Thursday 12 December 2019

Keeping sleep on track and the gut moving

Photo posed by model
Photo posed by model

Advice from our GP on what to do when a child has insomnia and on why fibre is important.

My eight-year-old daughter has always been a good sleeper - she had afternoon naps up until she was four and slept 11 hours every night. Recently, however, she has had weeks of insomnia. One-off incidents are related to early evening exercise such as swimming or GAA. I've noticed on these evenings she will be shattered but unable to sleep. She does not use electronic devices after dinner time and would have watched half an hour of TV before bed since she was three or so.

This hasn't seemed to affect her. On the nights she can't sleep she often says she is 'too hot' to sleep, even if she is only sleeping with a sheet. She has a very organised evening routine - bath, pyjamas, TV, milk, story and bed. Can you help?

Dr Nina replies: Sleeping difficulties are thought to affect up to 25pc of children at some stage. Short-term insomnia may only last for a few days. Chronic insomnia may lead to reduced performance at school, poor concentration, irritability and increased risk of mental health disorders. More long-term effects include an increased risk of obesity, reduced immune system function, and increased risk and severity of chronic disease, such as high blood pressure, diabetes and heart disease later in life.

Things like anxiety or depression, thyroid problems, incontinence and bladder problems and pain are common, usually treatable, causes in both adults and children. Less common causes in children include conditions such as attention deficit and hyperactivity disorder and other behavioural problems.

Sleep hygiene simply means having good sleep habits. Avoiding stimulants such as caffeine is very important. Eating large meals late disrupts sleep but a light snack may help. The bedroom should be a restful well-ventilated space and should only be used for sleep. There should be no screens in the bedroom. Blue light has been shown to disrupt natural sleep chemicals in the brain. Watching TV in bed actually hinders restful sleep. It is important that the house is also restful past the bedtime hours. Children overhearing adult conversation or disagreement may lead to restless nights.

Once a child passes beyond toddler years, daytime naps should be avoided. Stick to a sleep routine. Going to bed and getting up at the same time every day can really help. Things like a warm bath or shower may help aid relaxation. Children can be advised to keep a diary and sleep journal. Writing down distracting worries or thoughts can help the mind relax. Talk to your child and discuss any worries they may have. Sometimes a fear of the dark or anxiety around family or friend issues will be the cause.

Rituals such as a bedtime story or gentle music are a great sleep aid. Try not to focus too much on falling asleep, it will promote wakefulness. Clock-watching makes the wakeful hours seem longer. Remove them from the room. Getting out to play in the afternoon helps. Exercise several hours before bed will aid sleep but exercise late evening will disrupt it.

There are some herbal remedies that have been reported to help, they include lavender and camomile. Studies haven't really proven their efficacy and their safety especially in children hasn't been tested.

Good sleep is as important to health as diet and exercise and should be taken seriously. Most children, post-toddler years, require 10 to 11 hours per night. However hours are not as important as the quality. If your child is repeatedly lying awake get her out of bed for 15 to 20 minutes and allow her to partake in a restful activity. Then put her back to bed. Once you identify a time where she can fall asleep use this as "bedtime". Once sleep is established at this time slowly pull this back by 15 minutes each night until the desired time is achieved.

If simple solutions aren't working, talk to your GP about sleep therapy. This can be very helpful. Sleeping tablets are not the answer.

Why do we need to eat more fibre?

Dietary fibre comes from the parts of plants that are not digested by enzymes as they pass through our digestive tracts. Some of them may be partially broken down by bacteria that live in the gut. There are two main types and they have different benefits. Insoluble fibre (not water soluble) increases the bulk of our stool and therefore speeds up the passage of food through the digestive tract. Insoluble fibre is found mainly in whole grains, bran, fruit and vegetables. Soluble fibre dissolves in water and is found mainly in oats, beans, fruit and vegetables.

Insoluble fibre helps reduce constipation, haemorrhoids and diverticular disease. Regular bowel movements associated with a diet high in soluble fibre may help reduce the bloating, cramping, and sluggish feeling that constipation can bring. Soluble fibre may bind bile acids. These acids produced in the liver help the body get rid of cholesterol, therefore the increased expelling of these in a diet high in soluble fibre may help reduce blood cholesterol. High-fibre diets are believed to help reduce overall cardiovascular risk. The fibre found in oats is particularly associated with this benefit. Fibre has no calories but provides a feeling of being full, and so can result in reduced calorie consumption and less hunger pangs. Several studies have shown that the fibre found in grains in particular can help reduce the risk of colon cancer.

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