Bipolar Disorder in Children May Be Linked to a Circadian Clock Gene

A new study found that the circadian clock gene RORB may be involved in bipolar disorder in children.

The study analyzed the genetic make-up of 305 children with bipolar disorder. They were compared with 140 controls.

Results show a positive association between bipolar disorder and four variants of the RORB gene. The authors suggest that this gene may be an important target in the search for the molecular basis of bipolar disorder.

The study also notes that bipolar disorder often involves a decreased need for sleep. This symptom helps discriminate children with bipolar disorder from those with ADHD.

The NIMH reports that bipolar disorder is a brain disorder. It is also known as manic-depressive illness.

It causes unusual shifts in mood, energy, activity levels and the ability to carry out daily tasks. These symptoms tend to be severe.

Bipolar disorder often develops in a person's late teens or early adult years. But some people have their first symptoms during childhood.

The disorder tends to run in families. Children are four to six times more likely to develop bipolar disorder if a parent or sibling has the illness.

Currently there is no cure for bipolar disorder. But ongoing treatment can help control the mood swings and other symptoms.

In 2008 FRONTLINE reported that bipolar disorder was long believed to exist only in adults. But in the mid-1990s it began to be diagnosed at much higher rates in children. Now one million children in the U.S. have been diagnosed with bipolar disorder.

Earlier this year the Sleep Education Blog reported that sleep problems in children may predict the future onset of depression. Learn more about sleep and children.

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A Book of Sleep for Children

Born in South Korea and educated in London, illustrator Il Sung Na makes his American debut with A Book of Sleep.

“It's the rare picture book that, upon arrival, feels as though it has been around for years already,” noted Publisher’s Weekly.

The opening line sets the stage for the story: When the sky grows dark and the moon glows bright, everyone goes to sleep . . .except for the watchful owl!

This wide-eyed owl proceeds on a moonlit journey to see how the other animals sleep the night away.

“One of the sweetest and most original of the new nighttime picture books,” author Liz Rosenberg wrote in The Boston Globe. “Both children and adults will welcome its…archetypical beauty.”

The book contrasts sparse text with rich, textured illustrations of a starry night.

“So thoroughly does the book inhabit its sleepy world,” author Daniel Handler commented in a New York Times review. Handler is best known for penning the A Series of Unfortunate Events books under the Lemony Snicket pseudonym.

A Book of Sleep is available as a 24-page hardcover book from Knopf Books for Young Readers.

In September the Sleep Education Blog described two other sleep books for children.

Learn more about sleep and animals.

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Updating Memories to Prevent the Return of Fear

A new study shows that old fear memories can be “updated” to prevent the return of fear. The discovery is promising for the treatment of post-traumatic stress disorder.

"Our results suggest a non-pharmacological, naturalistic approach to more effectively manage emotional memories," study co-author Elizabeth Phelps, PhD, said in a press release.

The researchers used mild wrist shocks to condition participants to fear colored squares. A day later, the memory was reactivated.

Participants were re-exposed to the feared squares. This was followed by extinction training. They were repeatedly exposed to the colored squares without shocks.

The fear response was banished only if extinction training followed soon after the fear reactivation. This “reconsolidation window” appears to last for about six hours after the fear is reactivated.

During this time an old memory can be “rewritten.” It can be updated with non-fearful information.

"Timing may have a more important role in the control of fear than previously appreciated," said Phelps. "Our memory reflects our last retrieval of it rather than an exact account of the original event."

The study also found that the technique had a long-lasting effect. Fear responses were no longer expressed when tested one year later.

The AASM reports that recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Earlier this year the Sleep Education Blog reported that playing the computer game Tetris can reduce unwanted “flashbacks.” Last month the blog noted that imagery rehearsal therapy is helping some people change their nightmares.

Learn more about sleep and memory.

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Sleep & Hyperactive Boys

A new study examined the link between sleep duration and hyperactivity in preschool children.

The study involved 2,057 mothers in Quebec. They answered annual questionnaires until their child reached 5 years of age.

Results show that nightly sleep duration and hyperactivity were significantly associated. Highly hyperactive children were five times more likely to have a short sleep duration. Short sleepers were four times more likely to have high hyperactivity.

Boys were more likely than girls to be a hyperactive, short sleeper. Other risk factors included living in a low-income home and having a mother with a low education.

“Hyperactivity problems may interfere with night-time sleep,” senior author Jacques Montplaisir said in a news release. “We found that children who didn't sleep long were generally hyperactive boys who lived under adverse family conditions. On the other hand, short or fragmented sleep leads to sleepiness, which could manifest as hyperactivity in boys.”

He also noted that hyperactivity scores were low in young children who slept for at least 11 hours at night.

In September the Sleep Education Blog reported that living in a “fragile family” can affect how children sleep. Another study linked sleep loss to hyperactivity in children.

Earlier this year the Sleep Education Blog reported that children often respond to sleep loss in a different way than adults. Sleep-deprived adults tend to be sleepy and sluggish during the day.

But sleep-deprived children may be hyperactive. This is one key symptom of ADHD. Children with ADHD also may be inattentive or impulsive.

Learn more about sleep and children.

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Urine Test May Detect Sleep Apnea in Children

A new study shows that obstructive sleep apnea in children is associated with alterations in urinary concentrations of specific protein clusters.

The study evaluated morning urine proteins. It involved 60 children with OSA. They were compared with 30 children who have primary snoring and 30 controls.

The researchers found that the urine concentrations of 16 proteins were altered in children with OSA. Further analysis identified four proteins that have “favorable predictive properties.”

Using cutoff points for these biomarkers they correctly identified 95 percent of the children with OSA. This approach also produced no false-positive results.

"It was rather unexpected that the urine would provide us with the ability to identify OSA," lead author Dr. David Gozal said in a press release. “"These findings open up the possibility of developing a relatively simple urine test that could detect OSA in snoring children.”

Gozal would like to develop a color-based test that could be done in a doctor’s office or by the parents. But first the results need to be confirmed in a larger sample of children from around the country.

About two percent of young children have sleep apnea. In June the Sleep Education Blog reported that the causes of sleep apnea in children are complex.

Sleep apnea often occurs when a child has large tonsils and adenoids. But weight and nasal problems also can play a role.

Most children with sleep apnea have a history of snoring. It tends to be loud and may include obvious pauses in breathing and gasps for breath.

In October the Sleep Education Blog reported that sleep apnea affects heart rate and blood pressure in children. Another study found a high “sibling risk” of OSA in both boys and girls.

Learn more about obstructive sleep apnea in children. Get help at an AASM-accredited sleep center near you.

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Infant Sleep: SIDS & Crib Safety

A new study examined trends and factors associated with infant sleeping position.

The study analyzed telephone surveys from 1993 through 2007. Each year’s survey involved nighttime caregivers of infants born within the last seven months. They were asked, “Do you have a position you usually place your baby in?”

Results show that the proportion of babies placed to sleep on their backs steadily increased between 1993 and 2001. But there was no change after 2001.

Maternal concerns about infant comfort and choking reduced the rate that infants were placed to sleep on their backs. Caregivers were more likely to put infants to sleep on their backs if they were advised to do so by a doctor.

“Placing infants on their backs for sleep remains the single most effective means we know to reduce the risk of sudden infant death syndrome," Marian Willinger, PhD, said in a NIH news release. She is the special assistant for SIDS research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The NICHD funded the analysis.

In 1994 the NICHD launched the “Back to Sleep” campaign. It urges parents and caregivers to place infants to sleep on their backs.

The NICHD reports that the rate of infant back sleeping has increased from roughly 25 percent to about 70 percent. At the same time, the SIDS rate has decreased by more than 50 percent.

Last month the U.S. Consumer Product Safety Commission announced the voluntary recall of more than 2.1 million drop-side cribs made by Stork Craft. This included about 147,000 cribs with the Fisher-Price logo. The cribs were sold at major retailers such as Sears and Wal-Mart.



There have been 110 reported incidents of drop-side detachment in the U.S. and Canada. These included 15 entrapments and 20 falls from the crib. Four of the entrapments resulted in suffocation. Fall injuries ranged from concussion to bumps and bruises.

Consumers can contact Stork Craft to receive a free repair kit. It allows you to convert the drop-side on these cribs to a fixed side. Parents and caregivers are urged to stop using the recalled cribs until the repair is made.

Contact Stork Craft toll-free at (877) 274-0277 anytime to order the free repair kit. You also can go online to www.storkcraft.com. For more information on Crib Safety, visit the CPSC's Crib Information Center.

Earlier this year the Sleep Education Blog reported that babies should never be put to sleep in a car safety seat. Learn more about sleep and infants & toddlers.

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A Low-Energy Diet & Sleep Apnea

A new study examined the effect of weight loss on obstructive sleep apnea in obese men. The results were published online in the British Medical Journal.

The Swedish study involved 63 obese men with an average weight of 248 pounds. Their average age was 49 years. Sleep apnea was measured using a home sleep test.

All of the men had moderate to severe OSA and were being treated with CPAP therapy. They had an average apnea-hypopnea index of 37 breathing pauses per hour of sleep. An AHI of more than 30 is considered “severe” OSA.

Thirty men were assigned to the treatment group. The other 33 men acted as a control group.

The men in the treatment group were put on the Cambridge Diet for seven weeks. This is a very low-energy, liquid diet. It uses a powder that is mixed with water to replace every meal of the day.

After the seven-week diet normal foods were gradually introduced for two weeks. Treatment also involved group sessions for support and motivation.

Results show that men in the treatment group lost an average of 41 pounds. Twenty-two of the 30 men were no longer obese.

This weight loss produced an improvement in sleep apnea severity. The mean AHI of the treatment group dropped from 37 to 12.

Seventeen percent of the men no longer had sleep apnea. Fifty percent had mild sleep apnea with an AHI of less than 15. Men who initially had severe OSA showed the greatest improvement in AHI.

In a press release the authors noted that a very low-energy diet is not a general solution to weight problems. Typically it is used in the first phase of a long-term treatment program.

They also wrote that the main limitation of the study was its short duration. Weight regain is common after weight loss. Evaluating the long-term effectiveness of weight loss would require at least one year.

The study was funded in part by Cambridge Manufacturing Company Limited, which markets the Cambridge Diet.

The AASM recommends dietary weight loss as one treatment strategy for people who are obese and have sleep apnea. But weight loss should be combined with another treatment such as CPAP or an oral appliance.

In October the Sleep Education Blog reported on another study involving a low-energy diet and OSA. Read more about weight loss and sleep apnea.

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