S U P P O R T I N G S L E E P I N A S D V I C T O R I A K N O W L A N D U N I V E R S I T Y O F Y O R K

Transcription

1 S U P P O R T I N G S L E E P I N A S D V I C T O R I A K N O W L A N D U N I V E R S I T Y O F Y O R K

2 WHAT IS SLEEP FOR? If sleep doesn t serve an absolutely vital function, it is the greatest mistake evolution ever made. sleep researcher Allan Rechtschaffen Yet we don t entirely know There are a number of possibilities: It s a by-product of evolution and helps conserve energy and protect us at night Cleaning house Brain plasticity Learning and memory Probably all of the above As far as I know, he answered, the only reason we need to sleep that is really, really solid is because we get sleepy. William Dement co-discoverer of REM sleep

3 HOW DO WE MEASURE SLEEP? Polysomnography (many-sleep-readings) Brain activity (EEG) Eye movements (EOG) Muscle activity (EMG) Heart rate (ECG) Breathing (air flow) Sweating (skin conductance)

4 Sleeping brainwaves

5 SLEEP IN CHILDREN WITH ASD Prevalence of sleep difficulties Between 40-86% Type of sleep difficulties Longer to fall asleep More night wakings Less overall sleep More variable sleep timing Early morning waking More daytime sleepiness

6 SLEEP IN CHILDREN WITH ASD HODGE ET AL., (2014) Parent reported sleep problems Early childhood characterised by greatest behavioural sleep problems

7 SLEEP IN CHILDREN WITH ASD SOUDERS ET AL., (2009) Actigraphy 59 children with ASD, aged 4-10 years Longer sleep onset latency Longer night wakings More sleep fragmentation PSG Increased duration of stage 1 sleep Decreased stage 2 sleep Decreased slow-wave sleep Different characteristics of stage 2 and REM sleep

8 CAUSES OF SLEEP DISTURBANCE IN ASD Psychological Factors Anxiety Separation anxiety Emotion regulation Depression Biological Factors Melatonin Environmental Factors Sleep hygiene Family functioning Sleep disturbance Sleep anxiety Parasomnias Sleep onset insomnia Sleep maintenance insomnia Daytime sleepiness

9 WHAT ARE THE CONSEQUENCES OF DISTURBED SLEEP? Autism symptom severity (Tudor et al., 2012) Anxiety (Hollway, Aman, & Butter, 2013) Inattention and hyperactivity (Goldman et al., 2009) Memory consolidation SleepSmart: does disturbed sleep contribute to language difficulties? Parental stress (Hoffman et al., 2008; Meltzer & Mindell, 2007) Helplessness Frustration Anger Anxiety Self-blame Depression Paternal isolation (Wiggs & Stores, 2001) Child sleep maternal sleep maternal mood, stress fatigue (Meltzer & Mindell, 2007)

10 SUPPORTING SLEEP: MELATONIN Rossignol & Frye, 2011 % of children reported to benefit in some way: %

11 SUPPORTING SLEEP: MELATONIN Why does it work? Melatonin is a neuro-hormone made in the pineal gland What does it do? Starts to increase 2 hours before regular bedtime Sleep gate opens Sleep-wake cycle Circadian clock- entrained by melatonin Balance of sleep/wake that has been accumulated- melatonin increases drive to sleep Low concentrations in ASD& possibly higher in day

12 SUPPORTING SLEEP: MELATONIN When does it not work? For who- reason for sleep difficulty Anxiety A sleep diary could help you identify the difficulty Fast vs slow release Sleep onset vs night wakings Side-effects Rare Occasional morning fatigue

13 SUPPORTING SLEEP: BEHAVIOUR Sleep hygiene (habits) bedrock of other behavioural approaches Necessary component of successful sleep intervention May not work alone All suggestions have some evidence but there s very little research Sleep needs are as individual as the child Crucial for child and caregiver Jan et al., 2008; Vriend et al., 2011 Environmental Dark room Exposure to light inhibits melatonin secretion Quiet room Technology-free room

14 SUPPORTING SLEEP: BEHAVIOUR Regularity Sleep Practices Bedtime routine Daytime routines help promote circadian rhythm by acting as time cues Introduce some small changes to prevent unbreakable ritual (Kodak & Piazza, 2008) Visual prompts Scheduling Visual timetable Prompts about what happens next in the routine Consistent sleep schedule Particularly important for children who s circadian rhythm doesn t do this No more than an hour different between week and weekend times Faded bedtime (Piazza et al., 1997)

15 SUPPORTING SLEEP: BEHAVIOUR Physiological Encouraging physical activity during the day Bright daytime light aids melatonin rise at night Avoiding stimulating activities prior to bed Especially for children who are hypersensitive or easily stimulated Common stimulants: New or unexpected events- can include a different book Anxiety Excessive noise Heat or cold Vigorous exercise- can include playing with siblings Hunger or large meals Caffiene Difficulties with self soothing Discourage sleep associations that involve caregivers

16 SUPPORTING SLEEP: BEHAVIOUR Other types of behavioural approach Standard or graduated extinction Scheduled night wakings for night terrors (Durrand, 2002) Benefits of behavioural approaches Parents feel in control of sleep issues (Wolfson et al., 1992) How do these things help? Entraining circadian rhythm Behavioural conditioning Reducing anxiety and uncertainty Importance of this emphasised by nights away

17 SOURCES OF SUPPORT Childrens sleep charity Sleep Success for Families of Children with Autism Sleep Scotland Sensory Smart Store Specialist clinics Sheffield Children s NHS Foundation Trust Millpond Sleep Clinic

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19 THANK YOU

20 REFERENCES Hodge, D., Carollo, T. M., Lewin, M., Hoffman, C. D., & Sweeney, D. P. (2014). Sleep patterns in children with and without autism spectrum disorders. Research in Developmental Disorders, 35(7), Souders, M. C., Mason, T. B., Valladares, O., Bucan, M., Levy, S. E., Mandell, D. S., Weaver, T. E., & Pinto-Martin, J. (2009). Sleep behaviours and sleep quality in children with autism spectrum disorders. Sleep, 32 (12), Meltzer, L. J., & Mindell, J. A. (2007). Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: a pilot study. Journal of Family Psychology, 21 (1), Wiggs, L., & Stores, G. (2004). Sleep patterns and sleep disorders in children with autism spectrum disorders: insights using parent report and actigraphy. Developmental Medicine and Child Neurology, 46 (6), Tudor, M. E., Hoffman, C. D., & Sweeney, D. P. (2012). Children with Autism: sleep problems and symptom severity. Focus on Autism and other Developmental Disorders, 27 (4) Hollway, J. A., Aman, M. G., & Butter, E. (2013). Correlates and risk markers for sleep disturbance in participants of the Autism Treatment Network. Journal of Autism and Developmental Disorders, 43 (12), Goldman, S. E., Surdyka K., Cuevas, R., Adkins, K., Wang, L., & Malow, B. A. Defining the sleep phenotype in children with autism. Developmental Neuropsychology, 34 (5) Rossignol, D. A., & Frye, R. E. (2011). Melatonin in autism spectrum disorders: a systematic review and meta-analysis. Developmental Medicine and Child Neurology, 53 (9), Hoffman, C., Sweeney, D. P., Lopez-Wagner, M. C., & Hodge, D. (2008). Children with Autism: sleep problems and mothers stress. Focus on Autism and Other Developmental Disabilities, 23 (3), Jan, J. E., Owens, J. A., Weiss, M. D., Johnson, K. P., Wasdell, M. B., Freeman, R. D., & Ipsiroglu, O. S. (2008). Sleep hygiene for children with neurodevelopmental disabilities. Pediatrics, 122 (6), Vriend, J., Corkum, P. V., Moon, E. C., & Smith, I. M. (2011). Behavioural interventions for sleep problems in children with Autism Spectrum Disorders: current findings and future directions. Journal of Pediatric Psychology, 36 (9), Piazza, C. C, Fisher, W. W., & Sherer, M. (1997). Treatment of multiple sleep problems in children with developmental disabilities: Faded bedtime with response cost versus bedtime scheduling. Developmental Medicine & Child Neurology, 39 Also see: Roberts, C. A., Hunter, J., & Cheng, A-L. (2017). Resilience in Families of Children With Autism and Sleep Problems Using Mixed Methods. Journal of Paediatric Nursing, 37, e2-e9 Kotagal, S., & Broomall, E. (2012). Sleep in children with autism spectrum disorders. Pediatric Neurology, 47 (4),