Poor sleep associated with hyperactivity, obesity, poor school performance, depression. And affects parents, of course! Caffeine and Propranolol (as used for migraine prophylaxis) affect sleep!
REM (rapid eye movement) phase is light sleep. Usually in later part of night after deep sleep. Slow wave (deep) sleep is associated with increased anabolic hormone release, mitotic repair. Higher proportion of sleep in adolescence is slow wave. 60% of newborn sleep is REM.
Recommended sleep duration: 8-11hrs by age 11. Increases in adolescence!
Late insomnia (early morning waking) in depression. Cf early – mood disorders, anxiety (cortisol vs melatonin).
30 mins high intensity exercise is as good as melatonin. But ideally 3hrs before bed time!?
Sleep latency 19 min under 2yrs, 17-19 mins thereafter.
Night wakenings are normal! But parental response varies!
Excessive sweating seen in 11% of children, so considered normal. But beware weight loss, lethargy! Can also be associated with obstructive sleep apnoea.
For infants not going to sleep, options are extinction vs gradual retreat. Not appropriate for under 6/12 of age as may affect bonding. No adverse effects otherwise.
Melatonin does not increase total sleep time! Helps prepare brain for sleep – does not induce sleep, as such. Earlier waking as well!
Nocturnal seizures – stereotyped, multiple in one night, sudden stop and start, mostly after first third of sleep. Seen in BECTS.
Restless legs associated with iron deficiency!
Benign nocturnal leg pain common in children.
Teenagers generally do have different body clock, but not helped by major changes in bed/wake times at the weekend. Blue light from screens suppresses natural melatonin production besides distraction.
CAMHS won’t prescribe melatonin but do prescribe methylphenidate!?
Bio melatonin 3x the price, not approved by SMC.
Circadin should be replaced by generic MR melatonin
In early part of night, likely to be non REM, cf later in night.
Classic non REM =
- Confusional arousal – can appear fully awake but don’t make much sense, no recollection in morning.
- Sleep walking – quite complex behaviours possible (riding a motorcycle!)
- Sleep terror – worse for partner/parents, as rarely remembered
REM related =
- REM sleep behaviour disorder – typically violent, dream can often be remembered, can escalate. Can be sexual.
- Sleep paralysis – up to several minutes, usually terrifying (“like being dead”), often with hallucinations.
Beware Narcolepsy – poor sleep quality at night, then daytime somnolence, plus hypnagogic/hypnapompic hallucinations, sleep paralysis, cataplexy (laughing causes collapse). Genetic, treatable with stimulants.