Sleep problems are common in children and adults but often remain unrecognised or ignored. Inculcating healthy sleep habits and providing sleep hygiene for infants and children are important steps for parents. While transient disturbance in sleep is common, frequent disturbances in sleep need early recognition, proper evaluation and management. In this article, Dr. Amdekar discusses common sleep deterrents and management steps based on severity and cause of the issue.

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Sleep is not a luxury but a necessity. Adequate sleep is necessary to boost health and work performance. A neonate sleeps for 18-20 hours a day including daytime naps, an infant about 12-13 hours, a toddler around 10-12 hours and an adult for 7-8 hours a day. Day naps should not be more than 20-30 minutes if at all taken by adults. However, the majority of adults and many children are sleep-deprived because of changes in lifestyles, especially in cities. Sleep pattern is often ignored as an important part of health and so rarely discussed unless it poses a significant problem.

Inculcating ideal sleep habits

Most of the neonates sleep very well during the day and remain comparatively awake during night hours. This pattern settles down to a natural rhythm in a few weeks. Thereafter, babies sleep for 3-4 hours at a time and get up for a feed only to sleep again. However, as the infant grows and develops the ability to interact with his/her surroundings, sleep is easily disturbed and the infant remains awake for more time. Many a time, infant fights sleep in order to be with parents and other family members. It is at this time- around 6 months of age that parents should try to set a healthy sleep pattern. Parents should set a fixed sleep schedule that should be followed each day to an extent if possible. It is important to put the baby on the bed when sleepy but awake so that the infant learns to fall asleep. The mother should maintain physical contact with the baby while putting the baby to sleep and even sing a song to soothe the baby but not form the habit of breastfeeding or rocking to get the baby to sleep. A warm water bath often helps to put the baby to sleep.

Sleep hygiene consists of providing a comfortable quiet environment avoiding light or sound. Once this routine is repeated every night, the infant becomes habituated to sleep at that particular time. Initially, the baby shares the parents' bed and subsequently, a toddler could share the parents' room but sleep on a separate bed. Such healthy habits need to be sustained in subsequent years.

Older children and adults must plan a dinner time at least two hours prior to sleep time and also avoid ingestion of stimulants like coffee and exposure to electronic gadgets to facilitate good sleep. It is known that bright light sources including the TV screen disturb the initiation of sleep because melatonin - a hormone from the hypothalamus – is secreted in poor light inducing the sleep process. Meditation and other relaxation techniques such as concentrating on breath or body scan, light music or reading a book help to calm the mind and relieve stress.

Common sleep problems in children

The infant in the initial months does get up for a feed but goes back to sleep immediately at the end of the feed. Most infants towards the latter half learn to sleep through the night without the need for a feed. Occasional sleep disturbance is common in children and is due to minor illness or environmental disturbance. However, when it happens frequently, one must attend to it as a problem or a disorder. Such problems relate to initiation of sleep, interrupted sleep and daytime sleepiness.

Initiation of sleep: Parents may find it difficult to put the baby to sleep. This is usually due to the failure of instilling a timely sleep habit. Even an older child may face the same problem. Most households are busy till late in the night with many activities and this is a deterrent for a young child to go to sleep. Older children may be stressed with studies or fights that make them not get to sleep quickly. They waste time in bed trying to sleep and then find it difficult to wake up on time.

Interrupted sleep – arousal disorders: An infant may wake up several times due to hunger but often due to a habit formed by the mother to feed on breast or by a bottle to put him back to sleep. Once this habit is formed, the infant wakes up for sucking pleasure rather than for hunger. Older children may get up due to obstructed airway presenting as snoring or sleep apnoea – transient cessation of breathing in sleep that may not be remembered but results in day time sleepiness. Nightmares are other reasons for waking up; they occur after a dream and children are able to remember the event when fully awake. At times, an older child wakes up half-asleep, is confused and agitated and performs simple activities such as sitting up or mumbling, complex activities such as screaming and becoming aggressive – night terrors or even more complex activities such as sleepwalking and getting injured in the process. Children have no recall of such activities as opposed to nightmares, where the child remembers the entire event. Restless leg syndrome is another problem where a child gets a severe urge to move legs and hands due to perception of aching, itching, tingling or creeping sensations. This is a result of stress, anxiety or depression.

Day time sleepiness: Inadequate sleep due to difficulty in initiation of sleep and the need to get up in time for school or work and interrupted sleep due to a variety of reasons leads to daytime sleepiness. School going children burn the late-night oil to study specially during examination time and this is a common cause of daytime sleepiness. Some of them are habituated to do so at all times.

Common sleep problems in adults

Most of the problems faced by older children are also prevalent in adults and mainly arise from stress and tension at the workplace and at home. Chronic respiratory disorders such as chronic bronchitis and emphysema, asthma, sinusitis, chronic cardiac diseases, diabetes, chronic GI problems, other degenerative disorders of joints and physiological old age issues such as aches and pains as well as enlarged prostate in males are other reasons for sleep problems.

Consequences of sleep problems

Sleep disorders can take a toll on mental and physical health besides mood, energy, and memory issues, weight gain, ability to handle stress and poor performance at study and work. It is a silent problem but has a serious negative impact on life.

Management of sleep problems

1. Prevention is better than cure, and it is important for parents to inculcate healthy sleep habits that are as vital as other habits related to diet and exercise. It is also necessary to develop emotional and psychological health that helps to cope with stress in life effectively.
2. Sleep problems must be recognised early to manage well. Parents should try to change wrong habits in children with cooperation and firmness.
3. Pathological conditions are tackled appropriately such as adenoidectomy and tonsillectomy for obstructed sleep apnoea.
4. Stress, tension, depression need proper counselling and at times, an expert referral.
5. Rarely, investigations may be necessary to diagnose correctly the cause of sleep problems. Sleep laboratories are now available in major centres for sleep studies that involve continuous monitoring of several physiological parameters during sleep. Such a study can reveal apnoea episodes and other breathing disorders and may need special intervention.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.