Another Restless Night or Something More?: Five Signs of Sleep Disorders in School-Age Children with Special Needs

From the Kennedy Krieger Institute:

While sleep disturbances are common in all children at some point during childhood, the National Association of School Psychologists estimates that as many as 30 percent of children have restless nights serious enough to be diagnosed with a sleep disorder. For children with special needs, the likelihood of sleep disorders is even higher, due to factors such as physical and behavioral differences, and even side-effects from medication.

Left untreated, sleep disorders can exacerbate existing conditions or cause additional health problems. While not all children with special needs who experience sleep disturbances will be diagnosed with a sleep disorder, experts point to early detection of common signs as the key to improving sleep.

According to Dr. Jennifer Accardo, director of the Sleep Disorders Clinic and Lab at the Kennedy Krieger Institute in Baltimore, Md., parents know their child’s sleep patterns best and are often able to spot a more serious problem if they know the signs.

Signs of Sleep Problems in Children with Special Needs

1. Snoring. Children who struggle to breathe or who noisily pause, gasp or choke in their nighttime breathing are at risk for obstructive sleep apnea. This treatable condition prevents a child from achieving deep, restful sleep and often results in daytime attention and behavior problems.
2. Difficulty falling or staying asleep. Everyone has problems now and then, but chronic difficulty falling or staying asleep can make it hard for children to stay alert and focused during the day. Even children can have insomnia, and those with disabilities tend to struggle the most.
3. Sleepwalking, night terrors and other nighttime activities. At some point, many children walk, talk or cry out in their sleep. Doctors call these occurrences parasomnias and if they happen often or over a long period of time, parents should seek help to find potential triggers.
4. Sleeping too much. Children who have trouble waking up in the morning, getting to school on time or falling asleep during class have clear signs of a sleep problem.
5. Needing parents to be in the room to fall asleep. If children are unable to fall asleep without their parents in the room, then it may be time to seek guidance.

“While a good night’s sleep is important for all children, it is especially critical for children with special needs,” says Dr. Accardo. “Parents can make small changes at home to help their child get a better night’s sleep and improve their performance in daytime activities, therapies and social interactions.”

Tips to Improve Sleep Patterns

1. Make sleep a priority. Without a good night’s sleep, children may have difficulty participating fully in activities such as homework, sports and therapies.
2. Develop a bedtime routine. Everyone needs this, even adults! A short set of calming activities helps children “wind down” to be ready for sleep.
3. Keep schedules consistent between weekdays and weekends.Kids who stay up later and sleep in on weekends may find it hard to return to their regular schedules during the school week.
4. In fact, keep schedules consistent every day! Going to bed and waking up around the same time daily trains your brain to account for the hours you need for other regular activities.
5. Make the bedroom a restful place. TV and video games are not only distracting in the bedroom, but they also produce bright light that signals the brain to wake up.
6. Sleep in the same place every night. Children who sleep on the couch, on the floor or in different beds have more trouble developing good sleep habits.
7. Avoid caffeine. Caffeine in sodas, teas and coffees can keep children and adults awake.
8. Put your child to bed when they are sleepy, but not yet fully asleep. Self-soothing is a fundamental skill for children. Putting children to bed before they are completely asleep gives them an opportunity to develop this skill.
9. Address anxiety. Anxiety commonly affects children with disabilities, and makes sleep difficulties worse.
10. Take note of sleep problem signs. Tracking patterns and signs can help your pediatrician or a sleep expert to more quickly identify the problem and offer solutions.

“If parents are concerned about their child’s sleep patterns and behaviors, they should consult with their pediatrician or a sleep expert,” says Dr. Accardo. “Sleep evaluations can be extremely beneficial in identifying causes and ultimately improving sleep for the entire family.”

For more information on sleep disorders in children with specific diagnoses, see this overview on sleep disorders I wrote in 2009, and find other helpful information and tips in the Sleep Disorders section of the main site, www.tourettesyndrome.net.

Join Me at an All-Day Workshop for Educators & Parents on December 5th

I’ll be conducting an all-day workshop for educators on Monday, December 5, 2011 at the Grappone Conference Center in Concord, New Hampshire. The event is sponsored by the University of New Hampshire Institute on Disability and is geared to regular and special education teachers, school psychologists and social workers, behavior specialists, occupational therapists, administrators, and parents.

Description:

Neurological disorders that emerge in childhood often have significant impact on students’ academic, behavioral, and social-emotional functioning. Participants will learn about the cardinal features of Tourette’s Syndrome, Obsessive-Compulsive Disorder, Attention Deficit Hyperactivity Disorder, Executive Dysfunction, Mood Disorders such as Depression and Bipolar Disorder, and the memory deficits, sensory issues and “storms” that sometimes accompany them. Strategies and assistive technology to accommodate symptom interference in activities such as handwriting, homework, math calculation, and written expression and big projects will be described. Pitfalls in behavioral interventions, and simple social skills and problem-solving interventions will also be identified.

For more information on the workshop and registration information, download the brochure or register online at www.iod.unh.edu.

Hope to see you there!

 

Kids who bully, have aggressive behaviors are twice as likely to have sleep problems

Children who are bullies or have conduct problems at school are more likely to be sleepy during the day according to University of Michigan Medical School researchers.

Researchers looked at elementary school students in the Ypsilanti, Michigan public schools who had exhibited conduct problems like bullying or discipline referrals and found that there was a two-fold higher risk for symptoms of sleep-disordered breathing, particularly daytime sleepiness among these students. The study was published last week in the journal Sleep Medicine.

“What this study does is raise the possibility that poor sleep, from whatever cause, can indeed play into bullying or other aggressive behaviors – a major problem that many schools are trying to address,” says Louise O’Brien, Ph.D., assistant professor in U-M’s Sleep Disorders Center and the departments of Neurology and Oral and Maxillofacial Surgery.

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Trouble waking up?

Ever have trouble waking your child up? You might relate to this:

Back to School Tip #2: Re-establish wake-up time and routines

One of the great things about summer is that the kids can sleep late. For some of us, that means a break from the morning hassles that started so many of our days. But if you think that you can get your child back into an appropriate sleep cycle if you start the weekend before school re-opens, I’ve got a bridge in Brooklyn I’d love to sell you.

As soon as your child is back home from summer camp or wherever they’ve been off to, begin easing them back into a better sleep cycle for school. If your child hasn’t been away but has been in the habit of sleeping until oh, say, 10 am, 11 am, or the afternoon, you may have your work cut out for you. While some kids can readjust relatively quickly (within a week), for other kids, getting them back into the school routine takes much longer.

Start by doing the math to calculate the difference between their current wake-up time and the time they’ll need to wake up for school. If they currently wake up at 1 pm every day and you and your child figure out that they need to be up at 7 am so that they have time to dress, eat breakfast, brush their teeth and comb their hair and get to the bus or school on time, that’s a 6-hour difference to overcome. Some children may cooperate with getting back into the routine of getting up early, but if you are not one of the lucky parents, divide the difference you calculated by the number of days left until school starts. That’s how much you need to adjust the wake-up time by every day, beginning immediately, if you want to use a gradual approach instead of a “starting tomorrow, you get up at 7 am” approach.

Tips

1. The “standard” professional advice is to have a family meeting with your child to discuss what time they need to wake up for school and what time they will go to bed each night during the school week. Of course, many “standard” professionals have never tried to deal with our kids, many of whom have sleep issues galore. If your teen really gives you a rough time about going to bed earlier while it’s still vacation, you may want to go to Plan B: start by focusing on adjusting the wake-up time. For Plan B, you say to your child, “You can still go to sleep late if you want, but you need to be up at _______ one way or the other. If you get up on time, good things will happen. If you don’t get up on time, there will be consequences that you probably won’t like, including having to go to bed earlier.”

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