透徹了解寶寶的睡眠問題

(媽媽寶寶 2009/4/10) 長庚兒童醫院新生兒科主治醫師周怡宏

 老一輩的媽媽哄寶寶睡覺時，常在嘴中輕唸著：「嬰仔嬰嬰睏，一暝大一寸；嬰仔嬰嬰惜，一暝大一尺。」不可否認的，睡眠是人類生活中不可或缺的一部份，對於正在成長中的嬰幼兒而言，更顯得十分重要而不可或缺，睡眠對於寶寶的生長及發展影響十分深遠，並且無論老少，也都無時無刻受到睡眠的巨大影響。

睡眠問題有多常見？
許多文獻都報告成人及較大兒童的許多不同面向的睡眠問題，我們也可以了解睡眠疾患能夠造成相當嚴重的病症、社會功能的損失、生活品質的低下，以及直接與間接的經濟損失。

【台灣】根據主計處在民國94年調查發現，15歲以上民眾，約有24％有睡眠困擾（約500萬人）。而根據國內外研究報告指出，在6個月大到6歲之間的孩童有睡眠問題者，約在15～35％左右。

【香港】一項訪問調查1000多位育有2歲以下嬰兒的父母，結果發現近3成嬰幼兒每晚睡眠少於8小時，而嬰兒不酣睡而醒來，普遍家長認為基於發噩夢、肚餓、室溫和需要換尿片等。

【澳洲】一項針對6～12個月大嬰兒的研究指出，有36～45％的父母認為自己的孩子有一項以上的睡眠問題。
另一項研究也指出在8～10個月時，有睡眠問題的嬰兒，成長到3～4歲時，仍然有32％幼兒有睡眠問題，其中13％為持續發生，19％為再度發生。

 可見嬰幼兒時期的睡眠問題，常可以變成慢性疾病，對於孩子本身及家庭而言，都將造成可觀的負面影響，絕對不容輕忽，而必須進一步了解問題根源所在。

嬰幼兒睡眠有多重要？
【嬰兒睡眠與成長】嬰兒在睡眠中能夠恢復所消耗的體力，就像把電池再次充電一樣，而與人體生長所需最有關係的生長激素，尤其是在睡眠沉睡階段時分泌最多，嬰幼兒於睡眠時所釋出的生長激素較清醒時高達3倍或以上，有了睡眠中提供的足夠生長激素，才能促進神經系統和腦部發育，寶寶也才能健康地成長。此外，睡眠能加強釋放肌肉生長與修復的主要激素，生長激素能幫助嬰幼兒燃燒脂肪，並轉化成肌肉能量，幫助身體強化韌帶與肌腱，加強蛋白質合成等，因此睡眠與寶寶的發育成長及健康，可說是有著密不可分的關聯！

【嬰兒睡眠影響認知】嬰兒睡覺時有一半的時間，腦部在進行整理、重組和認知日間接收的資料，家長常誤解嬰兒眼皮轉動，是將近睡醒的現象。提醒父母應注意寶寶的睡眠品質，切勿無謂打擾弄醒，以養成良好的睡眠習慣。
研究報告國外研究指出，睡眠不足的嬰兒，專注和集中力都會較差。長期睡眠不足，會對外界事物失去興趣，長遠更影響情緒或入學前的適應期等。

【嬰兒睡眠與免疫抵抗力】睡眠減少或被剝奪與細胞免疫力的降低有直接的關係，它將造成自然殺手免疫細胞、T－細胞與單核白血球功能的降低。
研究報告在相關的研究中也提到，若完全剝奪白老鼠的睡眠達4週，將促使其因感染而死亡。在心血管疾病的部份，睡眠減少會增加體內細胞異常分裂，引起低度發炎的C－反應蛋白增加，此種蛋白質會破壞動脈內壁，導致中風或心臟疾病。

【嬰兒睡眠與學習的關係】研究報告芬蘭科學家在《自然》雜誌上發表研究結果指出，將微小傳感器附著在睡眠嬰兒頭部，通過所連接的監控器觀察嬰兒腦波。對嬰兒反覆播放兩個不同的母音"X"和"一"，並分析這些聲音在嬰兒大腦中激發的信號。在隔日發現，收聽聲音信號時間比較長的嬰兒可以對兩個不同的母音做出不同的反應，也就是說，" X "可以激發一種腦波，而"一"則激發另一種腦波。這表明長時間反覆聽取聲音的嬰兒學會了區分兩種不同的聲音。

 研究結論認為，嬰兒睡眠並不僅為了休息，而可刺激大腦的不同部位，對於學習非常重要。在學習方面，認知功能的維持與記憶力的發展，和睡眠也有直接的關係，而學習能力的產生建立在良好記憶力的維持。

 

 醫學專家對嬰兒安全睡眠的建議

（摘錄自美國國家衛生院報告　周怡宏醫師)

      美國國家孩童健康與人類發展研究院(The National Institute of Child Health and Human Development)指出，研究顯示成年人與嬰兒同睡一張床，在某些情況下可能是不安全的。每年約有數百萬個嬰兒與他們的母親睡在一起，過去十年這樣的作法在美國變得更為普遍。

      據發表於2003年小兒科和青春期醫學文獻(The Archives of Pediatrics and Adolescent Medicine )的一個大型研究估計，全國約有13%的嬰兒，通常整夜與父母同睡一張床中。半數的嬰兒，至少有部分睡眠是與成年人一起睡的。嬰兒與父母同睡越來越平常，所以應重視其安全。  

* 同睡的危險 *

　　消費者產品安全委員會反對嬰兒與成年人同睡，主要的依據是1999年的一項研究。該研究估計每年全國至少有64個嬰兒死亡，主要是由於與他們的父母或者其他成年人同睡一張床。1999年《英國醫學雜誌》(British Medical Journal)回顧數百個嬰兒死亡的原因，發現嬰兒與成年人睡在躺椅上，或與剛使用過藥物或者酒精的父母同睡皆會增加嬰兒死亡的危險。但是如果嬰兒的年齡是14週以上，或夜晚僅部分時間與父母同睡，或是與神智清醒且不吸菸的父母同睡在一張雙人床中則危險性很小。 

      另一些研究顯示，若嬰兒是單獨睡在自已的嬰兒床內，母親可能比較不會採用母奶餵食。然而研究不斷發現母奶確比牛奶更令孩子健康。兒科醫師Joseph Hagan 指出，很難知道究竟應該告訴媽媽們些什麼，因為沒有什麼資料可以作為參考。醫師並說: 「大部份的小兒科醫生會告訴人們，如果你要與你的嬰兒一同睡，請確認沒有一人是使用酒精或藥物的，確認你的嬰兒是仰臥的，不要吸菸，不要使用羽毛墊或羽毛被。如果這些事你都做到了，那對睡覺中的嬰兒可能就比較安全了。」即使只有少數的案例顯示嬰兒的死亡與父母同睡有關，這也具有足夠的警告。同時指出政府現在已開始蒐集嬰兒死亡的更多資料，這有助於將來確認在嬰兒猝死症候群中與父母同睡所扮演的角色。  

* 嬰兒安全睡眠的建議 *

綜合醫學專家們針對此問題的六項具體建議包括:

1--確信嬰兒是仰臥的

2--避免柔軟的床面、枕頭、鬆動的床罩

3--確信嬰兒不會陷在床墊和床架之間，床與牆之間，或者床與其他家具之間

4--如果你抽菸或者剛嗑過藥，喝過酒，或者使用會令人嗜睡的藥物，則需避免

   與嬰兒同眠

5--不要把嬰兒與另一個夜裡可能會起來爬行的孩子放在同一個床裡

6--無論是不是與成年人一起，嬰兒絕不能睡水床、躺椅或者沙發。

Sleep Hygiene(睡眠衛生=睡眠健康習慣)

美國睡眠基金會的資訊

https://www.sleepfoundation.org/sleep-hygiene

What it is, why it matters, and how to revamp your habits to get better nightly sleep

Written by Eric Suni, Staff Writer

Medically Reviewed by Dr. Nilong Vyas, Pediatrician

 

Paying attention to sleep hygiene is one of the most straightforward ways that you can set yourself up for better sleep.

 

Strong sleep hygiene means having both a bedroom environment and daily routines that promote consistent, uninterrupted sleep.

Keeping a stable sleep schedule, making your bedroom comfortable and free of disruptions, following a relaxing pre-bed routine, and building healthy habits during the day can all contribute to ideal sleep hygiene.

 

Every sleeper can tailor their sleep hygiene practices to suit their needs. In the process, you can harness positive habits to make it easier to sleep soundly throughout the night and wake up well-rested.

Why Is Sleep Hygiene Important?

 

Obtaining healthy sleep is important for both physical and mental health, improving productivity and overall quality of life. Everyone, from children to older adults, can benefit from better sleep, and sleep hygiene can play a key part in achieving that goal.

Research has demonstrated that forming good habits is a central part of health¹.

 

Crafting sustainable and beneficial routines makes healthy behaviors feel almost automatic, creating an ongoing process of positive reinforcement. On the flip side, bad habits can become engrained even as they cause negative consequences.

Thankfully, humans have an impressive ability² to make our habits serve our long-term interests. Building an environment and set of routines that promote our goals can really pay off.

 

Sleep hygiene encompasses both environment and habits, and it can pave the way for higher-quality sleep and better overall health.

 

Improving sleep hygiene has little cost and virtually no risk, making it an important part of a public health strategy³ to counteract the serious problems of insufficient sleep and insomnia in America.

Having trouble sleeping?

 

@ What Are Signs of Poor Sleep Hygiene?

不良睡眠習慣的徵兆

-          Having a hard time falling asleep,

-          experiencing frequent sleep disturbances,

-          suffering daytime sleepiness are the most telling signs of poor sleep hygiene.

-          An overall lack of consistency in sleep quantity or quality can also be a symptom of poor sleep hygiene.

 

@ How Do You Practice Good Sleep Hygiene?

建立健康睡眠習慣的四個重點

Good sleep hygiene is all about putting yourself in the best position to sleep well each and every night.

Optimizing your sleep schedule, pre-bed routine, and daily routines is part of harnessing habits to make quality sleep feel more automatic.

At the same time, creating a pleasant bedroom environment can be an invitation to relax and doze off.

A handful of tips can help in each of these areas, they aren’t rigid requirements. You can adapt them to fit your circumstances and create your own sleep hygiene checklist to help get the best sleep possible.

(1)   Set Your Sleep Schedule建立睡眠的時程表

Having a set schedule normalizes sleep as an essential part of your day and gets your brain and body accustomed to getting the full amount of sleep that you need.

·         Have a Fixed Wake-Up Time: Regardless of whether it’s a weekday or weekend, try to wake up at the same time since a fluctuating schedule keeps you from getting into a rhythm of consistent sleep.

·         Prioritize Sleep: It might be tempting to skip sleep in order to work, study, socialize, or exercise, but it’s vital to treat sleep as a priority. Calculate a target bedtime based on your fixed wake-up time and do your best to be ready for bed around that time each night.

·         Make Gradual Adjustments: If you want to shift your sleep times, don’t try to do it all in one fell swoop because that can throw your schedule out of whack. Instead, make small, step-by-step adjustments of up to an hour or two⁴ so that you can get adjusted and settle into a new schedule.

·         Don’t Overdo It With Naps: Naps can be a handy way to regain energy during the day, but they can throw off sleep at night. To avoid this, try to keep naps relatively short and limited to the early afternoon. 

(2) Follow a Nightly Routine 遵守夜間睡眠例行習慣

How you prepare for bed can determine how easily you’ll be able to fall asleep. A pre-sleep playbook including some of these tips can put you at ease and make it easier to get to fall asleep when you want to.

·         Keep Your Routine Consistent: Following the same steps each night, including things like putting on your pajamas and brushing your teeth, can reinforce in your mind that it’s bedtime.

·         Budget 30 Minutes For Winding Down: Take advantage of whatever puts you in a state of calm such as soft music, light stretching, reading, and/or relaxation exercises.

·         Dim Your Lights: Try to keep away from bright lights because they can hinder the production of melatonin, a hormone that the body creates to facilitate sleep.

·         Unplug From Electronics: Build in a 30-60 minute pre-bed buffer time that is device-free. Cell phones, tablets, and laptops cause mental stimulation that is hard to shut off and also generate blue light that may decrease melatonin production.

·         Test Methods of Relaxation: Instead of making falling asleep your goal, it’s often easier to focus on relaxation. Meditation, mindfulness, paced breathing, and other relaxation techniques can put you in the right mindset for bed.

·         Don’t Toss and Turn: It helps to have a healthy mental connection between being in bed and actually being asleep. For that reason, if after 20 minutes you haven’t gotten to sleep, get up and stretch, read, or do something else calming in low light before trying to fall asleep again.

(3)Cultivate Healthy Daily Habits 培養健康的白天作息方式

It’s not just bedtime habits that play a part in getting good sleep. Incorporating positive routines during the day can support your circadian rhythm and limit sleep disruptions.

·         Get Daylight Exposure: Light, especially sunlight, is one of the key drivers of circadian rhythms that can encourage quality sleep.

·         Be Physically Active: Regular exercise can make it easier to sleep at night and also delivers a host of other health benefits.

·         Don’t Smoke: Nicotine stimulates the body in ways that disrupt sleep, which helps explain why smoking is correlated with numerous sleeping problems⁵.

·         Reduce Alcohol Consumption: Alcohol may make it easier to fall asleep, but the effect wears off, disrupting sleep later in the night. As a result, it’s best to moderate alcohol consumption and avoid it later in the evening.

·         Cut Down on Caffeine in the Afternoon and Evening: Because it’s a stimulant, caffeine can keep you wired even when you want to rest, so try to avoid it later in the day. Also be aware if you’re consuming lots of caffeine to try to make up for lack of sleep.

·         Don’t Dine Late: Eating dinner late, especially if it’s a big, heavy, or spicy meal, can mean you’re still digesting when it’s time for bed. In general, any food or snacks before bed should be on the lighter side.

·         Restrict In-Bed Activity: To build a link in your mind between sleep and being in bed, it’s best to only use your bed for sleep with sex being the one exception.

(4) Optimize Your Bedroom 調整適宜的臥室環境

A central component of sleep hygiene beyond just habits is your sleep environment. To fall asleep more easily, you want your bedroom to emanate tranquility.

While what makes a bedroom inviting can vary from one person to the next, these tips may help make it calm and free of disruptions:

·         Have a Comfortable Mattress and Pillow: Your sleeping surface is critical to comfort and pain-free sleep, so choose the best mattress and best pillow for your needs wisely.

·         Use Excellent Bedding: The sheets and blankets are the first thing you touch when you get into bed, so it’s beneficial to make sure they match your needs and preferences.

·         Set a Cool Yet Comfortable Temperature: Fine-tune your bedroom temperature to suit your preferences, but err on the cooler side (around 65 degrees fahrenheit).

·         Block Out Light: Use heavy curtains or an eye mask to prevent light from interrupting your sleep.

·         Drown Out Noise: Ear plugs can stop noise from keeping you awake, and if you don’t find them comfortable, you can try a white noise machine or even a fan to drown out bothersome sounds.

·         Try Calming Scents: Light smells, such as lavender⁶, may induce a calmer state of mind and help cultivate a positive space for sleep.

Babies and Sleep

美國睡眠基金會的資訊

轉載來源 https://www.sleepfoundation.org/baby-sleep

An overview about how babies sleep and ways to help them get the rest they need

Updated June 10, 2022

Written by Danielle Pacheco, Staff Writer

Medically Reviewed by Heather Wright, Pathologist

 

# Fact Checked

Our team of writers, editors, and medical experts rigorously evaluates each article to ensure the information is accurate and exclusively cites reputable sources. Learn More

We regularly assess how the content in this article aligns with current scientific literature and expert recommendations in order to provide the most up-to-date research.

 

A baby’s first year of life is filled with a great number of milestones. Sleeping through the night on a regular basis may be one that parents look forward to the most.

It can take some time for parents to adjust to a new baby’s sleep routine and learn how to help ensure their baby is getting a healthy amount of sleep. It’s natural to have questions about what is considered normal sleeping habits and what changes might occur over the first 12 months of your child’s life.

# How Much Sleep Do Babies Need?

Sleep patterns will change over the first year of a baby’s life, including the number of hours of sleep needed and the duration of sleep periods throughout the day and night.

·         0 to 3 months: It’s normal for newborns to spend 14 to 17 hours¹ asleep in a 24-hour day, broken into shorter periods to accommodate feeding, diaper changes, and interaction with their family. Breastfed infants usually need to eat more frequently than bottle-fed infants², about every 2 hours versus every 3 hours. The American Academy of Sleep Medicine³ advises parents not to worry if their newborn’s sleep pattern doesn’t match the projections, as these amounts can vary before the first 4 months.

·         3 to 6 months: Starting at around 3 months of age, an infant’s daily sleep needs drop to 12 to 15 hours. Around this time, sleep also starts consolidating into longer periods⁴ as babies are able to go longer without feeding. Sometime during this period is when most babies start to sleep through the night, though there are exceptions to the rule.

·         6 to 12 months: From 6 months onward, babies do the bulk of their sleeping at night. However, other issues such as teething, growth spurts, illnesses, or sleep regressions may start leading to nighttime awakenings. Parents may opt to use more specific sleep-training strategies if babies aren’t sleeping through the night at this stage.

Sleep is essential for human development. During sleep the brain experiences intense activity, building the foundations for how we learn and grow, including the development of our behavior, emotions⁵, and immune system⁶. Poor sleep in infancy has been linked to problems⁷ with cognitive performance, social skills, obesity, and quality of life later in childhood.

Your baby will usually let you know they’re ready to sleep by fussing, crying, yawning, or rubbing their eyes. You can use these cues to establish a schedule that works for them. Deviating significantly from these recommendations may have adverse effects on your baby’s health or indicate an underlying problem.

A realistic goal is to help your baby sleep consecutively throughout the night by the time they reach their first birthday. As they grow into toddlers and school-age children, their sleep needs will become more similar to those of adults.

# How To Help Your Baby Get To Sleep (and Stay Asleep)

Setting a consistent routine⁸ is key to helping your baby learn to sleep through the night. During the first few months, your baby’s sleep schedule will largely be dictated by their eating pattern. However, as they grow, they’ll be able to go longer and longer between feedings. At this point, you can start to adhere to a day-night schedule.

To help your baby establish a healthy circadian rhythm, start by making sure your baby gets plenty of daylight and stimulation during the day. While young infants need several naps during the daytime, you can experiment to find a napping schedule that makes your baby tired enough to get to sleep at night without being overtired.

In the lead-up to bedtime, try to set a calming atmosphere and carry out the same bedtime routine every night. The following rituals can help your baby associate nighttime with sleeping:

·                     Taking a bath

·                     Changing into pajamas and a fresh diaper

·                     Reading a book

·                     Singing a lullaby

·                     Having a nighttime feed

·                     Giving a goodnight kiss

·                     Dimming the lights

·                     Turning down the thermostat

·                     Creating a quiet environment

An important part of developing healthy sleeping habits for your baby includes teaching them to fall asleep on their own⁹. Many babies find it soothing to be rocked or cuddled, but it’s best to put your baby to bed before they actually fall asleep. This way they will be less anxious if they wake up during the night and you are not there, and they will be more likely to fall back asleep without needing your help.

表單的頂端

# What To Do if Your Baby Isn’t Sleeping Well

Every baby is different, so don’t fret if your baby isn’t following all the rules. While it’s normal for newborns to wake up multiple times throughout the night, don’t hesitate to talk to your pediatrician if you have questions about your baby’s sleep patterns.

If your baby wakes up crying and doesn’t fall back asleep after a few minutes, they might be hungry, uncomfortable, or need their diaper changed. Quickly and quietly take care of their needs, using a nightlight instead of the overhead light if possible. You may soothe an anxious baby by patting them or saying a few reassuring words, but try not to take them out of the crib unless it’s strictly necessary.

Giving your baby plenty of love and attention during the day and encouraging them to be independent at night may ease the separation anxiety¹⁰ that many babies start to feel around the 6-month mark. Your baby may also feel more comfortable with a pacifier.

It’s not uncommon for babies to revert to an erratic sleep schedule once in a while. These sleep regressions are a normal (and often temporary) part of healthy infancy and can happen due to teething, illness, growth spurts, changing naptimes, or when they are learning new skills such as how to talk or walk.

If you’re a new parent, you’ll know firsthand how difficult it is to soothe a baby to sleep when you yourself are feeling sleep-deprived¹¹. Many caregivers find that the best time to grab a few winks is when the baby is sleeping, even if this means napping during the day. Don’t be afraid to reach out to family and friends for help taking care of the baby if you feel overwhelmed.