With the development of electricity, our environments went from 12 hour days of light, reliant primarily on sunlight, to 24 hours of available light in our indoor spaces. This has increased further with the development of the internet and our use of computers, television, smart phones, etc. The industrial revolution also has given us shift work that disturbs our sleep.  We all know how important a good nights sleep is but what exactly is sleep and why is it so important for optimal function? 

Stages of Sleep
Stage One – The lightest stage of sleep. Eye movements will be slow. This is the drowsy stage where you can easily be disrupted. Muscle tone and brain activity begins to slow from the awake stage. In this stage, people can experience the sensation of falling or hypo-tonic muscle jerks.

Stage Two – In this stage, awaking does not occur as easily. Slow eye movements stop and brain activity slows further with bursts of rapid activity. The rapid activity bursts are thought to protect the brain from awakening. In this stage body temperature decreases and heart rate slows.

Stage Three – This is deep non REM sleep, known as “dead to the world” sleep. This consists of slow brain waves called delta waves. This is the restorative stage of sleep where the body heals both physically and psychologically. In this stage waking up is rare. Sleepwalking, sleep talking, and night terrors occurs in this sleep stage. During this sleep, stage the body release growth hormone to help repair the stresses of the day.

Rapid Eye Movement Sleep – This is the dreaming stage of sleep. The brain activity is increased when compared to that of stage two and three. Awakening can occur more easily in this stage. Waking up in this stage leaves you feeling sleepy and groggy. During this stage heart rate and blood pressure increase. Body temperature become harder to regulate. This is when vivid dreams occur. If woken during this stage you are able to recall dreams easier. Muscle paralysis occurs in this stage to prevent the body from acting out dreams and injuring ones self.

Sleep begins in stage one and then cycles into stage two then three and back through two then one, followed by REM sleep. This cycle can take 90 to 120 minutes to progress through. Adults will have about five cycles through the night. In earlier cycles stage three, deep sleep takes more time in the cycle. Later in the sleep cycles (earlier morning) stage two and REM dominate.

Sleep and Optimal Learning​

Procedural Skills:
Many studies have revealed a relationship between memory, learning and REM sleep. When learning procedural memory tasks such as math, sleep can have an impact on how you retain that learning. When you learn new complex procedural memory tasks, the night after you learn, there will be an increase in brain activity during REM sleep. This also occurs in the third and fourth night after learning but not in the second night of sleep.  Interrupting REM sleep in the first, third and fourth night can therefore have an impact on one’s ability to recall and perform new learned tasks. 

Physical Skills:
When learning new physical skills such as, how to tie your shoe, skate, ski, any sport, or musical instrument, stage two sleep is most important for learning. Stage two sleep is concentrated in the latter half of sleeping, so early morning. When learning new athletic skills waking up too early in the morning can have a negative impact on retention of new skills.

Causes of REM Sleep Disturbance 

Now we know how important sleep is for the brain to learn, here are some main causes of REM sleep disturbance:
Alcohol
Booze is a substance known to directly disrupt REM sleep. It affect learning new information and alcohol consumption can interfere with retention of information. Studies show that students consuming alcohol on the weekends when learning in post secondary institutions will have decreased  learning and retention.

Shift Work
Another impact on REM sleep, and thus learning, is shifting your sleep schedule. If you delay going to bed by 4 hours, you will not have the same REM sleep. We are creatures of habit and sleep routine is no different. Your body gets REM sleep when it expects it. People who have shifting sleep schedules will have challenges when learning and processing new complex information.  When learning new physical skills such as, how to tie your shoe, skate, ski, any sport, or musical instrument, stage two sleep is most important for learning. Stage two sleep is concentrated in the latter half of sleeping, so early morning. When learning new athletic skills waking up too early in the morning do to shift work can have a negative impact on retention of new skills.

Activity Fact: There is also a strong relationship with sleep and pain processing. People with poor quality of REM sleep have a higher chance of also experiencing chronic pain. 

If you sleep for the recommended 8 hours a day and you keep your mattress for the average of 9 years, you will spend 3 of those years in your bed.  It is therefore one of the most important pieces of furniture you can buy.
Choosing a mattress can be an overwhelming experience. With all of the options available in firmness, top covers, cooling materials, and spring vs foam, it is hard to have a starting point.
I often get asked, "what is the best mattress?".  And the answer is: there isn't one.  People come in all different sizes, shapes, and all have different preferences when it comes to sleep.  This article will give  you some tips and ideas to consider when you are purchasing that next mattress for your bed.

What is Your Sleep Position?
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Some of us love to hug that pillow and sleep on our tummy or curl up in a ball and sleep on our side.  Each different position that we sleep in causes different pressure points on the mattress. 
Side sleepers often feel a soft to medium mattress is more comfortable so that the hips and shoulders do not get excess pressure and the small of the back is supported. The basic principle is you should feel that the mattress is contouring to your body.  Back and tummy sleepers benefit from a firmer mattress to help distribute the pressure throughout. Tummy sleepers will get back pain if the mattress is too soft as the most pressure on the bed is through the torso.  This area will drop into the bed if the mattress is too soft and cause over extension of the spine. 

How Much Do You Want to Spend?

Like most purchases, cost sometimes does not mean a better product. Don't go for the retail price. Mattress prices are often well inflated and go on sale for up to %50 off or even more.  You can even negotiate a price with most Mattress retailers.  There is also a large online industry for mattresses and the prices are significantly lower than going to a retail store.
Be cautious if a sales person is telling you that the bed will last longer if you pay more for it.  This is true if the material in the top cover and fabric are of higher quality but not true regarding the structural materials that make up the mattress. Most mattresses regardless of price only last around 10 years. 
Also do not pay more for a mattress that is endorsed by a group or association or is marketed with gimmicks such as "orthopedic", or "medically approved".  This is simply a marketing ploy. 

Children have spines, muscles, joints and tendons like adults and are not immune to having muscle and joint pain.  One of the most common presentations in my office when treating children, is knee pain.  There are many causes of knee pain in kids, from growing pains, growth plate pain, sports injuries and even bone cancer. It is important to pay attention to your child when they complain of knee pain.  Most conditions can be easily treated with conservative care.  

Growing Pains
 True growing pains are not well understood and the main theory is that the pain is originating from the muscles. The muscles are thought to be adapting to their increased length and growth.  The sensory receptors, that measure stretch, are effected more when the child is in a growth phase. This is most common around the ages of 3-4 and 8-12. Growing pains are felt in both legs, especially in the back of the legs(calves) and in the front of the thighs.  
These pains are more common after sport activities and mostly present later in the day and evenings. The pain can also sometimes present in the middle of the night.  Growing pains disappear in the morning and usually don't interfere with the child's ability to play sports or be active. When it comes to knee pain and growing pains, the pain is usually located at the top of the knee in the front or around the back of the knee. 
Treatment for growing pains is using heat and massage to the leg muscles. 

Osgood- Schlatter Disease

There are growth plates located at the ends of all growing bones.  In Osgood-Schlatter Disease, the tendon from the quad muscle pulls on the growth plate at the top of the shin bone, just under the knee cap.  The growing bone and short/tight muscle causes extra force to be placed over this growth plate area. 
The signs and symptoms are point tenderness over the Tibial Plateau (end of the shin bone close to the knee cap), a bump found at the Tibial Plateau, and pain after activities involving running and jumping.  An x-ray can also show if the growth plate has been disturbed. 
Pain from Osgood Schlatter's is  aggravated by activity and relieved by rest with ice and is most common during excelled growth periods. It can affect both knees or just one. 
Treatments for Osgood-Schlatter's Disease  includes rest, bracing, stretching, and muscle strength balance.

Bone Cancer-Osteosarcoma

Bone Cancer in children is very rare and makes up roughly 30% of all childhood cancers and the most common malignant one is called Osteosarcoma. This tumor is most often located in the femur,(thigh bone) around the knee area.  Osteosarcoma affects approximately 400 children younger than age 20 every year in the United States. Osteosarcoma occurs most often in children and young adults between the ages of 10 and 20 and often during a growth spurt. It occurs more frequently in boys than girls.
Signs and symptoms include one sided pain around the tumor area, secondary fracture due to bone weakening, decreased appetite, night pain, loss of energy, and swelling around the tumor area. 
Osteosarcoma presents with a gradual onset often not related to any explained trauma or injury.  Progressive pain occurs over time along with progressive symptoms. 
Treatment includes surgery to remove the tumor and also chemotherapy. 

Sports Injuries

Sports injuries are the most common presentation of childhood knee pain in my office.  Like adults, one of the most common areas for kids to get a sports injury is to their knees.  When obvious trauma is placed onto the knee it is very easy to diagnose a sprain, strain, or muscle injury. Sometimes sports injuries can be a repetitive strain type injury that develops slowly over time.  One of these injuries is patellofemoral syndrome, also called runners knee. It is characterized by pain around the knee cap and aggravated with running and jumping exercises.  Swelling can be present and pain is worse when squatting, climbing/descending stairs, and kneeling. It can be present in one leg or both.  
This condition is common in active children that are growing fast and their leg muscles are not balanced in strength and length. 
A thorough exam by a practitioner that treats muscle and joint problems is the first step with this type of knee pain.  A treatment plan of therapy, exercises, and stretches will be implemented.  

Summary:

Knee pain is a common presentation in children.  A lot of knee pain can be related to kids growing fast and the muscle balance is affecting the joints. Examples of this are growing pains,  Osgood Schlatters and Patellofemoral Syndrome.  These problems are all aggravated with activity and relieved with rest. They can also all be one leg or both with growing pains being more common in both legs. 
Be concerned of an underlying bone tumor when your child has one knee that hurts, rest doesn't relieve it, the knee is swollen all the time and they are having night pain. 

Activity Fact: Full bone growth is achieved at around the age of 21 but our body continues to make bone tissue throughout our life. Physical activity helps keep this process ocurring and helps prevent osteoporosis.

Children are not immune to back pain.  According to a review of the epidemiology of low back pain in children in the British Medical Journal, children on average have a 15% to 26% chance of having back pain.  Similar in adults, childhood back pain varies widely  depending on their age, sex, and socioeconomic status. 
Almost all back pain in children is related to muscle/joint pain and is self-limiting and resolves without complications. There are times though when you should pay close attention to your child's complaints. 

1. Pain For More Than a Month
Prolonged pain is not normal.  Children have an amazing ability to heal fast. If your child hasn't had a re-injury and still has symptoms that are not healing, you should seek care. Conditions, such as a stress fracture, can be the underlying cause. The most common type of spinal stress fracture is called a spondylolysis, an injury to the bone in the back of the spinal column. This injury occurs most often in adolescents who do sports involving repetitive hyperextension (bending backwards) of the spine, such as gymnasts and divers. If the stress fracture occurs on both sides of the spinal column, this can cause instability of the spinal column, or a condition called spondylolisthesis. This condition, also called a spinal "slip," can lead to the vertebral column alignment to shift.
Prolonged pain can also be a sign that there is a more serious injury to the joints or muscles involving damage to these structures.

2. Back Pain with Generalized Illness
Prolonged back pain with flue like symptoms, including fever, loss of appetite, fatigue, and weakness, can be a red flag for infection.   Infection of the spine is a very rare, but is a very serious condition. Infection of the urinary tract can be another reason for back pain and generalized illness as it can mimic back pain and can often be ignored.  Children will also complain of stiffness in the back accompanied with a flu or various viral infections. This pain is self-limiting with the flu symptoms.  If the pain and fever persist you should visit your doctor.