How an early bedtime can have lasting effects on kids

Making sure your little ones get enough sleep just might be one of the best things you could do for their health, both now and later on, experts say.

Scientists have long known that children who don’t get enough sleep may be at an increased risk of obesity, among other health concerns, but a new study suggests that having a late bedtime is linked to a greater obesity risk later in life, too. So, an early bedtime may be better.
“This study adds to a body of research that demonstrates that young children benefit from having a regular bedtime and bedtime routine,” said Sarah Anderson, associate professor of epidemiology at Ohio State University’s College of Public Health and lead author of the study.

How bedtime may be linked to obesity

For the study, which was published in this month’s edition of the Journal of Pediatrics, researchers analyzed data on 977 children who were part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development‘s Study of Early Child Care and Youth Development.
The data, which tracked the children from preschool-age to adolescence, indicated at what time they went to bed when they were about 4½ years old, as well as their height, weight and body mass index when they were about 15 years old.
After comparing the children’s bedtimes with their health as teenagers, the researchers found that only 10% of the children who went to bed at 8 p.m. or earlier during their preschool years were obese as teenagers. However, 23% of the children who went to bed after 9 p.m. as preschoolers were obese as teenagers.
For the children who went to bed between 8 and 9 p.m. as preschoolers, about 16% were obese as teenagers.
“Preschool-aged children with early weekday bedtimes were half as likely as children with late bedtimes to be obese as adolescents. This was true even after taking into account other factors that we know are related to risk for obesity,” Anderson said.
“Other research has shown benefits for children’s behavior, cognitive development and attention,” she added. “Regular bedtime routines, including an early bedtime, also are linked to fewer sleep problems such as nighttime awakenings or difficulty falling asleep.”
But how exactly can sleep habits early in life be linked to health outcomes later in life? There are a number of plausible potential mechanisms in this case, Anderson said.
“First, children who have a regular early bedtime are more likely to get enough sleep. Not getting enough sleep can result in changes in the hormones controlling appetite and metabolism,” Anderson said.
“Also, staying up later in the evening provides more opportunity for snacking and viewing television commercials that promote snacking,” she added. “Recommending that preschool-aged children are in bed by 8 p.m. is a potentially modifiable household routine that may help to prevent obesity.”

Early snooze benefits the brain, too

While an early and full night’s sleep for children can benefit their bodies, it also can improve their brains.
“An early bedtime benefits a child’s physical health, as well as mood and mental health, because it allows time for restorative sleep, which is important for the repair and recovery of the brain and the body,” said Reut Gruber, researcher at McGill University in Canada and director of the Attention, Behavior and Sleep Lab at the Douglas Mental Health University Institute.
“Sleep deprivation impairs the physiological processes that allow for adaptive emotional regulation. Emotional regulation processes are dependent on a ‘dialogue’ or interactions between the parts of the brain called prefrontal cortex and the amygdala,” she said. “These neural areas that govern emotional regulation are sensitive to sleep deprivation. When people are sleep-deprived, the connectivity between the prefrontal cortex and amygdala is impaired, and this leads to an individual’s difficulty to regulate emotions.”
Additionally, “there is a vicious negative cycle, with sleep deprivation impairing emotional regulation and with impaired emotional regulation leading to increased stress and arousal, further interfering with sleep,” Gruber said.
A small three-week study published in the Journal of Pediatric Psychology in 2013 involved 32 children, between 8 and 12 years old, who were instructed to go to sleep either one hour later or earlier than usual. They were asked to complete tasks that measured emotional functioning, memory attention and math fluency at the end of each week, and the researchers found that going to sleep one hour later impaired children’s performance on the tasks.
A separate 2010 study published in the journal Sleepfound that adolescents with bedtimes set at 10 p.m. or earlier were significantly less likely to suffer from depression and to have suicidal thoughts.
The research involved analyzing data from 15,659 students in grades seven to 12 who participated in the National Longitudinal Study of Adolescent Health, which included their bedtimes as well as their mental health.
“A variety of theories have been developed to explain why we need to sleep,” said Dr. Sumit Bhargava, clinical associate professor of pediatrics at the Stanford University School of Medicine and sleep physician at Lucile Packard Children’s Hospital.
“Some of the reasons are energy conservation theory: We sleep to conserve energy so we can be functional during the day,” he said. “Restorative theory suggests we sleep to ‘restore’ something that we lose while awake, with the body repairing and rejuvenating itself. Important hormones are secreted while we sleep and byproducts of the brain’s activity are cleared. … Brain plasticity theory suggests sleep is correlated to changes in the structure and organization of the brain.”

Bedtime advice for parents

Therefore, a child’s bedtime is not nearly as important as the amount of sleep he or she is getting each night, Bhargava said.
The woes of getting your toddler to sleep

The woes of getting your toddler to sleep 02:38
“An early bedtime, per se, will not necessarily affect a child’s physical health or mood and mental health in a positive way. The goal should be, choose an age-appropriate bedtime that allows the individual child to get the hours of sleep the child needs,” he said.
“Set an appropriate bedtime based upon the amount of sleep your child needs to be functional and effective during the day. Then, be consistent with it, even on weekends,” he added. “Sleep is just as important to human life as eating and breathing. We spend almost a third of our lives sleeping.”
The American Academy of Sleep Medicine released updated sleep guidelines for children in June, recommending that:
  • Babies 4 months to 12 months should get 12 to 16 hours
  • Children 1 to 2 years old should get 11 to 14 hours
  • Children 3 to 5 years old should get 10 to 13 hours
  • Children 6 to 12 years old should get nine to 12 hours
  • Teenagers 13 to 18 years old should get eight to 10 hours
Roughly, infants should sleep by 7 p.m., toddlers by 7:30 p.m., younger children by 8 p.m., preteens by 8:30 p.m. and teens between 9 and 10:30 p.m., said Harriet Hiscock, associate professor at the Murdoch Childrens Research Institute in Australia.
“There is no hard and fast rule for this, as sleep quality is probably more important than sleep duration, at least in children,” she added. “A regular bedtime and bedtime routine are probably more important.”
To get your child to go to sleep, Gruber advises, don’t negotiate bedtime.

Sleeping Positions to Relieve Back and Neck Pain

For most people suffering with back and neck pain, sleep may not be as pleasant. To better deal with such dilemmas, it is helpful to understand and know what you can do to alleviate your condition and prevent further damage. With proper guidance and a proactive attitude, you don’t need to simply manage the condition, but improve it.

Back Pain Sleeping Positions

Back pain can be triggered by a number of reasons such as osteoarthritis, cervicalgia, degenerative disc disease, spinal stenosis and sciatica, to name some. The best determine which sleeping position will work best for you, you need to know what is the underlying cause of your back pain.

• Supine Position

There are no rules when it comes to sleeping, but there are certain guidelines that you can follow to ensure a more comfortable sleep. If you prefer to sleep on your back, it is advisable to place a pillow underneath your knees, and another one under the small of your back. In this position, gravity can force the back to arch abnormally.

If you have sciatica or low back pain, sleeping in this position can be a challenge. So be sure to provide support on your back and beneath the back of your knees to alleviate any pressure on the lower back. A good variation of this position is to lie on your back but with both knees slightly bent.

• Side Lying

Now, if you prefer to sleep on your side, then that’s a good thing. Most experts consider this as the best position for people with back pain. However, keep in mind that you will still need pillows for support, one placed between your knees and under the waist. This position is best adapted by people who are in the inflammatory stage of pain, where even the most minimal movement can trigger pain.

• Prone Lying

This refers to lying on your stomach. In this particular position, gravity forces your back to arch towards the stomach. This can be uncomfortable for people with low back pain. To best accommodate this position, place a pillow under the stomach. This will effectively prevent your back from arching too much.

Neck Pain Sleeping Positions

Fact: for every single inch that the head is move to a forward position, its weight increases by up to 10 pounds. Abnormal neck posture can lead to a number of complications such as disc herniations, muscle strain, arthritis, and pinched nerves. Sleeping positions can affect as well as trigger neck pains. Abnormal alignment of the neck to the spine can result to joints deteriorating faster, and cause strain to the bones, muscles and ligaments.

The best approach to remedy neck pain is to correct posture, whether during sleep or when in an upright position. Since sleep should allow the neck and back to relax and relieve it from tension, it is beneficial to study the different positions and how to ensure proper alignment of the neck and spine.

• Supine Position

For people suffering from neck pains, this is the most idea position since it works well with the normal curvature of the spine. In this position, the head and neck should be supported by a pillow, as well as under the lower back area.

• Side Sleeping Position

This is another acceptable position but will require additional support. Pillow should be placed between the knees. With this support, there will be no need to provide lumbar pillows. However, raising of one arm above or under the head is not advisable, as it puts undue tension on the neck and shoulders. This position may also compress the

• Prone Position

There are people who are used to sleeping on their stomach. If you have neck pain, it is best to avoid this position as it increases the risk of aggravating the pain on the neck and lower neck. However, people who sleep in this position usually find it difficult to adjust their sleeping positions. You can work around this but putting a good assistance pillow under the head and neck as well as another pillow beneath the abdomen.


More Sleep, Fewer Colds?

Is there a link between getting a good night’s sleep and the ability to ward off winter ailments like bronchitis, colds and pneumonia?

There’s plenty of evidence linking poor sleep to chronic diseases like diabetes and heart disease, but remarkably few good clinical trials have looked at whether sleep is a bulwark against respiratory infections. One such study, published last September in the journal Sleep, reported that adults who slept less than five or six hours a night were four times more likely to catch a cold than those who slept at least seven hours.

The trial was one of the first to objectively measure the amount of sleep volunteers got before they were deliberately exposed to the common cold through nasal drops containing the cold virus. A clinical trial in 2009 that relied on participants’ own accounts of their sleep habits also found sleep protective against the common cold. In that trial, volunteers who reported sleeping fewer than seven hours a night were nearly three times more likely to catch a cold after exposure than those who slept eight hours or more.

An observational study from 2012 of nearly 60,000 women in the Nurses Health Study II also suggested sleep patterns may affect pneumonia risk. It found that women who slept five hours or less were more likely to develop pneumonia, though oddly enough, those who slept nine hours or more were also at higher risk. Dr. Sanjay Patel, the study’s author, suggested that the women who slept excessively may have suffered from poor quality sleep. It is also possible that being in the sleep position for an extended time increases susceptibility to pneumonia, since bacteria that colonize the nose and throat may drip into the lungs, he said. Sleep scientists were not aware of any studies examining the role of sleep in bronchitis.

Scientists are uncertain how sleep might help fight infections, but sleep is known to play a role in the regulation of the immune system. Studies suggest that sleep deprivation, for example, may lead to a weaker antibody response to vaccination, Dr. Patel said. Insufficient sleep “seems to reduce the functioning of cells like natural killer cells and lymphocytes that are important in giving you an immune response.”


Sleep Problems Tied to Type 2 Diabetes

 Women with sleeping difficulties are at increased risk for Type 2 diabetes, researchers report.

Scientists used data from 133,353 women who were generally healthy at the start of the study. During 10 years of follow-up, they found 6,407 cases of Type 2 diabetes.

The researchers looked at four sleep problems: self-reported difficulty falling or staying asleep, frequent snoring, sleep duration of less than six hours, and either sleep apnea or rotating shift work. The study is in Diabetologia.

Self-reported difficulty sleeping was associated with higher B.M.I., less physical activity, and more hypertension and depression. But even after adjusting for these and other health and behavioral characteristics, sleeping difficulty was still associated with a 22 percent increased risk for Type 2 diabetes.

Compared to women with no sleep problems, those with two of the sleep conditions studied had double the risk, and those with all four had almost four times the risk of developing the illness.

The senior author, Dr. Frank B. Hu, a professor of nutrition and epidemiology at Harvard, said that sleep problems are associated with excess secretion of two hormones: ghrelin, which increases appetite, and cortisol, which increases stress and insulin resistance. Both are linked to metabolic problems that increase the risk for diabetes.

“And,” he added, “it’s not just quantity of sleep, but quality as well” that is associated with these health risks.


Catching Up on Lost Sleep

It is unclear whether you can make up a long-term sleep debt, because most studies have looked at the effects of sleep loss and recovery only over a few nights or weeks, said Dr. Matt T. Bianchi, the chief of the division of sleep medicine at Massachusetts General Hospital and an assistant professor of neurology at Harvard Medical School. Simulated driving performance and reaction times are affected by just one sleepless night, research has shown.

There’s no doubt that sleeping just four hours a night catches up to people within a few nights, leading to impairments of attention, learning and memory and worse performance in school and at work.

And making up for lost sleep over the weekend doesn’t work. Five brief nights quickly add up to a shortfall of 20 hours, but people don’t sleep more than five to 10 extra hours to compensate, Dr. Bianchi said.

“The interpretation has been you can’t pay off your sleep debt, you just carry it with you,” though it’s also possible that people don’t sleep an extra 20 hours because they don’t need it, Dr. Bianchi said. He cited research by Jim Horne of Loughborough University in Britain showing that a timely nap of less than 20 minutes can equate to an extra hour of nighttime sleep.

Different people need somewhat different amounts of sleep, but anything less than six hours a night is definitely not enough, said Dr. Charles Czeisler, a professor of sleep medicine at Harvard.

In one sleep study, people were brought into a lab and required to stay in bed for 14 hours a day. They slept 10 to 12 hours a night at first, Dr. Czeisler said. Then they gradually slept less over the next few weeks until they stabilized at about 8.4 hours per night.

Chronic lack of sleep has been associated with a host of physical ailments, including heart disease, diabetes and memory loss.

People who sleep less than five hours a night for five years have a 300 percent increased risk of hardened arteries, Dr. Czeisler said. Once arteries are damaged, returning to a healthy sleep pattern is unlikely to heal them.

But a better sleep pattern can improve blood pressure in just a few weeks, he said. “The best thing to do is start getting enough sleep,” Dr. Czeisler said.


How Exercise Can Help Us Sleep Better

As a clinical psychologist and sleep researcher at the Feinberg School of Medicine at Northwestern University, Kelly Glazer Baron frequently heard complaints from aggrieved patients about exercise. They would work out, they told her, sometimes to the point of exhaustion, but they would not sleep better that night.

Dr. Baron was surprised and perplexed. A fan of exercise for treating sleep problems, but also a scientist, she decided to examine more closely the day-to-day relationship between sweat and sleep.

What she and her colleagues found, according to a study published last week in The Journal of Clinical Sleep Medicine, is that the influence of daily exercise on sleep habits is more convoluted than many of us might expect and that, in the short term, sleep might have more of an impact on exercise than exercise has on sleep.

To reach that conclusion, Dr. Baron and her colleagues turned to data from a study of exercise and sleep originally published in 2010. For that experiment, researchers had gathered a small group of women (and one man) who had received diagnoses of insomnia. The volunteers were mostly in their 60s, and all were sedentary.

Then the researchers randomly assigned their volunteers either to remain inactive or to begin a moderate endurance exercise program, consisting of three or four 30-minute exercise sessions a week, generally on a stationary bicycle or treadmill, that were performed in the afternoon. This exercise program continued for 16 weeks.

At the end of that time, the volunteers in the exercise group were sleeping much more soundly than they had been at the start of the study. They slept, on average, about 45 minutes to an hour longer on most nights, waking up less often and reporting more vigor and less sleepiness.

But Dr. Baron wondered if the novice exercisers had experienced immediate improvements in their sleep patterns. And on a day-to-day basis, had working out on any given day produced better sleep that night?

Boring deep into the data contained in the exercising group’s sleep diaries and other information for the new study, Dr. Baron discovered that the answer to both questions was a fairly resounding no. After the first two months of their exercise program, the exercising volunteers (all of them women) were sleeping no better than at the start of the study. Only after four months of the program had their insomnia improved.

They also rarely reported sleeping better on those nights when they had had an exercise session. And perhaps most telling, they almost always exercised for a shorter amount of time on the days after a poor night’s sleep.

In other words, sleeping badly tended to shorten the next day’s workout, while a full-length exercise session did not, in most cases, produce more and better sleep that night.

At first glance, these results might seem “a bit discouraging,” Dr. Baron said. They also would seem to be at odds with the earlier conclusion that four months of exercise improved insomniacs’ sleep patterns, as well as a wealth of other recent science that has typically found that regular exercise lengthens and deepens sleep.

But, Dr. Baron pointed out, most of these other studies employed volunteers without existing sleep problems. For them, exercise and sleep seem to have a relatively uncomplicated relationship. You work out, fatigue your body and mind, and sleep more soundly that night.

But people with insomnia and other sleep disturbances tend to be “neurologically different,” Dr. Baron said. “They have what we characterize as a hyper-arousal of the stress system,” she said. A single bout of exercise on any given day “is probably not enough to overcome that arousal,” she explained. It could potentially even exacerbate it, since exercise is itself a physical stressor.

Eventually, however, if the exercise program is maintained, Dr. Baron said, the workouts seem to start muting a person’s stress response. Her or his underlying physiological arousal is dialed down enough for sleep to arrive more readily, as it did in the 2010 experiment.

Of course, both of these studies were small, involving fewer than a dozen exercising volunteers, all of them middle-aged or older women. “We think the findings would apply equally to men,” Dr. Baron said. But that idea has yet to be proved.

Likewise, it is impossible to yet know the sleep-related impacts of workouts of different types (like weight training), intensities or timing, including morning or late-evening sessions.

Still, the preliminary message of these findings is heartening. If you habitually experience insomnia and don’t currently exercise, Dr. Baron said, start. Don’t, however, expect that you will enjoy or even complete workouts the day after a broken night’s sleep, or that you will sleep better hours after you’ve exercised.

The process is more gradual and less immediately gratifying than the sleep-deprived might wish. But the benefits do develop. “It took four months” in the original study, Dr. Baron said, but at that point the exercising volunteers “were sleeping at least 45 minutes more a night.” “That’s huge, as good as or better” than most current treatment options for sleep disturbances, including drugs, she said.


Weight Gain Possibly Tied to Later Bedtimes

There may be a link between later bedtimes and weight gain, new research suggests.

Researchers studied 3,342 adolescents starting in 1996, following them through 2009. At three points over the years, all reported their normal bedtimes, as well as information on fast food consumption, exercise and television time. The scientists calculated body mass index at each interview.

After controlling for age, sex, race, ethnicity and socioeconomic status, the researchers found that each hour later bedtime during the school or workweek was associated with about a two-point increase in B.M.I.

The effect was apparent even among people who got a full eight hours of sleep, and neither TV time nor exercise contributed to the effect. But fast food consumption did.

The study, in the October issue of Sleep, raises questions, said the lead author, Lauren D. Asarnow, a graduate student at the University of California, Berkeley.

“First, what is driving this relationship?” she said. “Is it metabolic changes that happen when you stay up late? And second, if we change sleep patterns, can we change eating behavior and the course of weight change?”

The scientists acknowledge that their study had limitations. Their sleep data depended on self-reports, and they did not have complete diet information. Also, they had no data on waist circumference, which, unlike B.M.I., can help distinguish between lean muscle and abdominal fat.


Ask Well: Do Sleeping Pills Induce Restorative Sleep?

Is sleep induced by a benzodiazepine counted as restorative sleep?

Researchers hate to admit it, but they don’t know enough about sleep to answer this question. Their best guess, several experts said, is that sleep is sleep.

Dr. John Weyl Winkelman, a sleep disorders expert at Massachusetts General Hospital and Harvard Medical School, said if a patient asked him whether medicated sleep was restorative, “I’d say: ‘You tell me.’”

There is quite a bit of evidence about the negative health consequences of insomnia, but researchers don’t know precisely what it is in the brain and body that is “restored” by sleep to aid optimal function. And it is unlikely that any specific stage of sleep is uniquely restorative, said Dr. Daniel J. Buysse, a sleep medicine expert and professor of psychiatry at the University of Pittsburgh.

More sleep, less interrupted sleep, and sleep at the right time of night are all likely to be important, he said.

There are two types of sleep: REM, when people dream, and non-REM, which has light, medium and deep portions. Sleeping pills mainly increase the amount of medium-depth non-REM sleep, Dr. Buysse said.

Medications can help people fall asleep faster and reduce nighttime wakefulness, he said, and those changes are usually considered to contribute to restorative sleep. But different people respond differently.

“Do you feel more rested, more alert, more able to concentrate, less irritable on medication versus off?” Dr. Buysse said. “If all those things are true then I would say it’s more restorative. If a hypnotic drug leaves you feeling hung over or more anxious, if it causes you to order five hickory smoked turkeys on the Internet without remembering, then it’s probably not good.”

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