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Sleep
Problems in Children
Introduction
Sleep is normal, something we take for granted most
of the time. However, lack of sleep, or insomnia, is a common and distressing
symptom and often leads people to consult their doctor. It may be due to
ordinary, everyday causes or it may be a symptom of more serious underlying
problems.
This pamphlet describes the
common problems that people have with sleeping. There are some simple
guidelines as to how to improve your sleep and also advice as to when you may
need professional help in dealing with poor sleep.
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What
is Sleep?
While sleeping, we are not aware of the world around us. However, while we
sleep, a lot of things happen that are essential for us to stay healthy.
We sleep in different ways at
different times of the night. One of the most important of these types of
sleep is called Rapid Eye Movement (REM) sleep. It comes and goes throughout
the night and takes up about one fifth of our sleep time. During REM sleep,
the brain is particularly active, our eyes move quickly from side to side and
we dream. During the other type of sleep (non-REM sleep), the brain is
inactive, but there is a great deal of bodily activity. Hormones are released
into the bloodstream and the body tissues are repaired after the wear and tear
of the previous day.
How
much sleep do we need
This depends mainly on our age but
varies a lot between people of the same age. Babies sleep for about 17 hours a
day, but this reduces to 9 or 10 hours per day for older children. Most adults
need between 7 and 8 hours sleep each night, less as they get older. There is
a lot of difference between individuals and some people can manage on only 3
hours a night. The elderly need less sleep and so often find their sleep at
night is broken, particularly if they take naps during the daytime.
What
happens if we do not get enough sleep?
It must be remembered that no one has died through lack of sleep. The
occasional night without sleep has very little effect on either our physical
or mental health. However, after several sleepless nights, people find
themselves dropping off to sleep during the day.
They find it more difficult to make decisions and their mood may be
affected. This can be extremely dangerous if somebody is operating heavy
machinery or driving.
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Sleep
Problems in Childhood
The
first six months of life
It is important for parents help young children to learn how to sleep well.
During the first few months, most parents have to get up more than once during
the night. Young babies sleep and wake throughout the day and night. Slowly,
they learn the difference and begin to do most of their sleeping at night.
Parents can help by getting into a regular daily routine for settling their
baby down to sleep. Babies settle more easily if they are put to sleep in a
quiet, darkened room, which is warm and comfortable. Often they get drowsy
after a good feeding, but will wake if they have gas, are hungry, in pain, or
wet.
Nine
months and after
Babies of this age are now able to keep themselves awake, so this is a common
time for sleep problems to start. Parents find that their babies are often
more wakeful if they are excited, overtired or anxious. Problems may follow a
break in routine, such as a holiday. At this age it is very common for babies
to feel panic-stricken at being left suddenly alone at night. Again, parents
can help by having an organized bedtime routine, and by going through exactly
the same steps each night. This helps a baby to understand what is going on,
and to settle down gradually and calmly. When you have said 'good night', you
can stay next door for a while, leaving the door slightly open, so your baby
can hear you moving around. At this age, babies find it comforting and
reassuring to have a soft cuddly blanket or teddy, and a pacifier to suck on.
Rocking or singing can also be helpful.
What if, despite all your
efforts to settle and reassure, the baby goes on and on crying? If you leave
your baby alone, this will only reinforce the feelings of abandonment and
panic. It is important for babies to know that you are still within reach if
they need you. Go into the child’s room to calm and soothe in increasingly
longer intervals (i.e. 1 minute 2, 5), but don't pick babies up, or they will
get the idea that if they scream long enough you will eventually give in and
pick them up.
Children
between 1 and 2 years old
At least half the children of this age make a terrible fuss about going to
bed. Some parents try to leave their toddler to cry, only to give up in
desperation after they have endured hours of screaming. Others abandon the
idea of sticking to a regular bedtime altogether. There is a middle way that
does not leave the child feeling abandoned and allows you to keep control.
This involves going through the usual bedtime routine, saying 'good night' and
leaving the room. As soon as your child starts to cry go back into the room,
repeat the last 'good night', and leave again. Do this every five minutes for
as long as the crying lasts. But don't take the child out of bed, and don't
stay away for more than 5 minutes at a time. It may take as much as a week for
this to work, but it is worth it.
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Particular
Cause of Sleep Problems in Childhood
Nightmares
Most children occasionally have frightening dreams or nightmares, and usually
just need cuddling and reassurance to help them settle down to sleep again.
Nightmares that happen again and again may be the result of severe stress or
emotional trauma. If your child suffers with nightmares, your family doctor
will be able to put you in touch with a specialist who can help.
Night
Terrors
Young children sometimes wake up suddenly, apparently in a panic, or in
terrible distress. If you ask, they can't remember any dream, and will not
remember anything in the morning. Although night terrors seem very dramatic,
they respond to simple comfort and reassurance and children grow out of them
quite quickly.
Bed-wetting
Most children are dry at night by the age of two, but it is not at all
uncommon for bed-wetting to continue well beyond this. 1 in 10 children are
still wetting their beds at the age of five and 1 in 50 adults still have this
problem. It often runs in the family and is much commoner in boys.
Occasionally, bed-wetting may be a sign of illness, so it is worth asking your
doctor's advice about this.
If your child is healthy and
old enough to understand, you may be able to increase the number of dry nights
by praising him after each dry night. Punishment for wet nights is not
helpful, and may actually make the situation worse! If your child is not dry
by the age of 6, you may want to ask the school nurse or your family doctor
for specialist help.
Where
can I get help if I need it?
Your primary care physician or pediatrician will be able to advice on
practical childcare. Excellent practical advice is also available in many
books on baby and childcare, some of which are listed below. If problems
continue, your family doctor/pediatrician may suggest referral to a
specialist.
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Self
Help Organization
Sleep Disorder Clinics:
There are a number of Sleep Disorder
Clinics, but referral to these clinics should be made through your
family doctor. Patients cannot be self-referred.
Useful
Reading
Get a Better Night Sleep
Ian Oswald and Kirstine Adam, Optima
Why We Sleep
James Home, Oxford University Press
Sleep like a Dream the Drug-Free Wa
Rosemary Nichol, Sheldon Press
Baby and Child: From Birth to Five
P Leach, Penguin
This
brochure was adapted by Duke University Medical Center Department of
Psychiatry from The Royal College of Psychiatrists
Original Brochure produced
with the help of an educational grant from The Sleep Council
©
Copyright The Royal College of Psychiatrists. Reprinted with permission by the
Computers in Psychiatry Special Interest Group and Department of Mental
Health, University of Exeter.
Original
Brochure produced with the help of an educational grant from Eli Lilly and Co.
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