Falling asleep is one of the major sleep problems commonly encountered in children and adolescents. The age may vary between 5 and 17.It can be better explained keeping in view of some factors. They are environmental, genetic and biochemical.
Liu et al. (2005) reported that the reason for this problem would be short sleep duration and snoring. Children who spent less time at bed are susceptible to early fatigue that makes them fall asleep during day time or in a class room. Neurotransmitters acetylcholine, dopamine, and serotonin may also contribute to this behavior. Acetylcholine that functions in impulse transport might get weakened in its cerebral circulation leading to a poor conduct of the neural transmission. This might result in poor attention accompanied by a feeling of tiredness and finally leading to sleep problem. Here, it can also be assumed that the function of acetylcholine receptors might have altered in recognizing the acetylcholine on the neural membranes.
Other factors could be dopamine or serotonin secretions below threshold levels that maintain sleep awakening cycle. An alteration in the series of events in the sleep cycle could also lead to sleep disturbance.
School children are prone to stress of any kind either at home or at school. As such, some stress response genes could be activated leading to the production of any gene product or secretion that might be interfering with the function of normal brain secretions. Similarly, the enzyme levels of vital biochemical pathways may get altered causing sleep defects.
The problem of falling asleep could also be attributed to hereditary factors. Specific genes inherited from the parents who might have faced sleep problems during childhood, could be contributing to the problem.
The problem of falling asleep could also be assigned to mental cognition that might vary depending upon the situation. For ex., when the class lecture or teaching appears difficult to perceive, the student might get bored and prone to sleep in the class room. Very often the topic may appear interesting, but the student fails to be attentive and falls asleep. This behavior may be time related. If it is a fresh morning, the chances of falling asleep would be remote. If it is a mid afternoon, the chances will be close.
Children suffering from sleeping problems may prone to asleep in the class room. This problem may also originate due to other disorders characteristic of child behavior. Attention deficit–hyperactivity disorder (ADHD) is a neuropsychiatric disorder that affects children’s attention, emotional and social behavior. Holmberg and Hjern (2006) highlighted that sleeping problems and tiredness as associated symptoms of ADHD. So, children falling asleep in a classroom may have ADHD. Further, while attending a class, students may encounter other problems that could affect their class performance. Loe and Feldman (2007) reported that children with ADHD have poor academic and educational outcome.
Hence, it is reasonable to connect the behavior of ‘falling asleep in a class room’ to ADHD.
Further, sleep problems are also associated with other behavioral and adjustment problems in children with idiopathic epilepsy (Cortesi , Giannotti, & Ottaviano,1999).
One of the disorders known to interfere with sleep is autism. Children with autism may suffer from severe sleep problems like difficulty in falling asleep, restless sleep, not falling asleep in own bed, and frequent wakenings( Gail Williams, Sears,& Allard,2004).Hence, it can be inferred that the above highlighted symptoms of disorders may become influential in making children fall asleep in a classroom.
Further, there are theories explaining sleep behavior. One of them that appear relevant in the present context is Recovery or restoration theories by Oswald (1980) and Horne (1988).This theory focuses on the advantages of sleep for the physiological system. The evidence for this theory was explained by Allison and Cicchetti (1976).According to these theories, one of the possible functions of sleep is to permit restoration of physiological functions. Previous studies have reported that there is strong association between the quality of sleep and mood.
From the theory, it was understood that insomniacs are more worried and tend to show anxious behavior. As reported by Berry and Webb (1983) in one of the experiments, people who slept well during a previous night had their anxiety lower than those who slept poorly. Naitoh (1975) further highlighted the effects of one night’s sleep deprivation on mood.
According to this report, sleep deprived individuals are prone to be less friendly, relaxed, good natured and cheerful than those who had not been-sleep deprived. It indicates that sleep deprived individuals are more unlikely to adjust to social environment. This was also true with ADHD patients who complain of sleep and social problems. It also seems reasonable to connect autism with the above explanation on sleep deprivement.
So, it can be assumed that student who falls asleep in a class room may have deprived his sleep last night simply or may be having ADHD or Autism. When there is no restoration of physiological function, there might not be any activity during the day time which could result in tiredness. According to the theory, sleep restores the physiological function. A defect in restoring physiological function might originate from the defect in sleep cycle. So, there may be a cascade of events leading to falling asleep behavior during day time or in a class room.
Further, the theory states that people with low exercise tend to sleep for a short period than people with long duration. It can be assumed that children although may not be doing strenuous exercise at their age, could have other excess of physical activities in school. As such, when they are deprived of sleep, it might contribute to tiredness or falling asleep behavior.
Secondly, the theory states that vulnerability to danger is considered as the predictor of rapid eye movement (REM).The more vulnerable to danger, the less will be the REM sleep.
People with delayed REM are also prone to sleep disturbances. So, any individual falling asleep during day time may also be having the complaint of REM defect. This could be due to a previous exposure to a situation of threat or danger that he is unable to forget. Hence the behavior of falling asleep in a class room cannot be underestimated.
Further, it is essential to know the family habits adopted. For ex. late night meals and drinks may show tremendous impact on the sleeping behavior of children. A heavy meal during day time which is commonly experienced in daily life would be another cause behind a nap.
To consider other factors, a feeling of physiological unrest would also arise due to fever, headache or any other severe disease. Some school children very often suffer from fits and giddiness.These disorders might affect the sleep-wakening cycle leading to inattention in the class room and might also promote sleep inducing factors.
Further, sleep behavior encountered in children may also persist in the adolescence.
Thorpy et al. (1988) reported delayed sleep phase syndrome in adolescents that results in falling asleep at a social unacceptable time and wake problems in the morning. Other reported symptoms of this syndrome are day time sleepiness and poor school performance.
Thus, it can be inferred that these examples are playing a vital role in supporting the theory, that sleep is central in restoring the physiological functions.
Keeping in view of the above assumptions and description, some of the experiments may prove beneficial in studying the sleep behavior in students.
Initially, students were screened especially for sleep behavior in the class by the school staff.
After screening, they were categorized into two groups. One group with sleep complaints is taken as subject group and the other without any complaints is taken as control group.
Both the groups were tested for the levels of important neurotransmitters by employing specific markers. The levels of markers are compared with a standard reference range and recorded.
The behavior of students identified with sleep problems were noted down by conducting a questionnaire that comprised of parents, teachers, and the students themselves.
The questionnaire thus obtained was compared to determine whether the behavior complaints would tally.
In another experiment, a group of fifteen children are allowed to undergo vigorous running that resembled sports-running for 30 minutes in the school ground of average size. A rest period of 15 minutes was given and the running was resumed. They were sent back home after the race and told to take rest. This group was told not to reveal any information of sleep when they come to the class. The next day they are compared with another 15 group of students who had also taken running. This group was told to keep awake themselves for three to four hours in the night and wake up early following a short night sleep. Here, parameters like nurotransmitters, mood behavior were taken into consideration while making the comparison.
Further, parents were divided into two groups. The parents of children with sleep complaints are classified as group A and those of children without any complaints are classified as group B. Both the groups are interviewed. The purpose of this interview was an attempt to connect the sleep behavior of parents during their childhood and adolescent stages, to that of children. Parents were told to recall their sleeping habits.
The genomic information of parents was also obtained by gene profiling to study alleles and their polymorphism. This information was later compared with the genotype of their children. In another experiment, children in two groups are given hectic work schedule to determine the activity of stress response genes by genotyping. Here, one group was with pre-planned sleep behavior and the other was without any plan and was told to sleep comfortably. In addition, students were screened for the alleles reported to be specific for ADHD. The associated symptoms of ADHD like, recurrent abdominal pain (RAP), tiredness and sleep problems as reported previously, were also noted down (Holmberg & Hjern, 2006).
Diet habits were also taken into consideration to determine its affect on sleep behavior.
Both parents and children were asked to reveal if they had any previous complaints related to nutrition and diet. This parameter was mainly focused to get information about some key elements like vitamins, zinc, magnesium, and omega 3 fatty acids that are known to play vital role in neuro psychiatric disorders like ADHD and Autism (Curtis & Patel, 2008).
To study the attention of students, children were initially told to take I Q tests. Based on the performance in the IQ tests they were divided into two groups of least and best performers.
Average performers were excluded from the study. Next, subject topics of higher level of difficulty and relatively easier ones were chosen to teach in a specially designed manner. Students with least IQ test performance were made to attend the class of only easy topic and were monitored. Students who revealed that they understood the easy class were relieved after a small topic related quiz. Students who revealed that they did not understand the class were retained for an interview with the objective of getting information on their attention levels or any other problem interfering with their academic life.
Students with better performance in IQ tests were made to attend only tough classes that required much attention and were monitored. Here, they were excluded from attending a relatively easier class as it might create any possible boredom initiated sleep.
Students who fell asleep during the tough class were retained and were interviewed after the session. Students who revealed that they understood the classes were relieved after a topic related quiz. The data obtained from both the student groups were later compared.
From the above mentioned experiments following results were obtained.
The levels of neurotransmitters were altered in the subject group when compared with that of control group. From the questionnaire results, it was found that the behavior of students with sleep complaints tallied with that obtained from the parents, teachers and the students themselves. In another experiment, the group with physical activity and no sleep information were found asleep in the class room, tend to be moody and also showed a variation in the levels of neurotransmitters, when compared with the group without any physical activity.
Further, in the group with the physical activity and pre planned sleep deprivement, sleep behavior also affected their class room activities, with changes in the levels of neuro transmitters and mood. Some of the subjects of physical activity who complained of a history of sleep disturbances also showed some variation with the levels of neurotransmitters, sleep and mood behavior during day time.
The alleles of parents identified with sleep problems were also found to be present on the same locus of chromosomes in children with altered sleep behavior. Polymorphism of specific alleles was also detected in parents and their children.
Further, stress response genes were detected in children in both the groups exposed to environmental stress compared to unexposed group. Genes specific of ADHD were detected in children complaining of other associated symptoms of ADHD. Diet habit questionnaire revealed late night and heavy meals. The levels of vitamins, Zinc, magnesium, and omega 3-faty acids showed alteration and coincided with the sleep complaints compared to control groups.
Next, students with low IQ performance and understanding problem revealed that they encounter frequent sleep disturbances during night time and falling asleep in the class room.
The same students also exhibited altered mood patterns like anger, irritation and unhappiness when monitored. Students with better performance in IQ and no understanding problems also revealed sleep disturbances they are having at night time.
There is a need to focus on falling asleep condition identified as one of the sleep driven behavior problems. There were altered levels of neurotransmitters in the subject group. It may indicate that the neurotransmitters are prone to exhibit variation when there is a sleep related problem. The level of neurotransmitters could also be considered as the predictor of altered sleep behavior.
Children with physical activity and no information of sleep were found to fall asleep the next day in the class room. Previously, it was reported that individuals with lot of physical exercise sleep longer than those with low exercise. Therefore, it can be assumed that the children might not have taken enough sleep during the previous night or there might be other factors known to interfere with their sleep patterns. This probably could have affected their day time activities and behavior.
Children with physical activity and preplanned sleep behavior were also found to exhibit the similar behavior. The results of these two groups also coincided with other children subjects of physical activity having natural sleep disturbances. Therefore, it indicates that sleep deprivement may induce severe unacceptable changes during the day time that might have resulted in altered neurotransmitter levels in both the groups.
From the genotyping studies, the alleles of both parents and children with similar sleep complaints were found to be contributing to the problem by showing some polymorphism.
Hence, the study of alleles that are believed to be risky might furnish better insights on problems associated with sleep behavior.
Further, the detection of stress response genes can be considered as an indication of environmental stress. These genes correlated positively in the stress induced subjects who seemed tired and fallen asleep in the class room. Whereas these genes did not correlate much in the stress induced subjects with good sleep. Therefore, it may indicate that stress response genes are associated with altered sleep patterns. Hence, understanding the activity of stress response genes may furnish better insights on the sleep behavior.
Further, the detection of genes specific for ADHD and the observation of its associated symptoms has drawn much attention. This information may indicate that the subjects may be having a strong predisposition to ADHD. As sleep problems are prevalent in ADHD, children falling asleep in class room may have associated symptoms characteristic of ADHD. Hence, they need to be screened cautiously while making a diagnostic study.
The alteration of nutrient factors may reveal that children might not be taking a balanced diet.
In addition, the sleep behavior in these children also got altered affecting their day time activities and behavior. Previously, children with ADHD also had similar nutrition complaints. (Curtis & Patel, 2008).So, it can be inferred that proper nutrition levels are vital for restoring hygienic sleep and behavior.
Children with low IQ test performance seem to have attention problems with altered sleep and behavior complaints. These symptoms are closely related with that of ADHD.Hence, it can be further strengthened that children in the present study may be having ADHD.
Children with better IQ test performance may not have attention problems. Bu their altered sleep and behavior patterns may indicate a likely association with sleep deprivement induced by any possible external stress or nutritional imbalance or hereditary factors.
Therefore, IQ tests followed by specially tailored classes and behavior screening may help in identifying children with a variety of sleep–related behavior disorders like ADHD and Autism.
In summary, the behavior of falling asleep in a class room is associated with many factors.
Initially, a connection with the levels of neurotransmitters was very prominent when a positive correlation was observed with altered sleep behavior patterns. Falling asleep behavior also correlated positively with the physical activity induced sleep complaints. It was understood that physical activity plays vital role in influencing sleep behavior both at night and day time under special circumstances. Neurotransmitter levels also correlated positively with the physical activity induced sleep disturbances.
There was strong association between parent and children genetic complements and this has also correlated positively with their sleep complaints. Stress response genes also appear to be better connected with sleep disturbances believed to originate externally.
Further, genes found to be inherited from the parents and that of stress have shown strong correlation with ADHD genes and the associated symptoms.
There was strong association between nutrition factors and sleep behavior, as the levels of vital elements have shown positive correlation with the sleep complaints of the children. An association was also found between IQ and sleep and social behavior. The low IQ levels of children correlated positively with falling asleep and altered social behavior complaints. The better IQ levels of children have also shown a positive correlation with sleep and other behavior complaints. In addition, both low and better IQ levels positively correlated with poor and good attention, respectively.
In conclusion, falling asleep behavior seems to be more prevalent in school attending children, if not adolescents. There is a need to identify large number of students to better diagnose them at an early stage keeping in view of available scientific findings and descriptions.
References
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Loe, I., M. &Feldman, H., M. (2007). Academic and educational outcomes of children with ADHD. Ambul Pediatr. 7 (1 Suppl):82-90. 2008. Web.
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Table 1: Table showing the association between variables: