04/17/2024
More good stuff from Beyond PANS!
Last year, after an infection, our daughter suddenly lost the ability to fall asleep. 😵💫
At bedtime, she rolled in bed for hours, agitated, until she finally collapsed into sleep out of sheer exhaustion around 1 a.m. 🛌
She’d never had sleep issues before.
We didn’t know it was one of the typical PANDAS/PANS symptoms. 🐼
The neurologists downplayed this symptom, calling it behavioral, and recommended a ‘regular bedtime routine’ as a solution. 👩🏻⚕️
If they had, instead, done a sleep study (polysomnography), they would most likely have found proof of a biological rather than a behavioral disorder. 💤
Research shows that ~80% of kids with PANS have clear sleep abnormalities in polysomnographic tests (links in the comments).
They are thought to result from the impacts of inflammation and abnormal immune responses on brain circuits that regulate sleep. 🧠
An important sleep circuit involves melatonin. Sufficient amounts are required to induce and maintain high-quality sleep.
Melatonin results from tryptophan metabolism through the serotonin pathway (tryptophan > serotonin > melatonin).
An abnormal immune response to an inflammatory trigger, such as an infection, can lead to a switch in tryptophan metabolism from the serotonin pathway to the kynurenine pathway (tryptophan > kynurenine > kynurenic & quinolinic acid). 🦠
This can lead to decreased serotonin production and, as a result, insufficient amounts of melatonin. ⤵
Additionally, the metabolism of tryptophan along the kynurenine pathway can lead to the production of potentially neurotoxic compounds, such as quinolinic acid. ⚠️
Obviously, problems with sleep in PANS can additionally have psychological components (anxiety, OCD), but these are also rooted in neuroinflammatory processes.
So:
1. Don’t let your doctor tell you that your child’s sudden-onset severe sleep issues are due to your parenting style. 👪
2. In many cases, melatonin supplementation may be extremely helpful, especially, as it’s also been shown to have a neuroprotective role. Please discuss this with your pediatrician. 💊
This is # 11 of my series.
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