Medications that are not FDA approved for children will be discussed. NAPNAP National Conference 2018

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1 Medications that are not FDA approved for children will be discussed NAPNAP National Conference 2018 (Honaker & Meltzer, 2016; Keyes, Maslowsky, Hamilton & Schulenberg, 2015) Chronically disrupted sleep leads to problems in: Cognitive functioning attention, learning memory, impaired vigilance Excessive daytime sleepiness Behavioral disturbances noncompliance, impulsivity, increased risk taking Growth Family stress Somatic complaints Affective disturbance irritability, emotional lability School problems tardy, poor performance Overuse of caffeine or other related stimulant like agents Bhargava,

2 Term Sleep latency Sleep duration Sleep quality Sleep arousal Sleep efficiency Definition period of time between bedtime and onset of sleep Self report overestimates duration measured by actigraphy Composite of 7 components, including latency, duration, medications, daytime sleepiness as measured by PSQI An abrupt change from deeper stage of non REM (NREM) sleep to a lighter stage, or from REM sleep toward wakefulness, with the possibility of awakening at the final outcome. time asleep / (total time in bed time to fall asleep) Butler et al., 2016; Kabali et al., 2015 revelsurgery.nhs.uk Sleep architecture REM sleep NREM sleep NREM1 NREM2 NREM3 4 Represents the cyclical pattern of sleep as it shifts between the different sleep stages, including NREM and REM. It allows us to produce a picture of what sleep looks like over the course of a night, taking into account various depths of sleep as well as arousals to wakefulness. Rapid Eye Movement sleep, characterized by desynchronized brain activity, atonia, and bursts of rapid eye movements, associated with dream sleep Non Rapid Eye Movement 4 levels of NREM sleep, distinguished by brainwaves, limb movements, eye movements [identified on EEG] Transitional, first stage after neonates, 2 5% of total sleep, easily aroused Low voltage, harder to arouse, up to 55% of total sleep. Sleep spindles, thought to represent memory consolidation Slow wave sleep, first third of night Stage 3 brief, Stage minutes in first cycle, total 10 15% of sleep Childhood insomnia Sleep latency of > 30 minutes, and/or frequent nighttime awakening with impaired daytime functioning Behavioral insomnia of childhood Psychophysiologic insomnia Circadian rhythm sleep disorder Inability to reset the sleepwake cycle in response to environmental cues Non 24 hour Delayed phase Behavioral Insomnia of Childhood Psychophysiologic Insomnia Most common behavioral sleep disorder in Primarily in older children and 0 5 yo. adolescents 25 50% of infants (>6mo) and toddlers ~11% lifetime prevalence of insomnia have night waking in yo 10 15% of toddlers have bedtime ~35% of adolescents experience resistance** insomnia at least several times a 15 30% of preschoolers have difficulty month falling asleep and night waking Can persist into middle childhood and adolescence 2

3 (Ramtekkar & Ivanenko, 2015) increased sleep onset latency and/or increased awakenings and arousals decrease sleep efficiency. Most studies done on fluoxetine and paroxetine (Rush et al, 1998; Sharply et al, 1996) 3

4 Medication Insomnia Drowsiness Fluoxetine 10 33% 5 17% Sertraline 12 28% 2 15% Escitalopram 7 14% 4 13% Citalopram 15% 18% [Paroxetine] 11 24% 15 24% Lexicomp/online Kidwell et al., 2015 (Moturi & Avis, 2010) Bhargava, (Moturi & Avis, 2010) 4

5 (Moturi & Avis, 2010) SLEEP HYGIENE Regular bed time all week (including weekends) Regulate naps, if they are necessary Limit/eliminate afternoon evening caffeine Eliminate electronics 1 2 hrs before bed Calming bedtime routine www. HealthyChildren.org/MediaUsePlan 5

6 Heussler et al., 2013 Bruni et al., 2017 Bruni et al., 2017 MT1 receptors sleep promoting effects MT2 receptors effects on circadian rhythms 6

7 Chaco Ross et al., 2017; Tordjman et al., 2017 Chaco Ross et al., 2017; Tordjman et al., 2017 Tordjman et al., 2017 animal sourced melatonin DISCOURAGED use of ( Lexicomp Natural Products; Owens and Moturi, 2009) 7

8 8

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