snooze it or lose it by annie o’connell senior occupational therapist, sleepwise project rise,...
TRANSCRIPT
Snooze it or Lose It
by Annie O’ConnellSenior Occupational Therapist,Sleepwise Project
RISE, November 2010
Need for sleep
Snooze it or lose it
• Health• Emotional wellbeing• Sensory processing• Learning• Coordination• Behaviour• Family Stress
Motor vehicle accidents
• Fatigue is a factor in up to 30 per cent of fatal crashes
• Not sleeping for 17 hours has the same effectas Blood Alcohol 0.05
• Not sleeping for 24 hours has the same effectsas Blood Alcohol 0.10
Linked to: – Obesity (leptin and ghrelan)– Diabetes– Cardiovascular disease
Research now links similar health outcomes with adolescents and children.
Poor sleep in adults
The Sleep Diet
• Neurotransmittors– Leptin – register food, stop eating– Ghrelin – need to eat more
• Study sleep restriction from 8hr to 5 hrs 15.5% decrease in Leptin and 14.9% increase in Ghrelin
• !?!Perhaps the best diet to suggest is SLEEP!?!
Average typical sleep time
New born 16–18 hours
Young child 12–14 hours
Child 10–12 hours
Teenager 8–10 hours
Young adult 7.5–8.5 hours
Adult 7–8 hours
Older adult 6–6.5 hours
Adolescents
USA (Carskadon 2007)– 40% had 4+ electronic devices:
slept 30 minutes less
Australian (Dollman et al 2007)– 10–15 yr olds: sleep less with age– Obese/overweight: sleep 20–30
minutes less– Compared with 1985–2004: sleep
average 30 minutes less
SA (Reynolds 2010)– 14–16 yr old girls: sleeping less
than 9 hours and linked with mobiles, email, computer and TV/DVD
SA (Short 2010)– Years 9,10,11 wanted more than 9
hours but fewer than 20% achieved this
– 1/3 overslept by 2 hours or more on weekends
Epworth Sleepiness Scale
• 0 = would never doze
• 1 = slight chance of dozing
• 2 = moderate chance of dozing
• 3 = high chance of dozing
Epworth Sleepiness Scale
Situation Score (0-3)
• Sitting and reading _____• Watching TV _____• Sitting inactive in a public place
(for example, in a theatre or a meeting) _____• As a passenger in a car for an hour
without a break _____
Epworth Sleepiness Scale
Situation Score• Lying down to rest in the afternoon
when circumstances permit _____• Sitting and talking to someone _____• Sitting quietly after lunch without alcohol _____• In a car, while stopping for a few minutes
in the traffic _____
Total ___/24
Epworth Sleepiness Scale
Score
0–4 satisfactory daytime functioning
5–9 daytime tiredness, lack of energy
>10 excessive daytime sleepiness,
possible underlying medical condition
Prevalence of sleep disturbance
Sleep disturbance is more common in children than previously known:
• 25–30 per cent of toddlers
• 15–30 per cent of preschoolers
• 37 per cent of younger school-age children
• 40 per cent of adolescents
Prevalence of sleep disturbance
Jan, J. E., Owens, J. A., Weiss, M., Johnson, K., Wasdell, M., Freeman, R. D., & Ipsiroglu, O. (2008). ‘Sleep Hygiene for Children With Neurodevelopmental Disabilities’. Pediatrics, 122, 1343–1350
Sleep disturbance is extremely common
(80 per cent) in the children and adults
with developmental disabilities, often with
a combination of sleep problems.
Prevalence of sleep disturbance
• People with autism spectrum disorders present with greater difficulty with getting to sleep and staying asleep
• People with Down syndrome present with
more sleep-related breathing disturbance
Certain groups present with higher occurrence of types of sleep disturbance;for example:
• Increased stress related to child’s sleep
and severity of diagnosis (Hoffman
2008)
• Parents (ASD group) had more sleep
problems than parents (TD group)
Parents of children with ASD
BEARS Sleep Screening
• Bedtime problems• Excessive daytime sleepiness• Awakenings during the night• Regularity and duration of sleep• Snoring
Adapted from Mindell & Owens, A Clinical Guide to Paediatric Sleep—Diagnosis and Management of Sleep Problems (2003)
Parent-directed question
Bedtime problems:
Does your child have any problems at bedtime?
Yes No
Excessive daytime sleepiness:
Does your child have difficulty waking in the morning, seem sleepy during the day or take naps?
Yes No
Parent-directed question
Awakenings during the night:
Does your child seem to wake up a lotat night?
Any sleepwalking or nightmares?
Yes No
Parent-directed question
Regularity and duration of sleep:
What time does your child go to bed and get up on school days? Weekends?
Do you think your child is getting enough sleep?
Yes No
Parent-directed question
Snoring:
Does your child have any loud or nightly snoring or any breathing difficulties at night?
Yes No
Parent-directed question
Three basic types of sleep disturbance
Quantity—not enough or too many hours of sleep (duration)
Quality—sleep is disrupted or fragmented
Timing—sleep‑wake rhythm is not well established
Positive Sleep Practices• Set a regular bed and wake time
• Consistent bedtime routine
• Keep the hour before bedtime relaxing
• Spend time outside and exercise during the day
• Keep TV viewing and use of technology in check
• Avoid large meals close to bedtime, provide snack
Positive Sleep Practices
• Provide a comfortable bed ‘nest’, warm to cool in temperature, quiet and dark (night light if needed)
• Go to sleep in the same place where you sleep all night
• Limit naps to 15–20 minutes
• Open curtains in the morning to signal it is time to wake up
• Positive modelling of sleep habits by parents (make sleep a priority)
Tryptophan
• Turkey• Tuna• Almonds, cashews, walnuts, natural
peanut butter• Cottage cheese, hard cheese, yoghurt,
cow’s milk, soymilk• Tofu, soybeans, eggs• Bananas and avocados
Avoid or limit caffeine
[Caffeine] is…the only psychoactive drug legally available to children.Carroll, M. in Handbook of Substance Abuse, 1998
Maximum daily intake• children 4–6 years: 45mg/day • children 7–9 years: 62mg/day • children 10–12 years: 85 mg/day • Adults: 400–450mg/day
Caffeine
• Coffee (drip) (240ml) 210mg • Coffee (instant) (240ml) 110mg• Coffee (espresso) (shot) 95mg• Tea (5 minute steep) (240ml) 95mg• Tea (3 minutes steep) (240ml) 55mg• Hot chocolate (240 ml) 15mg• Regular or diet Coke (356ml) 45mg• Most other soft drinks (356ml) 0mg• Small chocolate bar 25mg
Sleepwise: A Resource Manual
Divided into sections
• General information
• Workshops 1–3
• Guidelines for individual sleep plans
• Information booklet for parents
• References for A–H workers
• Bibliography
The Sleepwise Approach—for young people with DD
Sleepwise Workshops: • Sleep• Sleep Disturbance• Strategies to Reduce Sleep Disturbance
Actions: • Complete sleep diary• Score Sleep Disturbance • Complete sleep interview at home• Medical check/referral for specific sleep disorders• Assess family readiness
Ongoing Support:• Ongoing support over approximately 8–12 weeks from
allied health worker
Strategies to reduce sleep disturbance 1. Establish a routine2. Sensory cues/needs3. Communication cues/level4. Behavioural
• Timetabling of sleep• Change the bedtime• Change bedtime when not asleep• Restrict sleep• Gradual distancing of parents• Ignoring
• Standard• Gradual• With parents present
• Schedule awakening• Desensitisation
Results N=26
Ages of children:
1yr 1mth to
7yrs 1mth
Diagnosis:GDD (15)ASD (6)Other syndromes (5)
Sleep Disturbance N=26
Communication Strategy
Sensory Strategies
Behavioural Strategies
No of weeks to achieve short term sleep goals
Children Achieving Sleep Goal
0
1
2
3
4
5
6
2 3 4 5 6 8 9 10 11 14 22
Outcomes 6 months +
Medical Referral
Sleep problems related to
• epilepsy
• breathing
• movement during sleep
• pain
• severe anxiety
Where to from here
Adults 1. Discuss with your GP
– Home base or sleep laboratory assessment– Referral to psychologist or programme for example,
Insomnia Treatment Programme, Adelaide Institute for Sleep Health at the RGH 8275 1187
2. www.adelaidesleephealth.org.au– On line quiz for sleep, apnoea and BMI calculator
Young people (0–18 years)
1. Disability SA (group workshops and individual)
2. Discuss with GP and paediatrician3. Private psychologists
• SOMNIA Sleep Services www.somnia.com.au• Paediatric Sleep Clinic
Where to from here
