The Ups and Downs of Sleep Development

1. The Ups and Downs of Sleep Development Amy Salisbury, PhD, APRN, BC Assistant Professor of Pediatrics Alpert Medical School at Brown University Women & Infants Hospital Brown Center for the Study of Children at Risk Amy_Salisbury@Brown.edu

2. WHAT WE WILL COVER: • What is sleep? • Sleep 101 - abbreviated • Sleep Throughout Development • Potential Problems and Pitfalls WHAT DO YOU WANT TO KNOW ABOUT?

3. SLEEP BASICS • Sleep-Wake cycles • Entrained by light-dark cycle through brain • Relies on Timed Cues to keep running properly

4. SLEEP BASICS • Sleep is NOT a state of “rest” for the brain or body systems • Within sleep: sleep stages or states cycle • Non-REM (Rapid Eye Movement) Sleep • Stage 1 – very light sleep • Stage 2 – light sleep • Stage 3 – deep sleep (delta begins) • Stage 4 – very deep sleep (delta) • REM Sleep – Eyes move, body twitches, dreaming

5. SLEEP BASICS • Sleep-Wake cycles are basic human need. • Entrained by light-dark cycle through brain • Within sleep: sleep stages or states cycle • Non-REM (Rapid Eye Movement) Sleep • Stage 1 – very light sleep • Stage 2 – light sleep • Stage 3 – deep sleep (delta begins) • Stage 4 – very deep sleep (delta) • REM Sleep – Eyes move, body twitches, dreaming

6. Sleep Basics: Typical Rhythms

7. Sleep Problems Arise from disruptions in the NREM-REM Stage Cycle

8. Sleep Problems Arise from disruptions in the NREM-REM Stage Cycle AWAKE Results in sleep fragmentation

9. Sleep Problems OR Arise from disruptions in the sleep-wake cycle….

10. So Why Do We Need Sleep? • WITHOUT Sleep (<5 Hours/Night): • Decreased alertness and sustained attention • Impaired thinking, reasoning, and short-term memory • Poor health • Leads to (every year): • 25,000 deaths • 2.5 million disabling injuries • 100,000 automobile crashes • 71,000 injuries • 1,550 fatalities

11. Why Do Children Need Sleep? • Learning • Memory • Brain Development • Emotional Stability • Better Health • Better Family Relationships

12. Sleep during Pregnancy

13. Sleep During Pregnancy • What happened? • Hormonal Changes • Physical Changes • Mood Changes • Anxiety • Energy • Potential Problems • Insomnia • Restless Legs Syndrome • Sleep Apnea • Reflux

14. Sleep in the Fetus • Does the sleep of the mother affect the fetus? • Yes and No…. • Yes: • Baby does have sleep -wake cycles before birth • Fetus runs off mothers sleep - wake rhythms (hormones, brain changes, and behavior) • These may change the sleep-wake cycles of the fetus • No: • The fetus is going to sleep even when mother does not • Resilient to typical changes and variations through pregnancy

15. Tips for Healthy Sleep Before Birth • Prioritize Sleep • Exercise 30 minutes per day (per HCP) • Drink lots of water earlier in the day • Insomnia – get up and read or other quiet activity • Sleep on left side • Keep lights dim (red or night light) • Short daytime naps if possible (scheduled is best)

16. Typical Parent & Child Sleep

17. INFANT Sleep and Wake STATES Quiet Sleep (Deep, NREM Sleep) Drowse, Daze Quiet Awake/alert Crying Active Awake Active Sleep (REM Sleep)

18. Sleep in the First Month First 2 Weeks • Baby still running off Mother’s rhythm • Baby is usually sleepy • SOME babies sleep most of the time • Awaken every 3 hours for feedings day & night • Second 2 Weeks • MOST babies “wake up” by the 3rd week • SOME babies have a difficult time settling • Most common time for fussiness to begin

19. Sleep in the 2nd – 3rd Month • Baby’s brain development continues rapidly • Multiple rhythms developing all at once • By 5 weeks, most babies will sleep slightly more at night than during the daytime • By 6-8 weeks, crying is generally at it’s highest point for most babies (even those that are not “fussy”) • By 12 weeks, babies tend to sleep more in the nighttime than daytime (still sleep 15 hours)

20. Sleep During the First Year • Day/Night pattern by 12 weeks • Bedtime routines and some routine to the day helpful when used by 3 months of age • Sleep 8 hour stretches by 4 months • Breast-fed typically wake more often • Redevelop night waking 6-12 months • self-soothers vs. signalers

21. Sleep Problems First Year • Night waking • Unable to fall asleep • Crying • Feeding

22. How much sleep is needed? Roffwarg & Dement, 1964 Coons & Guilleminault,1982 Anders et al, 1983

23. INFANT SLEEP PATTERNS IDEAL COMMON!

24. Toddlers and Preschoolers • •Usually one nap 1 1/2 to 3 1/2 hours • •KEEP THAT NAP (thru 5 if possible)! • •Sleep Problems Common! (20-40% of children) • •Night fears and Nightmares develop • •Power struggles, end of day disorganization • •Bedtime routines, transitional objects more important

25. Toddler Sleep Problems • Bedtime Refusal • Anxiety • Night Awakenings • Nightmares • Night terrors • Uninvited co-sleeping

26. School-Aged Child’s Sleep • “Golden Years” of sleep • Still require more than 10 hours of sleep • Still do better with routines • Most kids actually want to sleep (at some point) • Should not be tired during the day

27. When Things do go Wrong • Sleep Problems vs. Sleep Disorders • Types of Child Sleep Problems/Disorders • Bedtime Refusal (Sleep Deprivation) • Frequent Awakenings (Sleep fragmentation) • Circadian Rhythm Disorders • Adjustment Sleep Disturbance • Obstructive Sleep Apnea • Sleep Terrors/Sleepwalking /Talking in Sleep • Nightmares • Teeth Grinding • Bed-wetting

28. Online Resources National Sleep Foundation: http://www.sleepfoundation.org/ National Institutes of Health Sleep Ed: http://science.education.nih.gov/supplements/nih3/sleep/default.htm http://sids-network.org/risk.htm