YEAR ONE

Newborn babies average 16 to 18 hours of sleep a day, spread out in about five sleep episodes. The hours they sleep are not random. Within just a few days of birth, babies usually sleep longer at night than during the day. By two months of age, nearly half stay asleep or rest quietly for at least five hours during the night, giving parents a chance to return to more normal sleep patterns.

By the end of the first year, most children are down to one long sleep period at night, and a morning and afternoon nap, altogether about 12 to 14 hours of sleep a day.

You can help your baby learn the ways of the world if you:

Schedule night as “sleeptime” and day as “waketime.” Avoid play and entertainment at night. Confine those activities to the preferred waking hours.

Teach your baby that the bed is for sleeping. Put the baby in bed when it’s bedtime. Try to keep the baby from getting used to falling asleep in your arms or in the living room couch, or needing a pacifier or bottle to fall asleep.

Keep lights off or low at night.

If the baby cries, go in but don’t make a fuss. Pat the baby, change a diaper, without taking the baby out of bed, if possible. Don’t turn on bright lights. Keep noise and conversation to a minimal.

YEARS ONE TO THREE

These are the years of growing independance. Children learn to talk, walk, feed and dress themselves and master toilet skills. Learning to fall asleep by themselves and to return to sleep quickly if they awaken during the night is an important accomplishment, too. As with walking, the first steps often are shaky.

Bedtime crying and middle of the night tearful awakenings are among the most common problems brought to pediatricians and specialists in children’s sleep. Parents find these problems exasperating. They often report they’ve “tried everything” and are usually surprised to learn that their best efforts to soothe may in fact be perpetuating the problem. Parents often take a crying child out of bed. They rock the child, sing, offer food, read stories, even bring the child into their bed. Sometimes they let the child fall asleep in front of the TV. All these measures establish conditions for falling asleep that require a parent’s prescence. The child doesn’t learn how to fall asleep alone.

One good way to cope with bedtime protests:

Put your child in bed awake in a darkend, quiet room. Some children need a special blanket or favorite toy to fall asleep initially and to provide comfort on awakening during the night.

Say goodnight and leave the room.

If your child cries, wait five minutes before going back.

Stay in the room for two or three minutes so your child knows you’re there, but don’t pick the child up. Keep your conversation to a minimum. Then leave, even if the child is still crying.

If the crying continues, wait 10 minutes before coming back. Stay briefly, then leave again.

If crying continues, wait 15 minutes before coming back.

Use the same routine for middle-of -the-night awakenings and at naptime.

On subsequent nights, add 5 minutes to all waiting periods, The going and coming show your confidence in your child’s ability to function independently. At the same time it provides reassurance that you are not going away forever. Most experts agree that crying during the learning process won’t harm your child psychologically. More likely, it will be harder on you.

AGES THREE TO FIVE

Bedtime routines remain important. A bath, quiet play and a story can ease the transition from waking to sleeping. Such activities also serve as a special time for sharing. Children thrive on direct, personal interaction; watching TV together is a poor substitute.

Avoid exciting activities and scary stories.

Tell your child when the time is almost up or you approach the end of the story.

Resist requests for “one more story” or “another drink of water”. Be consistant from night to night. Your child will learn the rules only if you stick to them.

AGES SIX TO TWELVE

During these years, sleep problems of early childhood subside. Most children fall asleep fast, sleep soundly, and are fully alert throughout their waking hours. Some children are “larks” or morning people and others are “owls” or evening people. These lifelong traits may manifest themselves quite early.

The major problem during these years often proves to be bedtime rather than sleep. A child may push back bedtime to watch TV, read or do homework. There is no arbitrary number of hours of sleep that is best for everyone. Some children, like some adults, need less sleep than others. It’s a mistake to make a child go to bed long before he or she is ready to sleep. But a sleepy child is cause for concern. Insufficient sleep may make a child irritable or cranky. Teachers may report that the child fails to pay attention or even falls asleep in school. The first step in remedying the problem is to enforce earlier bedtimes.

Sleepiness also may be the first symptom of a neurologic disorder, narcolepsy, or a breathing disorder, sleep apnea. Children with narcolepsy may fall asleep while talking or eating, even while riding a bike. They may experience muscle weakness and even collapse if they suddenly laugh or become excited. Children with sleep apnea may snore loudly. Some complain of morning headaches. They may have frequent upper airway infections. Any of these symptoms demands a visit to the doctor.

Anticipate sleep disturbances at times of going away to camp, illness, or family events such as moving or the birth of a sibling. Even very young children benefit form talking about their worries. Restrict such discussions to the daytime to keep bedtime worrying from becoming a habit.

AGES TWELVE TO TWENTY

These are the years of the most rapid body growth and development after infancy. Studies show teenagers need to sleep an hour more each day than they did in their pre-teen years. If permitted to sleep as long as they wish, teenagers average about nine hours of sleep a night. But most of them customarily sleep an hour or two less.The predictable consequence is dozing in class and sleeping late on weekends to catch up.

The typical teenager’s sleep habits make it hard for parents to know what is or isn’t normal sleep behavior. Late hours, a heavy or after-school work schedule, and use of drugs including alcohol may harm sleep. Serious mental illness such as depression or schizophrenia, may distrupt sleep.Additionaly, two other disorders commonly emerge during the teen years; Delayed Sleep Phase Syndrome and narcolepsy.

Delayed Phase Sleep Syndrome

A problem of not being able to fall asleep until 3 or 4 a.m. and than having trouble getting out of bed in the morning. This is particularly hard on the parents who complain they must take on the added responsibility of dragging their youngster out of bed. Adults with this problem frequently benefit from delaying bedtime further by two or three hours each day. They move entirely around the clock until they reach a desired bedtime. Teens often do well with a weekend “crash” treatment. If they stay up all night on Friday, and stay awake all day Saturday, they should feel sleepy enough Saturday night to fall asleep around midnight. Then they must get up Sunday at the time they would ordinarily awaken for school.From then on, they need to adhere to the same bedtimes and waketimes, seven days a week.

Narcolepsy

Teens with narcolepsy show sleepiness far beyond that of a typical sleepy teenager. They experience uncontrollable attacks of sleep several times a day, bizarre auditory or visual hallucinations as they are falling asleep. Episodes of being unable to move or speak or both at the same time of falling asleep and awakening, and attacks of sudden muscle weakness that last from a few seconds to perhaps 30 minutes, can also be symptomatic of narcolepsy. During the early stages of the disorder, They often report great difficulty getting up in the morning. When awakened, they may be confused, aggressive and verbally abusive.

Because sleepiness is common in teenagers, it often is overlooked until other symptoms show up. Early diagnosis is important because sleepiness interferes with classroom performance. It also may cause teachers (as well as the child) to attribute symptoms to laziness or dullness. Teens with narcolepsy benefit from regularly scheduled naps and often, from stimulant medication.

SLEEP TERRORS

Sleep terrors are the most extreme and dramatic form of arousal disorders and are the most distressing to witness. A sleep terror episode usually begins with a bloodcurdling scream or shout, and may produce signs that suggest extreme terror, such as dilated pupils, rapid breathing, racing heart, sweating, and extreme agitation. During a sleep terror, the person may bolt out of bed and run around the room or even out of the house. During a frenzied event the person can hurt themselves or others. As disturbing and frightening as sleep terrors are to an observer, individuals having them are usually totally unaware of what they are doing and do not remember the incident when they awaken. People who have sleep terrors do not recall vivid dream images, unlike people who have nightmares or bad dreams.

Because disorders of arousal are less common in older people, adults suffering from these disorders should seek evaluation. In some cases these events are triggered by other conditions such as sleep apnea, heartburn, or periodic limb movements during sleep. A sleep specialist should evaluate the person’s behavior and medical history.

In typical childhood occurences of arousal disorders, medical evaluation is rarely needed. However, you should contact your physician if a child experiences disturbed sleep that causes 1) potentially dangerous behavior that is violent or may result in injury 2) extreme disturbances of other household members 3) excessive sleepiness during the day. In these cases, formal evaluation at a sleep center is warranted.

Using simple safety measures can prevent serious injury to those with arousal disorders. Clearing the bedroom of obstructions, securing the windows, sleeping on the first floor, and installing locks or alarms on windows and doors will add a degree of security for the individual and the family. In severe cases, medical intervention may be needed with prescription drugs, behavior modification through hypnosis or relaxation/mental imagery.

Other Parasomnias

HYOPNOGOGIC HALLUCINATIONS AND SLEEP PARALYSIS

This phenomenon refers to dreaming while awake and usually occurs just before falling asleep. These dreams can be frightening because the setting reflects reality (i.e., occuring in the bedroom) and the content of the dream is often threatening.

Sleep paralysis is the experience of waking up (usually form a dream) and feeling paralyzed, except for being able to breathe and move the eyes. Hypnogogic hallucinations and sleep paralysis may occur together. These conditions are common in people with narcolepsy but can also effect others, particularly people who are sleep-deprived. Although a pretty terrifying event, these events are not physically harmful.

NOCTURNAL SEIZURES

These seizures, which occur only during sleep, can cause the victim to cry, scream,walk, run about, or curse. Like other seizures, these are usually treated with medication.

RAPID EYE MOVEMENT (REM) BEHAVIORAL DISORDER

All body muscles (except those used in breathing) are normally paralyzed during REM sleep. In some people, usually older men, this paralysis is incomplete or absent, allowing the person to act out dreams. Such dream-related behavior may be violent and cause injury to the victim or bedpartner. Unlike those who experience sleep terrors, the victim will recall vivid dreams. REM sleep behavior disorder can be controlled with medication.

SLEEP STARTS

Most people have experience the common “motor” sleep start - a sudden, often violent, jerk of the entire body that occurs upon falling asleep. Other forms of sleep starts also occur just as sleep begins such as;

visual sleep start - usually a sensation of blinding light coming from inside the eyes or head

auditory sleep start - a loud snapping noise that seems to come from inside the head

The different types of sleep starts can be frightening, but these occurences are harmless.

TEETH GRINDING (BRUXISM)

Grinding teeth during sleep is a very common occurrence and little evidence suggests that teeth grinding is associated with any significant medical or psychological problems, although, bruxism may be associated with arousals causing sleep fragmentation that can lead to daytime fatigue or sleepiness. A sleep study can determinr if teeth grinding is causing a problem in your sleep. In severe cases, mouth devices may help or reduce dental injury.

RHYTHMIC-MOVEMENT DISORDER

This condition is seen most frequently in young children but may also occur in adults. It takes the form of recurrent headbanging, headrolling, or bodyrocking. The individual also may moan or hum. These activities may occur just before falling asleep or during sleep. Medical or psychological problems are rarely associated with rhythmic-movement disorder. Behavior treatment may be effective in severe cases.

SLEEP TALKING (SOMNILOQUY)

Sleep talking is a normal phenomenon and is of no medical or psychological importance.

*Information taken from ASDA patient info brochure.