Are drugs the best solution for sleep troubles?
Q. My 4-year-old granddaughter has been given medication to help her “enter REM sleep” at night for more than two years. It was recently increased to 0.1 mg/5 ml or 3/4 teaspoon clonidine at bedtime and 0.5 mg/1 ml clonazepam at bedtime.
What would be the side effects and long-term concerns of taking these? The way she seems drugged and the very deep sleep she falls into concerns me.
A. Prior guidelines suggested that we experience five phases of sleep known as stages 1, 2, 3, 4 and REM, or rapid eye movement, with one-fifth the sleep time for adults in REM and the remainder in the other stages.
REM sleep stimulates areas of the brain. Infants and young children are known to spend more time in this phase. Some experts postulate that this phase of sleep helps the young brain to mature. Breathing during REM becomes more rapid, shallow and irregular, and our eyes move rapidly in all directions. Our heart rate increases and blood pressure rises. It is also believed that we “problem solve” during REM.
The American Academy of Sleep Medicine has updated the five stages of sleep and now refers to REM and non-REM (NREM). Non-REM is divided into only three stages, based on the EEG. The third or deepest stage of NREM sleep is where arousal is impaired, and sleepwalking, sleep terrors and confusion on awakening may occur. This commonly occurs during the first third of the night.
Sleep and wakefulness are influenced by neurotransmitter signals in the brain, by medicines and by foods. The balance of the signals to the brain determines whether we are alert or drowsy, and whether we sleep well or not.
Many antidepressants suppress REM sleep. People who smoke often have reduced amounts of REM sleep and tend to awaken because of tobacco withdrawal after a few hours. Alcohol will often induce sleep, but it will deprive an individual of REM sleep and its restorative stages. If REM sleep is disrupted on a given night, we are likely to slip directly into that phase the following night and will remain in the phase until sufficient restorative time is achieved.
Clonidine, an alpha agonist, can be prescribed to treat high blood pressure and other conditions. It is also used as a second-line medication in ADHD and for children with Tourette's syndrome. One source indicated it can be successful for those with sleep disturbances and hyper-arousal states. It works by relaxing blood vessels and decreasing the heart rate. Side effects include drowsiness, fatigue, a feeling of tiredness and difficulty sleeping.
Clonazepam is a benzodiazepine similar to Valium, Zanax and Ativan. It is primarily used for children with seizure disorders. Side effects include those listed for clonidine.
Your granddaughter appears to have difficulties settling down at bedtime, which is perhaps why she has been prescribed the two medications she is on. I am not a pediatrician and cannot pass judgment, but as she is only 4 years of age and has been on meds for two years already, I wish she weren't on any drugs to get her to a particular stage of sleep. I think there might be another issue involved here, and a second opinion by a different pediatrician or by a pediatric sleep specialist may be in order. You are in a difficult situation as a grandparent, so you will likely have to tread lightly.
© 2011 United Feature Syndicate Inc.