Health related information and news from around the world.

Before leaving the subject of sleep apnea, I want to discuss briefly the problem of sudden infant death syndrome—SIDS, also known as crib death. Each year this tragic affliction strikes as many as 10,000 to 18,000 babies between the ages of one and seven months. The exact cause of SIDS, unfortunately, is not yet known. Many experts believe it is a form of sleep apnea during which the re not yet fully developed, may stop breathing long whose central nervous system and respiratory drive enough to result in death. In some cases the infant is found to have a mild case of upper respiratory tract infection, or some mucus plugging the nose—seemingly a minor problem, until you realize that babies don’t learn to breathe through their mouths until the age of four months. Yet most normal infants commonly experience short spells of apnea; we don’t yet know how to identify those who may be at greater risk of SIDS so as to intervene and prevent its occurrence.If you are concerned about your child, some approaches to SIDS management are available: monitors attached to the crib may detect a breathing stoppage; alarms will wake the baby, causing it to begin breathing normally, and will alert others in the house as well. One psychologist reports some success in training infants to react vigorously to a breathing obstruction, such as a light cloth placed over the mouth for a short time.*149\226\8*

Our levels of acceptance fluctuates during the working-through process. When we have a setback we get caught up in our old ways of thinking and feeling. Some people may again start to doubt they have the disorder, and begin to worry that the diagnosis may be incorrect.

Non-acceptance means we are only making the situation worse for ourselves. We all have periods of doubt about the diagnosis. If this does happen it is important to go back and talk with our doctor.

Compounding this doubt are the anxiety symptoms and how they change. Once we get on top of one symptom, another one takes its place. Any new symptom needs to be checked by our doctor, and sometimes we may feel like a hypochondriac. However, it is more important for us to know what the new symptoms are, instead of continually worrying. If we are told the new symptom is another anxiety symptom, we need to accept the diagnosis and not get caught in the vicious circle again.

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A general guideline is to allow an infant about five or six months old to establish her own sleep habits. By then, most children have the neurological maturity to sleep more soundly. When your child is between fur and six months old, begin to encourage the sleep association you value.

The following is a discussion of the sleep associations that most commonly cause problems.

Feeding. The child who is nursed or fed to sleep learns to need the calming that comes from eating, sucking, and being held. If she rouses during the night, she will call for more of the same. She may also wake seeming “rested” with a burp after 20 minutes, but she will not be establishing dependable routines.

As she loses that newborn drowsiness, begin to keep her awake during feedings (easier said than done for some babies) or purposely rouse her while laying her down so that she knows she is falling asleep in her own bed, not in your arms.

Sucking. Pacifiers help some children settle themselves to sleep. Be aware that their use after ‘about three or four months means that this habit will eventually need to be unlearned.

Rocking. Rocking is a pleasant, calming experience for both child and parent, but it can be a strong sleep association. One alternative is to rock a child to soothe and lull him, but not put him into a full sleep. Or rock until it ceases to be soothing—perhaps at four or five months with the sociable child, or later, as mobility increases, when she squirms to get down to play.

Children love to “nest”—that is, move around in bed until it feels just right. If we confine them by rocking, walking, or whatever, we deny them this winding down pleasure. If you are a “pillow fluffer” yourself, you will understand.

Loveys. Many children become attached to special blankets, stuffed anim or toys. “Loveys” make it easier to sleep without parents. To avoid the pai of a lost or forgotten lovey, make more than one available (buy matchi blankets) or make it so general that a replacement might not be noticed.

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Fiona is a 60-year-old social worker and mother of three grown children who has been troubled by depression and mood fluctuations for years. Her depressive symptoms have often seemed more physical than emotional. During her depressions she would become fatigued, her arms and legs would feel heavy, her eyelids would begin to droop and she would feel ‘rather sad and tired’, wanting to sleep much of the time. To some extent these problems might have been related to a condition of adrenal failure, known as Addison’s disease, from which Fiona suffers. The steroid replacement that is necessary to control her medical condition has been partly responsible for causing Fiona’s mood swings. Because of these mood variations she has never been able to rely on her ability to cope and has chosen not to work at her profession.

Fiona had been on Prozac (20 mg per day) for six or seven years. Although she credits Prozac for lifting her out of her depression, it left her with a ‘dazed view of the world’. Things did not feel ‘quite real’. Her mind was not clear and she would forget things. Her reactions were delayed and it was hard to keep up with a conversation even though she had previously been an extrovert.

Fiona’s GP wondered to what degree her problems with thinking were due to the Prozac, and brought her off the medication in order to find out. She soon became depressed again, at which time he started her on St John’s Wort (500-750 mg per day). Within two weeks her mood picked up. Her thinking was clearer and she was able to read again. She rates the anti-depressant effect of the St John’s Wort on a par with that of Prozac, but she feels that she is now ‘part of the world again’. With her newfound clarity she has restarted therapy and is contacting old friends and having lunch with them. She has even initiated ‘play groups for adults’, where friends come over simply to do fun things like painting or throwing medicine balls around. These get-togethers remind her of the ‘co-operative games of the 1960s’. T never got to play them then,’ she observes, ‘and I want to play them now.’

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