What Have You

We do not usually need to think very much about our sleep – it is just a part of life that we take for granted. When we cannot sleep, though, it can be a real problem. In fact, most of us will find it hard to sleep at some point in our lives. We have a word for it – insomnia. It is often just for a short time, perhaps when we are worried or excited. After a few days, things settle down and we get back to sleeping normally. However, we need sleep to keep our minds and bodies healthy. If we carry on sleeping badly, we start to notice the effects.

It is easy to worry when one cannot sleep. The occasional night without sleep will make somebody feel tired the next day, but it will not harm someone’s physical or mental health. However, after several sleepless nights, one will start to find that: 1) you are tired all the time; 2) you drop off during the day; 3) you find it difficult to concentrate; 4) you find it hard to make decisions; and 5) you start to feel depressed. This can be very dangerous if one is driving or operating heavy machinery. Many deaths are caused each year by people falling asleep at the wheel while driving. Lack of sleep may also make us more vulnerable to high blood pressure, obesity and diabetes.

The adult pattern of sleep cycles, each approximately 90 min long, progressing in depth through stages 1-4 and followed by a period of rapid eye movement (REM), is established early in childhood, usually by the age of 12 months. As is the case in adults, deep or slow wave sleep consisting of stages 3 and 4 is a relatively predominant in the first half of sleep and REM duration is longer during the last half. The major maturational changes during childhood are to do with the establishment of a single phase of sleep as the child progresses from a circadian rhythm based on a 4 hr cycle in the neonatal period to one based on approximately 16 h of wakefulness and 8 h sleep by the early teens. It is thought that the 4 h cycle is dependent upon an endogenous pacemaker, probably located in the central hypothalamus, while the adolescent pattern is a function of compromise with environmental stimuli. The neonatal 4 h cycle does not, incidentally, depend upon feeding schedules since it can be found in infants fed intravenously and continuously.

Sleep disturbances in youth represent highly common phenomena that, in severe forms, can interfere with daily patient and family functioning. Recent research studies have sparked interest in pediatric sleep problems, yet further investigation is needed to develop empirically based detection and treatment of pediatric sleep disorders.

The consequences of untreated sleep problems may include significant emotional, behavioral, and cognitive dysfunction. The magnitude of these sequel is inversely proportional to the child’s overall ability to adapt and develop in spite of the sleep disturbance. Nevertheless, sleep regulation remains a critical part of health for youths. Elevated rates of sleep problems exist among children and adolescents with neurodevelopmental and psychiatric disorders.

Reciprocal relationships occur between sleep disorders and comorbid psychiatric disorders. For example, when a given child with recurrent depression has an exacerbation, sleep problems often increase simultaneously. On the other hand, disrupted and inadequate sleep alone can produce behavioral, affective, and cognitive dysfunction.

Neurobiologically, closely linked modulatory systems appear to regulate sleep, alertness, and attention span.