Sleep Study Terrie McNiffe, Cherie Miller, Dr Sivaramakrishnan, Dr - - PowerPoint PPT Presentation

Sleep Study

Terrie McNiffe, Cherie Miller, Dr Sivaramakrishnan, Dr Oliver

Background

 Sleep problems are common in childhood

with up to 43% of children affected at some time.1,2

 The problem is more common in children with

developmental problems and disabilities - up to 86% of children are reported to be

• affected. 3,4,5

Possible aetiologies6

 An increased incidence of issues that interfere with

sleep – reflux, constipation, spasms

 Parents are more concerned or protective about their

child with additional needs therefore not following same strategies as with other children

 People think that the usual behavioural strategies will

not work

 Child with neurodevelopment problems not picking up

• n the usual cues that indicate that it is coming to

bedtime

 Parents worrying that there might be another reason

for their child’s sleep problem

‘Tired all the time’7

 A report by the Family Fund which looked at the

effect of sleep difficulties on households

 Over 93% of parents are up in the night with their

child

 49% have health issues due to lack of sleep  22% have relationship problems as a result  15% are concerned about siblings and the wider

family’s health

Sleep problems in autism8

 Recent cohort study looking at sleep patterns in

children with ASD

 Found that from 30 months of age children with ASD

showed a trend towards reduced total sleep duration (reduction in night-time sleep duration wholly)

 Children with ASD woke more frequently at night

(13% vs 5% cohort at 30 months, 11% vs 0.5% at 81months )

 Reason hypothesised is an underlying disturbance in

circadian melatonin production.

The Barnsley Sleep Study

 The aim was to look at the scope and prevalence of

sleep problems in the children seen in the neurodevelopmental clinic in Barnsley.

 Between May and September 2013 an anonymous

questionnaire was handed out to parents attending clinic.

 The questionnaire asked about the problems, if any,

encountered and how it affected the family. We also asked whether they would like help with their child’s sleep problem and what help they would find most beneficial.

Demographics

 70 questionnaires handed out and 53

responded.

 40 males: 13 females  Age range from 1 year to 12 years of age

Diagnosis

20 6 3 2 2 2 5 13 Autism DD Downs syndrome Epilepsy Cerebral palsy ADHD Others Not doc

Does your child have a sleep problem?

37 16 yes no

Reported sleep problem vs. diagnosis

2 4 6 8 10 12 14 16 18

Number of children Autism DD Downs syndrome Epilepsy Cerebral palsy ADHD Others Not doc Diagnosis yes no

Problems reported

5 10 15 20 25 w a k i n g i n n i g h t G

• i

n g t

• b

e d E a r l y w a k i n g G

• i

n g t

• b

e d

• n
• w

n N

• d

a y t i m e n a p s M e d i c a l / e q u i p m e n t n e e d s Number reported

Sleep problem by diagnosis

5 10 15 20 25 30 35 40 Autism DD Downs CP Epilepsy ADHD Others Not doc Medical/equipment needs No daytime nap Going to sleep on own early waking Going to bed Waking in night

Number of nights affected

18 5 4 26 1 to 2 3 to 4 >4

Breakdown of those with >4 nights affected

13 2 1 1 1 2 3 3 Autism DD Downs Epilepsy CP ADHD Others Not doc

How is the parent/carer affected?

5 10 15 20 25 30 s l e e p e m

• t

i

• n

a l p a r e n t a l r e s p p h y s i c a l w

• r

k r e l a t i

• n

s h i p s m e n t a l h e a l t h n

• n

e

Household affected?

 Partner and other children = 10/37  Partner alone = 8/37  Other children alone = 6/37  No-one = 13/37  Therefore 24/37 of household members

affected

Would you like help?

 Yes = 23  No = 10  Support requested:

Medication = 10 Sleep service = 8 Physical help = 6 Respite = 4

Summary

 37/53 children were reported to have a sleep

problem.

 18/20 (90%) of children with a diagnosis of autism

had a reported sleep problem.

 26 children had more than 4 nights a week affected.

Half of these children had autism.

 29/37 parents with a child with a sleep problem

reported problems themselves – the most common being sleep problems.

 24/37 other household members affected  23 parents requested help with sleeping

What the study adds

This study adds to what is already known

 sleep problems are common in children with

a neurodevelopmental problem.

 It is not only the child that is affected when

there is a sleep problem

 The majority of parents want help

Where to go from here?

 Specialised sleep service?  Evidence on Effectiveness of Behavioural

Interventions to Help Parents Manage Sleep Problems in Young Disabled Children: A Rapid Review. McDaid, C. and Sloper, P. November 2008 Working Paper No. C4EO 2296

 Recently the department invited Cerebra to

do a workshop with parents and there is going to be 1-to-1 sessions with parents to identify individual concerns.

References

1.

Boyle J, Cropley M., Children’s sleep: Problems and Solutions. Journal of Family Healthcare 2004;14(3):61-3

2.

Blundel et al; Are sleep problems under recognised in general practice? Archives of Disease in Childhood 2004; 89:708-712

• 3. Bartlett, L.B., Rooney, V. and Spedding, S.

(1985) Nocturnal difficulties in a population

• f mentally handicapped children. British

Journal of Mental Subnormality; 31: 54-59

4.

Richdale, AL, Prior, M.R. (1995) The sleep/wake rhythm in children with autism. European Child and Adolescent Psychiatry; 4: 175-286.

5.

Wiggs, L., Stores, G. (1996) Sleep problems in children with severe intellectual disabilities: what help is being provided? Journal of Applied Research in Intellectual Disabilities; 9: 159-164. 6. Personal Practice: The management of sleep problems in children with neurodevelopmental problems, including the role of melatonin. Thomas,

• M. British Academy of Childhood Disability

Newsletter, Autumn 2013.

7.

Tired all the time. Family Fund Report

8.

Sleep patterns in children with autistic spectrum disorders: a prospective cohort

• study. Humphreys J. et al,

Archives of Disease in Childhood Online September 2013.