Sleep is Important

Jun 18, 2024, 00:00 AM by Dr. Sally Robinson

The Importance of Sleep

Keeping Kids Healthy by Dr. Sally Robinson

Nobody knows why we sleep but it seems to be a necessary aspect of life.  Ask any parent.  The sleep of infants is different than adults.  Knowing that the process of sleep goes through developmental stages helps to know if there is a sleep disorder and helps guide the infant into a healthy day-night rhythm.  Infants have no circadian rhythm and take frequent naps during the 24-hour day. The baby’s circadian rhythm aligns to the solar day over the first several months and is usually well established by 6 months of age.  Knowing the developmental changes in sleep patterns helps determine if there is a sleep disorder.

The American Academy of Sleep Medicine has a classification of 6 major categories of sleep disorders.  To help with the correct assessment of a sleep disorders there are various tests used.  Most common is the polysomnography (better known as a sleep study).  This test may use sensors for air flow through the mouth and nose, pulse rate, EKG’s, EEG’s, limb movements, sleep-related breathing. As can be imagined these tests are hard to accomplish on preschool children and those children with developmental disorders.  Because of this difficulty other tools such as sleep logs and actigraphy (wristwatch-like device that measures body movements and ambient light) help determine sleep-wake patterns. 

One of the broad categories of sleep disorders is insomnia.  Insomnia has one or more symptoms such as difficulty going to sleep, staying asleep, waking earlier than desired, resistance going to bed on an appropriate schedule or difficulty sleeping without a parent.  This sleep problem is usually associated with fatigue, impaired attention, daytime sleepiness, or irritability.

The rate of insomnia among children is 11% but may be higher.  Two common varieties of behavioral insomnia include sleep onset disordered (SOAD) and limit setting sleep disorder.  SOAD is a form of insomnia in which a child needs a parent to be present, bottle feeding, rocking, watching TV to fall asleep or return to sleep after waking up in the night.  In infants younger that 5-6 months night waking are normal but in older infants they are referred to as problematic night wakings.

To prevent or treat these infants parental education emphasizes consistent bedtime routines and sleep schedules.  Teaching independent sleep skills recommends that the infant should be put to bed “drowsy but awake”.  In the April 2023 edition,, problematic infant wakings discuss behavioral interventions using parental fading as ways of teaching independent sleep skills. Parental fading involves the parent placing the infant in bed awake and then checking on them at regular time increments until the infant falls asleep.  This is gradually decreasing how close to the infant the parent is as they fall asleep until the parent is out of the room.

Other techniques for establishing and reinforcing bed time expectations is the use of a Good Morning Light which is a night light that can signal sleep and wake times and the Sleep Fairy Positive Reinforcement Program.

Sally Robinson, MD  Clinical Professor
UTMB Pediatrics - Children's Complex Care
Also see:  Pediatric Primary Care

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