Inadequate Sleep Tied to Increased Pain, Discomfort in Children. (More Susceptible to Psychological Effects)

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PITTSBURGH -- Sleep deprivation in a child experiencing pain may cause physiologic and psychological problems that increase the severity of the child's suffering, Dr. Daniel S. Lewin said at a meeting on managing pain in pediatric patients sponsored by the Western Psychiatric Institute.

Disruptions in the sleep cycle can interfere with the sleep-dependent release of neurohormones (including growth hormone), which play an important role in cell reparation following tissue damage. Lack of sleep also can change the body's rhythm of cortisol secretion, thereby inhibiting protein synthesis. Finally, sleep deprivation appears to cause subtle decrements in cytokines, necessary components of immune function, said Dr. Lewin, a postdoctoral fellow at the institute.

Children may be more susceptible to the psychological effects of inadequate sleep because their coping skills are not as developed, he added. They may experience loss of memory, impairment of fine and gross motor abilities, and problems with regulating attention and mood. Additionally, nighttime and bedtime fears are often more acute in children suffering from chronic or recurrent pain, and this in turn may worsen the sleep problems.

Few studies have been conducted on children alone, but adult studies have evaluated pain perception after intervals of sleep deprivation. A 1998 study showed that healthy persons who were subjected to deprivation of slow-wave sleep reported increased perception of pain (J. Rheumatol. 25[6]:1180-86, 1998).

Two other studies came to similar conclusions, showing that fibromyalgia patients who experienced sleep deprivation had increased perception of pain (Psychosom. Med. 38[1]:35-44, 1976; Int. J. Neurosci. 89[3-4]:265-80, 1997). Another study found that sleep hygiene training for migraine patients decreased the frequency and duration of migraine attacks (Cephalalgia 19[suppl. 25]:57-59, 1999).

The significance of sleep quality is often overlooked by practitioners, Dr. Lewin said. When treating a child who has pain, physicians should ask whether the child has problems with sleep initiation or maintenance, Dr. Lewin recommended.

Inquire whether the quality of sleep is sufficient once it is achieved, whether the child has excessive daytime somnolence, and whether the child experiences snoring, pauses in breathing, or abnormal movements during the night, he said at the meeting, which was also sponsored by the University of Pittsburgh and the Children's Hospital of Pittsburgh. …