1. THE PEDIATRIC SLEEP HISTORY Stephen H. Sheldon, D.O., F.A.A.P Professor of Pediatrics Northwestern University Feinberg School of Medicine Director, Sleep Disorders Center Children’s Memorial Hospital

2. Does the Child have a Sleep Problem? YES o 90% have a sleep problem o 5% have symptoms suggesting problem NO o 10% will have significant sleep disorder o 71% have symptoms suggesting sleep problem

3. Recording the Sleep History Bedtime Sleep Onset Latency Nocturnal waking o Number o Frequency o Length o Interventions Morning Sleep Offset Sleep-offset Latency Diurnal Naps o Number o Frequency o Length o Timing

4. Sleep Environment Description Location Roommate Bed Partner Ambient Light Noise Level Temperature

5. Bedtime Rituals and Associations? Activities 1-2 hours surrounding bedtime Bath? Sleep Onset Associations

6. Recording Data Short-cut for Notations

7. Assessing Daytime Sleepiness Is the child sleepy? o Typical manifestations = Profound Sleepiness o Paradoxical Manifestations Impulsive Short Attention Span Distractible Doesn’t Finish Tasks Motor Restlessness More..........

8. Napping Behaviors Are naps appropriate? o Age o Developmental Level o Nocturnal Sleep Habits o Other Sleep-related disorder/pathology

9. Other Searching Questions Rocking, Head Banging, Feet Kicking o During Wake/Sleep Transitions? o During Sleep? o Stereotypic? Bruxism o State of the Crowns of Teeth? o Headaches/TMJ Dysfunction

10. Unusual Motor Activity During Sleep Somnambulism o Quiet o Agitated o Seizures? Restless Sleep o Amnesia o Vivid Dreaming o Somniloquy

11. Unusual Dreams/Nightmares Nightmares o Anxiety Dreams o Mild Autonomic Discharge o Clear Dream Mentation Sleep Terrors o Intense Autonomic Discharge o Brief o Amnesia for Event

12. Restless Sleep? Very Difficult to Evaluate o Sleep Disordered Breathing OSA UARS o PLMS o Idiopathic o Normal Developmental Phenomenon?

13. Sleep Related Enuresis Primary o Maturational Secondary o Psychological o Organic Other Sleep-Related Dysfunction/Pathology

14. Snoring Sleep Disordered Breathing o OSAS o UARS IT IS CLEARLY NOT NECESSARY TO HAVE A COMPLAINT OF SIGNIFICANT SNORING FOR SLEEP DISORDERED BREATHING TO BE PRESENT!!!

15. Children Speak a Different Language 7 years old female 2 older cousins Always received straight “A’s” in school Sleep terrors after her first report card.

16. Children Speak a Different Language Grades:

17. Children Speak a Different Language Grades: Reading: a Writing: a Arithmetic: a Citizenship: a

18. Children Speak a Different Language What’s wrong with her grades?

19. Children Speak a Different Language What’s wrong with her grades? None of her grades were “straight”

20. Children Speak a Different Language What’s wrong with her grades? A

21. Children Speak a Different Language What’s wrong with her grades? A ≠ a

22. BEARS QUESTIONNAIRE Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

23. BEARS QUESTIONNAIRE BEDTIME Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

24. BEARS QUESTIONNAIRE BEDTIME o Any problems going to bed? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

25. BEARS QUESTIONNAIRE BEDTIME o Any problems going to bed? o Any problems falling to sleep? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

26. BEARS QUESTIONNAIRE BEDTIME o Any problems going to bed? o Any problems falling to sleep? o How long does it take to fall to sleep? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

27. BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

28. BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

29. BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? o Feel sleepy during the day? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

30. BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? o Feel sleepy during the day? o Falling to sleep at odd times during the day? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

31. BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? o Feel sleepy during the day? o Falling to sleep at odd times during the day? o Have difficulty paying attention? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

32. BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? o Feel sleepy during the day? o Falling to sleep at odd times during the day? o Have difficulty paying attention? o Have difficulty sitting still? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

33. BEARS QUESTIONNAIRE Awakenings Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

34. BEARS QUESTIONNAIRE Awakenings o Awakening frequently during the night? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

35. BEARS QUESTIONNAIRE Awakenings o Awakening frequently during the night? o Sleepwalk or sleep talk? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

36. BEARS QUESTIONNAIRE Awakenings o Awakening frequently during the night? o Sleepwalk or sleep talk? o Any trouble falling back to sleep after waking up in the middle of the night? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

37. BEARS QUESTIONNAIRE Regularity and duration of sleep Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

38. BEARS QUESTIONNAIRE Regularity and duration of sleep o Has a regular sleep schedule been established? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

39. BEARS QUESTIONNAIRE Regularity and duration of sleep o Has a regular sleep schedule been established? o When does the patient get into bed? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

40. BEARS QUESTIONNAIRE Regularity and duration of sleep o Has a regular sleep schedule been established? o When does the patient get into bed? o What time does the patient awaken? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

41. BEARS QUESTIONNAIRE Regularity and duration of sleep o Has a regular sleep schedule been established? o When does the patient get into bed? o What time does the patient awaken? o Any significant differences in bed time and wake time between weekdays and weekends? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

42. BEARS QUESTIONNAIRE Snoring Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

43. BEARS QUESTIONNAIRE Snoring o Does the patient snore more than 3 nights per week? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

44. SUMMARY

45. SUMMARY If you talk to a patient long enough …

46. SUMMARY S/he will tell you exactly what is wrong.

47. THANK YOU