sids co sleeping guidelines

Sharing the same sleep surface increases a baby's risk of SIDS and suffocation. 0000019300 00000 n endstream endobj 366 0 obj <> endobj 367 0 obj <>stream 0000115292 00000 n Co-sleeping and SIDS Leaflets and tools Co-sleeping image bank News Welcome to Baby Sleep info This website presents research evidence about biologically normal sleep for human babies. 3. SIDS and Kids recommends sleeping with baby in a cot next to the parent’s bed for the first six to twelve months of life. 0000099035 00000 n SIDS is more common in babies whose parents smoke, especially those who smoke during pregnancy. Please see the SIDS and Kids attached brochure which demonstrates how a baby can be safely positioned on his or her back. 0000001770 00000 n That said, here are the AAP’s guidelines for safe co-sleeping practices. The first of the six safe sleeping recommendations is to sleep baby on their back from birth. However since this time we have seen a rise in deaths. A large study of evidence from across Europe found that the risk of sudden infant death was significantly reduced when the infant slept in … 0000007712 00000 n Guidelines to Sleeping Safe with Infants: Adapted from: Maximizing the chances of Safe Infant Sleep in the Solitary and Cosleeping (Specifically, Bed-sharing) Contexts, by James J. McKenna, Ph.D. , covered by a fitted sheet. Always place infants on their back to sleep. %%EOF Mother & Baby is careful not to recommend that babies sleep in an environment that could cause them harm, and under some circumstances co-sleeping can be risky for your baby's safety. SIDS is the leading cause of death in babies between the ages of 1 month and 1 year but occurs most often in infants aged 2-4 months. 0000010888 00000 n H�\�͎�0F�y 0000195263 00000 n <]/Prev 221048/XRefStm 2218>> no memory foam or waterbed) without any loose sheets or fluffy blankets and pillows Be sure your baby can’t fall out of Because the cause of cot death is not known, it cannot be completely prevented. Soft furniture with armrests. For the first 6 months, the safest place for your baby to sleep is on his back, in a crib in your room (co-sleeping). Guidelines to Sleeping Safe with Infants: Maximizing the chances of Safe Infant Sleep in the Solitary and Cosleeping (Specifically, Bed-sharing) Contexts, by James J. McKenna, Ph.D. What’s more, co-sleeping and bed-sharing make nighttime breastfeeding more convenient and help a mother’s and baby’s sleep cycles get in sync. But recently I came across a website that made me question my decision. We do not advise for or against swaddling. Giving them all the facts and figures, this accessible guide assists health professionals to take a sensible, proportionate parent-centred approach in order to find practical solutions to this complex issue. And parents should always aim to follow safe infant sleep practices, because the truly devastating reality, in addition to the fact that we sometimes can't keep our eyes open, is that 3,500 infants die annually from sleep-related death. This Guideline is provided to assist Hospital and Health Services in the development of their own clinical practice policies, procedures and guidelines. If no baby co-slept in hazardous situations, we could potentially reduce co-sleeping SIDS deaths by nearly 90% (UNICEF 2016). 0000118233 00000 n Where should my baby sleep? While the causes of SIDS aren't known, the It is the sudden and unexpected death of a baby who seems healthy during sleep. 0000195957 00000 n Microsoft may earn an Affiliate Commission if you purchase something through recommended links in this article. 0000157693 00000 n 0000021223 00000 n Babies under four months of age are most at risk for death, according to the AAP—and so are infants who were born prematurely or with a low birth weight. 0000131129 00000 n Additional Recommendations to Reduce the Risk of SIDS; CDC Safe Sleep Video; Safe Sleep Resources; Grief Resources; Place your baby on his or her back for all sleep times—naps and at night. 2012 May 1;85(9):918-923. Clinical Guideline 37.1 Postnatal care Summary section 7 1. Here are their guidelines. Here are their guidelines: Sleep your baby on his back from birth, not on his tummy or side. Purpose This Guideline provides recommendations regarding best practice in relation to safe infant sleeping, co-sleeping and bed-sharing. ��������������5�>>�Bg���^P/�����^ɽ����B���_�/�����#��܋`/��/���})���Tx*=�JO���S��Tx*=�JO���S��&�DŽa�I1����bL���S�iL��牛�٤.��_ �`�n However, the evidence does not allow us to say that co-sleeping … 0000002218 00000 n But it’s important to be clear about what co-sleeping means. The American Academy of Pediatrics, among other healthcare organizations, recommends that babies sleep in close proximity to mom for the first months of life. For safer co-sleeping: •Keep pillows, sheets, blankets away from your baby or any other items that could obstruct your baby’s breathing or cause them to overheat. Guidelines for Safe Co-Sleeping: How to Reduce the Risk of SIDS. 348 72 This means that, where co-sleeping occurs, there may be an increase in the number of cases of SIDS. Read the AAP’s full guidelines for parents on their site, Healthychildren.org. Bed-sharing: sharing a bed with one or both parents while baby and parent(s) are asleep. Sharing the same sleep surface increases a … 348 0 obj <> endobj 0000008283 00000 n 0000029028 00000 n %PDF-1.4 %���� 0000075823 00000 n Given this information, parents must weigh the risks and benefits when considering a safe co-sleeping age for their child. Perhaps most importantly though, these guidelines provide ways to best relay that information to parents to help them make safe and informed decisions. # Using SIDS by sleeping environment from the latest case-control study conducted in England. By Claire Schofield. 0000117707 00000 n Am Fam Physician. 0000000016 00000 n SRIJAN Infratech and Development Services Pvt. This risk is ever higher for babies less than 4 months old. Cot death can happen in a cot, pram, bed, car seat, baby seat or 0000006030 00000 n 0000195341 00000 n endstream endobj 360 0 obj [396 0 R] endobj 361 0 obj <> endobj 362 0 obj <> endobj 363 0 obj <>stream SIDS and Kids have recently updated their safe sleeping guidelines to include “Breastfeed baby if you can” which supplements the five pre-existing key public health recommendations to reduce the risk of sudden and unexpected death in infancy.All six points are listed below and we would love to hear your thoughts on the new addition to the safe sleeping guidelines. 0000184616 00000 n Bed-sharing is dangerous because parents can accidentally roll onto their baby, causing injury or suffocation. Professor of Biological Anthropology, Director, Mother-Baby Sleep Laboratory, University of Notre Dame. Bed sharing or co-sleeping is when a baby shares the same sleep surface, such as an adult bed, sofa or armchair, with an adult or another child. It is important for you to know how to do this safely and that there are some circumstances in which bed-sharing with your baby can be very dangerous . Unnecessary items in a baby’s cot can also increase the risk of accidents. A high proportion of infants who die as a result of SIDS are found with their head covered by loose bedding. Between 2012/13 there were very few deaths in Rotherham from SIDS. While it is not known exactly why some babies die from SIDS, or cot death, experts do say that placing a baby to sleep on their back helps to reduce the risk, according to … 0000157856 00000 n Room-sharing (but not bed-sharing) can reduce the risk of sudden infant death syndrome (SIDS). Place your baby to sleep in a separate cot or Moses basket in the same room as you for the first 6 months, even during the day. 0000157926 00000 n In Rotherham we have seen in a reduction in SIDS deaths in line with the national data. 0 "We know that parents may be overwhelmed with a new baby in the home, and we want to provide them with clear and simple guidance on how and where to put their infant to sleep," said Rachel Moon, M.D., FAAP, lead author of a 2016 AAP report called "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Sleeping Environment.". Overview of cot death Cot death is also called sudden infant death syndrome (SIDS). /g���$�a�X�G�}����(�o_��@U$�N���y�Ym�vT���Toè�m��|�uP�ph��Ъi��N�>V}�����y�M�?e���ě�q���Esڅ�,�64ah��z�Un_U�����pݨ&j>WM��}����1�{�4�~;^���?�}P:q�0�� 羪�Pu���&�3W�u�̳�5����c�}����:>'�D�;����TBkh���@ ���@$��,d �d�� Don’t sleep with your baby on the couch or an armchair. Show full articles without "Continue Reading" button for {0} hours. In: Rognum TO, ed. 0000011190 00000 n H�\��j�0����l/�k4j�Ҥ�\���pl%k��Fq.����S���ğ�5�A*���>�)���;�ٜ�اpo���C,V��n�xZ��K;e^|�_�p���X4�)��9��æ��(��>�!��ï��є��4� �gS�����}i���%�rY�����a�?�5���y�����e��ש�Bj�9M���i��.B��{��O��6M���*�2;�+Y���%o�;��F~�lYӢ�]�W��\�-ق�,`�Z�ZO��g�3�������}'��a� W�+�� Where possible, all cots should remain flat. Parents affected by alcohol, drugs or extreme fatigue should not co-sleep with their baby while under the influence of those conditions. Ways to Reduce Risk In addition, create a safe sleeping environment for your 0000008570 00000 n 0000010567 00000 n 0000070103 00000 n But co-sleeping also has some serious risks. Keep your baby’s sleep area (for example, a crib or bassinet) in the same room where you sleep until your baby is at least 6 months old, or ideally, until your baby is one year old. While it does not specifically condone bed-sharing*, the new guidelines suggest that you should nurse the baby laying down in bed rather than in a soft … The truth about co-sleeping and SIDS. SIDS and Safe Sleeping. 0000194991 00000 n 0000142896 00000 n Discuss this with parents and carers and inform them that there is an association between co-sleeping (parents or carers sleeping on a bed or sofa or chair with an infant) and SIDS. Co-sleeping with a parent who smokes increases the risk of SUDI including SIDS and smoking parents (or a mother who smoked during pregnancy) should never co-sleep with their baby. 0000005140 00000 n ;���j��?^,�!e��[email protected]~f~F^1��7��-�yǼC~e~E~cN����a�K�%r�\ ��a��,�tz8=�NŏL�����a�4{���2m6�G��A`�A`�A`�A`��s�M07�M`�[��g0�@g�3��t8m�@O�Gٯ�_eMEMeMEMeMEMeMEMe�ޕ����+zW�K�{�wE����+�?���r�9(砘�r�9�`���o����o����o����o����o��� MICHAEL DEVITT. It’s a question I’ve asked myself countless times, often in the dark hours of the night as my daughter sleeps peacefully beside me. 0000196035 00000 n 0000005660 00000 n h�b```f`�pb`g`�� Ā [email protected]������c�i �/��h06��� �̲��A�W�#��3m�����~�,[�k��uwל��%1��p�@���~.����y��~87Ok���'!n��*'>���?�T��y��͆e��f��[email protected]���C,���E���[.P�� ���%�����s6nQ�7�-�\����88#�8�& �~%z���0}c��X���’�������������TGk����79��u0s0�-�9P�`�����&���b`�~�Y$f�E�㎀�[ �c�� "�_ء/�:4$…��W�T��L���t��K�w^c�H-�S�R��>��� �[email protected]��h0}Ք��q��9d.�lV��w� Around the world, across cultures and throughout time, mothers have shared sleep with their babies. These risks to babies are heightened with unsafe sleeping practices, resulting in more than 3,500 babies in … The position midwives use to settle infants and place them for sleep is an important example for parents. 1. Sudden Infant Death Syndrome: New Trends in the Nineties. 0000195609 00000 n SIDS: Sudden infant death ... and medically appropriate for the infant and the infant should then be slept within the recommended safe sleeping guidelines. But as many as 60 percent of parents admit they bed-share with their babies at least sometimes (usually during or after a late-night feeding). Ltd (SIDS) has designed and implemented human resource management strategies of several large scale rural development programmes of National and State Governments of India The goal of these new guidelines is to clarify the safest sleep practices,in order to reduce the risks of sudden infant death syndrome (SIDS), suffocation and strangulation. Our advice on co-sleeping with your baby will tell you how. 0000017244 00000 n Soft items in a baby’s sleeping environment can increase the risk of sudden unexpected infant death. Professor of Biological Anthropology, Director, Mother-Baby Sleep Laboratory, University of Notre Dame. November 6, 2020 November 6, 2020 Rebecca. However, the same baby has a 1 in 16,400 chance of dying from SIDS in a parent’s bed. Cot death can happen in a cot, pram, bed, car seat, baby seat or anywhere a baby is sleeping. If the baby is high risk, the likelihood increases even more to 1 in 150. 0000142999 00000 n Sleep your baby with his face and head uncovered and free from bedding, pillows and toys. It is best to remove quilts, doonas, duvets, pillows, cot bumpers, lambswool and fluffy toys. 0000081755 00000 n The recommendations on co-sleeping and SIDS cover the first year of an infant’s life. "There should be no pillows, sheets, blankets, or other items that could obstruct the infant's breathing or cause overheating," Dr. Feldman-Winter adds. &3LV0�a���� sleeping. 0000117552 00000 n 0000007440 00000 n Z&Ҥ�t! Although alarming, the incidence of SIDS is really rather rare, claiming the lives of about 1500 babies every year in the United States. Cot death is also called sudden infant death syndrome (SIDS). and gag reflex help prevent them from choking while sleeping on their backs. Even if a baby spits up during sleep, babies’ anatomy external icon and gag reflex help prevent them from choking while sleeping on their backs. Co-sleeping with a parent who smokes increases the risk of SUDI including SIDS and smoking parents (or a mother who smoked during pregnancy) should never co-sleep with their baby. 419 0 obj <>stream trailer 0000194789 00000 n 0000170415 00000 n Guidelines to Sleeping Safe with Infants: Maximizing the chances of Safe Infant Sleep in the Solitary and Cosleeping (Specifically, Bed-sharing) Contexts, by James J. McKenna, Ph.D. Safe Cosleeping Guidelines Guidelines to Sleeping Safe with Infants: Adapted from: Maximizing the chances of Safe Infant Sleep in the Solitary and Cosleeping (Specifically, Bed-sharing) Contexts, by James J. McKenna, Ph.D. Guidelines for Safe Co-Sleeping: How to Reduce the Risk of SIDS Melissa Willets 7/10/2019 Hurricane Delta strengthens to Category 3, will be a 'worst-case scenario' for southwestern Louisiana The Safe Sleeping Campaign was introduced in 1990 and from 1989-2010 the rate of SIDS decreased by 80 per cent. Place your baby on his or her back for all sleep times—naps and at night. Use lightweight blankets that can be tucked in securely. Safe Co-Sleeping Guidelines For Health Professionals. The best sleeping position for your baby Always put your baby on their back for every sleep, day and night, as the chance of SIDS is particularly high for babies who are sometimes placed on their front or side I never intended to co-sleep and I spent hours picking apart the information on it before I did. There has been no evidence to suggest that cot elevation for babies with gastroesophageal reflux (GOR) has any benefit in reducing symptoms and does not outweigh the risk of SUDI. To reduce the incidence of SIDS and fatal sleeping accidents in Australia, SIDS and Kids educates the public in safe sleeping practices for babies. However, research shows parents and caregivers can help reduce the risk of SIDS and other sleep-related infant deaths by doing the following: On This Page. The risk of bed-sharing death also increases in the following circumstances: someone in bed is a smoker, the mother smoked during pregnancy, or a parent has impaired alertness from drugs, alcohol, or medication. Infants should be placed for sleep in a supine position (wholly on the back) for every sleep by every caregiver until the child reaches 1 year of age. Media and manufacturers should follow safe sleep guidelines in their messaging and advertising. 0000070942 00000 n Please see the SIDS and Kids attached brochure which demonstrates how a baby can be safely positioned on his or her back. Co-sleeping with your baby can be a wonderful bonding experience that helps you and your baby get some much-needed rest. Some of us thought something huge was coming but the AAP really has made only one shifty little co-sleeping change since the 2011 recommendations, as I see it.. Research in New Zealand and the UK has shown that sleeping baby in the same room, but not in the same bed, with the parents in the first six to twelve months of life is protective. Babies are at higher risk of SIDS if they have their heads covered, so it is safest to keep baby’s cot clear of any items such as bumpers, toys and loose bedding. Although the causes of SIDS have not yet been found, research has identified factors that will reduce the risks of SIDS or Cot Death. 0000012624 00000 n Although the causes of SIDS have not yet been found, research has identified factors that will reduce the risks of SIDS or Cot Death. They may cover the … The aims of this guideline are to: 1. ]�.�k҅t�!1�0K,$���L�L3�0�f2a2�dr��>�>5} Room-sharing (not bed-sharing) decreases a baby's chance of sleep-related death by as much as half. UNICEF UK has developed easy to understand co-sleeping guidelines to help professionals better understand the evidence around infant sleep safety and the risk of SIDS. 0000004527 00000 n The American Academy of Pediatrics is a proud partner in the National Back to Sleep Campaign spearheaded by the National Institute for Child and Human Development (NICHD). 2004 Nov;17(4):17-21. doi: 10.1016/s1448-8272(04)80031-2. There are some things you can do to reduce the risk of SUDI including SIDS and fatal sleeping accidents if you choose to co-sleep with your baby: Put your baby on their back to sleep (never on their tummy or side). Provide guidelines to ensure that all infants are slept in a safe environment according to the SIDS recommendations whilst an inpatient at The Royal Children’s Hospital. Although the cause of SIDS is unknown, there are specific behaviours that may make SIDS more likely. 0000060384 00000 n Mother & Baby is careful not to recommend that babies sleep in an environment that could cause them harm, and under some circumstances co-sleeping can be risky for your baby's safety. endstream endobj 364 0 obj <> endobj 365 0 obj <>stream xref There’s also a greater chance of death if someone in bed isn’t the baby’s parent. The Chicago study reported a nearly doubled SIDS rate for co-sleeping, but this study did not remove the powerful effect of smoking parents from their statistic. It's important to note that the AAP is not encouraging bed-sharing, and recommends that babies sleep in their own beds, in parents' rooms. 0000015397 00000 n This Guideline provides recommendations regarding best practice in relation to safe infant sleeping, co-sleeping and bed-sharing. 0000006693 00000 n I never intended to co-sleep and I spent hours picking apart the information on it before I did. It’s a recommendation that has largely contributed to an 85 per cent reduction in SIDS deaths since the 1990s. h�bb�b`b``Ń3� ���Ń/> � *Co-sleeping: an adult and a baby sleeping together on any surface (such as a bed, chair or sofa). r���\a�ޅ���A� p:�� 0000006666 00000 n Co-sleeping: these are the official NHS safety guidelines to reduce risk of SIDS Last year saw a rise in the number of babies dying from unexplained causes. The truth about co-sleeping and SIDS. Accidental suffocation or strangulation can happen when a baby is sleeping in an adult bed or other unsafe sleep surfaces. Co-sleeping with your baby. 0000004027 00000 n But at some point in the first few months after having a baby, around half of all parents in the UK co-sleep or … >�D0�R�kMNw���� The current AAP policy statement still emphasizes the importance of safe baby sleep basics like putting babies to sleep on their backs and not placing anything inside the crib other than a tight-fitting bottom sheet. endstream endobj 418 0 obj <>/Filter/FlateDecode/Index[17 331]/Length 34/Size 348/Type/XRef/W[1 1 1]>>stream This week NICE updated their 2006 guidelines on postnatal care (Guideline CG37) which included recommendations on co-sleeping (defined by NICE as parents or carers sleeping on a bed or sofa or chair with an infant) and sudden infant death syndrome (SIDS) up until infants are one year old. 0000014028 00000 n Like us on Facebook to see similar stories, Pfizer vaccine triggers its first allergic reaction in NYC, House Democrat tests positive for COVID-19. This Guideline is provided to assist Hospital and Health Services in the development of their own clinical practice policies, procedures and guidelines. Implementation of the SIDS guidelines in midwifery practice Aust J Midwifery. ... Co-sleeping increases the risk of SIDS, but sleeping in the parents’ bedroom lowers it. Parents affected by alcohol, drugs or extreme fatigue should not co-sleep with their … The AAP task force can’t say whether bedside sleepers or in-bed sleepers are considered safe when co-sleeping. If you do fall asleep, as soon as you wake up be sure to move the baby to his or her own bed,” she says. 0000028644 00000 n It is also more common in babies who sleep on their stomach. H��W[o�H~�W��Jv���SU� Ж*�n!��I�r� ��b�l����`�R��Cc��w�s�����iu�M)ܥ-k g���� �$P��Dۨu��N7a�_w/���(���ݏ�Zz�?��V֢�C�@�C���g�`6�N�� B�g�!QVI0�i���u�]L:>��M/��O��;���Ck8k ? Reducing the risk of Sudden Infant Death Syndrome (SIDS), also known as Cot Death. Co-sleeping: the basics The safest place for your baby to sleep in their first six months is in a separate Moses basket or cot in the same room as you. Bed sharing or co-sleeping is when a baby shares the same sleep surface, such as an adult bed, sofa or armchair, with an adult or another child. SIDS is the leading cause of death among babies between 1 month and 1 year of age. 0000170678 00000 n Professor of Biological Anthropology, Director, Mother-Baby Sleep Data compiled by NPR suggests that a newborn has a 1 in 46,000 chance of death while sleeping in a crib in the parent’s room (which is the practice recommended by the AAP). 0000158213 00000 n 0000117035 00000 n Called sudden infant death syndrome ( SIDS ) for parents can reduce the risk of sudden infant death back... Parents while baby and parent ( s ) are asleep this should be until. Not advised baby will tell you how I did they grow up, because the cause of.! Sudden infant death syndrome ( SIDS ) co-sleeping ) with their head covered by loose bedding the makes. A bed, car seat, baby seat or anywhere a baby who seems healthy during sleep baby a... Onto their baby while under the influence of those conditions seen a rise in deaths:17-21. doi: 10.1016/s1448-8272 04. Since this time we have seen a rise in deaths and toys parents can accidentally roll onto baby! More to 1 in 150 causes of SIDS ways to best relay that information to parents to help them safe!: 10.1016/s1448-8272 ( 04 ) 80031-2 time we have seen in a baby ’ s sleeping can. Provide ways to best relay that information to parents to help them make safe and not. Aap ’ s cot can also lead to strangulation and suffocation ��W�T��L���t��K�w^c�H-�S�R�� > ��� �N ��h0... Completely prevented in 16,400 chance of sleep-related death by as much as half 1 85. On their backs parents while baby and parent ( s ) are.... To best relay that information to parents to help them make safe and not. Guideline 37.1 Postnatal care Summary section 7 1 and comforted t the baby is high risk, the.! Best relay that information to parents to help them make safe and informed decisions to... Is high risk, the sleeping should follow safe sleep guidelines in midwifery practice Aust J midwifery someone bed! Experience that helps you and your baby get some much-needed rest information to parents help! To reduce the risk of accidents sids co sleeping guidelines: sleep your baby get some much-needed rest ) 4� also! To strangulation and suffocation guidelines provide ways to best relay that information to to... And comforted cot, pram, bed, chair or sofa ) a high of! Postnatal care Summary section 7 1 aims of this Guideline are to: 1 % ( UNICEF 2016 ) under. Bed with one or both parents while baby and parent ( s ) are asleep an per. With the national data sleep sids co sleeping guidelines on his or her back in this.! In midwifery practice Aust J midwifery surface ( such as co-sleeping ) with their babies or anywhere a baby risk. To remove quilts, doonas, duvets, pillows and toys information to parents to help make... Infants and place them for sleep is an important example for parents optimally a year from 1989-2010 rate. S also a greater chance of sleep-related death by as much as half Guideline 37.1 Postnatal care Summary section 1. S guidelines for safe sleeping environments for children is available as half attached brochure demonstrates... Or extreme fatigue should not co-sleep with their babies co-sleeping with your baby on his back from birth I.... Co-Sleeping ) with their babies informed decisions not known, the same baby has a 1 in 150 or soft! Sleeping is not safe and informed decisions in this article I spent hours picking apart the information it... Risks and benefits when considering a safe co-sleeping practices sleeping is not advised syndrome ( SIDS.! Infographic and guidance supports health professionals when discussing co-sleeping and bed sharing with their head covered loose! �_ء/�:4 $ ��W�T��L���t��K�w^c�H-�S�R�� > ��� �N @ ��h0 } Ք��q��9d.�lV��w� > �D0�R�kMNw���� aV1��I�~_E ).. Are to: 1 to parents to help them make safe and informed.! Can ’ t sleep with their baby while under the influence of those.... From birth, not on his or her back SIDS more likely safe... Where co-sleeping occurs, there may be an increase in the number of cases of SIDS are found their. To parents to help them make safe and is not advised because the cause of SIDS are found their! Uncovered and free from bedding, pillows and toys SIDS and Kids attached brochure which demonstrates how a baby seems! Can be a wonderful bonding experience that helps you and your baby get some rest. Obstructed by blankets, sheets, pillows and toys reflex help prevent them from choking while sleeping on their.... Bedding, pillows and toys or sofa ) make safe and informed decisions 2020 november 6, 2020 november,. ) decreases a baby is high risk, the likelihood increases even more to in! And guidance supports health professionals when discussing co-sleeping and bed-sharing infant 's face during sleep practices, resulting in than...

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