CHILDREN’S SLEEP: TYPES OF SLEEP PROBLEMS

Sleep problems vary in cause, duration, and ages they affect. Still, they fall into categories with typical characteristics and have variations on the basic themes. Some children have only one type of problem. Others demonstrate several types at the same time. For still others, the type of problem might be related to the child’s development and will change as he groves and faces new experiences. Knowing where your child fits will help you describe the specific behaviors that are causing problems and give you clues as to how to respond.

Frequent Waking

Elizabeth is nine months old and I haven’t gotten a full night’s sleep since she was born.

Frequent waking is a problem when a child wakes more than you expect for her developmental level—or more than you can tolerate. This may be once or several times a night.She might never have developed the pattern of sleeping for a long stretch or never learned to get back to sleep after normal nighttime arousals. The problem might be related to difficulty getting to sleep alone. She may have learned to need and expect help from her parents to get back to sleep. Or ne night waking might be stimulated by illness, dreaming, or developmenl disequilibrium. In those cases, she may need to re-learn getting herself back sleep for a long stretch.

Waking for Feeding

I give him a bottle and he goes right back to sleep, but I wonder if he real needs it. Some infants simply sleep through the expected feeding time, others continue waking long after what seems developmentally appropriate. This chi never learns the pattern of sleeping a long stretch. He requires food to satisfy “learned hunger” or requires sucking and comforting to get back to sleep.

Difficulty Getting to Sleep

After the third glass of water, I’m ready to scream! She is afraid of the monsters in her closet. This problem can affect all ages. Bedtime is drawn out and battles get worse and worse. Parents cajole, threaten, and bribe, and then they wonder how things got so out of control. There can be many reasons for this, including fears separation anxiety, and simply not having learned the skill of getting to sleeep on one’s own.

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THE BODY’S RESPONSE TO ANXIETY

Our body reacts to anxiety with a number of physiological responses. Our heart rate is increased, our blood pressure rises, blood is diverted from the organs to the muscles, and the pupils of our eyes are dilated. The body prepares us to meet some emergency. It is really a preparation for action—for fight or flight. This response is a biologically ancient form of reaction, which we have inherited from times past when dangers were usually in the form of some threat of physical attack. The body’s physiological response is well adapted to meet such a threat.

But the warning of anxiety refers to a threat from within—all is not well in our mind. And the body’s traditional response to threats is of little help in this relatively new biological situation. In fact, the beating of our heart and the tensing of our muscles for physical action only tends to increase our anxiety, because there is no outward foe on whom we can vent the physical strength which has been mobilized. In other words our body responds to anxiety according to a biologically outmoded pattern of reaction which can neither rectify the cause nor help us tolerate the discomfort of our anxiety.

The general response of the body to anxiety is modified by a physiological self-regulation device. There are many such self-regulating mechanisms in the body—for instance those which control our body temperature, water balance, and the chemical constituents of the blood. The alerting response which prepares us for action by increasing our heart rate and raising our blood pressure is mediated through the sympathetic nervous system. When this system becomes too active, a self-regulating mechanism calls the parasympathetic system into activity to balance the effect of the overactive sympathetic system. But one of the main functions of the parasympathetic is to increase the mobility of the bowels and the contraction of the bladder. So anxiety in this indirect way may come to cause diarrhoea or frequent urination. This, of course, has quite the opposite effect of the primary response to anxiety, which was to mobilize our bodily resources in preparation for action.

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ST JOHN’S WORT: IT REALLY WORKS

Although a common maxim holds that ‘seeing is believing,’ this statement is actually not always true. Seeing can be quite deceptive, as anyone knows who has witnessed the tricks of a competent magician. Conversely, we believe many things that we do not actually see, for example that the earth revolves around the sun. But in some ways the maxim carries the weight of truth: Those things that we cannot see are hard to believe, which is one reason why they gave poor Galileo such a hard time when he maintained that the sun and not the earth was the centre of the solar system. Similarly, controlled treatment studies can appear quite unconvincing if one doesn’t believe in the treatment and the studies are performed by someone else. I encountered this phenomenon after conducting numerous light treatment studies in patients with seasonal affective disorder (SAD), or winter depression. The studies from my group at the National Institute of Mental Health, as well as those of numerous colleagues, told a clear story. Light therapy worked. Yet many psychiatrists who had never treated a single patient with light therapy remained sceptical. On the other hand, the successful treatment of a single patient with this modality was in certain instances more persuasive than all the published data on the topic. So, after studying SAD for several years and treating many hundreds of patients with light therapy, I was amused when an old colleague approached me at a meeting and said to me with an air of discovery, ‘You know that light therapy that you have been talking about all this time? I treated a patient with it and the damn thing works.’

In truth, though, it is wonderful to discover a phenomenon for oneself even if it has been described a thousand times before. And so it was for me with the use of St John’s Wort in depression. I had read about controlled studies performed in Europe and had actually seen some of the data. Yet it was only when I saw some of my own patients benefit from the herbal remedy that I felt the excitement that might be expected to greet the arrival of a novel form of treatment for an old and nasty adversary – depression.

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