Tag Archives: sleep

October 2014 published

October 2014 holds quite a few topics: scalp ringworm, sleep and behaviour, support for victims of sexual abuse, immunotherapy for peanut allergy, link to parental asthma booklet and what to do with babies with chicken pox.  Do leave comments below…

How to help your child get a good night’s sleep

New leaflet available for downloading to give to parents struggling with getting their child to sleep.  Written by a paediatric registrar, Dr Sophie Niall, with input from the Redbridge child development and Early Years team.  I find it a useful summary of some of what I say in a general paediatric consultation when the conversation turns to the parents’ sleepless nights.

June 2013 ready to go!

Lots of things to talk about this month.  Reminder of what Koplik spots look like, good e-learning on human trafficking, a link to the new primary care guidelines page, night terrors v. nightmares, some good allergy websites and Jess Spedding again on scaphoid injuries.  Do leave comments below.

Parasomnias

Parasomnias – with thanks to Dr Sophia Datsopoulos

A group of sleep disorders that are paroxysmal, predictable in timing in the sleep cycle and characterized by retrograde amnesia. Polysomnography (type of sleep study in which various parameters are measured in order to rule in or out various sleep disorders), if performed, is abnormal. Diagnosis is based on a thorough history; extensive work-up seldom necessary.

Focus on: ‘Pavor Nocturnus’ or Night Terrors

Children aged three to eight years, M>F. Often family history of night terrors or sleepwalking. Occur approximately 90 minutes into sleep,
during non-REM sleep.

Presentation: Child suddenly sits bolt upright, screams, and is inconsolable for up to 15 minutes, before relaxing and falling back to sleep
with no memory of the event the next morning. Tachycardia, tachypnoea and other signs of autonomic arousal are apparent.

Management:

– Reassure families that they have a benign course and are self-limiting

– Advise them not to attempt to wake the child during an episode and that comforting during the episode may delay its recovery

– Explore and alleviate any stress in the child’s environment. Encourage a relaxing bedtime routine

– If frequent and occurring at a specific times every night, behavioural interventions such as scheduled awakenings (see http://www.epic.edu.au/sites/default/files/Sleep/PDFed/Night%20terrors.pdf) may be beneficial

– More severe forms may benefit from treatment with benzodiazepines (e.g., clonazepam) under direction of specialist services.

Main differential: nightmares – these can occur at any age, during the lighter stage of sleep when dreaming, and so tend to be later in the night.  Seizures due to temporal lobe epilepsy can appear similar to night terrors but the seizures are usually brief (30 seconds to a few minutes) and are more common in older children and adults.

 

Comparison: Night Terrors and Nightmares

Factor Sleep Terrors Nightmares
Age 3 – 8 years Any age
Gender M>F Either
Occurrence in sleep cycle NREM REM
Arousable? No Yes
Memory for event No Yes
Exacerbated by stress Yes Yes

REM = rapid eye movement; NREM = non-rapid eye movement.

 

Next month: Focus on: Somnambulism (sleep waking) and Somniloquy (sleep talking)

 

March 2013 up and running

Delayed sleep phase this month and chronotherapy which sounds like quite an undertaking.  Also a link to a new parent’s guide to picking up and talking about sexual abuse, links to handy recent uploads to the site, the BSACI guideline on allergic rhinitis and more banging on about vitamin D supplementation – please.

February 2013 uploaded!

A timely reminder of an albeit old guideline on otitis media this month, continuation of our minor injuries series and introduction to a new series on sleep disorders.  Also a link to a new Whipps “1st afebrile fit” guideline and a bit of background on hypospadias.