Doctor’s Diary
Effective ways to defeat the many enemies of sleep
Night terrors, where a child wakes screaming, the eyes wide open, call for a different approach
The restorative power of sleep is one of the great miracles of nature, which, when curtailed, gives rise to a host of psychological and physical adverse effects: poor concentration, emotional lability, headaches, disturbances of bowel function and so on. This can be a problem in young children, a third of whom are prone to insomnia – having difficulty in falling, or staying, asleep. And if (inevitably) their parents, too, are deprived of sleep both in quality and quantity, that, as reported in this paper last week, may persist for several years.
The resolution of persistent childhood insomnia depends on identifying its cause. In most, observes paediatric sleep medicine specialist Catherine Hill, it will be behavioural – resisting bedtime (or refusing to stay in bed) or troublesome night awakening. The most drastic of the several strategies to combat this is the (selfexplanatory) “crying it out”, though controlled comforting (ignoring bedtime protests, but returning at pre-set intervals to give sleep reassurance) and gradual retreat may be similarly effective.
The phenomenon of night terrors, where a child wakes screaming, the eyes wide open and staring, calls for a very different approach. Parents, having noted when these are most likely to occur, then wake their child 10 to 15 minutes beforehand, allowing a return to sleep soon after. In virtually all, the night terrors will cease within a week.
There is regrettably no similarly effective remedy for recurrent nightmares that can be a potent cause of chronic sleep deprivation in adults who, waking in an agitated state, find it difficult to drop off again. “Sometimes I am reluctant to go to bed for fear of what might happen with my next bout of dreaming,” writes one woman.
Three possibilities, however, are worth considering. Nightmares may be a side effect of several commonly prescribed drugs – notably statins and beta blockers – but recently a couple of readers have also implicated the prostate-shrinking finasteride (“the most intense, distressing dreams every night”) and donepezil for mild dementia.
Next, the psychological dodge of imagining, when awake, some way of resolving the situations commonly encountered in nightmares can be useful. This might involve, for example, inventing a Superman character who can deliver lost passports or summon back missed buses or trains. This scenario is then imagined repeatedly until it is firmly imprinted, after which the frequency and intensity of the nightmares may diminish. Then there are anecdotal reports that a small dose of the antidepressant dothiepin can, if taken at night, abolish repetitive nightmares.
Resuscitation risk
Finally, a reader is alarmed at the proliferation of defibrillators in public places – “No shopping mall or church hall is complete without one.” This may all be very laudable, but she (79 and in good health) would be “furious” to find herself being resuscitated by an overeager first aider. At her age, dropping dead without warning seems the ideal way to go.
The practicalities of how to convey one’s views on this matter when unconscious include wearing a necklace or wristband with the acronym DNACPR (Do Not Attempt Cardiopulmonary Resuscitation)
– or having it tattooed across one’s chest. The latter, though unarguable with, is not very aesthetic so she favours a more discreet version – say, on the inside of the left wrist – with the accepted convention that this be checked prior to any attempt at resuscitation.
It probably won’t happen, but care home residents and others at risk of being importunately resuscitated should take preemptive action and ensure that their wish that “nature should take its course” is properly documented.