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Sleep has a significant impact on memory, and poor sleep can affect not only memory, but also cognition and brain activity. It is desirable to get an adequate amount of sleep each day, as sleep deprivation reduces the brain's ability to retain information and absorb new things. Sleep deprivation affects not only what we remember, but also affects procedural memory, which is how we remember how to do things.
Setting and following a set sleep schedule is an often overlooked task, but having the same bedtime and nightly routine can go a long way toward improving overall sleep quality and getting the best, deepest sleep possible. Humans have a predetermined sleep pattern or circadian rhythm, but daily activities can disrupt this pattern. By strictly determining when to go to bed and when to wake up, the body and brain can adapt and create a more natural pattern. Fixed sleep times allow the brain to properly adjust memory retention to the sleep pattern.

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Robbert Havekes: Sleep deprivation and memory problems

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Sleep deprivation is a common problem in our modern 24/7 society due to social and economical demands. Loss of sleep negatively impacts the brain and particularly affects cognitive processes that require a brain region called the hippocampus.

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Good Quality of Sleep Increases Happiness (IR)

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Good Quality of Sleep Increases Happiness (IR)

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Sleep deprivation is common not only among those who work a lot, but also among students and children. For those who don't have time to sleep due to overtime work, assignments, part-time jobs, studying for exams, etc., drinks to wake them up are often seen.
In today's society, it would not be wrong to say that "sleeping" is considered a waste of time, or that "working hard without sleep" is valued more than sleeping.
However, there are many good things that come from sleeping. There are many things that can only be done with sleep, such as organizing what is in your head and storing what you have learned as a solid memory.

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In this short talk, Arianna Huffington shares a small idea that can awaken much bigger ones: the power of a good night’s sleep. Instead of bragging about our sleep deficits, she urges us to shut our eyes and see the big picture: We can sleep our way to increased productivity and happiness -- and smarter decision-making.

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The human body has a sleep-wake rhythm in which people fall asleep at night and wake up in the morning. However, if lifestyle habits and stress continue to interfere with nighttime sleep, disturbed sleep, such as difficulty falling asleep and waking up refreshed, will become the norm. It is important to try to get to sleep naturally at night by keeping light stimulation, diet, and activities in line with the body's internal clock.

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Disclaimer: This article is for informational purposes only and should not be taken as medical advice.

We've all had those nights of little to no sleep. Whether it's because we're up late finalizing travel plans, suffering from sleep anxiety, or stuck listening to a snoring partner, the effects of not getting enough sleep - a term often referred to as "sleep deprivation" - can be all too apparent the next day.

Understanding sleep deprivation stages and their associated symptoms can help you recognize when you're getting an insufficient amount of sleep. Typically, the longer you keep yourself from sleeping, the worse your symptoms become. Keep reading to learn more about sleep deprivation stages and what you can do to make sure you're giving your body the sleep it needs.

What Is Sleep Deprivation?

Sleep deprivation is what happens when you don't get the full amount of sleep your body needs to function properly. You're likely to feel fatigued, less able to focus, and your reaction time may be slowed.

There are myriad sleep deprivation causes, some of the most prevalent being socializing, relaxing, and engaging in other leisure activities. Some of us also inadvertently practice revenge bedtime procrastination to steal back a few hours of our day, leading to a lack of sleep.

Sleep Deprivation Symptoms

Not getting enough sleep can cause a variety of side effects, but the main ones are daytime drowsiness and impaired cognitive functions. Lack of sleep can affect your whole day, as your ability to concentrate may be lessened and you're likely to suffer from insufficient energy. It's also one of the main reasons why we yawn during the day. Other possible symptoms of sleep deprivation can include:

Irritability/anger

Drowsiness

Impaired concentration

Increased stress

Food cravings

Slowed reaction time

Visual misperceptions

Hallucinations

Stages of Sleep Deprivation by Hour

The early stages of sleep deprivation don't affect everyone the exact same way. You may have worse side effects than someone else even after staying awake for the same amount of time. For this reason, you should be aware of different potential symptoms associated with each stage.

If you're experiencing severe symptoms from lack of sleep, it's best to consult a medical professional. It's particularly important to see a doctor if you're experiencing any kind of sleep problem that's preventing you from getting the sleep your body needs.

Stage 1: 24 Hours of No Sleep

Staying up for 24 hours is unlikely to cause any severe symptoms, but you'll likely feel tired and experience some side effects.

Keep in mind that while the symptoms may be manageable, any form of sleep deprivation can make everyday tasks difficult to do. Driving and other activities that require full attention can even prove dangerous. In fact, lack of sleep for 24 hours or more is equivalent to having a blood alcohol level of 0.1% - higher than most states' legal limit.

While everyone experiences different sleep deprivation symptoms, some common ones you may feel at this stage are:

Irritability/anger

Drowsiness

Impaired concentration

Increased stress

Food cravings

Slowed reaction time

Stage 2: 36 Hours of No Sleep

Your symptoms will gradually get worse after going 36 hours without sleep. Aside from drowsiness and impaired concentration, your physical health may begin to take a toll. One study suggests that you're likely to have an increased appetite and a higher risk of developing cardiovascular disease over an extended period of time.

Stage 3: 48 Hours of No Sleep

On top of all the previous side effects mentioned, after going two days without sleep, you may also experience short periods of unintentional "microsleep." When this happens, you doze off for a few seconds and your brain is in a state similar to when you're sleeping.

Along with microsleeps, you may also experience other sleep deprivation symptoms, such as:

Immune system decline

Increased confusion

Depersonalization

Increased irritability

Stage 4: 72 Hours of No Sleep

After going 72 hours (or three days) without sleep, the previous symptoms listed above can become more severe. Not only can you experience worsened mood and higher cholesterol levels, but your urge to sleep will likely be extremely intense. At this stage, you may also experience disordered thinking and hallucinations.

Stage 5: 96+ Hours of No Sleep

Going 96 hours or more without sleep can be very dangerous for your body. Sleep is your body's way of recharging. Studies have shown that the longer time we spend without sleep, the more psychotic systems we begin to develop. This can range from simple visual misperceptions to complete sleep deprivation hallucinations. After going 96 hours with no sleep, your perception of reality is likely to be distorted.

How To Prevent and Treat Sleep Deprivation

Many people suffer from the inability to fall asleep right away or unintentionally waking up at various times throughout the night. While some conditions should be discussed with a medical professional, there are a few things you can do to help set yourself up for a successful night of sleep. Likewise, there are also some things you can do to help with the lack of sleep you might be experiencing.

Take a Power Nap

Taking a power nap the right way can help ease drowsiness and increase your focus. Just be sure to nap four to five hours before bedtime to make sure you'll still be able to fall asleep later as well.

Sleep a Few Extra Hours Each Night

Sleeping a few extra hours each night or just every once in a while can help your body get the full amount of sleep it needs. However, be cautious about oversleeping, as this has some negative side effects as well.

Go To Bed a Bit Earlier

By intentionally planning out when you'll go to sleep, you'll be able to create a routine for your body that can make falling asleep a bit easier. Starting your sleep schedule a little earlier so you can go to bed sooner can help combat feelings of sleep deprivation.

Practice Sleep Hygiene

Practicing good sleep hygiene has the potential to improve your ability to both fall asleep and stay asleep. Good sleep hygiene includes exercising regularly, avoiding stimulants a few hours before bed, and putting technology away at least an hour before bed.

Improve Your Bedroom Environment

Not all sleepers are made equal. However, there are a few general recommendations that anyone can apply to create a sleep-inducing bedroom environment. By setting your bedroom to a certain temperature and using colors that elicit sleep, you'll be more eager to go to bed and better able to fall asleep. If you need to get some shut-eye on the road, you can also adapt your space to sleep in a car all night long.

Avoid Caffeine at Night

It's best to avoid drinking caffeine such as coffee or soft drinks at least four or five hours before you plan to go to sleep. If you're craving something to eat or drink, munch on some nuts or another healthy nighttime snack.

Talk to Your Doctor

If you're having trouble falling or staying asleep consistently, you may have an underlying condition and should seek the advice of your doctor. They can help identify the problem and give you different treatment options as necessary.

While the sleep deprivation stages carry their own side effects, each should be taken seriously. Not getting a sufficient amount of sleep for your body can cause drowsiness, impaired focus, and, in extreme cases, hallucinations.

There are many causes of sleep deprivation, from serious medical conditions to lousy mattresses that make it impossible to sleep. If your sleeping arrangements are comfortable, it's best to see a doctor. But if you're sleeping on a mattress or pillow that causes discomfort and wakes you regularly, it may be time to find a new mattress or pillow better suited for your needs.

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Sleep Deprivation Stages (and How To Avoid Them) | Casper Blog

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Disclaimer: This article is for informational purposes only and should not be taken as medical advice. We've all had those nights of little to no sleep. Whether it's because we're up late finalizing travel plans, suffering from sleep anxiety, or stuck listening to a snoring partner, the effects of not getting enough sleep - a term often referred to as "sleep deprivation" - can be all too apparent the next day.

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In depression, symptoms such as melancholy and loss of pleasure last for a short time of period, with no recovery and no attempt to change one's mood, without managing to get rest by sleeping, which is unsuccessful. Depression makes it difficult to get sleep or to get rest and recover from mood and disease through sleep. In a state of depression, in general, people are unable to enjoy the things they used to love to do, and although they know in their heads that they need distractions and diversions, they are unable to actually carry out these activities. The depression and mental illness can last for a long time.

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If you or someone you love is having trouble sleeping or struggling with symptoms of depression, you likely already have an intimate understanding of the link between sleep deprivation and depression. It's no secret that not getting the sleep you need can bring down your mood, zap your productivity, and make it difficult to get through the day.

For the estimated 322 million people around the world living with depression, one of the most common symptoms is insomnia or trouble falling and staying asleep.﻿﻿﻿ Over 80% of people being treated for depression in the United States also experience difficulty sleeping.﻿﻿﻿﻿ Research shows insomnia is also correlated with more severe cases of depression.

Disrupted sleep and low mood can make you feel as if you're trapped in a vicious cycle as one problem feeds the other. However, the connection between sleep deprivation and depression also means understanding the relationship between the two could help you better manage both.

Sleep Deprivation and Depression Links

The relationship between sleep and mental health is well known. While it's long been understood that mental health conditions like depression often trigger issues like insomnia or oversleeping, recent research suggests the relationship between sleep deprivation and depression is bidirectional.

This means a lack of sleep isn't only a consequence of depression. Sleep deprivation or disrupted sleep in itself may also cause or worsen symptoms of depression.﻿﻿﻿﻿

Case in point: One 2011 meta-analysis of 21 studies showed that people with insomnia have a two times higher risk of developing depression in the future compared to those who don't have trouble sleeping.﻿﻿﻿﻿

Since insomnia has been identified as a risk factor for depression, researchers believe diagnosing and treating sleep issues early on could possibly help lower the risk of developing depression or reduce symptoms of depression.

However, more studies are needed to further explore the potential impact of insomnia treatment on the risk of depression and symptom reduction.

Chronic vs. Acute Sleep Deprivation and Depression

What Is Clinical Depression?

Clinical depression, often referred to as depression or major depressive disorder, is a common mood disorder that causes changes in your feelings and thoughts. We all feel down from time to time, but depression causes more intense and long-lasting mood changes and physical symptoms that make it hard to sleep, work, and function in daily life.

While everyone experiences depression differently, common symptoms may include:

Frequent feelings of sadness, anxiety, hopelessness, or emptiness

Irritability

Loss of interest in activities that once brought joy

Lack of energy

Trouble concentrating or making decisions

Difficulty falling or staying asleep or oversleeping

Changes in appetite or eating habits

In some cases, suicidal thoughts or suicide attempts

Factors like your family history, major stressors or traumatic experiences, other medical conditions, or certain medications could increase your risk of developing depression.

Why Sleep Is So Important

Just like food, water, and air, restorative sleep is vital for your health. In terms of your mental health, sleep allows your brain to create new pathways and memories which help you learn, solve problems, pay attention, and make decisions. After a good night's sleep, you're more alert, able to think clearly and concentrate, and better control your emotions and behavior.﻿﻿﻿

Sleep is also a necessity for your physical health as it helps your body grow, make repairs, maintain a healthy balance of hormones, and keep your immunity up. In light of this, it's no surprise that sleep deprivation has been linked to a slew of chronic health issues including high blood pressure, heart disease, stroke, kidney disease, diabetes, and obesity.

Psychological Effects of Sleep Deprivation

Besides making you feel drowsy and out of it, sleep deprivation can have major effects on your mental health. Sleep deprivation has been associated with an increased risk of:

Changes in mood and behavior such as increased irritability, anxiety, depression, and impulsivity

Issues with higher-level thinking like judgment, planning, and organization

Trouble concentrating and lower reaction times linked to a higher risk of accidents and injury and decreased productivity and performance at work and school

Disorientation, paranoia, and hallucinations

Suicidal thoughts or suicide attempts

Sleep Disorder Treatment

Sleep disorders associated with depression such as insomnia can be treated with a combination of medication, therapy, and lifestyle changes.

Antidepressants That May Help With Sleep

Certain antidepressants can help relieve symptoms of depression and in turn might reduce sleep disruptions, too. Your healthcare provider may prescribe one of the following depending on your individual needs and health history:

Selective serotonin reuptake inhibitors (SSRIs) such as Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), Paxil (paroxetine), or Zoloft (sertraline)

Serotonin/norepinephrine reuptake inhibitors (SNRIs) such as Khedezia or Pristiq (desvenlafaxine), Cymbalta (duloxetine), Fetzima (levomilnacipran), or Effexor (venlafaxine)

Tricyclic antidepressants such as Elavil (amitriptyline) or Pamelor (nortriptyline)

Sedating antidepressants to be taken at night such as Remeron (mirtazapine) or trazodone

Side Effects May Include Insomnia

Hypnotics That May Help With Insomnia

Hypnotics, also known as sleeping pills, can also be prescribed short-term to help you fall and stay asleep. These may include:

Ambien, Edluar, Intermezzo, or Zolpimist (zolpidem)

Lunesta (eszopiclone)

Rozerem (ramelteon)

Sonata (zaleplon)

Side Effects of Hypnotics

Cognitive Behavioral Therapy

It's common for people living with depression and sleep deprivation to come to associate their bed with negative feelings and thoughts. A poor night's sleep can feel like a natural extension of a bad day or downer mood, especially when it's become a habit.

This is where meeting with a mental health professional may be important. Cognitive behavioral therapy (CBT) for insomnia can help you reframe these reactions in a more positive light and build your confidence that you can get a good night's sleep. There is some evidence to support this type of CBT for insomnia, and it's also a proven treatment method for depression.

Lifestyle Habits to Improve Sleep and Mental Health

Along with help and guidance from a healthcare provider, many coping mechanisms can help improve both your mood and sleep health. While it may take some time to sort out what works best for you, here are a few to consider adding to your life.

Sleep Hygiene

First, sleep hygiene-or basic steps you can take to support your sleep health-are a must. Here's how to improve your sleep habits to combat insomnia and depression:

Create a sleep schedule.Set designated times to go to sleep and wake up in order to ensure you hit the sweet spot of seven to nine hours of sleep.

Avoid caffeine, alcohol, and large meals a few hours before you go to sleep.

Darken your space one hour before bed.Tools like blackout shades, dimmed lights, an electronics-free bedroom, and a sleep mask could help.

Add comfort to your sleep space.Turning the air conditioning up for a cool bedroom and treating yourself to supportive pillows and crisp sheets could also support sleep.

Use the bedroom for only two things: Sleep and sex.This way, your bed serves as a cue for sleepytime rather than hours of stress and sleeplessness.

Physical Activity

A lack of sleep can make it difficult to show up for workouts or muster the energy for a long walk, but it's worth it. Getting active can help you fall asleep faster, get more restorative deep sleep, and wake up less throughout the night.

If possible, include regular exercise outdoors such as a morning walk since natural light helps maintain your circadian rhythms or your internal body clock.

Relaxation Techniques

Life with depression and insomnia can be so stressful, but relaxing is a skill you can practice to help ease yourself into bedtime. Progressive muscle relaxation, deep breathing exercises, meditation, and guided imagery are all worth trying out as you figure out your ideal wind-down routine.

A Word From Verywell

Poor sleep and depression often strike at once, but you don't have to be condemned to either. With the guidance of a healthcare provider, you can learn how to rescue your mood and start getting the quality sleep you need to thrive again.

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If you or someone you love is having trouble sleeping or struggling with symptoms of depression, you likely already have an intimate understanding of the link between sleep deprivation and depression. It's no secret that not getting the sleep you need can bring down your mood, zap your productivity, and make it difficult to get through the day.

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Sleep is Important for Mental Health (IR)

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Sleep is Important for Mental Health (IR)

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When sleep is inadequate at an age as young as the teenage years, it risks altering the connections within the brain. As sleep duration declines, mental health suffers, which in turn
further reduces sleep quality, creating a vicious cycle that repeats itself in cycles. One important point is that this is a potentially long-term problem because it results from changes in the connections within the brain. Because the adolescent brain is developing rapidly, persistent sleep deprivation can lead to permanent impairment to brain and cognitive function.

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Why teenage sleep is so important for mental health

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Teenagers can sometimes struggle to get out of bed in the morning - but ensuring they get enough sleep could be vital for health in later life.

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Negative Effect of Lack of Sleep in Students (ER)

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Negative Effect of Lack of Sleep in Students (ER)

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Sleep deprivation, when accumulated over a long period of time, becomes "sleep debt. As sleep debt accumulates, brain and cognitive functions gradually deteriorate without being
noticed. However, most people are probably unaware of their own declining abilities. For example, they may not be able to do as much as they used to, they may not be motivated to study as much, and they may not be able to make friends as well. Decreased concentration in class becomes a problem. A lot of errors increase and memory deteriorates. This leads to poor grades. In the examinations, those students will not be able to perform to their full potential.

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Major Cause of Sleep Deprivation in Students (ER)

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Major Cause of Sleep Deprivation in Students (ER)

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If sleep deprivation persists, the ability to concentrate is impaired. If this happens, students may end up studying inefficiently. Studying in a state of reduced efficiency does not stick in the memory very well. Moreover, it is necessary to be careful because it may only take time.
Since deep sleep is difficult to achieve, a lack of sleep affect on their physical, the secretion of growth hormones is insufficient. This may delay the growth of height. Since they are not tired, they are more likely to catch colds.
It leads to negative mental health which is disturbance of the autonomic nervous system increases emotional instability and depression. Some students may become irritable because they cannot get up in the morning, and some may even stop going to school. Sleepiness may cause hyperactivity.

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How Lack of Sleep Effect on Academic Performance (ER)

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How Lack of Sleep Effect on Academic Performance (ER)

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Poor academic performance in school, sleep problems negatively impact on academic performance, getting lower grade, the risk of academic failure, without being aware of it, it affects physical and mental performance without being aware of it. When it accumulates, it does not stop at mere poor performance, but it can lead to physical and mental disorders.

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Abstract

Objective

Examine associations between a range of sleep problems and academic performance in a national sample of collegiate athletes. Participants: Data were obtained from the National College Health Assessment of US college/university students from 2011-2014 ( N = 8,312 collegiate athletes). Methods: Univariate comparisons for all sleep variables and demographics were stratified across GPA, using one-way ANOVA for continuous variables and chi-square for categorical variables. Multinomial logistic regression models, with GPA as outcome (reference = A) and sleep variable as predictor, were examined and adjusted for age, sex, and survey year. Ordinal regression examined a 1-level change in GPA associated with each sleep variable, adjusted for covariates. Results: Sleep difficulty was associated with increased likelihood of B/C averages. Initial-insomnia was associated with increased likelihood of B/C, and D/F averages. Tiredness was associated with increased likelihood of B/C, and D/F averages. Conclusions: Sleep problems are highly prevalent and associated with poorer academic performance in collegiate athletes.

Additional information

Funding

This work was supported by K23HL110216, R01MD011600, and an Innovations grant from the National Collegiate Athletic Association.

This study was supported by a 1K01AG05462-01A1 grant from the National Institute of Aging and a R25HL10544-08 grant from the National Heart Lung Blood Institute for the NYU Behavioral Sleep Medicine PRIDE Program.

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Sleep problems are associated with academic performance in a national sample of collegiate athletes

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Abstract Examine associations between a range of sleep problems and academic performance in a national sample of collegiate athletes. Participants: Data were obtained from the National College Health Assessment of US college/university students from 2011-2014 ( N = 8,312 collegiate athletes).

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Sleep disorders can cause hormonal imbalance and a weakened immune system.
Hormonal imbalance makes people more susceptible to lifestyle-related diseases and other illnesses. It also takes a toll on the mental health, increasing the risk of depression, stress, and other mental illnesses.

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Sleep disorders in children and adolescents is a topic that has been, and remains, neglected in both public health education and professional training. Although much knowledge has been accumulated in recent times, it has been poorly disseminated and, therefore, relatively little is put into practice. Only some general issues can be discussed in this article. The aspects chosen relate mainly to clinical practice, but they also have relevance for research. They concern various differences between sleep disorders in children and those in adults, the occurrence of such disorders in young people, their effects on psychological and physical development, the essential (but often ignored) distinction between sleep problems and their underlying causes (ie, sleep disorders), types of sleep disturbance encountered at different ages during development, and the differential diagnosis of certain parasomnias that are at particular risk of being confused with each other.

Los trastornos del sueño en niños y adolescentes constituyen un tópico que ha sido y continúa abandonado tanto en la educación de salud pública como en el entrenamiento profesional. Aunque se ha acumulado bastante conocimiento en el último tiempo, éste ha sido escasamente difundido y por lo tanto es relativamente poco lo que se ha traspasado a la práctica. En este artículo sólo es posible discutir algunos temas generales. Los aspectos elegidos se relacionan principalmente con la práctica clínica, pero ellos también tienen importancia para la investigación. Estos se refieren a diversas diferencias en los trastornos del sueño entre niños y adultos, a la ocurrencia de tales trastornos en gente joven, a sus repercusiones en el desarrollo psicológico y físico, a la distinción esencial (pero a menudo ignorada) entre problemas del sueño y sus causas subyacentes (por ej. trastornos del sueño), a los tipos de alteraciones del sueño encontrados en diferentes edades durante el desarrollo, y al diagnóstico diferencial de ciertas parasomnías que fácilmente pueden confundirse entre ellas.

Les troubles du sommeil chez l'enfant et l'adolescent ont été et restent un sujet négligé à la fois par la politique éducative de la santé publique et par la formation professionnelle. Malgré l'accumulation récentes de nombreuses connaissances, ces dernières ont été peu divulguées et donc faiblement mises en pratique. Cet article n'envisage que quelques points de vue généraux, principalement liés à la pratique clinique, mais qui peuvent être intéressants pour la recherche, ils concernent plusieurs différences entre les troubles du sommeil de l'enfant et ceux de l'adulte, leur apparition chez le jeune, leurs effets sur le développement psychologique et physique, la distinction essentielle (mais souvent ignorée) entre les perturbations du sommeil et leurs causes sous-jacentes (par exemple, les " troubles " du sommeil). L'article traite également des types de perturbation du sommeil selon les différents âges pendant le développement et du diagnostic différentiel de certaines parasomnies qui peuvent être confondues entre elles.

A wareness of the importance of sleep disorders medicine is undoubtedly gaining ground, but the pace of progress is slow. The considerable amount of knowledge that has accumulated in recent times remains underutilized because awareness of these advances by both the general public and professionals remains inadequate. This is especially so regarding pediatric aspects of sleep and its disorders.

Health education for parents and prospective parents often pays little regard to sleep. With some commendable exceptions, medical students, and specialist trainees, including pediatricians and child psychiatrists, health visitors, child psychologists, and teachers, receive little relevant instruction despite the fact that they all come into contact with many young people whose sleep is disturbed, sometimes with serious consequences. This relative neglect of children is interesting historically. To some degree it can be seen to reflect the very gradual and sporadic emergence of pediatrics in general as a branch of medicine in its own right. At times (and in some respects still), children have been thought of as little adults.

The extent to which this has been the case has been hotly debated by historians. On various grounds, Aries argued that for many centuries childhood was not acknowledged as a distinct period of development. This view was considered by some to have lingered on in some respects until as late as the 19th century; witness child labor and sometimes the use of severe punishment of the type meted out to adults. Others have vigorously contested Aries' claim, pointing out the various ways in which, from early times, children have been recognized by parents and both secular and Church law, for example, as being very different from adults.

Despite this counterclaim, it is interesting to trace the slow and (at least initially) faltering development of pediatrics as a specialty, the classic account of which remains Still's The History of Paediatrics, first published in 1931. Hippocrates was probably the first eminent writer to pay special attention to children's diseases, followed, some hundreds of years later, by Soranus and Galen and then, much later again, Rhazes and Avicenna. Still describes the gathering (although sporadic) momentum in more recent centuries, often in relation to descriptions of individual pediatric conditions, but eventually leading to more systematic and comprehensive clinical accounts and provision of pediatric services in the 19th and 20th centuries.

Along the way, a particularly notable figure, for whom Still seems to have had a special regard, was Thomas Phaire, a lawyer and physician, who in 1545 published The Bote of Chyldren, the first pediatrics textbook written by an Englishman. The book proved very popular, and ran to several editions. It deserves special mention for many reasons, not least because it discusses children's sleep problems and disorders.

Phaire described (fancifully by modern standards) the clinical features, supposed causes, and recommended treatments for various "infirmities of children":

Although (as affirmeth Plinie) there are innumerable passions & diseases, where unto the bodye of man is subiecte, and as well maye chaunce in the young as in the olde: Yet for moste commonly the tender age of children is chefely vexed and greuved with these diseases folowyng.

He then lists 40 such diseases which include "watchyng out of measure," (sleeplessness) " terryble dreames and feare in the slepe" ucolyke and rumblyng in the guttes" (a potential cause of bedtime settling difficulties), and "pyssyng in bedde"!

The flavor of his account can be judged from the following example concerning 'Of Watchyng Out of Measure' (substitute 'v' for 'u' in places):

...it procedeth commonly by corrupcion of the mylke, or to muche abundance, which e ouerladeth the stomake, & for lacke of good dygestion, vapours and fumes aryse into the head, and infect the b raine, by reason wherof the child can not slepe, but turneth & vexetli it self wt crying. The rf ore it shalbe good to prouoke it to a natural slepe thus...

...the seades & the heades of popye, called chesbolles, stamped with rosewater, and myxte with womans mylke, and the whyte of an egge, beaten al together and made in a plaister causeth the chylde to receyue his natural slepe.

Knowledge of children's sleep problems has improved considerably since Phaire's time, but the attention paid to them still lags behind that regarding sleep disturbance in adults. 'Ihe 2005 revision of the International Classification of Sleep Disorders (ICSD-2)5 improved on previous classification schemes, but its reference to children's disorders remains somewhat gestural. Similarly, children's sleep disorders, including their distinctive characteristics, are consistently under-represented at conferences.

ICSD-2 describes nearly 100 sleep disorders, many of which occur in children and adolescents. That being so, it would be "mission impossible" to attempt even an outline account of them all in this short article. Instead, just some aspects of sleep disorders in young people have been selected, chosen because they deserve special attention, as they are somewhat understated in usual accounts. More detailed coverage of pediatric sleep medicine (including complete references) can be found elsewhere. A further, nontechnical source for lay readers (including parents), or professionals with limited familiarity with the field, is also available.

Comparison of children and adults

Discussion of the differences concerning sleep and its disorders between children and adults is appropriate because of the basic importance of the topic for both clinical practice and research. Such differences can be identified in various respects.

Changes in sleep physiology

There are profound changes in sleep physiology during childhood and adolescence for which there is no real counterpart in adult life. Rapid eye movement (REM) sleep is particularly abundant in very young children, perhaps because of its importance for early brain development. The circadian body clock takes time to develop but, from about 6 months, should allow fairly continuous night-time sleep without the need for repeated feeds at night.

Sleep reciuiremeiits

'Ihcsc gradually lessen throughout childhood until about the time of puberty, when the need for sleep might actually increase somewhat. This, combined with a physiological delay in the sleep phase at puberty (opposite to the sleep phase advance in the elderly), as well as late-night social activities, sets the scene for potentially severe sleep deprivation and excessive daytime sleepiness (the delayed sleep phase syndrome, or DSPS) which readily leads to educational and social difficulties in adolescence.

Pattern of occurrence of sleep behaviors and disorders

'Ihis differs between children and adults. Some sleep disorders occur much more commonly in children and adolescents, notably bedtime settling and troublesome nightwaking in young children (the result of not acquiring good sleep habits and ovcrdepcndence on parental attention). Adolescent DSPS has just been mentioned. Other examples include rhythmic movement disorders (such as head-banging), nocturnal enuresis, and arousal disorders seen mainly in prepubertal children.

Interestingly, some sleep disorders previously thought to occur mainly or exclusively in adults are now recognized in children, eg., obstructive sleep apnea, restless legs syndrome, periodic limb movements in sleep, and even REM sleep behavior disorder (RED).

Etiological factors

In explaining the cause of sleep problems at any age, both physical and psychological possibilities (perhaps in combination) have to be considered. In children, as in adults, neurological, respiratory, metabolic, endocrine, genetic, medication, or other physical factors may have an influence. That said, parenting practices play a major part in many children's sleep problems. Parental knowledge, attitudes, and emotional state often determine whether a child's sleep pattern is a problem or not. Some parents construe normal behavior as a problem; others do not seek help when they should, perhaps because they mistakenly think there is no treatment available.

Clinical manifestations and associations

Whereas obesity is a common feature of obstructive sleep apnea (OSA) in adults, enlarged tonsils and adenoids are usually responsible in children. Although obesity is increasingly an important factor at all ages, only a minority of children with OSA are overweight and, indeed, ver}' early onset may cause low body weight from failure to thrive.

Adult OSA generally causes sleepiness and reduced activity. In contrast (as in other causes of excessive sleepiness such as narcolepsy), some sleepy children are abnormally active. This can lead to a diagnosis of attention-deficit hyperactivity disorder (ADHD) and inappropriate treatment with stimulant drugs.

Misdiagnosis

'Ihcrc is a risk that certain sleep disorders will be misdiagnosed at any age.'" Possibly this risk is greater in children than adults because of the wider range of clinical manifestations and alternative explanations for the behavioral changes involved both as primary features of the sleep disorder but also because of secondary complications. Narcolepsy can be a case in point. Diagnostic problems can also arise from the fact that polysomnography (PSG) criteria for OSA and narcolepsy are illdefined and different from those used for adult patients.

Significance

Many childhood sleep disorders can be expected to resolve spontaneously in a way that is unusual in adults. However, in the meantime (as at any age), persistent sleep disturbance can have harmful effects on mood, behavior, performance, social function, and, sometimes, physical health. Ihis can have particularly serious consequences in young people especially, as poor management of childhood sleep problems can also lead to their persistence into adult life.

However, children's sleep disorders are generally less associated with psychiatric illness. It is important for parents to know that the strange sleep-related behavior (in, for example, head-banging or sleep terrors) is ver}' unlikely to mean that their child has a serious psychiatric or medical disorder.

Treatment and prognosis

Treatment of most children's sleep disorders is, in principle, straightforward and likely to be effective if appropriately selected and implemented with conviction.

Unfortunately, however, many parents are unaware of frequently simple ways in which sleep problems in young children in particular can be prevented or minimized by the way they deal with their child at bedtime or during the night.

Although it is true that many adults are also unaware that their sleep problems are amenable to treatment, in a significant number of cases (say, of chronic insomnia), effective treatment is less readily achieved than in children because the origins of the sleep problem and, therefore, the management required, is more complicated. Especially in the treatment of insomnia or sleeplessness, medication has an even smaller part to play in children than it has in adults. Instead, behavioral methods (also often important for adults) arc much more appropriate and effective, with the possible exception of sleeplessness in children with neurodevelopmental disorders and some other chronic pediatric conditions for whom further research on pharmacological approaches (including the use of melatonin - a contentious topic still) is required.

It might be argued that the relevant specialties and disciplines on which it is necessary to draw for assessment and management of children with disturbed sleep are wider than is the case with adults. The number of traditional boundaries which have to be crossed in sleep medicine is considerable at any age, but in the case of young patients, in addition to medical specialties, for example, developmental psychology, and child and family psychiatry, often have to make their contributions. Different influences may operate at different ages as the many changes during the course of development proceed.

Occurrence of sleep problems in children and adolescents, including high-risk groups

Estimates vary but, from the early years to adolescence, at least 30% of children in general have a sleep disturbance which is considered by parents, or the children themselves, to be significant. However, the nature of the sleep problem varies considerably with age. Bedtime difficulties and problems with night waking are common up to about 3 years of age, whereas nightmares and sleepwalking, for example, feature more in older children, and many adolescents suffer from the delayed sleep phase syndrome mentioned earlier.

However common such problems arc in children overall, certain groups have sleeping difficulties much more often than this. Children with a learning disability, other neurodevelopmental disorders including autism, or psychiatric conditions almost invariably have their lives (and those of their parents) further complicated by disturbed sleep and its consequences. The same can be said of children with other types of chronic pediatric illness.

Children with these various conditions do not have a new set of sleep disorders compared with other children; it is the pattern of occurrence of their sleep disorders that is different. Physical factors may loom large in the etiology of the sleep problem in many of these conditions (eg. OSA in Down syndrome) but behavioral factors (failure to develop satisfactory sleep habits) are very common overall.

Similarly, these groups of children can generally be expected to respond to the same types of treatment as other children, providing the treatment programs are correct for the sleep disorder in question. One obstacle to this is the mistaken view that, for example, serious sleep problems are inevitable in neurodevelopmentally disordered children, and that the problems have to be endured because treatment will not work. Ihis is not the case, even when the sleep problem has already lasted some time but, sadly, for lack of information to the contrary, many such children go untreated.

Developmental effects of persistently not sleeping well

The potentially serious and widespread effects of persistently disturbed sleep (especially inadequate or poor quality sleep) deserve to be more widely known by parents and professionals alike. This alone would increase the use of the various types of treatments that are available.

Emotional state and behavior

"Overtired" children often become very difficult to handle; they become irritable, distressed, and even aggressive, much to the exasperation of their parents. In some children, such problems are frequent and seriously disrupt family life. Reference has been made to the fact that certain young children said to have ADHD characterized by overactivity, impulsiveness, and poor concentration, are reported to have a primary sleep disorder. Stimulant drugs arc not appropriate in this subgroup and might make matters worse by increasing the sleeping difficulty.

Especially in adolescence, persistent loss of sleep can have a depressing effect and lead to the problems at home and at school to which reference has also been made.

Disturbed sleep can affect a child's emotional state and behavior in various other ways. Bedtime can become a source of distress if associated with frightening thoughts or experiences that are associated with various sleep disorders, including night-time fears.

Intellectual function and education

There is convincing evidence that insufficient sleep can cause impaired concentration, memory, decision-making, and general ability to learn. Performance on tasks calling for sustained attention is particularly affected, and also those requiring abstract thinking or creativity. Similarly, motor skills and reaction time can be impaired. Studies in the USA have suggested that 80% of adolescents obtain less than adequate sleep (ie, 9 hours), 25% less than 6 hours, and over 25% fall asleep in class. Students with insufficient sleep generally achieve lower school grades. Findings in other countries might well be similar.

Physical effects

As the production of growth hormone is closely linked to deep NREM sleep, if sleep is seriously disrupted from an early age, physical growth may be affected. As mentioned earlier, OSA can disrupt sleep from about the age of 2, causing the child to "fail to thrive" and be smaller for his or her age than ideal.

In addition to this effect of OSA on growth, persistent sleep loss in particular is being increasingly associated in adults with physical ill-health such as impaired immunity, obesity, hypertension, and diabetes. There is no particular reason to expect that children are free of at least some of these risks.

Family and other social effects

There have been reports that relationships between parent and a child with a serious and persistent sleep problem can be severely tested to the point of increased use of physical punishment in extreme cases. Parents may disagree with each other about ways of dealing with the child's refusal to go to sleep at the required time, or his or her insistence on joining them in their own bed after waking during the night. In these circumstances, marital relationships may become seriously strained.

Because of the changes of behavior that can result from sleep disturbance, the affected child's interpersonal problems may extend beyond his family. Irritable, difficult, or otherwise disturbed behavior is likely to affect friendships. Relationships with teachers can also easily suffer, especially if they are unaware that behavioral problems can be the result of inadequate or otherwise disturbed sleep.

In view of these various potential complications to the child's life, it is essential that ail concerned realize they can be at least partly the result of sleep disturbance for which effective treatment can be provided in most instances.

The distinction between sleep problems and their underlying causes (sleep disorders)

It is essential to distinguish between a sleep problem and a sleep disorder, although, in practice, this is often not done.

At any age, there are just three basic sleep problems (or complaints)

Not sleeping well ("insomnia" or "sleeplessness")

Being excessively sleep ("hypersomnia")

Behaving in unusual ways or having strange experiences in relation to sleep ("parasomnias").

These sleep problems are not diagnoses or conditions in their own right, no more than are "breathlessness" or "pain." In order for the correct advice or treatment to be decided, it is necessary to identify the underlying cause, ie, the sleep disorder.

As mentioned earlier, nearly 100 sleep disorders are now officially recognized, many relevant to children and adolescents. Choice of advice and treatment rests essentially on the patient's sleep disorder. In a way that would be unacceptable in many other areas of medical practice, where the need to know the underlying cause of someone's symptoms is considered axiomatic, sleeping difficulty is often treated (quite possibly doing more harm than good) by means of medication without the cause of the problem being considered.

The treatment of sleepless young children is an example of the point just made. Many of those who do not settle to sleep at bedtime or who wake during the night demanding their parents' attention are prescribed hypnotic-sedative drugs, such as antihistamines, despite the evidence that they are usually ineffective and subject to other drawbacks. Despite its advocates' claims, especially for children with a developmental disorder, something similar can be said about the use of melatonin. As the cause of the sleeping difficulty is often failure to have acquired good sleep habits, behavioral methods are much more appropriate for encouraging such habits or undoing bad habits. Unfortunately, parents are rarely taught ways of preventing or dealing with their children's sleep problems, with the result that many suffer needless sleep loss and distress because the child does not sleep well.

Changes in the pattern of sleep problems and disorders during development

Parents and professionals need to be familiar with the kinds of sleep disturbance that their child might develop at different ages, and know that they are collectively common and that they can be prevented or helped, for the most part. Only the main forms of sleep disturbance are mentioned here.

Infancy

It is important to encourage good sleep habits from an early stage to avoid bad sleep habits later on. The following practices are recommended to help parents to achieve this in infants:

Establishing a consistent 24-hour routine, including a bedtime routine that provides the baby with cues that is time to go to sleep

Not prolonging night-time feeding beyond the age (about 6 months) when the baby's body clock has developed enough to allow feeding to be confined to daytime

Teaching the baby to fall asleep alone so that when he or she wakes in the night (a natural occurrence at all ages) he or she is able to fall asleep again without requiring his or her parents' attention ("self-soothing")

Establishing a clear difference between day and night to help to develop the infant's body clock which controls sleep and wakefulness

Ensuring the environment is conducive to sleep.

Safety measures to reduce the risk of the infant coming to harm at night from suffocation or other breathing problems sometimes associated with sudden infant death syndrome (SIDS), should also be part of parental education about sleep. Main recommendations include the following:

Have the baby sleep on his or her back and on a firm mattress that will not obstruct breathing

Use a safety-approved cot with narrow gaps between the rails

Ensure that the baby's face cannot be covered during the night

Do not allow the baby to become overheated at night

Be sure the bedroom is smoke-free

Do not sleep with the baby on a sofa or armchair

Avoid cosleeping if either parent has consumed alcohol, or has taken medication or other substances with a sedative affect.

Preschool children

The nature of the usual sleep disturbance, and the advice required, is different after infancy into the toddler period and beyond. Many children at this stage of development recurrently resist going to bed at the required time, and/or wake repeatedly at night, demanding their parents' attention, including coming into their bed. As at other ages and with other sleep problems, medical factors must be excluded but the usual explanations are behavioral, especially:

Anxiety about separating from parents at night

Stimulating activities within the bedroom

Inadequate limit-setting on uncooperative bedtime or night-time behavior

Unhelpful associations with being in bed. If parents lose their temper, or threaten or punish the child, he or she will come to associate bedtime with upset and fear

Having failed to acquire self-soothing ways of coping with night waking.

Behavioral treatment methods can be very effective in these circumstances (sometimes in a surprisingly short time).

Other possible contributory factors with which parents need to be acquainted include:

Inappropriate patterns of daytime napping, ie, too little or too much daytime napping for the child's age or, alternatively, a nap too near bedtime

Putting the child to bed too early while he or she is in the "forbidden zone" of maximal alertness and not yet physiologically capable of sleep. Bedtime should coincide with being "sleepy tired"

Night-time fears, which often begin at an early age, can cause difficulty getting off to sleep or disturbance during the night.

School-age children

Again, the pattern of sleep disorders changes somewhat at this age. Certain causes of sleeplessness in preschool children may still apply, but other causes of sleeping badly may begin to show themselves.

Night-time fears might intensify and become more complex. Such fears are usually transient and require only reassurance and comfort until they cease. Occasionally, however, they are so intense and persistent that they need special attention. In such instances the content of the fear or accompanying nightmares might be revealing. Once more, behavioral treatment is reported to be very effective.

Needless to say, the child's reluctance to go to bed because he or she is genuinely afraid must be distinguished from pretending to be afraid as a delaying tactic.

Worry and anxiety about daytime matters may cause difficulty in getting to sleep or staying asleep. However, the original source of concern may no longer exist but the difficulty falling asleep may persist because the child has developed the habit of lying awake in bed in an agitated state ("conditioned insomnia").

Restless legs syndrome, which (as mentioned before) is now described in children, consists of disagreeable leg sensations with an irresistible urge to move the legs causing difficulty getting to sleep. It is often accompanied by periodic limb movements. "Growing pains," said to be a cause of sleep difficulties in otherwise healthy children, is an ill-defined condition. Where they occur around bedtime, the restless legs syndrome is a possibility.

In older children and later, early-morning wakening may be part of an anxiety or depressive disorder. Otherwise, the child may have been woken too early by noise or other environmental factors which intrude into his or her sleep.

Adolescence

The generally ver}' efficient sleep of prepubertal children changes to less satisfactory sleep in adolescence for both physiological and psychosocial reasons.

Worries, anxiety, and depression are commonly quoted easons for not being able to sleep at this age. Nicotine, alcohol, and caffeine-containing drinks, as well as illicit drug use, arc additional possible influences.

However, inability to get off to sleep and to wake up in the morning is often part of DSPS, to which reference was made earlier. This condition, which is reported to be particularly common in adolescence, is potentially very disruptive educationally and socially. As such, it deserves further discussion. DSPS is commonly misconstrued as something other than a sleep disorder.

The problem usually arises from the sleep phase delay at puberty and habitually staying up late for social or other reasons, especially at weekends or during holidays. The result is that it becomes impossible to go to sleep earlier by choice.

The features of DSPS are persistently severe difficulty getting to sleep (possibly until well into the night), uninterrupted sound sleep for just a few hours, but then great difficulty getting up for school, college, or work because of not having nearly enough sleep. This causes sleepiness and underfunctioning, especially during the first part of the day. The abnormal sleep pattern is maintained by sleeping in very late when able to do so at weekends and during holidays.

"Chronotherapy" includes gradually changing the sleep phase to an appropriate time. Where the phase delay is about 3 hours or less, bedtime can be gradually brought forward. More severe forms of the disorder require progressive sleep phase delay in 3-hour steps round the clock until a satisfactory timing is achieved which then has to be fixed.

Additional measures to maintain the improved sleep schedule include early-morning exposure to bright light and firm agreement with the adolescent to maintain a new pattern of social activities and sleep. Melatonin in the evening might also help.

Difficulties achieving and maintaining an improved sleep-wake schedule by these means are compounded if there is a vested interest in maintaining the abnormal sleep pattern, for example, to avoid school ("motivated sleep phase delay"). Psychological problems, including depression, may well also make successful treatment less likely. The teenager's reluctance to go to bed earlier and to get up at the required time is often misinterpreted as "typical difficult adolescent behavior" causing trouble in the family. Otherwise the condition might be mistakenly viewed as the usual form of school non attendance, primary depression, or substance misuse.

Differential diagnosis of childhood parasomnias

Parasomnias are repetitive unusual behaviors or strange experiences that occur just before, during, or arising out of sleep, or on waking. The many parasomnias (some primary sleep disorders, others secondary to medical or psychiatric conditions) now officially recognized (over 30 in ICSD-2) indicate how commonly and in many ways (some subtle, others dramatic) sleep can be disturbed by episodic events.

Confusion between the different parasomnias seems to be common. For example, in pediatric textbook accounts, sleep terrors and nightmares (two very different types of parasomnia) are mistaken for each other. Indeed, sometimes there is a tendency to call any dramatic parasomnia a nightmare. Correct diagnosis is important because different parasomnias each have their own significance and call for contrasting types of advice and treatment. The following brief account is concerned with the main features to be recognized in reaching the correct diagnosis. Fiiiphasis is placed on just some of the more dramatic parasomnias (namely arousal disorders, nightmares, and sleep-related epileptic seizures) as these often cause most confusion and concern. Detailed accounts of these parasomnias and others are provided elsewhere. Often an accurate diagnosis can be made by means of a detailed account of the subjective and objective sequence of events from the onset of the episode to its resolution, and of the circumstances in which the episode occurred, including its duration and timing. Audiovisual recording (including by means of home recording by parents) can be very informative and often adds details that are missed in descriptions given in the clinic.

For the most part (seizure disorders generally being a main exception), physiological recordings are required only when clinical evaluation is inconclusive or where the child might have more than one type of parasomnia. Table I compares the main diagnostic features of the three chosen types of parasomnia. The meaning of the three categories is as follows.

The term "arousal disorders" refers to childhood confusional arousals, sleepwalking (calm and agitated forms of which are described) and sleep terrors. Used properly, nightmare is a straightforward term. As sleep-related epilepsy covers a number of seizure disorders of different types, permissible generalizations are limited.

The following types of epilepsy are, to varying degrees, related to sleep. The first four types have been classified as benign in the sense that, despite their focal origin in the brain, they are not typically the result of a structural abnormality and can be generally expected to remit spontaneously in time. All five types can readily be confused with nonepileptic parasomnias as their clinical features can be complex and dramatic.

Benign partial epilepsy with centro -temp oral spikes (Rolandic epilepsy) is a common form of childhood epilepsy in which about 75% of patients have their seizures exclusively during sleep. The seizures involve distressing oropharyngeal-facial movements and sensations corresponding to the anatomical origin of the seizures. Actually, some doubt has been raised recently about their entirely benign nature.

Apparent terror and screaming occur in benign epilepsy with affective symptoms

The child's reactions to the complex visual experiences (including hallucinations) that can occur in benign occipital epilepsy can involve dramatic behavior.

In the Panayiotopoulos syndrome seizures often involve distressing vomiting and other autonomic symptoms.

Nocturnal frontal lobe epilepsy (NFLE) deserves special mention because its clinical manifestations make it particularly prone to misinterpretation as nonepileptic phenomena. Although mainly described in adults, it also occurs in children. It is now known that NFLE can take a variety of forms, but a usual variety is often misdiagnosed mainly because the complicated motor manifestations (eg kicking, hitting, rocking, thrashing, and cycling or scissor movements of the legs) and vocalizations (from grunting, coughing, muttering or moaning to shouting, screaming, or roaring) which characterize many attacks. As such, they are very different from other seizure types. The abrupt onset and termination, short duration of the attacks (different from seizures of temporal lobe origin) and, sometimes, preservation of consciousness can also suggest a nonepileptic (even attention-seeking) basis for the attacks.

In the first instance, diagnosis rests on awareness of this form of epilepsy and recognition of its clinical features. EEG recordings, even during the episodes, are of limited diagnostic value.

The distinction between epilepsy and other parasomnias can be difficult. Recently, the Bologna group of clinical researchers have attempted to set out clearly the (mainly clinical) criteria for distinguishing between NFLE and other parasomnias.

Aspects of sleep disorders in children and adolescents

Conclusion

Hopefully, this brief and highly selective account will have conveyed some of the special considerations and points of emphasis that are relevant to sleep disorders in children and adolescents. As much is already known but little is practised, it is to be hoped that awareness will increase about such developmental aspects which are important for both clinical work and research in the field of sleep disturbance in young people.

REFERENCES

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American Academy of Sleep MedicineInternational Classification of Sleep Disorders, 2nd edition Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine.2005

StoresG. Sleep disorders. In: Gillberg C, Harrington R, Steinhausen H-C, eds A Clinician's Handbook of Child and Adolescent Psychiatry. Cambridge, UK: Cambridge University Press;2006 304 338

StoresG.WiggsL.edsSleep Disturbance in Children and Adolescents with Disorders of Development its Significance and Management. London, UK: MacKeith Press.2001

WolfsonAR.CarskadonMA. Understanding adolescents' sleep patterns and school performance: a critical appraisal Sleep Med Rev20037491 506 15018092

ColtenHR.AltevogtBM.edsSleep Disorders and Sleep Deprivation: an Unmet Public Health Problem. Washington, DC: National Academies Press. 2006

QuineL. Severity of sleep problems in children with severe learning difficulties: description and correlates J Community Appl Soc.19922247 268

Dalla BernadinaB.ColamariaV.ChiamentiC.CapovillaG.TrevisanE.TassinariCA. Benign partial epilepsy with affective symptoms ('benign psychomotor epilepsy'). In: Roger J, Bureau M, Dravet Ch, Dreifuss FE, Perret A, Wolf P, eds Epileptic Syndromes in Infancy Childhood and Adolescence. 2nd ed. London, UK: John Libbey1992 219 223

ProviniF.PlazziG.MontagnaP.LugaresiE. The wide clinical spectrum of nocturnal frontal lobe epilepsy Sleep Med Rev.20004375 386 12531176

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Aspects of sleep disorders in children and adolescents

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Sleep disorders in children and adolescents is a topic that has been, and remains, neglected in both public health education and professional training. Although much knowledge has been accumulated in recent times, it has been poorly disseminated and, therefore, relatively little is put into practice. Only some general issues can be discussed in this article.

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During sleep, humans perform maintenance on various parts of the body. The most
important of these is brain maintenance. The human brain is a very delicate structure, and if sleep
deprivation continues, it can lead to a decline in brain function. Therefore, it is necessary to rest
and maintain the brain in the form of sleep. Of course, sleep is also essential in terms of recovery
from fatigue. No matter how physically fit they are, they need to make sure that they get enough
sleep.