Sleep clinics also study why children have trouble slipping into delta, or REM, sleep, which is crucial for rebooting the brain and maintaining memories of information that was learned during the day — such as class work — and discarding junk memories, like the color of the textbook.
“REM is like wiping all the nonsense memories you learn during the day and the brain is ready to learn new things for the next day,” explained Shahzeidi. Every memory of the day is mapped into the brain and the maps are synapses of neurons with different shapes for various events.
“The synapses stay there until you go to REM that night. During the REM phase these synapses are disengaged. If the kid actually does not go into REM sleep or has a sleep problem then they synapses are not disengaging,” Shahzeidi said. The result is that the child “becomes preoccupied and can’t concentrate anymore and learn the new things.”
There are four patterns of sleep and each should shift into the next, like a well-tuned transmission.
“If there is something disrupting it, it gets stuck in that stage and can not advance to REM. Each time you stay in REM for 10 to 15 minutes that’s enough to refresh and recycle all those synapses for the new memories,” Shahzeidi said.
Teens should get up to nine hours of sleep a night.
“Teens normally have delayed sleep phase syndrome in which teens tend to be night owls and go to sleep late and get up late on the weekends. A lot of teens are sleep deprived and get four to six hours of sleep at night. Teens are the sleepiest of all the age groups for some reason. The state of Florida has teenagers get up earlier when they go to high school and the opposite of that should happen. Kids are getting up at 5:30 a.m. to get ready and go to sleep at midnight. Sleepiness causes you to not be able to pay attention and absorb information, especially in the morning,” Deray said.
Lack of sleep can also trigger obesity, Deray said. The hormone ghrelin is produced while awake and promotes feelings of hunger. Leptin is produced when we are asleep and induces satiation.
When you have a longer period of time to produce ghrelin this is “causing kids to eat more, they are awake more of the time and idle and have more time on their hands to do things. One thing you can do when awake is eat. There is a clear relationship between lack of sleep and obesity,” Deray said.
Shelly Holguin, now 21 and a paralegal student at Miami Dade College, was treated at Miami Children’s at age 8 when her family first discovered she had a sleep problem.
“I noticed my nails and toenails and my mouth would turn blue and I was not getting enough oxygen,” Holguin said from her home in Hialeah.
In December 2011 she was referred to Shahzeidi, who diagnosed her problem: ROHHAD syndrome, or rapid onset of obesity hypothalamic hypoventilation and autonomic nervous system disorder.
“When I was born one of my neurons in the brain did not develop fully,” she said.
“All of a sudden she started to gain weight and I saw her for headaches to start with,” Shahzeidi said. “She had central apnea, the brain doesn’t order the lung to breathe. Genetically, she had this problem where the part of her brain, the medulla ... does not fire the impulses and she forgets to breathe when going into the deep sleep. We don’t know what is the cause, but we know it’s genetic. When they really don’t breathe, oxygen saturation goes down and might damage their brain. Carbon dioxide goes up and they get headaches.’’
To treat ROHHAD, patients are fitted with a special CPAP mask, which basically does the breathing for them while they sleep or nap.
“Dr. Shahzeidi was the first person who found the right type of machine for me. It helps me breathe when I need it and it records information when I have episodes as it has its own database,” Holguin said. “I’m basically overweight so that’s another issue. Due to the central apnea, my system does not work the normal way. Everybody knows the brain is the most important part of the body and since I don’t have that certain neuron, when it comes to studying I don’t register the same type of information as other people. I have to take it slow, I don’t grasp easily. I struggle because of that.”
The mask and treatment is helping, both say.
“She’s a very clever girl and in college now, and she’s very happy with the treatment,” Shahzeidi said.
Holguin said she eventually wants to become a lawyer to help others with unusual medical conditions like hers.
“It hasn’t been easy. It is how it is. Sometimes [the mask] feels uncomfortable but at the end of the day this is me, this is what I have, this is for my benefit.”
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