The Developing Child Newsletter: Issue 3
Insights and Developments in Therapeutic Treatment Approaches for Pediatric Conditions
Sleep is a huge topic in parenting literature. There are so many views on how to do it best. We like to look at it from the viewpoint of how it affects the brain and behavior. In this newsletter we touch on what happens in the brain when we sleep, the ill effects of poor sleep and strategies to try to promote quality sleep.
First off - let's set out what we mean by quality sleep. Sleep is composed of cycles of REM and non-REM (NREM) stages. In REM stage, the activity in the brain is similar to when one is awake and is often described as dreaming sleep. REM sleep is when new neural connections are made. NREM is deep sleep and is like a brain cleanout - neural connections that are not being used or deemed unneeded are pruned away. It's important for a child to have sufficient hours of sleep in order to cycle through the appropriate number of stages needed according to their developmental stage. For adults, the cycle is about 90 mins per stage, with a split of 80/20 NREM/REM sleep. For a 6 month old, the split of REM to NREM is 50/50 and at age 7 a child will typically have 70 percent NREM and 30 percent REM.
Humans experience the most REM sleep before they are even born. In the 3rd trimester, a massive amount of the brain's neural network is created. Once born, this work continues, which is why babies and young children require an enormous amount of sleep - the brain is under heavy construction. Any deprivation in the amount of REM sleep for a mammal can result in brain abnormalities, particularly in the development of the cerebral cortex, the higher functioning part of
the brain which controls motor movement, sensory processing and complex cognitive processes such as decisionmaking. Daytimes naps are an important part of this equation.
What tells us to sleep? Our circadian rhythm. As a baby gets older, sleep and wake cycles gradually become more stable due to repeating signals such as daylight, internal temperature changes and feeding. By age 4, the circadian rhythm is mostly dominant with the majority of sleep happening during the night. In about 30 percent of people, the so called night owls, these sleep cycles are different with later waking and sleeping times.
Lack of the right quantity and quality of sleep can present as inability to concentrate, social withdrawal, excessive mood swings, as well as contribute to major health issues. A 2012 study published in Pediatrics found that sleep characterized by disordered breathing, such as snoring or apnea resulted in ADHD like behaviors. However, while lack of sleep can mimic diagnoses, sleep is also impaired by children diagnosed with ADHD or Autism. A sleep study on children with autism found that they did not have normal sleep patterns and did not have the typical peaks and drops of melatonin, and therefore a weak circadian rhythm. The study also found that there is about a 30-50 percent shortage in REM sleep, compared to children without an autism diagnosis.
Quality sleep of the age appropriate amounts is vital. For families struggling to get their children to sleep, we recommend the following strategies. Most parents report positive changes within 2 weeks.
Strategies To Promote Sleep
- Lots of exercise and fresh air in the afternoon.
- Quiet activities after dinner. No TV or electronics. The light from electronics interrupts the production of melatonin which signals to the body to prepare for sleep.
- Establish a set bedtime based on how many hours of sleep your child needs.
- Use the same routine every night to help establish the circadian rhythm.
- Sleep music may be helpful.
- Some kids may find a bath alerting rather than calming. You may want to try a bath before dinner in this case. It's also important to note that showers are alerting rather than calming.
Sleeping aids to consult with an occupational therapist on:
- "Chillow" pillow or similar to help keep hot bodies cool
- Heavy blanket, weighted blanket or body pillows to provide proprioceptive calming input
- Dreampad by iLs
This newsletter is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.