Sleep and Rest

Sleep and Rest

1. Sleep Cycle

   • REM
     • Dreaming phase. EEG similar to awake state. Function remains unclear.
     • Associated with arousals, preponderant in the first year of life. Infants likely to have problems maintaining sleep.
     • Occurs in approximately 90 minute periods. Longest episode occurs just after body temp reaches lowest point; around 5am.
     • REM sleep decreases from 55% in infancy to about 25% by the time child is 5 years old.
   • NREM
     • Stage 1
       • Drowsiness, transition to sleep. In mature individuals, accounts for 5% of sleep.
     • Stage 2
       • Deeper than Stage 1, person can still be easily aroused. Muscles weaken, RR, HR slow. Mature sleepers spend 50% of sleep in this stage.
     • Stage 3 & 4
       • Nearly identical, sometimes called delta, deep, or slow-wave sleep. Deep relaxed, breathing shallow, HR slow. When delta waves occupy 50% of EEG pattern, Stage IV has begun. Hard to arouse.

2. Sleep Issues

   • Co-sleeping
     • AAP - bed sharing should not be considered a strategy to reduce SIDS risk
     • Benefits when practiced safely.
       • Care should be taken to aboid using soft sleep surfaces such as quilts, pillows, comforters or other similar materials
       • Bed sharer should not smoke or use substances that impair arousal.
       • Parents should understand that safety standards are in place for the design of infant cribs, but not adult beds, so entrapment is possible.
       • Co-sleeping parents should have an "exit plan" - ending practice at 6 months, before child will protest excessively. School age children who want to co-sleep may have issues such as separation anxiety.
     • Current SIDS task force recommendation: "a separate but proximate sleeping environment"
   • Sleep Positioning
     • AAP recommends all infants sleep in a SUPINE position unless there is some specific medical contraindication. Side sleeping is not recommended.
     • AAP recommends parents place baby on its stomach while awake to encourage upper body motor development and prevent positional plagiocephaly.

3. Indicators of sleep problems

   • Infants should NOT have sleepiness that interfere with feeding.
   • Toddlers/preschoolers may show signs of hyperactivity, emotional lability, irritability and aggressiveness when sleepy.
   • School age children are usually good sleepers. Taking naps or sleeping at school are not normal behaviors.
   • Adolescent obesity risk increases by 80% due to each hour of chronically lost sleep.