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Understanding sleep and how Osteopathy can help

Recent research has shown that tired children do not cope well with life.

While there may be no surprise there, what may come as a surprise is the number of children affected. Prof Gregory Stores, head of research into child sleep disorders at Oxford University, has described it as “An epidemic of sleeplessness that is way above levels usually expected.”

  • An estimated 20% of children aged between 1-3y and
  • 10% between 4-5y, have difficulty either settling or staying asleep.

“Sleep disturbance is very common among young children.” He continues. “Their school attainment and performance is affected, as well as their social relationships. It’s happening on a large scale and it’s getting worse.” As a result of poor sleep and the sort of disruptive behavioural problems that arise, many children are being mis-diagnosed with attention-deficit type disorders, which can result in being prescribed powerful drugs like Ritalin.
Classic symptoms of overtiredness include hyperactivity – this leads to parents thinking that they are aren’t tired at all, or just don’t need much sleep. Whereas, in fact this is a symptom of chronic sleep deprivation and the child becomes more and more incapable of sleeping well.

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A Dutch study in 2000 looked at the lifestyles of young children, to see how this might be affecting their sleep. What they found was that in many cases hard-working parents wanted to spend time with their children, which they frequently did late in to the evening. In addition, bedrooms were no longer places to sleep, but also served as “entertainment centres” equipped with televisions, video recorders and computer equipment.

Another study showed that a children with a lack of sleep showed poor performance at school etc. “Children who feel better rested display a more positive self image, more achievement motivation, have more control over their aggressive behaviour, are less bored and are more receptive to their teacher.”

Tired children are irritable, quick tempered and less able to learn or negotiate with peer relationships. Parents have to see that it is in their child’s best interests to help them learn good sleep habits, and this ability to be able to separate with confidence and go to sleep independently needs to be learnt. Often young children with sleep problems have never been allowed to learn to go to asleep unassisted, and this hinders their ability to learn. Bedtime stories are part of a winding down routine that helps to establish a regular sleep pattern. So, sleep is an important issue for the child. The immune system, as well as levels of growth hormone, is affected by the amount of sleep they get.

New born babies sleep for a large proportion of a 24 hour period, while learning to differentiate between day and night, until eventually the longest sleep is at night. By about a year, babies still need between 12-14 hours sleep over 24h. With at least one good nap of between 1-2 hours. At 2 years old you would expect them to still continue with this routine, but by 3-4 years old the daytime nap would reduce. gradually phasing, while the night-time sleep should average 12 hours.

If a baby is allowed to go off to sleep peacefully and alone, rather than being constantly fed or rocked, then when he wakes briefly during the night, he can put himself back to sleep without parental attention. This ability creates the possibility of good sleep habits. Because introducing a bedtime routine helps a baby to learn that there is a slowing down at the end of the day’s activities towards the inevitability of bed and sleep, it’s worth introducing this from early on – say from 4 months. Any night-time waking is kept purposefully very peaceful and low-key. 4-6 months coincides with the introduction of solid foods, so night feeds may have been dropped; it should be possible for your baby to sleep through the night.

Sometimes babies can’t settle because they are over tired – it’s hard to settle when you are feeling cranky. Keeping a baby going until night-time seldom works. What happens is the “awake” hormone, (cortisol, which is also a stress hormone) come into play to compensate, and it becomes increasingly difficult for the baby to calm down enough to off to sleep. This often encourages a greater pattern of parental involvement until a child can’t manage to go to sleep alone, and also wants attention if he wakes during the night. When babies and toddlers are finding it hard to settle it’s better to bring bedtime forward slightly, so that they have the chance to peacefully sleep alone without becoming fractious. Once a baby is put to bed, any night-time handing should be kept to a minimum.

When older children are finding it hard to settle and sleep, the same key principles apply. Keep the bedtime routine low-key, but shift the emphasis off going to sleep straight away and focus on enjoying going to bed as a preliminary to sleep – perhaps with a book or listen to a story tape peacefully and alone before settling. But, insist that they stay in bed. Don’t say that they have to “go to sleep” but that they have to stay in bed.

Sometimes it is hard for parents to “let go” of their children and let them go to sleep on their own. Children sense this and then start to play up. Be stern and resolved with yourself as much as your child.

Cranial Osteopathy can be very helpful to treat sleep disorders for a number of reasons.
Often we don’t get to see babies until they are about 10 months old, when parents expect that their baby’s sleep pattern should be beginning to get easier for adults to cope with!

Physically when we feel the child we often find a degree of tension in the head and neck in babies that are difficult to settle, wake often or are poor sleepers. This is very common and occurs at the junction of the base of the skull and the neck, or between the base of the neck and thorax. With a baby born by Ventouse suction, for example, irritation between the neck and thorax is very common. This irritation causes autonomic nerve excitement that interferes with the fight/flight response, keeping the baby in a constant state of arousal. As a result, settling becomes a problem. But, this is relatively straightforward to address with cranial osteopathy.

Sometimes less specific causes are found – with a difficult pregnancy or delivery, accompanied by a lot of medical intervention, a baby may be traumatized by these events. We call this birth trauma, and comes in a variety of guises symptomatically and on examination. Feelings of fear resurface at the time of falling asleep, making a baby unsettled. Relaxing the vertebrae along the spine, releasing tension in the thorax (chest) helps too, especially around the diaphragm and solar plexus. This links the emotions and our more vegetative functions and helps to relax the nerves that connect the two. This also applies to babies that have been squashed in the womb, or during delivery.

Teenagers with sleep problems have sleep challenges for different reasons. In particular, after 10 years old, the immune system is less active and teenagers often suffer from immuno-depletion and become very tired as they adjust to increased demands on their energy. But, because of increased tiredness they often can’t get to sleep or don’t sleep well. This becomes a vicious circle. In this case, work is done to strengthen and support their immune system, and postural advice is frequently needed too because the junction between the neck and thorax can become irritated. A heavy school bag, too many pillows can all contribute.

With children there may be physical problems – rhinitis, post-nasal drips, coughing and asthma – and working to alleviate these can bring about peaceful sleep. Children with cerebral palsy, or autism, where the brain function is complex and the tuning in and out of sleep doesn’t happen easily are often helped with treatment.

Other problems:

Douse the night light

Keep your bedroom as dark as possible when you are sleeping. Too much brightness during the night depresses your immune system. This is because only when it’s really dark does your body produce melatonin, a hormone that not only helps you drift off to sleep but also helps prevent colds, flu, infection and certain diseases. Not sleeping enough, or being exposed to light during the night, decreases melatonin production and boosts oestrogen levels, and higher than normal levels of oestrogen are associated with an increased risk of breast cancer. Recent studies have found a massive 60 per cent increased risk of cancer among women who work night shifts, and an even greater increase among women with bedrooms that are brighter than they should be. Not surprisingly, women with limited vision or blindness have an approximate 20-50 per cent reduction in breast-cancer risk.

Even a dim source like a bedside clock or a night light may switch melatonin production off, so keep your bedroom as dark as possible. And if light from street lamps shines into your bedroom, invest in some black-out curtains.

Get a full night’s sleep

Everybody’s different: your body may need anywhere from 6-8 hours of sleep each night. Whatever your personal sleep requirement is, make sure you get it!

Sleeping better may help you fight off illness. People who are sleep deprived often have raised levels of stress hormones, as well as running the risk of persistent inflammation in the blood and a decrease in immune function. Millions of chronically deprived people are putting their health, quality of life and even length of life in jeopardy by not getting enough quality sleep. There is a clear connection between sleep and health, and therefore sleep deprivation and disease, and the evidence is getting stronger.

Quality sleep has been linked to balanced hormone levels (including human growth hormone and the stress hormone, cortisol); these keep weight down, lead to clear thinking and reasoning, improve mood, and engender vibrant, healthy skin. Blood pressure and heart rate are typically at their lowest levels during sleep; people who tend to sleep less have higher blood pressure. New research from a Warwick study of the sleep patterns of some 10,000 Britains links cutting sleep to five hours or fewer to a doubled risk of dying from cardiovascular disease. Shortage of sleep is also linked to increased risk of weight gain and diabetes.

Put simply, people who sleep well live longer. So if you want good health and to live to a ripe old age, do your immune system and yourself a favour and say ‘good night’ sooner

Copyright © Gayle Palmer 2009

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