Sleep Stages Overnight NREM is more common in the first part of sleep. REM is more common in the latter half of sleep
Children’s Sleep Architecture Differs from Adults More REM Earlier REM More frequent REM More Total Hours of Sleep
Sleep in Preemies “Indeterminate Sleep” –Neither REM nor NREM –Characterized by “Delta Brushes” and temporal spikes –Predominant pattern at 34 wks –Disappears by 3 months of age As gestational age increases… – maximum EEG sleep activity switches from temporal to frontal – Indeterminate Sleep decreases – Synchrony between the 2 hemispheres increases The preemie’s sleep legacy is easier arousal later on…
Normal Infant Sleep Patterns 18 hours a day, 50% REM, at birth Infants start sleep with REM Most sleep through night by 3 months –25 % still have not by 6 months of age Naps –Usually 2 / day until 1st Birthday –2nd nap usually given up by age 3
Night Wakenings Promotion of Good Sleep Habits starts early ** Beware of bastardizations of Ferberizing **
SIDS Death of an infant under the age of 1 during sleep –90% under the age of 6 months –Usually during winter months No known cause but many theories –Poor respiratory response to CO2 –Poor blood pressure control –Inability to remove obstructions to breathing Known associations –Sleeping on tummy –Smokers in the house –Not being breastfed
School-Age Sleep Issues Bedtime Struggles –Associated with TV viewing behaviors Parasomnias
Impressive Phenomena Positive Family History Usually Deep NREM Sleep (Stages 3/4) Common in childhood, decrease with age –Persistence into adulthood NOT a sign of psychopathology Can be induced or precipitated by fever, sleep deprivation, and certain medications
Prevalence of Parasomnias in Childhood Persists
Parasomnias Go Together Sleepwalking Sleeptalking Night Terrors Bruxism
Nightmares Extremely common –2/3 of all kids experience them Preschoolers ages 3-6 REM Child believes them to be real.
Night Terrors 5 % of pre-schoolers. Starts between ages 4-12 and resolves spontaneously Increased FHx of enuresis / sleepwalking in 1 st degree relatives During Stage 3-4 during 1 st third of night. Sits upright, stares, appears frightened, screams, cries, autonomic arousal, unresponsiveness –Lasts ~ 10 minutes then child returns to undisturbed sleep. No recall.
Night Terrors Not associated with psych problems in childhood; although in adults, associated with PTSD, panic disorders If disruptive or occur daily, can try Benzo qhs. Sometimes can be manifestation of seizures
NightmaresNight Terrors Age yrs4 - 8 yrs Sleep Stage REMNREM (3/4) Time of Night LateEarly State on waking Upset / ScaredDisoriented Response to parents Consolable Unaware of Parents Return to Sleep DifficultEasy / Rapid Memory of Event VividNone
Sleep Bruxism Up to 88% of children; 20 % of adults Any stage of sleep May result in damage to the Periodicity of 20 to 30 seconds. Malocclusion plays no role in bruxism
Sleeptalking Begins during school age NREM and REM sleep No treatment
Sleepwalking More than just walking around… –Simple Behaviors –Complex Behaviors Begins in ages 4-8 yrs and resolves spontaneously by adolescence. 10 % of children (2.5 % of adults) Positive Family History Stage 3-4 Sleep; 1 st third of night.
Nocturnal Enuresis NREM sleep May be restricted to Stage 3-4 Increased bladder pressures during deep sleep Males with Family History 15% of 5 year olds 10% cure per year, with 3-5% of adolescents
Treatment Of Nocturnal Enuresis Behavioral Modification Less drinks Double night Timed Nighttime voids Alarm Systems
Sleep Motor Phenomena Hypnic Jerks Body Rocking Restless Legs Syndrome –“Periodic Limb Movement Disorder” –Parathesias and desire to move the legs –Stage 1-2 NREM Sleep –More common in children than recognized 40% start in childhood
“Restless Legs Syndrome” –“Periodic Limb Movement Disorder” –Stage 1-2 NREM Sleep –More common in children than recognized 40% start in childhood –Secondary Causes Anemia, Pregnancy, Uremia, Neuropathy
Periodic Limb Movement Disorder
Persistence of Childhood Parasomnias into Adolescence
Adolescent Sleep Public Safety Extracurriculars School Start times
Nocturnal Emissions Nocturnal penile erections throughout all life stages –Occurs in utero 13 yrs, 2 months Sexual dream causes ejaculation –How common?
Delayed Sleep Phase Syndrome Excessive Daytime Sleepiness or typically as the sum of its complications Patients complain of inability to get to sleep until the early morning hours, but little difficulty sleeping once asleep Melatonin
Narcolepsy Begins in adolescence Triad of Symptoms Daytime Sleep Attacks Cataplexy Hypnagognic Hallucinations Sleep Study Findings –Normal total sleep time onset of sleep –Decreased latency Highest HLA-disease linkage in medicine
Obstructive Sleep Apnea Periodic apneas due to sleep- related airway obstruction –Large adenoids –Obesity –Not all snorers have OSA Daytime Sleepiness in the short-term Pulmonary hypertension and right heart failure in the long term
All Sleep Phenomenon can be a Seizure… Anything that is recurrent, stereotyped, and inappropriate may be the manifestation of a seizure Most often confused with sleep terrors, More common in the first 2 hours of sleep, or around 4-6 am. More common in kids than adults.