Insufficient Sleep is a Modern Problem

The Healthy Child

Written by Mary M. Moebius, MD, FAPA

Diplomat of the American Board of Psychiatry and Neurology, General and Child Psychiatry

Assistant Clinical Professor, UCLA-NPI

Private Practice, Tarzana, Ca.

Issue: March/June 2008

From the ancient times until the light bulb was invented, we human beings slept from sundown to sun up.

What came first the proverbial “chicken” or the “egg”?

In children and adults with symptoms of Attention Deficit Disorder, some contend sleep deprivation is the cause of ADD and sleep is the treatment. A more probable conclusion is that the attention and behavioral symptoms of ADD are improved when one is well slept. It is thought persons with ADD start to elevate the hormone (in charge of responding to light and dark) called Melatonin later in the evening than others. Evolutionarily, these individuals may have been guarding the caves at night for our ancestors who would in turn go out to hunt food for these other clan members who “slept in”.

Does someone you know snore, stop breathing or end up sideways, upside down, off the bed by morning? Multiple arousals from quality sleep at night might not even be known to a person unless someone else, kindly, points it out to them. This inefficient sleep leads to the body feeling tired, run down, lazy as well.

Anxiety before bed may lead to inability to fall asleep (especially in your child’s own bed!) that then leads to a sleepy anxious child by day (doesn’t want to go to school). Sound familiar?

Disrupted sleep or changes in sleep occur in depression and manic depressive bipolar illness as well as may lead someone in to these states. Extreme sleep deprivation shows that people suffer from hallucinations, paranoia, and false beliefs (delusions). They actually look Schizophrenic!

Medical concerns associated with sleep debt are: seizures, metabolic imbalances including elevations in serum lipids and the stress hormone Cortisol, weight gain, diabetes, growth problems, weakened immune systems, high blood pressure, and memory decline with heightened chances of dementia later in life. Did I leave out car accidents?

Children and teens require 8-10+ hours of sleep per night depending on age and one's own variability. This means prioritizing bedtime and awakening times then seeing how to fit in other activities around this. Awakening and bed times should vary by only one hour on weekends as one cannot "catch up" on sleep debt.

Melatonin is a hormone every animal (with a backbone) makes in the brain. This hormone tells animals what to do when the sun comes up and when the sun goes down. Some sleep specialists have suggested adolescents take 500 mg of Melatonin on Sunday nights as many have overslept on the weekends, further disrupting their sleep cycles. Melatonin should not be taken in people with immune deficiency problems or an allergy to the supplement.

Staring at a computer screen or being in a brightly lit room before bed sends a message to the brain, "Do not increase your Melatonin yet-it's still daytime!" Turn off the computer at least an hour before bedtime. If that is not enough to calm your child's brain, back up by 15 minute increments until finding the appropriate "dose" allowed. Homework on the computer may be done first to minimize exposure.

Eliminate caffeine after noon or altogether if necessary. Be aware of hidden sources of caffeine, even in those "decaffeinated" beverages. Is your teen smoking cigarettes or using drugs that impair sleep? Random drug screens may explain why the teen has had a change in sleep.

Make sure your child is not starving before bed. Children taking medication for ADHD are not hungry during the day. When the meds wear off; they are ravenous, grazing the kitchen when they should be sleeping. A protein type of pre-bed snack will keep up the blood sugar for longer periods than a quick fix carbohydrate.

Exercise from play or a structured sport allows children to blow off steam and sleep better.

Addressing health issues like allergies, asthma, enlarged tonsils and adenoids crucial in order to get enough oxygen at night to sleep deeply can help. Other health imbalances that disrupt sleep should be evaluated for a resolution.

A change in sleep patterns in a child with a neuropsychiatric disorder, like depression or epilepsy, (to mention only 2 of many) may announce that deterioration is coming, so see the doc to prevent this.

Be cautious of some over-the-counter and prescription sleep medications as "rebound" insomnia may occur after only a few days use, making the problem worse. Other problems that might arise with medications are difficulty awakening, concentrating, learning impairment the next day, getting into car accidents with our newest drivers, physical or psychological reliance, and amnesia to bizarre behaviors done in sleep. Of course, there may be circumstances that warrant a trial of medication but it is much better to try the nonmedical approaches first.

The nonmedical treatments do require time, practice, and commitment to follow through.

Relaxation techniques like guided imagery, soothing music, "white noise," and hypnotherapy to learn self-hypnosis are all effective techniques. Cognitive Behavioral Therapy can provide your child with tools he/she can carry into adolescence, college and then adulthood.

When your child awakens on his/her own or with minimal difficulty, you've made it!

Good luck and sweet dreams.

Provided as a courtesy by

Swanson, Conti and Associates

A Psychological Corporation

(818) 986-9666

Printed and released by Swanson, Conti and Associates strictly for educational purposes only.
In no way is the information provided within this newsletter intended to be representative of,
or a replacement for, therapy.