Sleep disorders

Caring for Children With Autism Spectrum Disorders P H Y S I C I A N FA C T S H E E T S
Sleep Disorders
● Three percent of primary care pediatric visits are for sleep problems.
● Abnormal sleep cycling● Abnormal melatonin amount or duration ● One third to one half of children with autism spectrum disorders (ASDs) are reported to have sleep problems.
Associated Problems
● Sleep problems are associated with increased family stress.
● Amount of daytime and nighttime sleep varies with age.
● Sleep problems also associated with increased daytime ● The appropriate range for preschoolers is 10 to 13 hours.
● There is a slow decrease in amount of sleep with age in school-aged children (about 8–11 hours is appropriate for a 12-year-old).
Assessment
Medical Factors
● Children with ASDs may have other reasons for sleep problems. Workup for medical causes identified in history and physical examination History and physical examination determine need to evaluate for● Sleep apnea ● Detailed history of bedtime routine, night wakings, and ● Where does the child sleep? With whom? Potential Reasons for Sleep Problems in Children
With Autism Spectrum Disorders
● What do you do when the child gets out of bed? ● Melatonin is the hormone released by the pineal gland to ● Lower measured levels of salivary melatonin in some studies ● Disrupted sleep cycles on polysomnogram.
● Describe interventions you have tried to improve sleep in detail.
● Sleep onset may be delayed because of ● Sleep diary for 2 weeks to determine extent of problem Treatment
1. Behavioral interventions have more data to support use than ● Social attention from caregiver for behaviors around Regular time for going to bed and awakening ● Bedroom conducive to sleep (quiet, dark, without ready ● Inability to self-soothe when arousal occurs in normal ● Sleep cues (bed and bedtime need to be associated with ● Decreased awareness of social cues distinguishing day and night ● Trained night waking (eg, child learns that food, attention, ● Falling asleep under conditions that will be reproducible ● Discomfort (eg, reflux, restless legs) PA G E 1 O F 2
Sleep Disorders
P H Y S I C I A N FA C T S H E E T S
Medication (see also “Psychopharmacology”)
Medication
Mechanism
Side Effects
experience”; studies neededretrospective.
safe and effective for short-term insomnia.
● Sometimes sufficient by itself to resolve sleep problems ● Other complementary therapies such as Valerian root and (additional interventions may be necessary) aromatherapy are used without scientific validation. The 3. Graduated extinction (planned ignoring of behavior); most production of these substances is not regulated and their potential studied intervention is sleep hygiene + graduated extinction. interactions with other medications have not been studied.
This is successful if implemented consistently.
● Medication, when used, should be part of a larger behavioral ● Say “good night” and reinforce child with praise.
● Check on the child at predetermined intervals and ignore References
1. Interval between checks gradually increases during Giannotti F, Cortesi F, Cerquiglini A, Bernabei P. An open-label study of controlled-release melatonin in treatment of sleep disorders in children withautism. J Autism Dev Disord. 2006;36:741–752 2. Intervals also increase over successive nights.
3. Precise schedule can be individualized to suit child or Meltzer LJ, Mindell JA. Nonpharmacologic treatments for pediatric sleeplessness. Pediatr Clin North Am. 2004;51:135–151 ● Checks involve briefly looking in the bedroom, encouraging Mindell JA, Emslie G, Blumer J, et al. Pharmacologic management of the child (if awake) to go to sleep, and leaving.
insomnia in children and adolescents: consensus statement. Pediatrics.
2006;117:e1223–e1232 ● Ensure that all caregivers are consistent.
● Bedtime hygiene: implement for approximately 2 weeks Owens JA, Rosen CL, Mindell JA. Medication use in treatment of pediatric before beginning graduated extinction.
insomnia: results of a survey of community-based pediatricians. Pediatrics.
2003;111:e628–e635 ● Length to try graduated extinction: 2 weeks.
● Protests may worsen for 2 to 3 days.
Richdale AL. Sleep problems in autism: prevalence, cause, and intervention. ● Improvement should be clear by 1 week and should Dev Med Child Neurol. 1999;41:60–66 ● Support family for 2-week trial.
Durand VM. Sleep Better! A Guide to Improving Sleep for Children with ● Families may need ongoing support to carry out, especially Special Needs. Baltimore, MD: Paul E. Brookes Publishing Co; 1997 Ferber R. Solve Your Child’s Sleep Problems: New, Revised, and Expanded Edition. New York, NY: Fireside; 2006 ● Faded bedtime: move bedtime to point child will fall asleep ● Stimulus fading: co-sleeper moves progressively further away or the child is moved gradually out of parents’ room.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
● Scheduled awakenings: caregiver rouses but not overly Copyright 2008 American Academy of Pediatrics. All Rights Reserved.
stimulates the child approximately 15 minutes before the Published as part of AUTISM: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians. child typically wakes up spontaneously during the night, thus resetting the sleep cycle.
PA G E 2 O F 2

Source: http://www.pediatrics.uottawa.ca/assets/documents/Smith%20Sleep_Disorders.pdf