Decoding sleep disorders through fairy tales

Some traditional fairy tales and classic children's fiction that have soothed many a child to sleep may also provide accessible and engaging ways to discuss healthy sleep with children, suggest researchers in the Christmas issue of The BMJ.

Megan Thomas and colleagues analyzed four popular fairy tales that include information about the benefits of sleep and the characteristics of sleep disorder.

For example, Snow White illustrates some of the daytime consequences of poor sleep due to obstructive sleep apnoea which is common in some conditions associated with short stature. These can include irritability (Grumpy), tiredness (Sleepy), and weaker social skills (Bashful), write the authors. Problems with attention and word fluency are also recognized consequences of sleep deprivation and might explain Doc's speech difficulties. 

And while Sneezy might have allergies contributing to his respiratory obstruction, the authors suggest that perhaps the lack of sleep has lowered his immunity, making him more susceptible to respiratory disorders.

In The Princess and the Pea, the princess' sleepless night could point to an autism spectrum disorder, note the authors. Sensory sensitivities are common, as are sleep difficulties, with insomnia (the inability to fall or stay asleep) being the most commonly reported problem.

Meanwhile, Goldilocks and the Three Bears shows that a key part of achieving healthy sleep is optimizing environmental conditions: a comfortable bed and a room that is not too hot or too cold but "just right" and is dark and quiet is ideal, say the authors.

Remembering this fairy tale may also prompt the use of the BEARS screener for children's sleep problems (Bedtime issues, Excessive daytime sleepiness, night Awakenings, Regularity and duration of sleep, and Snoring), they add. 

Finally, throughout Peter Pan, the reader is introduced to symptoms of parasomnias (unusual and undesirable behaviors during sleep) that are common in childhood and include sleep walking, sleep talking, confessional arousals, and night terrors, explain the authors. For instance, Peter Pan experiences frequent "painful" dreams that might reflect nightmares or night terrors. 

Contributing factors to parasomnias are stress, separation anxiety, and sleep deprivation, which aligns with the experiences of Peter Pan and the Lost Boys, who were abandoned by their families and are fleeing the dangers of Captain Hook and his crew, they note.

The story also underscores the importance of healthy sleep for memory consolidation and optimal mood, they add. Each night, Mrs Darling tidies up her sleeping children's memories by storing them in their proper place and leaves the happiest thoughts at the top of her children's minds for the next day.

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