Snooze it or Lose It by Annie O’Connell Senior 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 effect as Blood Alcohol 0.05 Not sleeping for 24 hours has the same effects as 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 born16–18 hours Young child12–14 hours Child10–12 hours Teenager8–10 hours Young adult7.5–8.5 hours Adult7–8 hours Older adult6–6.5 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, , 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 0–4satisfactory daytime functioning 5–9daytime tiredness, lack of energy >10excessive 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 lot at 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 routine 2.Sensory cues/needs 3.Communication cues/level 4.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

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 –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 paediatrician 3.Private psychologists SOMNIA Sleep Services Paediatric Sleep Clinic Where to from here

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