likely to worsen your symptoms.

Restless Legs Syndrome Treatment vs. Fibromyalgia Treatment

RLS treatments don't generally conflict with FMS treatments, and in many cases, treatment may help both conditions. Many people with FMS find relief from benzodiazepines, opiates or anticonvulsants. (While they're widely used, benzodiazapines and opiates aren't part of official recommendations for FMS.) Also, many RLS lifestyle management techniques (regular sleep schedule, moderate exercise, hot baths) can be useful in managing FMS symptoms.
If you're taking or considering medications for both fibromyalgia and restless legs syndrome, be sure to talk with your doctor and pharmacist about any possible drug interactions.

Periodic Limb Movement Disorder (PLMD)
Periodic limb movement disorder often occurs alongside RLS. In fact, 80% of those fibromyalgia sufferers who have RLS also have PLMD. PLMD is very similar to RLS, however it only occurs during nighttime sleep. It can also become quite exacerbated and even violent, unlike RLS.
PLMD causes intermittent movement of a person’s limbs while they are in deep sleep. A person with PLMD may move their feet, knees, or thighs rhythmically without even realizing it. Most movements occur at intervals of between 5 and 60 seconds. For example, a person with PLMD might suddenly flex their knee, and then 60 seconds later, flex it again. These flexes tend to last for 10 seconds or more. The most common movements seen in this sleep disorder are flexes of the big toe, fanning of the toes, and flexion of the knees.
PLMD can be quite annoying when you are already suffering from widespread pain and other fibromyalgia symptoms. Sometimes people with PLMD can become quite violent, kicking and flailing while they are in bed. People with PLMD often report bouts of insomnia or daytime sleepiness, which can exacerbate their symptoms.
Bruxism
Bruxism (teeth grinding), frequently affects people with fibromyalgia. Bruxism is thought to be a part of a disease that is closely related to fibromyalgia, calledTemporomandibular Joint Disorder (TMJD). This disorder causes muscle pain in the face, neck, shoulders, and back, and often leads to grinding of the teeth. 75% of people with fibromyalgia also have TMJD.
Nocturnal bruxism occurs when you are sleeping. For some reason, sufferers begin to clench the muscles in their face causing their teeth to grind together. Many are unaware of this as they are sleeping, but in the morning they can be left feeling achy and sore in the jaw area. Bruxism can lead to a variety of dental problems, including loosened and broken teeth.


Wednesday, July 14, 2010

10 STEPS TO PEACEFUL BEDTIME By Claire Marketos

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