Foreword: Counting Sheep

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Harsh K. Trivedi, MD Consulting Editor

A flock of sheep that leisurely pass by

One after one; the sound of rain, and bees

Murmuring; the fall of rivers, winds and seas,

Smooth fields, white sheets of water, and pure sky -

I've thought of all by turns, and still I lie Sleepless…

—William Wordsworth, “To Sleep”

Whether discussing the sleep-wake patterns of an infant, the crankiness of a school-aged child who stays up past bedtime, or the chronically late-sleeping teenager who instant messages friends until the wee hours of the morning, the topic of sleep is one that most clinicians confront on a routine basis. In addition to the routine frequency of questions regarding ‘normal’ sleep, there are also issues with sleep that can be profoundly more serious.

So I ask you: How many hours of sleep are considered “normal” for a 2-month-old, a 3-year-old, a 7-year-old, a 13-year-old, and a 17-year-old? How do you define age-appropriate sleep? How do you determine when the threshold has been crossed between a variant of normal sleep and the onset of a pediatric sleep disorder? How do you appropriately assess for the presence of a sleep disorder? Does the definition of normal sleep differ in a patient with a psychiatric illness or significant psychosocial stressor? Which sleep issues are ones that can dramatically affect the health and well being of the child? What non–medication-based interventions can you use to effectively treat sleep disorders? How do you decide when to prescribe a pharmacologic agent? At what point should you refer your patient to a pediatric sleep lab? These questions, though innocuously basic at first glance, can become quite difficult and complex when applied to the clinical care of a patient sitting in your office.

I am grateful to Drs. Shatkin and Ivanenko for thoughtfully assembling a thorough and practical volume on pediatric sleep disorders. They have created an issue that provides an update of the current knowledge base while also providing a rich context for its application to clinical care. I also thank each of the outstanding contributors for sharing their expertise in this developing field.

Let us hope not only that this issue of the Clinics will allow you to rest easier tonight but also that it may help your patients to count fewer sheep on their way to a more restful, refreshing, and healthy sleep.