Why No Sleep Is No Good for the Brain

WORDS
Dawn McMullan
PUBLISHED
December 2008 in
DallasChild, FortWorthChild, NorthTexasChild
UPDATED
December 16, 2008
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Renee Nikolai, mother of a 14-month-old son, would like to fulfill her son’s sleep requirement of 14 hours per day – if he would let her. She gets four consecutive hours of sleep, maximum. Since her son was born, she’s gained weight, is irritable, has dark circles under her eyes, dry skin, as well as memory and concentration loss.

“I’m not sure if it’s because he still wants to nurse every four hours or if he’s just not a good sleeper, but I haven’t had more than four hours of sleep in a row in about 17 months. I would never have believed a person could still function on so little sleep,” bemoans the Dallasite. “Where’s the sandman?”

We all know what “sleeping like a baby” really means. Yet it seems that even once our babies are in elementary school, we’re still not getting our proper pillow time.

Deadlines. Laundry. Late-night homework or soccer games. Facebook. Nightmares. Sleepovers. Sleep apnea. The Daily Show. Insomnia. Sleepless kids. There are endless reasons why we don’t get enough sleep. It could be as simple as not making it a priority. An easy fix? Not so fast ….

Dr. Donald Watenpaugh can go on and on about sleep habits, sleep needs and sleep deprivation. But he has a one-question quiz to determine whether you (or your child) are getting enough sleep: Is something – an alarm clock or, more likely, a child – waking you up in the morning?

If the answer is yes, you are, by definition, not getting enough sleep.

“You would’ve kept sleeping,” explains Watenpaugh, director of Sleep Consultants Inc., based in the Metroplex. “Most of my patients are shocked. But if you have to wake up at 6 in the morning to make your day go like it needs to, then you should be going to bed at a time where you naturally wake up at 6, feeling refreshed and ready to go. For a child who’s, say, 6 years old, that time might be 7:30 or 8pm. If you’re 72 years old, that time might be 11pm.”
Stop rolling your (tired) eyes.

Sleep Hygiene: How's Yours?
Watenpaugh, a self-professed night owl who admits he doesn’t always listen to his own advice, says much of our sleep deprivation is due to poor sleep hygiene. Yes, hygiene. Never heard the term before? That’s probably because you don’t take sleep as seriously as you do brushing your teeth or washing your hair.

The truth is, as much as we obsess about sleep, we also don’t want to give up our long days.
In fact, the 2008 “Sleep in America” poll by the National Sleep Foundation blames long workdays for much of our sleep deprivation. Those surveyed say they work an average of 9.5 hours per day, while also spending an extra 4.5 hours per week working at home.

And here’s how we cope with the dark circles:
→ 84 percent say they just deal with it.
→ 58 percent hope caffeine will help.
→ 38 percent try to wake up by eating more sugar or carbs.
→ 5 percent take medications to perk them up.

Some, however, are at least trying to spend a little more time with their pillow:
→ 61 percent try to go to bed earlier.
→ 54 percent try to make up for lost sleep on the weekends.
→ 37 percent hope for a nap later.

Andrea Loubier of Dallas dabbles in many of these methods to try to stay alert each day. The single mom of two boys, ages 3 and 5, juggles her parenting and work schedules by toiling into the wee hours of the morning, getting five to six hours of sleep each night so she can make ends meet. And she’s feeling it.

“The most trying effect is that I’m not as patient or tolerant as I need or want to be,” she says. “When I’m only able to get five hours per night for three or more nights in a row, I notice that my creativity and problem solving vis-à-vis my kids goes out the door.”

She finds herself saying, “because I said so” and “don’t argue with me” more than she’d like. Eventually, her body rebels: “The longer I have to maintain that less-than-six-hours-per-night schedule, the more my health declines. I begin to get headaches with sinus and earache issues.”

Why? Because she needs eight hours of sleep, as adults generally do. If you’re not getting it, things like parenting and focus start to fall apart.

The Brain: Why It Needs Sleep
Loubier’s symptoms don’t surprise Dr. David Clark, a Dallas chiropractic neurologist.

“Basically, if you don’t sleep, you don’t heal,” he says. “Every day, part of our being alive is getting broken down a little bit. There’s tissue repair that needs to happen, the recycling of proteins, etc. When you get normal, restful sleep, that process is allowed to happen. You have your best shot at normal function.”

When you don’t get enough sleep, the brain goes haywire. Part of this is caused by your hypothalamic-pituitary-adrenal axis (or HPA axis). What it is and does is complicated. What it does on a lack of sleep isn’t.

“When you’re getting normal sleep, the HPA axis is in first gear,” Clark explains. “If you get only six hours of sleep, the next day it’ll be in second gear. The next night with six more hours of sleep, it shifts into higher gear.”

At this point, your brain releases too much cortisone, which is toxic to your nerve cells. That’s when brain function begins to break down. According to the “Sleep in America” study, that’s happening quite often in our very sleepy nation. In a one-month period:
→ 29 percent of Americans are either sleepy at work or have actually dozed on the job.
→ 36 percent have nodded off while driving.
→ 20 percent are choosing sleep over sex.

We’re not talking just a drowsy afternoon. These are serious issues, whether they are caused by a true sleep problem like sleep apnea or a not-enough-hours-in-the-day (or night) issue like Loubier’s.

Sleep Deprivation: Life Stage or Diagnosable Problem?
Mary Garcia of Dallas has never been a big sleeper. When her children, now 8 and 11, were young, she had the normal sleep interruptions of a parent with kids who don’t sleep very well. She rarely slept more than two hours at a time until the youngest was 3. She had two years of regular sleep before her mom, now 89, broke her hip almost three years ago.

Since then, Garcia has been functioning (or trying to) on five hours of sleep a night. Even when she finally makes it to bed, she has a difficult time falling asleep, regardless of her exhaustion.

She, too, loses patience easily, especially with her children. She has six bulging discs in her back. And, every few months, her body says enough is enough: “I end up having just a total down day where my body gets sick, shuts down. I end up sleeping for a day, and then I’m a whole new woman.”

Garcia has a full-time job. Like any mother, her to-do list seems never ending: dinner, laundry, lunches, homework, baseball game, football game – oh, and fun time with her boys and husband. Now, she also has to make time to take care of her mother: visiting her at the nursing home at least once a day, doing her laundry, taking her to the doctor and dealing with any emergencies that may come up. Garcia rarely goes to bed when she should in order to get enough sleep before her alarm goes off at 5:30am.

“There’s nothing that can give,” she says. “I can’t step away from being a daughter, and I can’t step away from being a parent.”

Does she have a true sleeping disorder? Maybe. Poor sleep hygiene based on life circumstances? Definitely.

Poor sleep hygiene is a lifestyle issue you can work through on your own. Sleeping disorders generally require outside help, usually starting with an overnight observation at a sleep clinic. While that doesn’t sound very restful, Anna Cash, manager of the Sleep Diagnostic Institute at the Medical Center of Lewisville, says it’s really quite easy. The Institute has two bedrooms where patients can read or relax until they fall asleep. Then the tests begin.

“We put wires on your head so we’ll know how deeply you go into sleep,” Cash explains. “We monitor your oxygen level, your breathing, whether you jerk your legs.”

A night at a sleep clinic often turns up the most common diagnosable reasons people don’t get good sleep: sleep apnea (which often causes snoring) and restless legs syndrome.

Jodi Evans, an area mom, began noticing how tired she was during the day after she had children and gained about 30 pounds. She wasn’t getting good sleep even though her kids, who are 21 months old and 9 months old, sleep through the night.

“It’s not really so much about people not getting enough sleep, its just them not getting through the stages,” Cash says. “Everybody needs REM sleep. Sleep apnea prevents you from getting to that stage.”

Evans has been diagnosed with sleep apnea and is supposed to wear a CPAP (continuous positive airways pressure) mask, although she isn’t a very good patient about it. Sometimes she stops for a five-minute nap in her car on the way to work. If she doesn’t have time for that, she slaps herself in the face. On the weekends, she tries to catch up by napping.

“It’s basically like I’m a kid again,” she says. “I just nap with my kids.”

The Eternal Question: Why Won't My Child Just Sleep?
For many parents, the simple reason they aren’t sleeping enough can be summed up by the bedside visits of their pint-size night owls. Their child is once again awake and wants company. Why do they resist that which we crave?

Dr. Hilary Pearson, medical director at the Pediatric Sleep Institute in Plano, hears this dilemma a lot. Parents ask it of her. And they ask it of their children, even preschoolers.
Sometimes they are waking up due to a medical problem. Pearson estimates that 10 to 20 percent of children have sleep apnea, with the most common symptom being snoring. The usual fix is taking out the child’s adenoids and tonsils.

But, most children who don’t sleep well either have bad sleep hygiene or – and you won’t want to hear this – bad sleep genes.

“Sleep habits are extremely inheritable,” Pearson says. “A parent will say to me, ‘I’ve been a night owl since I was in the seventh grade,’ but that doesn’t seem to translate to their 10- or 11-year-old. But they’re probably just like you. If a child comes from two parents with insomnia, they will have a lot of work ahead of them.”

Not only do they inherit your sleep genes, they inhabit your personality genes, which can also play into all of this.

“They inherit a little bit of your disposition – being nervous, a worrier, ultra-sensitive. It takes time to come down from one emotion to another,” she says. “Sometimes the only time you spend alone in your life is bedtime. So that could be your child’s time to think, to process. The things that make Dad a great businessman because he’s awake and alert and going and thinking and worrying and making lists … those things translate to the 5-year-old kid even though the 5-year-old is not the CEO.”

With kids who just don’t sleep well, sticking to a schedule offers the best chance to create better sleep habits – going to bed on time even during the holidays and focusing on that gift to parents of small children: the nap. Watenpaugh finds that sleep becomes less of a priority for parents when children turn 3, with many children giving up naps way before they are ready.

Research shows kindergarteners are getting about 30 minutes less sleep than they did 30 years ago, while kids from elementary school through high school sleep about an hour less than they used to.
“Their sleep isn’t being honored anymore,” he says. “In adults, sleep is mainly about function, getting their day-to-day bodily functions taken care of. In children, it’s about development. Sleep is the time when our body secretes most of its growth hormones. And growth hormones are a biggie for driving the rest of developmental functions.”

Pearson agrees, blaming late-night homework or sports games for much of our societal sleep problems.

“I have tried to stick with the idea that once per week a late bedtime is acceptable, but other than that, I think parents should try to preserve sleep time,” she says. “Growth hormone is secreted during sleep, and REM sleep is necessary for long-term memory, also known as learning. We should all remember that growth and development are essential for a child’s success. This means planning for an appropriate bedtime.”

Bottom Line: How Everyone Can Get More
You’re thinking, just tell me how to get more sleep! So, here it is:
→ Make sleep a priority. The truth is that you are the master of your family’s sleep. Sure, sleep problems are real, but sleep habits are more often than not the culprit in a sleepy home. So, go to bed at the same time every night.
→ Routine, routine, routine. Sleep experts and parents can’t stress this enough. Sure, it’s inconvenient to leave your playgroup 30 minutes early because it’s almost naptime. Of course, it would be fun to stay at your friend’s house until 10pm on a Friday even though your 7-year-old has an 8am baseball game the next morning. And we do it … occasionally. But more than one night of this a week has its consequences.
→ Don’t assume your children will sleep late if you put them to bed late. That’s urban legend and you know it. (Just wait: The teenage years are the time to live this dream.)
→ Don’t let your kids see violent images: “This is a prescription for nightmares,” Watenpaugh says.
→ Get your kids outside (climbing trees, riding their bikes), but don’t let them do high-intensity activities (full-court basketball or laps in the pool) within an hour of bedtime.
→ Don’t drink caffeine before going to bed (you or your kids).
→ Don’t start any sleep habits that you aren’t willing to keep. If you want to rock your kids to sleep every night, lay down with them until they fall asleep or put them in the car because it’s the only way they’ll nod off, that’s fine. But realize these habits don’t die easily. Respecting your child’s sleep idiosyncrasies – whether they are based in personality or age – is generally a good parenting skill. But finding the balance by respecting those of yours and the rest of your family is the key to a family that sleeps well.
→ If sleep deprivation is chronic, seek professional help; it could be a treatable disorder.

SIDEBAR
If You Can’t Catch a Nap, At Least Catch a Breather

Here are five ways to chill during the day to make up for a bad night’s sleep:
  1. Shop and eat Swedish meatballs. Ikea in Frisco offers free childcare in one-hour increments, during which you can shop, eat lunch, and maybe even try out the beds for a quick snooze if no one is looking. Kids have to be between 37 and 54 inches tall to play.
  2. Relax in a pretty place. The Dallas Arboretum has Mommy & Me Mondays and Tiny Tot Tuesdays with special events planned from 10am to 2pm. Stroll through the lovely landscape or take a blanket and rest while your child rolls down the grassy hill.
  3. Breathe and stretch. Several yoga or exercise centers offer on-site child care, including Dynamic Power Yoga in Addison.
  4. Catch a movie: If your children are old enough to sit still (or sit in your lap), catch a movie during the afternoon for some downtime and, if you’re lucky, maybe a 15-minute doze if the storyline isn’t holding your attention. The Angelika Dallas offers a Cry Baby Matinee every Tue and Wed at 1:30pm; Angelika Plano every Thu and Sat at 1:15pm (children under 5 free).
  5. If all else fails, dance: Baby Loves Disco (www.babylovesdisco.com) turns nightclubs into child-friendly discos for kids between the ages of six months to 7 years (and their Saturday Night Fever-loving parents). The group meets each month at Purgatory Dallas; upcoming events: 2-5pm Jan 24 and Feb 28.
SIDEBAR

The Sleep Factor

How much sleep do you and your child need? Of course, each person is unique. But here's what experts say:

Infant: 16-17 hours
1: 14 hours
2: 13 hours
3-4: 12 hours
5-6: 11 hours
7-8: 10.5 hours
9-11: 10 hours
12-14: 9.5 hours
15-17: 9 hours
18-20: 8.5 hours
21-79: 8 hours
80+: 7.5 hours

Source: Solve Your Child's Sleep Problems, by Dr. Richard Ferber.

SIDEBAR

The Sleep-ADHD Connection

The symptoms of sleep deprivation often mirror those of ADD and ADHD. And kids who already have problems with attention and hyperactivity become more inattentive and hyper if they don’t get the right amount of sleep.

“The first question that a doctor should be asking when a child is suspected of having ADHD is ‘how does that child sleep,’” says Dr. Donald Watenpaugh, director of Sleep Consultants Inc.

Why would a sleepy child be hyper? If you have to ask, you probably don’t have an ADHD child.

“Sleep problems in adults usually lead to daytime sleepiness. In children, especially hyper kids, their brains are so busy. They have no interest in sleep,” explains Watenpaugh. “What they do to cope is fidget. They move to stay awake and it’s not just motor activity. Their brain is hyperactive. There are a lot of kids out there right now on medication for ADHD problems when all they really have is a sleep problem.”

Children are often just not getting enough sleep because they’re overscheduled, which also leads to problems with ADD/ADHD. Dr. David Clark, a Dallas chiropractic neurologist, agrees with the connection, but says it’s a chicken-and-egg scenario.

“I could say 80 percent of kids with ADHD have sleep problems,” he says. “Whether one causes the other, it’s hard to say.”

Remember the HPA axis (see main story)? Well, in a child predisposed to attention issues, the effects of sleep deprivation on the brain magnify all of his or her symptoms. So, it’s difficult to find the root of the problem. What isn’t in dispute is that the two are connected and that your ADD/ADHD child needs more sleep than you might think.



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