Later School Times Suggested by American Academy of Pediatrics

Dr. Judith Owens, director of sleep medicine at Children's National Medical Center in Washington has recently submitted a policy statement requesting that school districts delay starting times for morning classes.
Recent research has shown that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life. Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need.

Many school districts are debating the change; the Long Beach, California, school board voted last year to delay the start of middle school until 9 a.m. But it’s a complex issue with school boards, educators and parents struggling to balance bus schedules, after-school activities and work schedules for older students. 

Nonetheless, Owens says biology should trump convenience. She notes that when teenagers go into puberty, there are changes in their circadian rhythm, the body's natural clock that regulates sleep and wake patterns. At the beginning of adolescence there is a natural delay in sleep and wake times, so that the average teenager doesn't fall asleep until around 11 pm.
 However, they also need between eight and nine hours of sleep per night so they are biologically programmed to wake at around 8am, when they're already in first period class. Teens often sleep in over the weekend, and many teen habits make it even harder to fall asleep which makes matters worse. But parents can help: it's especially important to set limits on the nighttime use of electronics. Studies have shown that the light from an tablet or cell phone can keep the brain in a waking, excited state. Quick naps late in the afternoon for 20 minutes or so can take the edge off and temporarily restore alertness.

A separate study published this month in the Journal of Pediatrics found that teenagers who don’t get enough sleep are more likely to become obese. Shakira Suglia of the Mailman School of Public Health at Columbia University and colleagues found that about a fifth of the 16-year-olds reported getting less than six hours of sleep a night, in a survey of 10,000 teens and young adults. Those with less sleep were 20 percent more likely to be obese by age 21, compared to their peers who got more than eight hours of sleep

 “Lack of sleep in your teenage years can stack the deck against you for obesity later in life,” Suglia said in a statement. “Once you’re an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer.”

---

Read more:
Houston Sleep.net
Teen Sleeplessness Piles on Risk for Obesity

Rapid-eye-movement sleep behavior disorder (REMBD) may be an indicator for Alzheimer's, Parkinson's Disease

Researchers at the University of Toronto say a sleep disorder that causes people to act out their dreams is the best current predictor of brain diseases like Parkinson's and Alzheimer's.
According to an article in Trends in Neurosciences, John Peever, MD, associate professor at the University of Toronto suggests the link occurs because brain degeneration attacks the brain circuits controlling REM sleep before it attacks those areas involved in Parkinson’s, Alzheimer’s, and other neurodegenerative conditions.

Sleep occurs in five distinct phases; the the fifth stage is REM, the the most active sleep phase in which you’re most likely to dream. The REM stage is also when you may find yourself twitching or tossing.
During normal REM sleep your brain temporarily paralyzes your muscles, but in people with REM sleep behavior disorder (REMBD) this paralysis ceases to occur; they may act out their dreams, resulting in injury to themselves and/or their bed partner.

The new research examines the idea that neurodegeneration might first affect areas of the brain that control sleep before attacking brain areas that cause more common brain diseases like Alzheimer’s. REMBD is most common in older men – 90 percent of people who develop it are male, and most are over the age of 50. Scientists already knew REMBD was associated with certain brain disorders including Parkinson’s: previous research has shown that approximately 30 percent of people diagnosed with REMBD will develop Parkinson’s within three years. However, the new study suggests that  80 to 90 percent of people who develop REM sleep behavior disorder will develop degenerative brain disease within the near future.

Medications are available for many of these conditions that can delay or slow progression of the disease when taken early enough, so REMBD could serve as an alert to do so. Once you’re diagnosed with REMBD the usual treatment is a muscle relaxant such as clonazepam (Clomid or Klonopin). However this new research suggests it’s a good idea for anyone diagnosed with REMBD to have a complete workup for Parkinson’s, Alzheimer’s, dementia, and other brain disorders.

Dr. Peever suggests that “...It’s important for clinicians to recognize RBD as a potential indication of brain disease in order to diagnose patients at an earlier stage. This is important because drugs that reduce neurodegeneration could be used in RBD patients to prevent (or protect) them from developing more severe degenerative disorders.”

---

References:

Breakdown in REM sleep circuitry underlies REM sleep behavior disorder (Abstract; Trends in Neuroscience, 03/04/2014
Specific Sleep Disorder Associated with Brain Diseases: Psyche Central

Sleep disorders may cause ADD/ADHD

For more than three decades, there has been a growing recognition that some people have difficulty focusing and maintaining attention; in various instances, they also may have difficulty sitting peacefully in a classroom
or calm setting. These individuals have been labeled with attention deficit disorder - with or without hyperactivity -known as ADD/ADHD.

Traditional treatment for ADD/ADHD has been with stimulant medications, such as Ritalin or Adderall, which provide improvement by stimulating a fatigued, unrested brain. It is now known that problems with sleep can result in difficulties with concentration and the ability to stay focused during the day. The increased physical activity -hyperactivity - displayed by many of those affected is a way of remaining stimulated, thus overcoming the sleepiness. This difficulty is most noted when sitting inactive and under-stimulated.

About 30 percent of these patients have a sleep disturbance as a fundamental cause according to Dr. Simmons, who has treated these types of patients for over 20 years. If a sleep disorder is present, there are other treatment options for improvement of the ADD/ADHD symptoms.
"If there is a concern that a child or adult has ADD/ADHD, then it is imperative to first make a few observations regarding the person's sleep in order to determine whether a sleep disorder center consultation is necessary, prior to starting stimulant drugs," Dr. Simmons continued. "In many cases, those who have been placed on stimulants can be successfully taken off them if a sleep problem has been properly diagnosed and treated. For years now, I have taken this approach and many patients labeled with ADD/ADHD in whom we have diagnosed with a sleep disturbance have demonstrated dramatic improvement after treating the sleep disorder. This treatment has minimized or eliminated their reliance on stimulant medications."

The main causes for the disturbed sleep in the ADD/ADHD population are lack of sleep due to domestic/environmental factors in the home, restless legs syndrome or obstructive sleep apnea, or an associated condition known as the Upper Airway Resistance Syndrome.

UARS is a subtle breathing disorder not properly diagnosed at most sleep centers; but by utilizing extra measures Dr. Simmons' team is able to recognize and treat this disorder properly. "We look at a whole battery of issues when someone complains of ADD/ ADHD, including both psychological and physiological factors," Simmons said. "I've seen many patients improve when we treat their sleep without the need for stimulants."

An example of one such patient is Trey Girlinghouse, a 9-year-old whose teachers became concerned with his difficulties in school. They encouraged his mother to find medical assistance for what they labeled as ADD; he was placed on stimulant medication treatment, but his mother was concerned about medication usage and looked for alternative treatments.
She had Trey evaluated by Dr. Simmons, and after a comprehensive sleep test he was found to have UARS. He then began treatment for this breathing disorder and is no longer on stimulants: he has also markedly improved his performance at school.
"Now that his sleep is better and he does better at school, the teachers agree that he no longer needs to be on medications," his mother said.

Dr. Simmons provides this partial list of signs which should raise concerns when considering whether ADD/ADHD may be associated with a sleep disturbance:

•  Difficulty falling asleep 
• Difficulty staying asleep 
• Snoring or labored breathing 
• Kicking repetitively during the night 
• Excessively grinding or clenching teeth 
• Difficulty awakening in the morning 
• Sleep walking or sleep talking 
•  Noticeable sleepiness during the day when not active

If someone has any of these indicators and appears to suffer with ADD/ADHD symptoms, then a proper sleep evaluation would be warranted. Patients can be evaluated by contacting CSMA's sleep centers throughout Greater Houston at 281-407-6222.
Visit www.HoustonSleep.net for more information and fill out our questionnaire to initiate an evaluation.

New study suggests that children without regular bedtimes have more behavioral problems.

Researchers from University College London recently completed a long-term study of  babies born in the UK in 2000 to 2002, which regularly surveyed parents about sleep and behavioral problems. After analyzing data for over 10,000 children they discovered that children without a regular bedtime tended to score worse on a measure of behavior problems such as acting unhappy, getting into fights and being inconsiderate.
In three year olds, close to 20 percent of parents said their child sometimes or never went to bed at a consistent time. That fell to 9 percent among five year olds and 8 percent for seven year olds: at seven  those without a regular bedtime scored an 8.5, on average, based on their mothers' reports. That compared to scores between 6.3 and 6.9 for kids who had a consistent bedtime before 9 p.m.
The assessment is scored from 0 to 40, with higher scores indicating more problems. Researchers said one to two points represents a small or moderate difference, but is "meaningful."

Children with attention-deficit/hyperactivity disorder or an autism spectrum disorder were not included in the study. Teachers of seven year olds were also asked to report on their, and gave worse scores to children who didn't have a regular bedtime. Although the researchers accounted for other parent characteristics and family habits, it's still possible kids' behavior problems weren't directly caused by irregular bedtimes.

Nonetheless, the effects that a regular sleep schedule have on your "biological clock" have been well documented. Yvonne Kelly, who led the study says that "If you are constantly changing the amounts of sleep you get or the different times you go to bed, it's likely to mess up your body clock. That has all sorts of impacts on how your body is able to work the following day." 

Kids whose parents said they had non-regular bedtimes on every survey growing up had the most behavioral issues, but when children went from having a non-regular bedtime to a regular bedtime on the following survey their behavior scores improved.

---

References:
Pediatrics (online October 14, 2013)
Non-regular bedtimes tied to kids' behavior problems (Reuters)