Week 04: Sleep Flashcards
What is SDB?
Sleep-disordered breathing
What is leptin?
satiety hormone
What does leptin have to do with sleep and obesity?
lack of sleep increases leptin resistance which leads to obesity
When does the sleep cycle/circadian rhythm start to establish in a child?
2-4 months of age
How long does a typical sleep cycle last?
90 minutes
How many non-REM stages are there?
3
What are the non-REM stages?
NREM 1: eye movements/eye rolling
NREM 2
NREM 3: difficult to arouse
What happens during REM sleep?
muscle paralysis
vivid dreams
How much of sleep is REM sleep for infants?
50%
How much of sleep is REM sleep at age 5?
25%
symptoms of lack of sleep
excitable
more anxiety
intense fatigue
At what age do babies no longer need nighttime feeds?
6 months onward
At what age do most babies start sleeping through the night?
3 months
How long do babies keep the 2nd nap?
age 1
When do children often give up the afternoon nap?
age 3
DEFINE: night wakening
a child awakens >= 1x between 12A-5A
4-7x per week
>4 consecutive weeks
What is the FERBER METHOD?
a sleep training method that teaches self-soothing
Define SIDS
death of an infant (< age 1) during sleep
Known associations with SIDS
not breastfeeding
smokers in the house
sleep on tummy
School-age sleep struggles: when to cut out screen time?
at least 1 hour before bed
Define PARASOMNIAS
sleep disorder that causes abnormal behavior while sleeping
Parasomnia: normal or abnormal
COMMON in childhood; decreases with age
What can lead to parasomnias?
fever sleep deprivation overly busy day some medications alcohol in a teenager emotional stress stimulants antihistamines menstruation
Should kids use Benadryl?
generally not due to respiratory depression effects; NOT recommended to aid with sleep; if child needs something like Benadryl, use Allegra or Claritin instead
DEFINE: bruxism
grinding of teeth at night
Name some parasomnias
sleepwalking sleeptalking night terrors RLS enuresis bruxism
What parasomnias do boys tend to experience more?
sleep talking
What parasomnia do girls tend to experience more?
RLS
Parasomnias tend to decrease except for which 3, which are more common at age 13?
sleeptalking
RLS
bruxism
Night terrors: more in boys or girls?
boys
What kind of family history makes night terrors more common?
FHx enuresis/sleepwalking in 1st degree relatives
When do sleep terrors tend to occur?
During 1st 3rd of sleep, stage 3-4
What medications can be beneficial for sleep terrors? Who prescribes them?
benzodiazepines, typically prescribed by sleep clinic
For whom are sleep terrors associated with a neurological or psychiatric disorder?
Child: generally not
Adult: can be manifestation of PTSD
**Can be manifestation of a seizure
When do NIGHTMARES tend to occur?
LATE in the sleep cycle
3-6 years
When do NIGHT TERRORS tend to occur?
EARLY in sleep cycle
ages 4-8
Issues with sleep bruxism
can damage teeth –> refer to dentist IF CHILD doesn’t outgrow it
For whom does sleepwalking more commonly occur?
FHx of sleepwalking
Major concern with sleepwalking
safety
Treatment for sleepwalking
benzodiazepines or sedating anti-depressants: these are prescribed by a sleep clinic and NOT primary care
DEFINE: nocturnal enuresis
bedwetting
Why does nocturnal enuresis occur?
child develops bladder pressure during deep sleep
For whom does nocturnal enuresis more commonly occur?
FHx of nocturnal enuresis
kiddos with:
OSA
constipation
What is PRIMARY ENURESIS vs. SECONDARY ENURESIS?
PRIMARY: never attain dryness
SECONDARY: previously potty trained and dry for 6 months and nighttime wetting is happening again
Treatments for nocturnal enuresis
- behavior modifications (until ages 6-8): adequately hydrate earlier in the day; limit at night
- double void: pee when dressing for bed; do bedtime routine; void right before bed
- nighttime voids: wake child prior to when child typically wets the bed
- alarm systems (try for 2-3 months): to arouse child enough that they awaken before an accident
If using an alarm system for nocturnal enuresis, how many nights in a row does a child need to be dry in order to stop using it?
14
Drug used to treat nocturnal enuresis
DDAVP (desmopressin 0.2mg)
ISSUEs with using DDAVP for nocturnal enuresis
reduces urine volume at night, but there is high relapse rate
nasal spray not recommended due to higher adverse effect of hyponatremia
If prescribing desmopressin for nocturnal enuresis, how long should a child use it?
stop it every 3 months to see if child has stopped bedwetting
Tips for SLEEP HYGIENE
cut off screen time 1 hour before bed
comfortable environment
all night lights > 6’ from bed; dark if possible
nothing high energy right before bed; do something relaxing
When do nocturnal penile erections typically begin?
13 years, 2 months
but can happen in utero; occurs throughout life
What is Delayed Sleep Phase Syndrome?
difficulty falling asleep until early morning hours, but no trouble sleeping once they fall asleep
With what is Delayed Sleep Phase Syndrome associated?
melatonin off
vitamin D deficiency
vitamin B12 deficiency
What is used to treat Delayed Sleep Phase Syndrome?
melatonin, 1mg - 10mg
40-60min before bed
short term is the best so you don’t throw off innate melatonin and circadian rhythm
What is associated with OSA?
obesity
large adenoids
Medical word for sleep study
polysomnography
What are nocturnal seizures?
can mask as disturbed sleep
more common in children
more common in 1st 2 hours of sleep
