New studies in the journal Sleep focus on helping children, women sleep better

October 01, 2006

WESTCHESTER, Ill., September 29 -- New studies in the October 1st issue of the journal SLEEP report the following findings:

The refusal of young children to go to bed at night can cause unnecessary stress for members of their family. However, parents and guardians can take comfort in knowing that behavioral treatments are an effective means for resolving a child's bedtime problems and night wakings.

The study, conducted by Jodi A. Mindell, PhD, of St. Joseph's University in Philadelphia, is based on a review of 52 treatment studies, participated by 2,500 infants and toddlers, by a task force appointed by the American Academy of Sleep Medicine (AASM).

"The results indicate hat behavioral therapies produce reliable and durable changes in bedtime problems and night wakings in infants and children," wrote Mindell. "Across all studies, 94 percent report that behavioral interventions produced clinically significant improvements in bedtime problems and/or night wakings. Approximately 82 percent of children benefit from treatment and the majority maintain these results for three to six months."

Mindell noted that additional research is needed to examine the delivery methods of treatment, longer term efficacy and the role of pharmacological agents.

According to Mindell, studies have shown that 20 to 30 percent of young children have significant bedtime problems and/or night wakings. In addition, night wakings are among the most common sleep problems in infants and toddlers, with 25 to 50 percent of children over the age of six months waking during the night, added Mindell.

AASM offers the following tips to help a child sleep better:Experts recommend that infants (three to 11 months) get 14 to 15 hours of sleep per night, while toddlers get 12 to 14 hours, pre-schoolers 11 to 13 hours and school-age children 10 to 11 hours.

A child who gets enough sleep and sleeps well is more likely to be cheerful during the day. The better the child sleeps, the happier the entire family will be.


The first report on healthcare utilization in women with obstructive sleep apnea (OSA) reports an increase in the years prior to the diagnosis of OSA, but then a decrease in the following two years. This conclusion demonstrates the importance of early diagnosis and treatment of OSA so that women can sleep better faster and, too, our healthcare system is less burdened.

Katsuhisa Banno, MD, and colleagues of the Sleep Disorders Center in St. Boniface General Hospital's Section of Respiratory Diseases studied 414 women with OSA. According to the results, there was an increase in fees in the two years before, and a decrease in fees in the two years following, diagnosis. In addition, the number of physician claims in the two years preceding diagnosis rose, and then fell in the following two years. Furthermore, the number of clinic visits in the two years prior to diagnosis increased, and declined in the two years following diagnosis.

"Our results showed that sleep-clinic evaluation (correcting diagnosis and recommending treatment) in patients with OSA may lead to a significant reduction in physician claims and ambulatory clinic visits. Early diagnosis and treatment of OSA may thus contribute to a significant cost savings to healthcare systems," the authors wrote.

OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs. OSA afflicts an estimated 15 million to 20 million Americans, as well as millions more who remain undiagnosed and untreated.

Continuous positive airway pressure (CPAP), the most common and effective treatment for OSA, provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing the pauses in breathing that characterize sleep apnea and restoring normal oxygen levels.


The burden placed on an elderly caregiver whose spouse suffers from Alzheimer disease can often cause sleep disturbance, which can, in turn, lead to early physical signs of cardiovascular problems. This finding pinpoints further the detrimental effects a poor night of sleep can have on a person's well-being, and advises the elderly of the importance of sleep in maintaining their health.

The study, conducted by Brent T. Mausbach, PhD, and colleagues of the University of California, San Diego, focused on 40 elderly spousal caregivers of patients with Alzheimer disease, who participated in an in-home full-night polysomnography and had other tests performed. The results indicated that wake after sleep onset (WASO) was positively associated with norepinephrine levels, indicating that caregivers with greater time spent awake during the night had elevated plasma norepinephrine concentrations. In addition, WASO was significantly related to plasma D-dimer.

Sleep needs change over a person's lifetime. Older adults need about the same amount of sleep as younger adults -- seven to nine hours of sleep per night.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have, in addition to health problems, a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids. Poor sleep is also associated with a poorer quality of life.


The amount of light exposure can have a profound effect on an individual's sleep pattern. Stronger light intensity enables noradrenergic locus coeruleus (LC) neurons, which regulate arousal, to function normally and, therefore, provide a circadian regulation of the sleep-wake cycle. Light deprivation, on the other hand, induces a loss of noradrenergic fibers which, in turn, throws a person's sleep-wake rhythm out of kilter.

The study, conducted by Mónica McGonzález, PhD, and Gary Aston-Jones, PhD, of the University of Pennsylvania, Philadelphia, focused on rats, that were maintained on a light-dark (LD) schedule or in constant darkness (DD) for three to four weeks, and treated with DSP-4, a neurotoxic agent specific for noradrenergic-LC projections. Vigilance states were analyzed before and three weeks after LC lesion. The DSP-4 lesion was verified by immunohistochemistry of noradrenergic fibers in the frontal cortex.

"DSP-4 decreased the amplitude of the sleep-wake rhythm in LD animals by significantly decreasing wakefulness and increasing sleep during the active period," the authors wrote. "However, DSP-4 had no effect on the sleep-wake cycle of DD animals. Moreover, DD itself decreased the amplitude of the sleep-wake cycle similar to that of the neurotoxic lesion of the noradrenergic system in LD animals.

This study is particularly useful for those persons suffering from shift work, a circadian rhythm sleep disorder that occurs due to a work schedule that takes place during the normal sleep period. This schedule requires you to work when your body wants to sleep. Then you have to try to sleep when your body expects to be awake. The timing of when you sleep and wake is much different than what your internal body clock expects.

This sleep problem causes you to have trouble sleeping or to be severely tired. It is most often reported due to the night and early-morning shifts. These workers typically sleep one to four hours less than average. They also feel that the quality of their sleep is very poor. They do not feel refreshed when they wake up. This can hinder their performance at work. It can also make them less alert. This can put them at risk of an injury on the job.

One of the ways to cope with working an overnight shift is to adjust the lighting of your work space. Intense light exposure will enable your body to adjust to the "daytime-like" conditions in your office, and make you more alert and effective at your job. When it's time for you to go to sleep, take the steps necessary to make your bedroom dark. This will train your body to go to sleep at a bright time of day.

Sleep problems from shift work affect male and female workers of all age groups. Those who have unusual work hours are most likely to have it. Estimates are that two-to-five percent of the general population is affected, not including people who work early-morning shifts.
SLEEP is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society., a Web site maintained by the AASM, provides information about the various sleep disorders that exist, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

To arrange an interview with an AASM spokesperson regarding any of these studies, please contact Jim Arcuri, public relations coordinator.

American Academy of Sleep Medicine

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