FIRST AID

What causes nosebleeds?

The most common causes are dryness (often caused by indoor heat in the winter) and nose picking. These 2 things work together -- nose picking occurs more often when mucus in the nose is dry and crusty.

Other, less common, causes include injuries, colds, allergies or cocaine use. Children may stick small objects up the nose. Older people may have atherosclerosis (which is the hardening of the arteries), infections, high blood pressure and blood clotting disorders, or they may be taking drugs that interfere with blood clotting, such as aspirin. Sometimes, the cause of nosebleeds can't be determined.

Why is the nose prone to bleeding?

The nose has many blood vessels in it to help warm and humidify the air you breathe. These vessels lie close to the surface, making them easy to injure.

Are nosebleeds serious?

A few nosebleeds stem from large vessels in the back of the nose. These nosebleeds can be dangerous. They may occur after an injury. This type of nosebleed is more common in the elderly and is often due to high blood pressure, atherosclerosis, daily aspirin use or bleeding disorders. Usually, the older the patient, the more serious the nosebleed.

You'll need to get medical attention if a nosebleed goes on for more than 20 minutes or if it occurs after an injury (such as a fall or a punch in the face), especially if you think you may have a broken nose. A nosebleed after a fall or car accident could be a sign of internal bleeding.

Frequent nosebleeds may mean you have a more serious problem. For example, nosebleeds and bruising can be early signs of leukemia. Nosebleeds can also be a sign of blood clotting disorders and nasal tumors (both cancerous and non-cancerous).

What should I do when I get a nosebleed?

A nosebleed can be scary to get -- or see -- but try to stay calm. Most nosebleeds look much worse than they really are. Almost all nosebleeds can be treated at home.

If you get a nosebleed, sit down and lean slightly forward. Keeping your head above your heart will slow the bleeding. Lean forward so the blood will drain out of your nose instead of down the back of your throat. If you lean back, you may swallow the blood. This can cause irritate your stomach.

Use your thumb and index finger to squeeze together the soft portion of your nose. This area is located between the end of your nose and the hard, bony ridge that forms the bridge of your nose. Keep holding your nose until the bleeding stops. Don't let go for at least 5 minutes. If it's still bleeding, hold it again for another 5 to 10 minutes.

Once the bleeding stops, don't do anything that may make it start again, such as bending over or blowing your nose.

Pinch your nose to stop a nosebleed

See your doctor if:

• The bleeding goes on for more than 20 minutes.
• The bleeding was caused by an injury, such as a fall or something hitting your face.
• You get nosebleeds often.

What will my doctor do for a nosebleed?

Your doctor will try to find out where the bleeding is coming from in your nose. He or she will probably ask you some questions and examine your nose. If the bleeding doesn't stop on its own or when pressure is applied, your doctor may cauterize the bleeding vessel or pack your nose to stop the bleeding.

Cauterization involves using a special solution called silver nitrate or an electrical or heating device to burn the vessel so that it stops bleeding. Your doctor will numb your nose before the procedure.

Packing the nose involves putting special gauze or an inflatable latex balloon into the nose so that enough pressure is placed on the vessel to make it stop bleeding.

Tips on preventing nosebleeds

• Keep children's fingernails short to discourage nose picking.
• Counteract the drying effects of indoor heated air by using a humidifier at night in your bedroom.
• Quit smoking. Smoking dries out your
• Open your mouth when you sneeze.

First Aid Kit Essentials

Why do I need a first aid kit?

Falls, bee stings, burns, allergic reactions -- all of these are common accidents that can happen in any home or on any outing. That’s when a first aid kit comes in handy. When you have a well-stocked first aid kit, you have the supplies you need to be ready for most minor emergencies.

Putting a kit together is as simple as placing some basic items in a small container, such as a plastic tub, tool kit or tote bag. Keep one in your medicine cabinet at home, making sure it’s out of young children’s reach.

What do I need in a first aid kit?

Here’s a breakdown of some supplies every first aid kit needs.

Dressings and bandages:

• 25 adhesive bandages of various sizes (brand names: Band-Aid, Curad, others)
• 5 sterile gauze pads (3 x 3 inches)
• 5 sterile gauze pads (4 x 3 inches)
• Gauze roll
• Eye shield or pad
• Roll of adhesive tape
• Elastic bandage (brand names: ACE, Coban, others) for wrapping wrist, elbow, ankle and knee injuries (3 to 4 inches wide)
• 2 triangular bandages for wrapping injuries and making arm slings
• Sterile cotton balls and cotton-tipped swabs

Equipment and other supplies:

• 2 pair latex or non-latex gloves (These should be worn any time you may be at risk of contact with blood or body fluid of any type.)
• Instant cold pack
• 5 safety pins to easily fasten splints and bandages
• Turkey baster or other suction device to flush out wounds
• Aluminum finger splint
• Syringe and medicine spoon for giving specific doses of medicine
• Thermometer
• Tweezers to remove ticks, insect stingers and small splinters
• Scissors for cutting gauze
• Breathing barrier for giving CPR
• Blanket
• Hand sanitizer (liquid and/or wipes)
• First aid manual
• List of emergency numbers

Medicine for cuts and injuries:

• Antiseptic solution or wipes, such as hydrogen peroxide, povidone-iodine (one brand name: Betadine) or chlorhexidine (one brand name: Betasept)
• Antibiotic ointment (brand names: Neosporin, Bactroban) that contain ingredients such as bacitracin or mupirocin
• Sterile eyewash or saline, such as contact lens saline solution
• Calamine lotion for stings or poison ivy
• Hydrocortisone cream, ointment or lotion for itching

Other medicines:

• Pain and fever medicines, such as aspirin, acetaminophen (one brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin). (Note: Do not give children and teenagers aspirin, because it has been related to a potentially serious disease called Reye's syndrome in children younger than 18 years of age.)
• Antihistamine (one brand name: Benadryl) to treat allergies and swelling
• Decongestants to treat nasal congestion
• Anti-nausea medicine to treat motion sickness and other types of nausea
• Anti-diarrhea medicine
• Antacid to treat upset stomach
• Laxative to treat constipation

Think about any special needs in your family, such as those of a child or elderly person, as well as allergies or diseases. Add supplies as needed for these conditions. Also, be sure to refill your kit with any supplies you have used or that may have expired.

Can I purchase a first aid kit?

Yes. The American Red Cross and many drugstores sell first aid kits with the necessary items. Remember, for the kit to be useful, you need to know how to use it. You may want to take a Red Cross first aid course or at least purchase a first aid manual to learn first aid basics.

Cardiopulmonary Resuscitation (CPR)

When is CPR important?

CPR may be done when a person stops breathing or the heart stops beating (like when a person has a heart attack or almost drowns). When it's possible that the person may get better, CPR is an important life-saving technique. CPR can help keep oxygenated blood circulating in the body, which can help prevent brain and organ damage.

However, when a patient has an advanced life-threatening illness (such as advanced stages of cancer) and is dying, CPR may not be the best option. It's important for the patient, family members and doctor to talk about this issue before the need arises.

What happens during CPR?

CPR consists of 2 stages: chest compressions (forceful pressing on the chest to stimulate the heart) and artificial respiration (mouth-to-mouth rescue breathing).

Electric stimulation to the chest (called an automated external defibrillator or AED, which a device that help start the heart) and special medicines are sometimes used to resuscitate a person whose heart has stopped beating. This is usually done for 15 to 30 minutes. A tube may also be put through the mouth or nose into the lung. This tube is then connected to a breathing machine and helps the person breathe.

What happens if CPR isn't done?

A person will become unconscious almost immediately and will die in 5 to 10 minutes.

What are the benefits of CPR?

For a patient who has an advanced life-threatening illness and who is dying, there are really no benefits.

CPR may prolong life for patients who have a better health status or who are younger. CPR may also prolong life if it's done within 5 to 10 minutes of when the person's heart stopped beating or breathing stopped.

What are the risks of CPR?

Pressing on the chest can cause a sore chest, broken ribs or a collapsed lung. Patients with breathing tubes usually need medicine to keep them comfortable. Some patients who survive may need to be on a breathing machine in the intensive care unit (ICU) to help them breathe for a while after they receive CPR.

Few patients (fewer than 10%) in the hospital who have had CPR survive and are able to function the way they used to. Many patients live for a short time after CPR, but still die in the hospital. CPR may also prolong the dying process.

Patients who have more than one illness usually don't survive after CPR. Almost no one who has advanced cancer survives CPR and lives long enough to leave the hospital. Of the few patients who do, many get weaker or suffer brain damage. Some patients may need to live on a breathing machine for the rest of their lives.

How do I learn CPR?

CPR is a skill that you need to learn by taking an accredited first-aid training course. This course will probably teach you how to perform CPR and how to use an automatic external defibrillator (AED). 

First Aid: Cuts, Scrapes and Stitches

How should I clean a wound?

The best way to clean a cut, scrape or puncture wound (such as a wound from a nail) is with cool water. You can hold the wound under running water or fill a tub with cool water and pour it from a cup over the wound.

Use soap and a soft washcloth to clean the skin around the wound. Try to keep soap out of the wound itself because soap can cause irritation. Use tweezers that have been cleaned in isopropyl alcohol (rubbing alcohol) to remove any dirt that remains in the wound after washing.

Even though it may seem that you should use a stronger cleansing solution (such as hydrogen peroxide or iodine), these things may irritate wounds. Ask your family doctor if you feel you must use something other than water.

What about bleeding?

Bleeding helps clean out wounds. Most small cuts or scrapes will stop bleeding in a short time. Wounds on the face, head or mouth will sometimes bleed a lot because these areas are rich in blood vessels.

To stop the bleeding, apply firm but gentle pressure on the cut with a clean cloth, tissue or piece of gauze. If the blood soaks through the gauze or cloth you're holding over the cut, don't take it off. Just put more gauze or another cloth on top of what you already have in place and apply more pressure for 20 to 30 minutes.

If your wound is on an arm or leg, raising it above your heart will also help slow the bleeding.

Should I use a bandage?

Leaving a wound uncovered helps it stay dry and helps it heal. If the wound isn't in an area that will get dirty or be rubbed by clothing, you don't have to cover it.

If it's in an area that will get dirty (such as your hand) or be irritated by clothing (such as your knee), cover it with an adhesive strip (one brand: Band-Aid) or with sterile gauze and adhesive tape. Change the bandage each day to keep the wound clean and dry.

Certain wounds, such as scrapes that cover a large area of the body, should be kept moist and clean to help reduce scarring and speed healing. Bandages used for this purpose are called occlusive or semiocclusive bandages. You can buy them in drug stores without a prescription. Your family doctor will tell you if he or she thinks this type of bandage is best for you.

Should I use an antibiotic ointment?

Antibiotic ointments (some brand names: Neosporin, Ultra Mide) help healing by keeping out infection and by keeping the wound clean and moist. A bandage does pretty much the same thing. If you have stitches, your doctor will tell you whether he or she wants you to use an antibiotic ointment. Most minor cuts and scrapes will heal just fine without antibiotic ointment, but it can help the wound close up and help reduce scarring.

What should I do about scabs?

Nothing. Scabs are the body's way of bandaging itself. They form to protect wounds from dirt. It's best to leave them alone and not pick at them. They will fall off by themselves when the time is right.

When should I call my doctor?

Call your doctor if your wound is deep, if you can't get the edges to stay together or if the edges are jagged. Your doctor may want to close your wound with stitches or skin adhesive. These things can help reduce the amount of scarring.

You can close small cuts yourself with special tape, called butterfly tape, or special adhesive strips, such as Steri-Strips.

Call your family doctor if any of the following things occur

• The wound is jagged
• The wound is on your face
• The edges of the cut gape open
• The cut has dirt in it that won't come out
• The cut becomes tender or inflamed
• The cut drains a thick, creamy, grayish fluid
• You start to run a temperature over 100°F
• The area around the wound feels numb
• You can't move comfortably
• Red streaks form near the wound
• It's a puncture wound or a deep cut and you haven't had a tetanus shot in the past 5 years
• The cut bleeds in spurts, blood soaks through the bandage or the bleeding doesn't stop after 20 minutes of firm, direct pressure

How do I take care of stitches?

You can usually wash an area that has been stitched in 1 to 3 days. Washing off dirt and the crust that may form around the stitches helps reduce scarring. If the wound drains clear yellow fluid, you may need to cover it.

Your doctor may suggest that you rinse the wound with water and rebandage it in 24 hours. Be sure to dry it well after washing. You may want to keep the wound elevated above your heart for the first few days to help lessen swelling, reduce pain and speed healing.

Your doctor may also suggest using a small amount of antibiotic ointment to prevent infection. The ointment also keeps a heavy scab from forming and may reduce the size of a scar.

Stitches are usually removed in 3 to 14 days, depending on where the cut is located. Areas that move, such as over or around the joints, require more time to heal.

What is skin adhesive?

Skin adhesive is another way to close small wounds. Your doctor will apply a liquid film to your wound and let it dry. The film holds the edges of your wound together. You can leave the film on your skin until it falls off (usually in 5 to 10 days).

It's important not to scratch or pick at the adhesive on your wound. If your doctor puts a bandage over the adhesive, you should be careful to keep the bandage dry. Your doctor will probably ask you to change the bandage every day.

Don't put any ointment, including antibiotic ointment, on your wound when the skin adhesive is in place. This could cause the adhesive to loosen and fall off too soon. You should also keep your wound out of direct light (such as sunlight or tanning booth lamps).

Keep an eye on your wound. Call your doctor if the skin around your wound becomes very red and warm to touch, or if the wound reopens.

Do I need a tetanus shot?

Tetanus is a serious infection you can get after a wound. The infection is also called "lockjaw," because stiffness of the jaw is the most frequent symptom.

To prevent tetanus infection when the wound is clean and minor, you'll need a tetanus shot if you haven't had at least 3 doses in your life, or haven't had a dose in the last 10 years.

When the wound is more serious, you'll need a tetanus shot if you haven't had at least 3 doses before or if you haven't had a shot in the last 5 years. The best way to avoid tetanus infection is to talk to your family doctor to make sure your shots are up to date.

First Aid: Burns

What causes burns?

You can get burned by heat, fire, radiation, sunlight, electricity, chemicals or hot or boiling water. There are 3 degrees of burns:

• First-degree burns are red and painful. They swell a little. They turn white when you press on the skin. The skin over the burn may peel off after 1 or 2 days.
• Second-degree burns are thicker burns, are very painful and typically produce blisters on the skin. The skin is very red or splotchy, and may be very swollen.
• Third-degree burns cause damage to all layers of the skin. The burned skin looks white or charred. These burns may cause little or no pain because the nerves and tissue in the skin are damaged.

How long does it take for burns to heal?

• First-degree burns usually heal in 3 to 6 days.
• Second-degree burns usually heal in 2 to 3 weeks.
• Third-degree burns usually take a very long time to heal.

How are burns treated?

The treatment depends on what kind of burn you have.

See a doctor if:

• A first- or second-degree burn covers an area larger than 2 to 3 inches in diameter.
• The burn is on your face, over a major joint (such as the knee or shoulder), on the hands, feet or genitals.
• The burn is a third-degree burn, which requires immediate medical attention.

First-degree burn

Soak the burn in cool water for at least 5 minutes. The cool water helps reduce swelling by pulling heat away from the burned skin.

Treat the burn with a skin care product that protects and heals skin, such as aloe vera cream or an antibiotic ointment. You can wrap a dry gauze bandage loosely around the burn. This will protect the area and keep the air off of it.

Take an over-the-counter pain reliever, such as acetaminophen (one brand name: Tylenol), ibuprofen (some brand names: Advil, Motrin) or naproxen (brand name: Aleve), to help with the pain. Ibuprofen and naproxen will also help with swelling.

Second-degree burn

Soak the burn in cool water for 15 minutes. If the burned area is small, put cool, clean, wet cloths on the burn for a few minutes every day. Then put on an antibiotic cream, or other creams or ointments prescribed by your doctor. Cover the burn with a dry nonstick dressing (for example, Telfa) held in place with gauze or tape. Check with your doctor's office to make sure you are up-to-date on tetanus shots.

Change the dressing every day. First, wash your hands with soap and water. Then gently wash the burn and put antibiotic ointment on it. If the burn area is small, a dressing may not be needed during the day. Check the burn every day for signs of infection, such as increased pain, redness, swelling or pus. If you see any of these signs, see your doctor right away. To prevent infection, avoid breaking any blisters that form.

Burned skin itches as it heals. Keep your fingernails cut short and don't scratch the burned skin. The burned area will be sensitive to sunlight for up to one year, so you should apply sunscreen to the area when you're outside.

Third-degree burn

For third-degree burns, go to the hospital right away. Don't take off any clothing that is stuck to the burn. Don't soak the burn in water or apply any ointment. If possible, raise the burned area above the level of the heart. You can cover the burn with a cool, wet sterile bandage or clean cloth until you receive medical assistance.

Is there anything I shouldn't do when treating a burn?

Do not put butter or oil on burns. Do not put ice or ice water directly on second- or third-degree burns. If blisters form over the burn, do not break them. These things can cause more damage to the skin.

What do I need to know about electrical and chemical burns?

A person who has an electrical burn (for example, from a power line) should go to the hospital right away. Electrical burns often cause serious injury to organs inside the body. This injury may not show on the skin.

A chemical burn should be flushed with large amounts of cool water. Take off any clothing or jewelry that has the chemical on it. Don't put anything on the burned area, such as antibiotic ointment. This might start a chemical reaction that could make the burn worse. You can wrap the burn with dry, sterile gauze or a clean cloth. If you don't know what to do, call 911 or your local poison control center, or see your doctor right away.

Cast Care

Why do I need a cast?

You have been given a cast to help your broken bone or torn ligaments heal. A cast can help keep the injured area from moving so you can heal faster without risk of repeated injury. The amount of time you'll need to wear your cast depends on the type of injury you have and how serious it is. Your doctor may want to check your cast 1 to 3 days after putting it on to be sure that the cast isn't too tight and that your injury is starting to heal.

Will the broken bone hurt?

Almost all broken bones cause pain. The cast should relieve some pain by limiting your movements. Your pain should become less severe each day. Call your doctor immediately if the pain in the casted area gets worse after the cast has been applied. New pain or numbness may mean that the cast is too tight. You should also call your doctor right away if you have new pain that develops in another area (for example, pain in your fingers or forearm if you have a wrist or thumb injury, or pain in your toes or calf if you have an ankle or foot injury).

To relieve discomfort that can occur when you get a cast, raise the cast above your heart by propping your arm or leg on pillows (especially in the first 48 hours after you first get the cast). You will have to lay down if the cast is on your leg. This may reduce pain and swelling. Flexing your fingers or wiggling the toes of the affected limb also helps reduced swelling and discomfort.

Is it okay to get the cast wet?

With some fiberglass casts, you can swim and bathe. However, most casts shouldn't get wet. If you get a cast wet, irritation and infection of the skin could develop. Talk to your doctor about how to care for your cast.

To avoid getting the cast wet during bathing, you can put a plastic bag over the cast and hold it in place with a rubber band. You can also buy a waterproof cast cover.

If the cast does get wet, you may be able to dry out the inside padding with a hair dryer. (Use a low heat setting and blow the air through the outside of the cast.)

What can I do about itching?

If your skin itches underneath the cast, don't slip anything sharp or pointed inside the cast to try and itch the spot. This could damage your skin and you could get an infection. Instead, try tapping the cast or blowing air from a hair dryer down into the cast

What else should I know?

Try to keep the area around the edge of the cast clean and moisturized (but do not put lotion down inside the cast). Check the skin around the cast for irritation, chafing or sores.

Check with your doctor if a bad smell is coming from the inside of your cast (especially if you are running a fever). This may mean you have an infection.

Don't break off or file down any part of the cast. This could weaken the cast and make it more likely to crack or break. If there is an area of the cast that is uncomfortable, try padding it with a small towel or soft adhesive tape.

Caring for Your Incision After Surgery

When do I remove the bandage?

Your bandage should be removed the day after surgery. Your doctor may ask you to replace your bandage each day. Most wounds don't require a bandage after a few days, but you may decide to wear a bandage to protect the incision.

The incision is red. Is this normal?

The edges of a healing incision may be slightly red. Redness is normal, but call your doctor if the redness is increasing or if it spreads more than half an inch from the wound. Call your doctor if you see pus in the incision or if the incision is more than mildly tender or painful.

Your doctor may ask you to put an antibiotic cream on the incision. You can buy some antibiotic creams without a prescription.

What do I do if the incision bleeds?

If your bandage becomes bloody, replace it with dry gauze or another bandage. Applying pressure directly to the incision for a few minutes will usually stop the bleeding. If the wound keeps bleeding after you apply pressure, call your doctor.

Do I need to keep the incision dry?

Keep your incision clean and dry for the first 24 hours. Avoid showering or bathing the first day. Try taking a sponge bath instead. It's usually okay to wash with soap and water by the second day. Take a shower instead of a bath if you have stitches or skin tape on your incision. Gently towel dry the incision after washing.

Will the stitches be removed?

Internal stitches are absorbed by your body gradually and don't need to be removed. Your doctor will remove stitches that don't absorb into the tissues. Stitches are usually removed 3 days to 3 weeks after surgery, depending on where they are and how quickly you heal.

Your doctor may apply skin tape after the stitches are removed. Skin tape provides additional wound support. The tape can be removed in 3 to 7 days. Healing skin may need months to regain most of its strength.

Should I limit my activities?

Limiting movement of the area around your incision improves healing. Avoid activities that could cause your incision to pull apart. Your doctor may ask you to avoid lifting, straining, exercise or sports for the first month or so after surgery. Call your doctor if the incision pulls apart.

Should I avoid sun exposure?

A healing scar will darken and become more noticeable if it gets sunburned. Limit your sun exposure for the first 6 months after surgery. When you go outdoors during the day, cover your scar with tape or sunscreen.

Head Injuries: What to Watch for Afterward

What are the main causes of head injuries?

A serious head injury is most likely to happen to someone who is in a car wreck and isn't wearing a seat belt. Other major causes of head injuries include bicycle or motorcycle wrecks, falls from windows (especially among children who live in the city) and falls around the house (especially among toddlers and the elderly).

Are head injuries serious?

They can be. Bleeding, tearing of tissues and brain swelling can occur when the brain moves inside the skull at the time of an impact. But most people recover from head injuries and have no lasting effects. See the box below for a list of types of head injuries.

How can the doctor tell how bad the damage is?

The doctor will ask about how the injury occurred, about past medical problems, and about vomiting, seizures (fits) or problems breathing after an injury.

The injured person may need to stay in the hospital to be watched. Sometimes, tests that take pictures of the brain, such as a computerized tomography (CT) or a magnetic resonance imaging (MRI) scan, are needed to find out more about possible damage.

Types of head injuries

• A concussion is a jarring injury to the brain. A person who has a concussion usually, but not always, passes out for a short while. The person may feel dazed and may lose vision or balance for a while after the injury.
• A brain contusion is a bruise of the brain. This means there is some bleeding in the brain, causing swelling.
• A skull fracture is when the skull cracks. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or other injury.
• A hematoma is bleeding in the brain that collects and clots, forming a bump. A hematoma may not be apparent for a day or even as long as several weeks. So it's important to tell your doctor if someone with a head injury feels or acts oddly. Watch out for headaches, listlessness, balance problems or throwing up.

What happens after a head injury?

It's normal to have a headache and nausea, and feel dizzy right after a head injury. Other symptoms include ringing in the ears, neck pain, and feeling anxious, upset, irritable, depressed or tired.

The person who has had a head injury may also have problems concentrating, remembering things, putting thoughts together or doing more than one thing at a time.

These symptoms usually go away in a few weeks, but may go on for more than a year if the injury was severe.

Will the head injury cause permanent brain damage?

This depends on how bad the injury was and how much damage it did. Most head injuries don't cause permanent damage.

What about memory loss?

It's common for someone who's had a head injury to forget the events right before, during and right after the accident. Memory of these events may never come back. Following recovery, the ability to learn and remember new things almost always returns.

Is it true that the person must be kept awake after the injury?

No. If the doctor thinks the person needs to be watched this closely, he or she will probably put the person in the hospital.

Sometimes, doctors will send someone who has had a head injury home if the person with them is reliable enough to watch the injured person closely. In this case, the doctor may ask that the person be awakened frequently and asked questions such as "What's your name?" and "Where are you?" to make sure everything is okay.

Get help if you notice the following symptoms:

• Any symptom that is getting worse, such as headaches, nausea or sleepiness
• Nausea that doesn't go away
• Changes in behavior, such as irritability or confusion
• Dilated pupils (pupils that are bigger than normal) or pupils of different sizes
• Trouble walking or speaking
• Drainage of bloody or clear fluids from ears or nose
• Vomiting
• Seizures 

Casts and Splints

What are casts and splints?

Casts and splints are hard wraps used to support and protect injured bones, ligaments, tendons and other tissues. They help broken bones heal by keeping the broken ends together and as straight as possible. Casts and splints also help relieve pain and swelling, and protect the injured area from more harm.

What is the difference between a cast and a splint?

All casts are custom-made with fiberglass or plaster. A cast wraps all the way around an injury and can only be removed in the doctor's office.

A splint is like a half cast. The hard part of a splint does not wrap all the way around the injured area like it does with a cast. Instead, there are usually 2 hard areas connected with an elastic bandage or other material that hold the splint in place. Unlike casts, splints can be easily removed or adjusted. Splints can be custom-made from fiberglass or plaster, or may be ready-made. Splints come in lots of shapes and sizes for different injuries.

How long does a cast or splint stay on?

A splint usually stays on for several days to a few weeks. If your injured area is very swollen, you may need a splint until the swelling goes down. You may still need a cast after the swelling goes down. Also, if your injury is swollen, both splints and casts may need to be adjusted in the first few days. As the swelling goes down, a cast or splint may become too loose. If swelling increases, the splint or cast may become too tight.

Casts that are kept in good condition can stay on for several weeks. Your doctor will tell you how long your cast will need to stay on.

What if the pain gets worse?

Some people have mild pain and swelling if they don't rest the injured area enough. To avoid this, it is important to remember the following:

• Keep the injured area above the level of your heart (for instance, prop it up with pillows).
• Wiggle your fingers or toes while resting.
• Apply ice, if needed. Ice can be used for 15 to 30 minutes over a cast or splint as long as it doesn't get the splint or cast wet or touch the skin for too long.
• Talk to your doctor before taking pain medicine.

When should I call my doctor?

Call your doctor right away if you have:

• Increased pain
• Numbness, tingling, burning or stinging on or near the injured area
• Circulation problems (if your skin, nails, fingers or toes become discolored, pale, blue, gray or cold to the touch, or if you have trouble moving your fingers or toes)
• Bleeding, pus, drainage or bad smells coming from the cast
• A wet, broken or damaged cast or splint

Your doctor may need to adjust, remove or change your splint or cast.

Can I bathe or shower if I have a cast or splint?

Yes. But be sure to keep your cast or splint dry, especially during baths and showers. Casts and splints made from plaster can break if they get wet. Fiberglass casts are water-resistant, but the lining will absorb water. And if moisture gets trapped in the cast or splint, it can irritate your skin or cause an infection.

When you bathe or shower, wrap 2 layers of plastic over the cast or splint and make sure a plastic bag is tightly sealed over it. This will make it water-resistant, but not waterproof, so do not put the cast or splint directly in water.

What else do I need to know if I have a cast or splint?

Take good care of your cast or splint to help your injury heal properly. Also remember:

• Never stick objects inside a cast or splint. They can get stuck, break off or damage your skin.
• Don't get dirt or sand inside a cast or splint.
• Don't apply powders or deodorants inside a cast. If you have severe itching, call your doctor.
• Never break off pieces of your cast or splint or try to adjust it yourself. If it needs to be adjusted, call your doctor.
• Check the cast and the exposed skin daily. If you notice damage to the cast or any injury, call your doctor.

How is a cast taken off?

Your doctor will use a special cast saw with a blade that vibrates but does not spin. It cuts through the outer layer, but not the lining.

Never remove a cast yourself. Using any type of home saw or cutting materials could cause serious injury to your skin, blood vessels and injured limb.

Dog Bites: How to Teach Your Children to Be Safe

Most dogs will never bite anyone. However, any dog may bite if it feels threatened. Children are the most common victims of dog bites. Infants and young children should never be left alone with a dog. This handout tells you how to teach your children to avoid getting bitten.

What should I do if I want a dog for a pet?

Take time to learn about the breed of dog you want. To learn about dog breeds, talk with a veterinarian, read books about dogs and search the Internet. Don’t get a dog only because of the way it looks. If you have an infant or young child, think about getting a puppy. Be especially careful if you have a baby in your house. Aggressive dog breeds aren’t right for families with children. Neutered male dogs are generally less aggressive.

Consider taking your new dog to obedience school. Keep your dog’s immunizations up to date. Have your dog checked regularly by a veterinarian.

What do I tell my children about dogs?

• Don’t go near strange dogs.
• Never bother a dog that is eating, sleeping or caring for puppies.
• Tell an adult about any stray dogs.
• Always have an adult with you when you play with a dog.
• Never tease a dog.
• Never pet a dog without first letting it smell you.

What should I tell my children to do when a dog approaches them?

• Don’t run away and scream.
• Stand very still, “like a tree.” (See first picture below.)
• Avoid making direct eye contact with the dog.
• If you fall or are knocked down, act “like a log.” (See second picture below.)
• When the dog understands that you are not a threat, it will probably walk away.
• If a dog bites you, tell an adult right away.

A dog is a wonderful addition to a family, but it can be a problem if you aren’t careful. Always talk to children about how they should act when they’re with a dog. Remember that dogs can feel threatened by new surroundings or strangers

SLEEP DISORDERS

Sleep Disorders and Sleeping Problems

SYMPTOMS, TREATMENT, AND HELP FOR COMMON SLEEP DISORDERS

At one time or another, most of us have experienced what it’s like to have trouble falling asleep, to lie awake in the middle of the night, or feel sleepy and fatigued during the day. However, when sleep problems are a regular occurrence—when they get in the way of your daily routine and hamper your ability to function—you may be suffering from a sleep disorder.
Sleep disorders and other sleep problems cause more than just sleepiness. A lack of quality sleep has a negative impact on your energy, emotional balance, productivity, and health. The good news? You don’t have to live with sleeping problems. Read on to learn about the signs and symptoms of common sleep disorders, what you can do to help yourself, and when to call the sleep doctor.

Understanding sleep disorders and sleeping problems

If you’re having trouble sleeping, you’re in good company. According to the National Commission on Sleep Disorders Research, at least 40 million Americans suffer from chronic, long-term sleep disorders and another 20 to 30 million experience occasional sleep problems.
Unfortunately, even minimal sleep loss takes a toll on your mood, energy, efficiency, and ability to handle stress. Ignoring sleep problems and disorders can lead to poor health, accidents, impaired job performance, and relationship stress. If you want to feel your best, stay healthy, and perform up to your potential, sleep is a necessity, not a luxury.
It’s not normal to feel sleepy during the day, to have problems getting to sleep at night, or to wake up feeling unrefreshed. But even if you’ve struggled with sleep problems for so long that it does seem normal, you can learn to sleep better. You can start by tracking your symptoms and sleep patterns, and then making healthy changes to your daytime habits and bedtime routine. If self-help doesn’t do the trick, you can turn to sleep specialists who are trained in sleep medicine. Together, you can identify the underlying causes of your sleeping problem and find ways to improve your sleep and quality of life.

Signs and symptoms of sleep disorders and sleeping problems

Everyone experiences occasional sleep problems. So how do you tell whether your sleeping problem is just a minor, passing annoyance or a sign of a more serious sleep disorder?
Start by scrutinizing your symptoms, looking especially for the telltale daytime signs of sleep deprivation. If you are experiencing any of the following symptoms on a regular basis, you may be dealing with a sleep disorder.

Is it a sleep disorder?

Do you . . .

• feel irritable or sleepy during the day?
• have difficulty staying awake when sitting still, watching television or reading?
• fall asleep or feel very tired while driving?
• have difficulty concentrating?
• often get told by others that you look tired?
• react slowly?
• have trouble controlling your emotions?
• feel like you have to take a nap almost every day?
• require caffeinated beverages to keep yourself going?

If you answered “yes” to any of the previous questions, you may have a sleep disorder.

Insomnia: The most common type of sleep disorder

Insomnia, the inability to get to sleep or sleep well at night, is an all-too common sleeping problem—in fact, it’s the most common sleep complaint. Insomnia can be caused by a wide variety of things including stress, jet lag, a health condition, the medications you take, or even the amount of coffee you drink. Insomnia can also be caused by other sleep disorders or mental health conditions such as anxiety and depression.

Common signs and symptoms of insomnia include:

• Difficulty falling asleep at night or getting back to sleep after waking during the night.
• Waking up frequently during the night.
• Your sleep is light, fragmented, or unrefreshing.
• You need to take something (sleeping pills, nightcap, supplements) in order to get to sleep.
• Sleepiness and low energy during the day.

Whatever the cause of your insomnia, being mindful of your sleep habits and learning to relax will help you sleep better and feel better. The good news is that most cases of insomnia can be cured with changes you can make on your own—without relying on sleep specialists or turning to prescription or over-the-counter sleeping pills.

Putting a stop to sleepless nights

Insomnia takes a toll on your energy, mood, and ability to function during the day. But you don’t have to put up with insomnia. Simple changes to your lifestyle and daily habits can put a stop to sleepless nights.

Other common types of sleep disorders

In addition to insomnia, the most common sleep disorders are sleep apnea, restless legs syndrome (RLS), and narcolepsy.

Sleep apnea

Sleep apnea is a common sleep disorder in which your breathing temporarily stops during sleep due to blockage of the upper airways. These pauses in breathing interrupt your sleep, leading to many awakenings each hour. While most people with sleep apnea don’t remember these awakenings, they feel the effects in other ways, such as exhaustion during the day, irritability and depression, and decreased productivity.
Sleep apnea is a serious, and potentially life-threatening, sleep disorder. If you suspect that you or a loved one may have sleep apnea, see a doctor right away. Sleep apnea can be successfully treated with Continuous Positive Airway Pressure (CPAP), a mask-like device that delivers a stream of air while you sleep. Losing weight, elevating the head of the bed, and sleeping on your side can also help in cases of mild to moderate sleep apnea.
Symptoms of sleep apnea include:

• Loud, chronic snoring
• Frequent pauses in breathing during sleep
• Gasping, snorting, or choking during sleep
• Feeling unrefreshed after waking and sleepy during the day, no matter how much time you spent in bed
• Waking up with shortness of breath, chest pains, headaches, nasal congestion, or a dry throat.

Restless legs syndrome

Restless legs syndrome (RLS) is a sleep disorder that causes an almost irresistible urge to move your legs (or arms). The urge to move occurs when you’re resting or lying down and is usually due to uncomfortable, tingly, aching, or creeping sensations.
Common signs and symptoms of restless legs syndrome include:

• Uncomfortable sensations deep within the legs, accompanied by a strong urge to move them.
• The leg sensations are triggered by rest and get worse at night.
• The uncomfortable sensations temporarily get better when you move, stretch, or massage your legs.
• Repetitive cramping or jerking of the legs during sleep.

Narcolepsy

Narcolepsy is a sleep disorder that involves excessive, uncontrollable daytime sleepiness. It is caused by a dysfunction of the brain mechanism that controls sleeping and waking. If you have narcolepsy, you may have “sleep attacks” while in the middle of talking, working, or even driving.
Common signs and symptoms of narcolepsy include:

• Seeing or hearing things when you’re drowsy or starting to dream before you’re fully asleep.
• Suddenly feeling weak or losing control of your muscles when you’re laughing, angry, or experiencing other strong emotions.
• Dreaming right away after going to sleep or having intense dreams
• Feeling paralyzed and unable to move when you’re waking up or dozing off.

Circadian rhythm sleep disorders

We all have an internal biological clock that regulates our 24-hour sleep-wake cycle, also known as our circadian rhythms. Light is the primary cue that influences circadian rhythms. When the sun comes up in the morning, the brain tells the body that it’s time to wake up. At night, when there is less light, your brain triggers the release of melatonin, a hormone that makes you sleepy.
When circadian rhythms are disrupted or thrown off, you may feel groggy, disoriented, and sleepy at inconvenient times. Circadian rhythms have been linked to a variety or sleeping problems and sleep disorders, including insomnia, jet lag, and shift work sleep difficulties. Abnormal circadian rhythms have also been implicated in depression, bipolar disorder, and seasonal affective disorder, or the winter blues.

Jet lag

Jet lag is a temporary disruption in circadian rhythms that occurs when you travel across time zones. Symptoms include daytime sleepiness, fatigue, headache, stomach problems, and insomnia. The symptoms typically appear within a day or two after flying across two or more time zones. The longer the flight, the more pronounced the symptoms. The direction of flight also makes a difference. Flying east tends to cause worse jet lag than flying west.
In general, it usually takes one day per time zone crossed to adjust to the local time. So if you flew from Los Angeles to New York, crossing three time zones, your jet lag should be gone within three days. However, jet lag can be worse if you:

lost sleep during travel are under a lot of stress

drink too much alcohol or caffeine didn’t move around enough during your flight

Shift work

Shift work sleep disorder is a circadian rhythm sleep disorder that occurs when your work schedule and your biological clock are out of sync. In our 24-hour society, many workers have to work night shifts, early morning shifts, or rotating shifts. These schedules force you to work when your body is telling you to go to sleep, and sleep when your body is signaling you to wake.
While some people adjust better than others to the demands of shift work, most shift workers get less quality sleep than their daytime counterparts. As a result of sleep deprivation, many shift workers struggle with sleepiness and mental lethargy on the job. This cuts into their productivity and puts them at risk of injury.
There are a numbers of things you can do to reduce the impact of shift work on sleep:

• Minimize the frequency of shift changes
• When changing shifts, request a shift that’s later, rather than earlier (it’s easier to adjust forward in time, rather than backward)
• Use bright lights at work and take regular breaks
• Take melatonin when it’s time for you to sleep
• Create a dark bedroom environment (for example, you may want to invest in black-out shades or heavy curtains that block the daylight).

Delayed sleep phase disorder

Delayed sleep phase disorder is a sleep disorder in which your 24-hour cycle of sleep and wakefulness—your biological clock—is significantly delayed. As a result, you go to sleep and wake up much later than other people. For example, you may not get sleepy until 4 a.m., at which time you go to bed and sleep soundly until noon, or at least you would if your daytime responsibilities didn’t interfere. Delayed sleep phase disorder makes it difficult for you to keep normal hours—to make it to morning classes, get the kids to school on time, or keep a 9-to-5 job.
It’s important to note that this sleeping problem is more than just a preference for staying up late or being a night owl. People with delayed sleep phase disorder are unable to get to sleep earlier than 2 to 6 a.m. no matter how hard they try. They struggle to go to sleep and get up at socially acceptable times. But when allowed to keep their own hours (such as during a school break or holiday), they fall into a regular sleep schedule.
Delayed sleep phase disorder is most common in teenagers, and many teens will eventually grow out of it. For those who continue to struggle with a biological clock that is out of sync, treatments such as light therapy and chronotherapy can help. To learn more, schedule an appointment with a sleep doctor or local sleep clinic.

Self-help for sleeping problems and sleep disorders

While some sleep disorders may require a visit to the sleep doctor, you can improve many sleeping problems on your own. The first step to overcoming a sleep problem is identifying and carefully tracking your symptoms and sleep patterns.

Keep a sleep diary

A sleep diary is an incredibly useful tool for identifying sleep disorders and problems and pinpointing both day and nighttime habits that may be contributing to your difficulties. Keeping a record of your sleep patterns and problems will also prove helpful if you eventually find it necessary to see a sleep doctor.

Download and print Helpguide’s sleep diary.

Your sleep diary should include:

• what time you went to bed and woke up
• total sleep hours and perceived quality of your sleep
• a record of time you spent awake and what you did (“stayed in bed with eyes closed,” for example, or “got up, had a glass of milk, and meditated.”)
• types and amount of food, liquids, caffeine, or alcohol you consumed before bed, and times of consumption
• your feelings and moods before bed ­(e.g. happiness, sadness, stress, anxiety)
• any drugs or medications taken, including dose and time of consumption

The details can be important, revealing that your certain behaviors are ruining your chance for a good night’s sleep. After keeping the diary for a week, for example, you might notice that when you have more than one glass of wine in the evening, you wake up during the night.

Improve your sleep hygiene and daytime habits

Regardless of your sleep problem, a consistent sleep routine and improved sleep habits will translate into better sleep over the long term. You can address many common sleep problems through lifestyle changes and improved sleep hygiene. For example, you may find that when you start exercising regularly, your sleep is much more refreshing. The key is to experiment. Use your sleep diary as a jumping off point.
Try the following simple changes to your daytime and pre-bedtime routine:

• Keep a regular sleep schedule, going to sleep and getting up at the same time each day (including the weekends)
• Set aside enough time for sleep (most people need at least 8 hours each night in order to feel good and be productive)
• Make sure your bedroom is dark, cool, and quiet.
• Turn off your TV, smartphone, and computer a few hours before your bedtime. The type of light their screens emit are activating to your brain and interfere with your body’s internal clock.

Simple tips for better sleep

The cure to sleep difficulties and daytime fatigue can often be found in your daily routine. The following sleep tips will help you optimize your nightly rest, minimize insomnia, and lay the foundation for all–day energy and peak performance.

 

Do sleeping pills help?

When taken for a brief period of time and under the supervision of your doctor, sleeping pills may help your sleep problems. However, they are just a temporary solution. Insomnia can’t be cured with sleeping pills. In fact, sleeping pills can often make insomnia worse in the long run. Therefore, it’s best to limit sleeping pills to situations where a person’s health or safety is threatened.
In general, sleeping pills and sleep medications are most effective when used sparingly for short-term situations, such as traveling across many time zones or recovering from a medical procedure. If medications are used over the long term, they are best used “as needed” instead of on a daily basis to avoid dependence and tolerance.

Safety guidelines for sleeping pills

• Only take a sleeping pill when you will have enough time to get a full 7 to 8 hours of sleep. Otherwise, you may be drowsy the next day.
• Read the package insert that comes with your medication. Pay careful attention to the potential side effects, dosage instructions, and list of food and substances to avoid.
• Never mix alcohol and sleeping pills. Not only does alcohol disrupt sleep, it can interact dangerously with prescription and over-the-counter sleep medications.
• Never drive a car or operate machinery after taking a sleeping pill. Especially when you first start taking a new sleep aid, as you may not know how it will affect you.

When to call the sleep doctor

If you’ve tried a variety of self-help sleep remedies without success, schedule an appointment with a sleep specialist or ask your family doctor for a referral to a sleep clinic.
Call the sleep doctor if:

• Your main sleep problem is daytime sleepiness (and self-help hasn’t improved your symptoms)
• You or your bed partner gasps, chokes, or stops breathing during sleep.
• You sometimes fall asleep at inappropriate times, such as while talking, walking, or eating.

At your appointment, be prepared with information about your sleep patterns and provide the sleep doctor with as much supporting information as possible, including the information from your sleep diary.

What to expect at a sleep clinic or center

Find a sleep center

The American Academy of Sleep Medicine provides a sleep center locator with information on finding a sleep center near you.

If your physician refers you to a sleep center, the latest technology will be used to monitor you while you sleep. A sleep specialist will observe your sleep patterns, brain waves, heart rate, rapid eye movements and more using monitoring devices attached to your body. While sleeping with a bunch of wires attached to you might seem difficult, most patients find they fall asleep very easily.
The sleep specialist will analyze the results from your sleep study and design a treatment program if necessary. A sleep center can also provide you with equipment to monitor your activities (awake and asleep) at home.

Sleep and Sleep Disorders in Children and Adolescents: Information for Parents and Educators

Physicians and psychologists estimate that as many as 30% of children may have a sleep disorder at some point during childhood. Sleep disorders have implications both for social-emotional adjustment and for school performance. For this reason it is important for both parents and educators to understand how sleep works and how disruptions in normal sleep patterns can affect children and teenagers. This handout will provide an introduction to normal sleep patterns, definitions and descriptions of the kinds of sleep disturbances that may affect children and adolescents, and a brief description of recommended treatments.

Normal Sleep Patterns

Types of Sleep Patterns
Sleep is broadly classified into two types: REM (rapid-eye-movement) sleep and non-REM sleep (NREM). By studying brain wave patterns we know that NREM sleep consists of several stages, ranging from drowsiness through deep sleep. In the early stages (Stages I and II) you awake easily and may not even realize that you have been sleeping. In the deeper stages (Stages III and IV) it is very difficult to wake up, and if you are aroused you are likely to find yourself disoriented and confused. In NREM sleep your muscles are more relaxed than when you are awake but you are able to move (although you do not because the brain is not sending signals to the muscles to move).
REM sleep is more active. Breathing and heart rate become irregular, your eyes move rapidly back and forth under your eyelids, and control of your body temperature is impaired so that you do not sweat when you are hot or shiver when you are cold. Below the neck, however, you are inactive because the nerve impulses that travel down the spinal cord to body muscles are blocked. Your body is essentially paralyzed. It is during this sleep stage that you dream.

Developmental Characteristics

Infants and children. Both these sleep states develop before birth. Infants cycle through many sleep periods throughout the day. As they develop, they sleep longer at night and have fewer sleep periods during the day. Newborns sleep almost all the time. By 6 months they sleep about 13 hours a day with the longest sustained period being about 7 hours. By 24 months children sleep for 12 hours, including naps, and by 4 years children sleep 10–12 hours with one daytime nap at most.
Throughout childhood children typically get about 10 hours of sleep a night. This drops significantly at adolescence, but less for biological reasons than for socio-cultural reasons. Sleep researchers studying the optimal sleep periods of teenagers have found that when the sleep-wake cycle is studied in the laboratory under controlled conditions (e.g., removing clocks and lighting cues), teenagers typically sleep 9 hours a night. In the real world—especially during the school year—very few teenagers get this much sleep and thus are constantly coping with sleep debt to a greater or lesser degree.
Whereas infants enter into REM sleep immediately, young children move quickly from drowsiness and the lighter sleep stages to Stage IV, then experience cycles of light to deep sleep, arousal, etc., eventually cycling between REM and Stage II sleep, much like the sleep patterns of adults.
Adolescents. Adolescent sleep patterns deserve particular attention because of the potential impact on school performance. It has only been in the last 20 years or so that sleep researchers have recognized that there are distinctive changes in sleep patterns in adolescence. There are changes in the biological clock (also called circadian rhythms) of teenagers. With the onset of puberty, teenagers begin to experience a sleep phase delay such that they develop a natural tendency both to fall asleep later in the evening and to wake up later in the morning. Even youngsters who have experienced sleep deprivation (and therefore accumulated some sleep debt) tend to feel more alert in the evening, thus making it more difficult to go to bed at what parents might consider a reasonable hour.
The onset of sleep is triggered by the release of melatonin, a natural body hormone. Toward dawn, melatonin shuts off as another hormone, cortisol, increases, signaling the youngster to wake up. Research shows that the pattern of melatonin secretion makes it hard for teenagers to fall asleep early in the evening and to wake up early in the morning. Schools with early start times (any time before 8:30 a.m.) place students at a disadvantage in terms of arousal and alertness—not only for early morning classes but throughout the day because the adolescent’s biological rhythms are out of sync with typical school routines.

Recognizing and Treating Sleep Disorders

Some sleep disturbances are mild, fairly common, and fairly easy to treat. Others may be more stubborn, or they may be signs of potential physical problems that could have long-term consequences if left untreated.
Diagnosis
Sleep disorders are generally diagnosed either by a pediatrician or a sleep specialist. If parents are concerned about possible sleep problems, they may want to begin by discussing their concerns with their child’s physician. Not all pediatricians recognize the variety of sleep problems children and teenagers experience, and if parents are not satisfied after meeting with their child’s physician, they may want to request a referral to a sleep specialist or to a sleep clinic.
At school parents might find some assistance from the school psychologist or social worker, who may use a diagnostic interview as part of an evaluation. This interview should include questions about the child’s normal sleep patterns, including bedtime routines, typical bedtime and wake time on school days and weekends, whether the child has trouble falling asleep or staying asleep, and the frequency of nightmares. When parents or teachers have concerns about both attention and behavior problems, sleep problems may be an issue. This is because side effects associated with sleep disturbance or deprivation include inattention, irritability, hyperactivity, and impulse control problems.
Treating Sleep Disorders
Different types of sleep disorders call for different treatments.
Night terrors. Night terrors are sudden, partial arousal associated with emotional outbursts, fear, and motor activity. Occurring most often among children ages 4–8 during NREM sleep, the child has no memory of night terrors once fully awake. If your child experiences night terrors, make sure he or she is comfortable but do not wake the child. In extreme cases, night terrors may require medical intervention.
Sleep walking. Sleep walking is most common among 8–12 year-olds. Typically, the child sits up in bed with eyes open but unseeing or may walk through the house. Their speech is mumbled and unintelligible. Usually children will outgrow sleepwalking by adolescence. In the meantime, take safety precautions (e.g., using a first floor bedroom), but keep efforts to intervene to a minimum. Awakening the child on a regular schedule can reduce or eliminate episodes.
Nighttime bedwetting. This type of bedwetting is a common sleep problem in children ages 6–12, occurring only during NREM sleep. Primary enuresis (the child has never been persistently dry at night) is associated with a family history of the problem, developmental lag, or lower bladder capacity, and is unlikely to signal a serious problem. Secondary enuresis (a recurrence of bedwetting after a year or more of bladder control) is more likely to be associated with emotional distress. Interventions include use of reinforcement and responsibility training (such as keeping a dry night chart), bladder control training, conditioning (e.g., bedwetting alarms), and sometimes medication. In the case of secondary enuresis it might be most helpful to determine any source of emotional stress and address it directly. (For example, if a child starts wetting the bed at night following parents’ separation or divorce, providing counseling to address loss issues might help alleviate bedwetting.)
Sleep-onset anxiety. Sleep-onset anxiety refers to difficulty falling asleep because of excessive fears or worries. The problem may be caused by stressful events or trauma or because of ruminating on more commonplace issues of the day. This type of sleep problem is most common among older elementary school children. Intervention strategies include reassurance, calming bedtime routines, and, in some cases, cognitive-behavioral therapy, which is designed to help children develop effective coping strategies to address their worries.
Obstructive sleep apnea. Although more common in adults, 1–3% of children experience difficulty breathing because of obstructed air passages. Symptoms include snoring, difficulty breathing during sleep, mouth breathing during sleep, or excessive daytime sleepiness. In children this type of sleep disturbance is usually not serious, but most children benefit from removal of the tonsils and adenoids. When this is not effective, the condition can be treated (by a physician) with a procedure known as nasal continuous positive airway pressure (CPAP).
Nacrolepsy. Nacrolepsy is a rare but potentially dangerous, neurologically based genetic condition that may include sleep attacks (irresistible urges to sleep), sleep-onset paralysis, or sleep-onset hallucinations. It affects 1 of every 2,000 adults and may first appear in adolescence. If this disorder is suspected, refer to the child to a sleep specialist. Treatment may include ensuring a full 12 hours of sleep per night or more, scheduled naps, or medication.
Delayed sleep-phase syndrome. This is a disorder of sleep (circadian) rhythm that results in an inability to fall asleep at a normal hour (e.g., sleep onset may be delayed until 2–4 a.m.) and results in difficulty waking up in the morning. Symptoms among children include excessive daytime sleepiness, sleeping until early afternoon on weekends, truancy and tardiness, and poor school performance. Treatment might include light therapy (exposure to very bright light in the morning), chronotherapy (gradually advancing the child’s sleep schedule 1 hour per night until a normal routine is achieved), maintaining a consistent sleep schedule, or a short course of sedative medication to help achieve a new schedule. It may be necessary and beneficial to (temporarily) adjust the child’s school day to allow for a later start.

Help for Children and Families

A sleep disorder not only results in a sleepy, cranky, and often poor-performing student at school, but also an irritable, unhappy child or teenager at home. A youngster with a disrupted sleep pattern more than likely is wreaking havoc on the sleep and patience of other family members.
If you suspect that your child or teen has a sleep problem that goes beyond a few nightmares or restless nights, do not delay seeking help. Start with your family physician. The earlier a sleep problem is identified and treated, the more quickly a normal sleep routine can be restored—for everyone.

Sleep Problems in Children

Children and adolescents need at least nine hours of sleep per night. Sleep problems and a lack of sleep can have negative effects on childcare's performance in school, during extracurricular activities, and in social relationships.
A lack of sleep may cause:

• Accidents and injuries
• Behavior problems
• Mood problems
• Memory, concentration, and learning problems
• Performance problems
• Slower reaction times

Signs of Sleep Problems in Children

Talk to your pediatrician if your child exhibits any of the following signs of a sleep problem:

• Snoring
• Breathing pauses during sleep
• Problems with sleeping through the night
• Difficulty staying awake during the day
• Unexplained decrease in daytime performance
• Unusual events during sleep

Tips for Helping Your Child's Sleep Problem

• Establish a regular time for bed each night and do not vary from it. Similarly, the waking time should not differ from weekday to weekend by more than one to one and a half hours.
• Create a relaxing bedtime routine, such as giving your child a warm bath or reading a story.
• Do not give children any food or drinks with caffeine less than six hours before bedtime.
• Make sure the temperature in the bedroom is comfortable and that the bedroom is dark.
• Make sure the noise level in the house is low.
• Avoid giving children large meals close to bedtime.
• Make after-dinner playtime a relaxing time as too much activity close to bedtime can keep children awake.
• There should be no television, radio, or music playing while the child is going to sleep.
• Infants and children should be put to bed when they appear tired but still awake (rather than falling asleep in the parent's arms, or in another room). Parents should avoid getting into bed with a child in order to get them to sleep. If this is difficult, they should consult their pediatrician or sleep specialist

Common Adult Sleep Problems/Disorders

Below is information - including symptoms, causes and possible treatment options -- on some of the more common sleep-related problems and disorders in adults. Click on any of the problems listed below, or scroll down to read more about them all.

Poor Sleep Habits
Poor sleep habits (referred to as hygiene) are one of the most common problems encountered in our society. We stay up too late and get up too early. We interrupt our sleep with drugs, chemicals, work, and we overstimulate ourselves with late-night activities such as television. 
Insomnia
Insomnia is the inability to sleep or inability to sleep well at night. Many different medical and mental health problems cause insomnia. Insomnia may be situational, lasting a few days to weeks, or chronic, lasting for more than 1 month.
Around 9-12 percent of the American population report chronic insomnia. In severe cases, patients experience fatigue, sleepiness, difficulty concentrating and difficulty with thinking. Many sufferers feel that they have been robbed of the joy of life. Insomnia may be a symptom of breathing problems at night like sleep apnea, of medical illness like heart failure, a side effect of medications, or a symptom of severe anxiety or depression illness.
While short-lasting insomnia periods are well treated with medication, chronic or long-lasting insomnia may not respond well to medications. Thus, throwing sleeping pills at many patients with chronic insomnia is not an effective way to treat the problem.
An evaluation by the patient's personal physician or a sleep specialist often helps get to the root of the problem. Many patients respond well to what is called "cognitive behavioral therapy." In this form of therapy, incorrect ideas about sleep are corrected. In addition, relaxation and behavioral techniques may be used to help patients fall asleep. This combined with treatment of any underlying disorders is often the best way to treat the devastating symptom of insomnia.

Sleep apnea is a common and potentially devastating sleep disorder. It is the most common reason that patients are referred to sleep centers around the country.
The word apnea means "not breathing." Patients with the usual form of sleep apnea actually close off their airway at night.
This airway closure occurs either behind the tongue or behind the nose. Patients continue to make efforts to breathe. Then after 10 to 120 seconds, the brain, realizing it is not getting any oxygen, actually "wakes up." The brain then tells the upper airway to open to let some air in.
This is associated with loud bothersome snoring, often described as snorting and gasping. Patients may take a few breaths of air, the brain goes to sleep again and the cycle may repeat itself several hundred times a night. Patients are often not even aware that they are doing this (although the bed partner is).
Sleep apnea is dangerous, common, relative easy to diagnose, and treatable. Patients with sleep apnea are at great risk for heart disease, heart attacks, strokes and high blood pressure. In addition, since the sleep is poor quality (remember the brain keeps waking up), patients are often sleepy during the day. Sleepiness is associated with inability to concentrate, remember or think. There is also increased risk in falling asleep while doing vital tasks such as driving or using heavy machinery.
Medical treatment involves weight loss if the patient is overweight, avoidance of drugs, which increase the risk of apneas such as sleeping pills, alcohol and sedative medicines, and sometimes sleeping semi-upright. However, in most cases additional treatment is warranted.
In some cases we use Continuous Positive Airway Pressure (CPAP for short) to treat patients. For this treatment a mask is fit over the nose or over the nose and mouth. The mask is pressurized slightly to hold the airway open and allow the patient to sleep normally. Newer technology has made the masks relatively comfortable to use.
Some patients may be candidates for surgery on the upper airway. In the usual upper airway surgery the uvula (that punching bag in the back of the throat) and some of the surrounding soft tissue is removed to enlarge the air passage. In other cases a dental device designed to move the lower jaw down and outwards slightly may be worn at night.
In a few cases, treatment is begun with an emergent tracheostomy when sleep apnea is considered to be immediately life-threatening. The decision about which form of treatment to use should be decided by the patient and his/her physician on the basis of the sleep studies and rest of the clinical data.
Narcolepsy
Narcolepsy is a chronic sleep disorder that commonly begins during adolescence and is characterized by excessive daytime sleepiness with the occurrence of sleep attacks. Narcolepsy can run in families, but can occur in the absence of any family history as well. There are several other characteristic symptoms that may or may not be present, including cataplexy, sleep paralysis and hypnogogic hallucinations.

• Cataplexy is the sudden loss of muscle tone, commonly associated with strong emotions. It may be a subtle sensation of weakness or a complete loss of strength with a fall to the ground.
  
  
• Sleep paralysis is a sensation of not being able to move on waking, usually for a few seconds.
  
  
• Hypnogogic hallucinations are very vivid and sometimes violent or bizarre sensations, almost dreamlike, that occur on waking or falling asleep.

The treatment of narcolepsy and its associated symptoms commonly requires a combination of behavioral modification and drug therapy. Many patients with narcolepsy will do well with naps scheduled at specific times during the day. Stimulant medication may be used to alleviate symptoms of daytime sleepiness. Other medications, such as certain anti-depressants, are used to treat cataplexy. A new promising treatment for cataplexy using a drug called sodium oxybate has recently become available. Treatment for each patient must be individualized and each patient with his/her physician needs to discuss this on a case-by-case basis.
Restless Legs Syndrome and Periodic Limb Movement Disorder
Restless legs syndrome (RLS) is characterized by an intolerable, internal itching sensation occurring in the lower extremities that causes an almost irresistible urge to move the legs. The sensation is commonly described as a "creepy" or "crawly" sensation and is typically relieved by movement of the legs or walking around. When movement stops, however, the sensations frequently return. The abnormal sensations are more common in the late afternoon or evening hours.
In some patients, this problem persists into the nighttime and may prevent patients from getting a restful night's sleep. Pregnancy and iron deficiency are associated with an increased frequency of this disease. In many patients, RLS is extremely distressing. Further, RLS is more common than previously thought, affecting 5-10% of adults and increasing with age.
Almost all patients with restless legs syndrome have a problem called period limb movement disorder. In this, there are leg (sometimes arm) movements occurring at regular intervals during the night. These movements may fragment sleep, leading to poor quality, non-refreshing sleep. Periodic limb movement disorder can also occur as an isolated problem, often reported by the bed partner.
Luckily, in most people, restless legs syndrome and periodic limb movement disorder are relatively easily treated. Treatment commonly includes the incorporation of both aerobic and leg stretching exercises. Leg stretching or even yoga exercises can be done prior to bedtime to alleviate symptoms and may be all that is needed in mild cases. Iron replacement therapy is used if patients are iron deficient. Drugs used to treat Parkinson's disease are very effective in treating most cases. These include the drug pramipexole (Mirapex®) and ropinirole (Requip®). Medications, such as valium-type medications, such as clonazepam (Klonopin®) or analgesic medications related to morphine and opium, can be also be used. In some cases, anti-seizure medications may be effective.
Sleepwalking/Somnambulism
Sleepwalking, also referred to as somnambulism, is characterized by walking or other physical activities during sleep. Sleepwalking is common in children -- up to 15 percent of children have had this problem -- but can occur at any age. In children, it can be associated with sleep deprivation or anxiety. In adults, it is more commonly associated with other medical disorders, medication use, or anxiety or depressive disorders.
Clinically, the person may simply sit up with their eyes open, appearing to be awake, or they may engage in a complex task. Episodes can last from seconds to minutes. Contrary to popular belief, it is safe to wake a sleepwalker, but they may be confused and disoriented on waking.
There is no specific treatment except to avoid triggers if known, or treat anxiety or depression. If severe, short-term use of sedatives may be considered. Otherwise it is best to keep the person safe and out of harm's way. We often advise families to make sure the windows are closed and that there is no possibility of sleepwalking leading to danger for the patient.
Sleep Disorders in Medical Illnesses
Many medical illnesses are associated with disturbances of sleep. Patients with chronic lung disease may experience low oxygen levels at night that disturb sleep. Patients with asthma may develop wheezing or shortness of breath at night, usually in the early morning hours. Patients with heart failure may develop abnormal breathing at night, which disturbs sleep much in the way that sleep apnea does. Patients with Parkinson's or other neurological diseases may develop disturbed sleep.
Sleep Disorders in Mental Illnesses
Many people with mental illnesses, notably depression, anxiety, post-traumatic stress syndrome, and panic attacks, develop profound sleep disturbances. Insomnia is a common symptom in many people with these problems. Evaluation and treatment by a health care provider skilled in these disorders, usually in conjunction with evaluation by a sleep specialist, often brings about great improvement.