Sleep disorders instead of Ritalin - Sleep: The young and the restless

February 3, 2004

http://www.upi.com/view.cfm?StoryID=20040121-075218-6503r

Sleep: The young and the restless

By Lidia Wasowicz

UPI Senior Science Writer

Published 2/2/2004 7:55 AM

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Editors' Note: This is a repeat of a series published in December and January.

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UPI surveyed 71 specialists for a 7-part series of articles examining the

consequences and costs of the industrialized world's nightmarish sleep debt and

ways to turn around the troublesome trend. Part 7 analyzes the largely ignored

problem of slumber deprivation in children.

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A growing body of evidence suggests sleeplessness is the root of many childhood

evils.

Stacks of newfound clues implicate stifled slumber in an array of ailments

suffered by the young, including curtailed concentration, reduced recall,

disorderly deportment and chronic chubbiness.

" I suspect that many children do not use their full brain capacities to learn

and absorb information because of their chronic sleep deprivation, " psychologist

Avi Sadeh of Tel Aviv University in Israel told United Press International. " I'm

even more worried that the increasing rates of attention problems (ADHD, or

hyperactivity, as well as) youth violence and other forms of lowered frustration

tolerance are related to this growing tendency to shorten sleep. "

Research also suggests lost slumber may net gained pounds, feeding the obesity

epidemic swelling across the United States and other parts of the world.

" If you're overtired, you're more sedentary, you don't run off the calories, and

you are chronically stressed, so you eat comfort foods, " reasoned Dr. Marc

Weissbluth, professor, author and 30-year veteran of pediatric practice. " It

would appear overtired children tend to become obese children. "

Specialists hope the disquieting research results will rouse a dormant society

that, for the most part, has shut its eyes to its children's accruing sleep

debt.

" Lots of people don't appreciate sleeping as a healthy habit that enhances mood,

performance and cognitive development in children, " observed Weissbluth,

professor of clinical pediatrics at the Feinberg School of Medicine at

Northwestern University in Chicago. " Over 90 percent of articles on sleepiness

problems never mention children. "

Yet skimping on the basic biological need to snooze can prove particularly

costly to the maturing body. Scientists seeking to clarify the still-fuzzy

picture of nature's universal rest requisite have turned up signs of sleep's

influence over physical growth, brain development and memory consolidation, as

well as mental, emotional and corporeal health.

The findings shed light on humans' widely disparate sleep requirements, which,

on average, lounge around:

--14 to 16 hours a day for infants under 1 year old, with up to 20 hours during

the first two months of life;

--12 to 15 hours for toddlers ages 1 to 3;

--11 to 13 hours for young children 3 to 5;

--9 to 11 hours for older children 5 to 12;

--9 to 10 hours for adolescents, and

--7 to 8 hours for adults.

" Children likely need more sleep than adults because they are growing and

developing, " surmised Tworoger of the Fred Hutchinson Cancer Research

Center in Seattle.

Diurnal drowsiness provides a good gauge of any slumber obligation left

unfulfilled from the previous night.

" Feeling sleepy during the daytime regularly suggests that more sleep is

necessary, " advised Dr. Anne McTiernan, author of " Breast Fitness: An Optimal

Exercise and Health Plan for Reducing Your Risk of Breast Cancer " (2000, St.

's Press) and member of the Seattle cancer center.

Allowed to accumulate, the slumber deficit carries severe liabilities.

" In children, insufficient or poor sleep ... leads to learning and behavioral

problems and can significantly impair academic achievement, " noted Dr. na

McColley, director of the Cystic Fibrosis Center at Children's Memorial Medical

Center in Chicago.

Research reported in the British journal Nature showed though a good night's

rest can rescue memories that fade during the course of a day, no mechanism

appears capable of repairing the damage caused by slumber cut short.

" Sleep deprivation, at least in terms of memory consolidation, is not like the

bank, " explained study author , instructor of psychiatry at Beth

Israel Deaconess Medical Center and Harvard Medical School in Boston. " You

cannot accumulate a debt and hope to pay it off in a lump sum at a later date.

It is an all or nothing event, and if you don't snooze, you lose. "

Another study, published in the journal Sleep, showed even a single night of

restricted slumber can restrain a youngster's higher cognitive functions, such

as verbal creativity and abstract thinking.

Failing to acknowledge the sleep factor can lead to misinterpreted mental

measures and misdiagnosed medical maladies, students of snoozing styles

cautioned.

" Something seen as impaired cognitive development may, in fact, be the result of

insufficient sleep, " Weissbluth noted.

So might behavioral aberrations, such as the commonly diagnosed

attention-deficit hyperactivity disorder, which can shroud chronic fatigue,

scientists observed. A student who cannot sit still or concentrate or stop

fidgeting may be fighting sleep deprivation, not attention deficiency,

scientists remarked.

" Instead of parents growing concerned about their children not sleeping, we have

a nation of children on Ritalin (a drug prescribed for youngsters diagnosed with

ADHD), " complained Dr. Pelayo, a Stanford University neurologist who

specializes in the relatively new medical field of sleep disorders.

A number of research groups, including Pelayo's, are conducting trials to

determine whether at least some hyperactive patients might instead be poor

sleepers.

" Looking at sleep disorders as a pediatric problem is a recent, very important

development, " Weissbluth noted. " We are seeing more disturbed sleep among

children with such sleep disorders as sleepwalking and talking and night

waking. "

For the first time last year, the American Academy of Pediatrics recommended all

children be screened for snoring, loud-mouthed breathing during sleep that

affects an estimated 15 percent of youngsters.

" The idea that children who don't sleep well may have behavioral problems is

finally catching on, " Pelayo remarked.

Up to half of the industrialized world's population fails to meet its sleep

needs consistently, a shortfall suffered by an estimated 15 percent to 35

percent of children.

" Chronic sleep deprivation or chronic partial sleep loss is endemic in our

population, " stated neurologist Dr. Clete Kushida, director of the Stanford

Center for Human Sleep Research in Palo Alto, Calif. " Adolescents and

pre-adolescents are at highest risk for sleep deficiency, which affects their

performance and, I suspect, their general health. "

With fluctuating biological rhythms pushing up their natural sleep schedule,

adolescents typically are just settling into their deep morning sleep when the

alarm rings. A National Sleep Foundation poll showed more than 75 percent of

America's teens hit the sack after 11 p.m. and 25 percent stay there less than

6.5 hours, a shortfall that also shortchanges their grades, alertness and even

driving skills.

" Because of social and academic activities, sleep time is restricted, " said

Phyllis Zee, professor of neurology at Northwestern. " On top of that, their

biological circadian rhythm is delayed, so (they have) more difficulty falling

asleep until past midnight and therefore (are) unable to wake up for school. "

The discrepancy has prompted officials in several educational systems to

consider later start times for high school students than the traditional 8 a.m.

Many young adults hope their employers will do likewise.

The sleep survey found more than a third of adults ages 18 to 29 have difficulty

getting up for work, with one-fourth -- twice the number of those 30 to 64 --

showing up late and 13 percent admitting to falling asleep on the job.

Disturbing, but the percentage of this age group suffering from significant

daytime sleepiness -- 33 percent -- surpasses that of shift workers -- 29

percent -- a notoriously tired group that battles the body's natural inclination

to sleep between midnight and 6 a.m.

Even more worrisome, younger people are most likely to be involved in the more

than 100,000 car accidents caused by drowsy drivers each year. An alarming 60

percent of the under-30 vehicle operators admit to hitting the road sleepy and

24 percent report dozing off at the wheel.

Despite the startling statistics, only 25 percent of young adults have ever been

asked about their sleep habits by a physician and a mere 12 percent have

mentioned the issue on their own. Of the young and restless who do seek out

sleep aids, 26 percent turn to alcohol -- a substance that actually disrupts

slumber.

Some parents use equally ineffective methods to attract the sandman to the

nursery, scientists claim.

" Most of the sleep-related problems 20 percent of children have during the first

four months of life -- extreme wakefulness, irritability, light sleep, irregular

sleep, crying -- are due to parental mismanagement, " opined Weissbluth, author

of two Random House books offering advice to caregivers of the sleeplorn.

The deadliest mistakes include putting babies down to rest on their stomachs, a

position demonstrated to make them susceptible to sudden infant death syndrome,

and in adult beds, where studies show the tiny sleepers to be 40 times more

likely to suffocate than in a standard crib.

Researchers also find fault with permissive parents who fail to set limits or

consistently enforce rules to sleep well by, a laxness surveys have connected

with slumber disturbances.

Scientists take special exception to caregivers who send the wrong message by

confining youngsters to bed as punishment and letting them stay up late as a

reward. They advocate doing just the opposite.

" Moms and dads not paying attention to nap times and sleep times and not

inquisitive about whether their babies are getting enough rest present a hazard

they may not even realize, " Weissbluth observed. " Babies who don't sleep well

turn into middle-age adults and elderly who don't sleep well. "

If a child continues to awaken unrefreshed no matter how much shut-eye he or she

gets, the problem may be physical, including one or more of 88 known sleep

disorders, scientists advised.

" The major groups affected by sleep-disordered breathing are children and

middle-age men, " noted comparative bioscientist Dr. Zabka of the

University of Wisconsin in Madison.

A number of surgical, medical and behavioral alternatives are available for

children with sleep disorders, including removing tonsils or adenoids to ease

breathing disruptions; using medicines, such as antihistamines, to induce

sleepiness, and -- most highly recommended -- altering behavior. Any option

should be selected with the advice of a physician, researchers stressed.

" Sleep is important to the immune system, to brain maturation, and to our

ability to learn and function; good sleep optimizes our performance, mood and

health, " Sadeh concluded. " There is just no way to adapt to extreme sleep diet.

We pay a price in the short or the long run. "

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E-mail Lidia Wasowicz at lwasowicz@....

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February 3, 2004