Supporting your child’s physical & mental health with a ...€¦ · • sleep paralysis •...
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Supporting your child’s physical & mental health with a good sleep routine
Transcript of Supporting your child’s physical & mental health with a ...€¦ · • sleep paralysis •...
Supporting your child’s physical
& mental health with a good sleep
routine
Not enough sleep
distractible
moody
irritable
easily frustrated
disorganised
inattentive
anxious jumpy
defiant
digestion physical health
continence mental health
SLEEP
DIFFICULTIES & ND
Often 45 mins less than peers
Poor circadian rhythms
Poor understanding of
social cues
Melatonin
produces later in
the night
Abnormality in
cerebellum
vermis
Abnormality in the limbic system
Comorbid differences add to
difficulty
Inability to welcome new
routines
Higher than with LD children
Increased night waking & early
rising
Factors affecting children’s
sleep
Genetics
Environment
Family/Parents/ Carers
Social/Cultural
Development
Health
Social/Emotional
Sleep practices
Our nightly sleep is made up of several sleep cycles each made up of
several different sleep stages including:
• Non rapid eye movement (NREM)
• Rapid eye movement (REM)
3-5 years
• most do not nap
• difficulty falling asleep and waking up during
the night are common
• development of imagination
• commonly experience night time fears and
nightmares
• sleepwalking and sleep terrors peak *
6-13
• experience an increasing demand on their time
from school (e.g., homework), sports/other
• become more interested forms of media
• access caffeine products
• lead to difficulty falling asleep, nightmares and
disruptions to their sleep
• watching TV close to bedtime has been
associated with bedtime resistance, difficulty
falling asleep, anxiety around sleep and
sleeping fewer hours *
SLEEP
WAKE
DISORDERS
Insomnia
Hyper-somnolence
Central sleep apnoea
Obstructive sleep apnoea
Non-REM sleep arousal
Circadian Rhythm Nightmare
REM sleep behaviour
Restless Leg Syndrome
Narcolepsy
Sleep-related hypoventilation
DSM V identify
sleep-wake
disorders
comprising of 11
diagnostic groups:
Insomnia is difficulty falling asleep or staying asleep, even when a person
has the chance to do so.
Symptoms:
• fatigue
• low energy
• difficulty concentrating
• mood disturbances
• decreased performance
Treatments include:
• behavioural
• psychological
• medication
• combination of any/all
• sleep hygiene
Insomnia
Hypersomnolence is a condition where a person experiences significant
episodes of sleepiness, even after having 7 hours or more of quality sleep.
Hypersomnolence
Stimulants are most commonly prescribed to treat hypersomnolence. These include:
• amphetamine
• methylphenidate
• modafinil
• additional drugs include: clonidine, levodopa, bromocriptine, antidepressants, and monoamine oxidase inhibitors (MAOIs).
• sleep hygiene
A disorder in which your breathing repeatedly stops and starts
during sleep.
Causes include:
• problems affecting the brainstem
• brain infection
• stroke
• conditions of the cervical spine (neck)
• severe obesity
• certain medicines, such as narcotic
painkillers
• high altitudes
Treatments:
• treat existing conditions
• assistive breathing device
• supplemental oxygen.
Central sleep apnoea
Where the muscles and soft tissues in the throat relax and collapse sufficiently to
cause a total blockage of the airway; it's called an apnoea when the airflow is blocked
for 10 seconds or more. Symptoms:
• loud snoring
• noisy and laboured breathing
• repeated short periods where breathing
is interrupted by gasping or snorting
• night sweats
• need to urinate.
Treatments:
• lifestyle changes, weight loss, exercise
• sleeping position
• continuous positive airway pressure (CPAP)
• mandibular advancement device (MAD)
• Tonsillectomy/adenoidectomy
• tracheostomy
• weight loss (bariatric) surgery
• removal excess tissue in the throat to widen your airway
• soft palate implants
Obstructive Sleep Apnoea:
Non-rapid eye movement (NREM) sleep arousal disorders
Repeated episodes of incomplete awakening from sleep that include behaviours
such as sleepwalking and sleep terrors.
Symptoms:
• sleepwalking
• sleep-related eating behaviour
• sleep-related sexual behaviour
Treatments:
• padding the floor/area
• window protection
• removing dangerous objects
• locking doors and windows
• medication
• sleep hygiene
Internal (endogenous, or built-in) abnormalities of the circadian rhythms, the body's internal
clock. They arise when a person is unable to fall asleep at a normal bedtime (late evening),
although he/she is able to sleep at other times.
Types:
• delayed sleep phase type
• free-running type
• advanced sleep phase type
• irregular sleep-wake type
• shift work type
• jet lag type
Treatments:
• behaviour therapy
• bright light therapy
• medications
• chronotherapy
• sleep hygiene
Chronic circadian rhythm sleep disorders
In humans, melatonin secretion starts when darkness begins and is at
its peak between 2 and 4 am, gradually declining through the second
half of the night. Maintained levels are dependent on continuous output
from the pineal gland
Circadian Rhythms & Melatonin
Nightmares that occur frequently and keep you from getting restful sleep are considered a
sleep disorder.
Usually coherent visual dreams that seem real and get more disturbing as they unfold and cause you to
wake up. Happen towards the end of your sleep, involving imminent physical danger; and focus on other
distressing themes and provoke negative emotions such as: anxiety; fear; terror; anger; rage;
embarrassment or other negative feelings
Treatments:
• understand and manage anxieties
• positive imagery
• stress management
• relaxation techniques
• counselling/therapy
• Medication
• sleep hygiene
Nightmare Sleep Disorders
RBD is characterised by the acting out of dreams that are vivid, intense, and
violent. Dream-enacting behaviours include talking, yelling, punching, kicking,
sitting, jumping from bed, arm flailing, and grabbing. More common in older
males.
Treatments:
• Clonazepam
• Benzodiazepine
• Some antidepressants or
• Melatonin may reduce the violent behaviour
• Make the bedroom a safe environment, removing all sharp and breakable
objects.
REM sleep behaviour disorder
Also known as Willis-Ekbom Disease. RLS is a neurologic sensorimotor
disorder. An overwhelming urge to move the legs when they are at rest; can
be accompanied by unpleasant sensations. Occurs during inactivity and
they are temporarily relieved by movement or pressure. Most severe in the
evening and night time hours and can profoundly disrupt sleep and daily life. Treatments:
• avoiding stimulants in the evening
• not smoking
• regular daily exercise
• avoiding some medicines
• massaging legs
• taking a hot bath in the evening
• applying a hot or cold compress to your leg muscles
• doing activities that distract your mind, such as reading or puzzles
• relaxation exercises
• sensory aids
• sleep hygiene
Restless Legs Syndrome (RLS),
Narcolepsy Rare long-term brain disorder that causes a person to suddenly fall asleep at
inappropriate times. The brain is unable to regulate sleeping and waking patterns
normally.
Symptoms
• excessive daytime sleepiness
• sleep attacks
• cataplexy
• sleep paralysis
• excessive dreaming and waking in the night – dreams often come as you fall asleep
Treatments:
• taking frequent, brief naps throughout day
• keep to a strict bedtime routine
• possible medication
• sleep hygiene • NB: DVLA
Breathing-related disorder that interrupts normal sleep. Diagnosed when all
other sleep disorders have been ruled out, though it may appear
simultaneously with other sleep disorders. Breathing is restricted, leading to
low levels of oxygen or elevated levels of carbon dioxide in the blood.
Symptoms:
• daytime sleepiness
• frequent awakenings
• morning headaches
• Insomnia
• stomach problems
• faintness
• difficulty breathing
• reduced exercise capacity.
Treatments:
• Weight loss
• Hormone treatments (hyperthyroidism)
• Substance misuse treatment
• CPAP or BPAP machines
Sleep-related hypoventilation
Common reasons for bedwetting:
• Not producing enough of the hormone vasopressin
that slows down the production of urine at night.
Low vasopressin = large quantities of urine.
• Overactive bladder. Bladders need to empty
before filling; during the day look for rushing to the
toilet, frequent urination.
• Hard to wake up – not responsive to the sensation
of a full bladder
Continence: enuresis
Ideas:
Do shift times for drinking
Do schedule bathroom breaks prior to bedtime
Do be encouraging, praise successes
Do eliminate bladder irritants in die
Do avoid thirst overload
Do consider if constipation is a factor
Don't wake children up to urinate
Don't resort to punishment, naming or shaming
Common reasons for soiling:
• not yet learned to recognise when they need to
open their bowels – under responsive
• afraid of the toilet – irrational fears
• hold on to their poo and it sneaks out later
• Constipation – soft stool can sneak past the
blockage
Continence: Encopresis
Set rules - use contracts
Set plenty of rules, children with ASC respond to clear logical rules. These can set time limits for
routines, and the contexts they are allowed to happen.
Manage stress and anxiety
Make sure daily stresses are addressed to reduce issues of constipation leading to ‘sneaky poo’
Sensory systems
Tight pyjamas/pants to contain – reduces smearing behaviours
Reinforce desired behaviours
Reward successes
Share the clean up
Encourages motivation to change
With ND…all
clocks can be
compromised!
With all sensory preferences, we need to ask:
• Is it a need or a want?
• Are they a seeker or avoider?
• Is there too much (hypersensitive) or not
enough (hyposensitive)?
Smell:
Lavender
Parent’s
scent
Distractions
Sight:
Lights
Curtains
Colours
Distractions
Vestibular:
Spinning/
twirling/
swinging
Taste:
Toothpaste
Food
Medication
Proprioception
:
Blanket
Tight pyjamas
Stretch tube
Pushing/pulling
Chew toys
Touch:
Bedclothes/
fabrics
Nightwear
Textured
covers
Sound:
Memory
foam/silicone
earplugs
White noise
Natural sounds
Décor
Distractions
Addressing
proprioceptive seeking
behaviours prior to
settling down
…can be part of a
daily diet…timing
can be crucial!
A need or a want?
Seeking the ‘just
right’ position –
avoiding too much or
not enough
The sleep environment
includes external &
internal influences
Important to consider
what we can and cannot
change…internally and
externally
Have we created
enough
opportunity
during the day to
achieve best
outcome at night?
Exercise? • A good workout can make you more alert, speed up your metabolism and
energise you for the day ahead, but exercise right before bedtime can lead to a
poor night’s sleep.
• National Sleep Foundation recommend exercising at least three hours before
bedtime; the best time is usually late afternoon.
• Exercising at this time is beneficial because body temperature is related to
sleep. Body temperatures rise during exercise and take as long as 6 hours to
begin to drop.
• Because cooler body temperatures are associated with sleep onset, it’s
important to allow the body time to cool off before sleep.
Is the layout, decor,
temperature the best/only
option for:
• Light interference
• Sound interference
• Calm inducing
• Air flow
• Optimal temperature
(low)
• ??????
Will the processing of emotions always need YOU?
This activity can be led by a you. For some, they like to have a photo or draw a picture of their ‘safe place’
(e.g. beach, outer space, favourite room), and look at it when trying to relax.
• Imagine a place where you can feel calm, peaceful and safe. It may be a place you've been to before,
somewhere you've dreamt about going to, or maybe somewhere you've seen a picture of.
• Think about the colours you see in your peaceful safe place.
• Now notice the sounds that are around you, or perhaps the silence.
• Think about any smells you notice there.
• Focus on any skin sensations - the ground beneath you, the temperature, any movement of air, anything
else you can touch.
• Now while you're in your peaceful and safe place, you might choose to give it a name, whether one word or
a phrase that you can use to bring that image back, anytime you need to.
• You can choose to stay there for a while, just enjoying the peacefulness and serenity. You can though,
leave whenever you want to, just by opening your eyes and being aware of where you are now.
Relaxing 'Safe Place' Imagery
• Yoga
• Meditation
• Mindfulness
• Programmed Muscle Relaxation
• Podcasts
• Apps
Bedtime snack?
A few ideas for pre-bed snacks are: wholemeal toast
and cheese, bagel and peanut butter, oatmeal/porridge
with bananas, or yogurt and low-sugar granola.
Vitamin deficiencies due to unhealthy food choices can
affect a child's sleep.
A daily assortment of healthy foods is ideal….a limited
diet will influence/exacerbate any sleep difficulties
Tryptophan is an amino acid that when ingested gets turned into the neurotransmitter serotonin and then converted into the hormone melatonin. Here are some of the best foods loaded with tryptophan:
• Dairy products (milk, low-fat yogurt, cheese)
• Poultry (turkey, chicken)
• Seafood (shrimp, salmon, halibut, tuna, sardines, cod)
• Nuts and seeds (flax, sesame, pumpkin, sunflower, cashews, peanuts, almonds, walnuts)
• Legumes (kidney beans, lima beans, black beans split peas, chickpeas)
• Fruits (apples, bananas, peaches, avocado)
• Vegetables (spinach, broccoli, turnip greens, asparagus, onions, seaweed)
• Grains (wheat, rice, barley, corn, oats)
Tryptophan
During the day
• Spend time outside – helps create Melatonin
• Exercise – get rid of tension and stress and burns up excess energy
• Avoid napping or dozing during the day
After school
• Get homework/tasks done
• Organise bag for next day
• Eat early enough to digest your food
• Avoid any drinks with caffeine or sugar from lunchtime
Before bed
• Try having a relaxing bath (caution!)
• Switch off electrical gear – phones, tablets, consoles (keep in a box?)…their light interferes with melatonin production
• Spend an hour ‘winding down’
• Read a book or listen to relaxing music, knit, crochet
• Stick to regular times for routine to set your body clock
• White noise app or fan on
Tips
• Avoid late nights and over long lie-ins at the weekend – impacts on routine and body clock
• Keep a sleep diary
• Aim for 9 hours or more
Transitions
Difficulty with transitions can happen in a number of ways depending on the
child and the setting. It can take the form of resistance, avoidance, distraction,
negotiation or a full meltdown.
Some of these reactions are the result of children being overwhelmed by their
emotions; some are what they have learned, works to successfully delay or
avoid the transition; especially between wake and sleep.
Consider:
• Preview & countdowns
• Transition soundtrack
• Visual cues
• Motivational rewards
• Appropriate consequences
• Praise, praise, praise
Links:
http://www.sleepscotland.org/
https://sleepfoundation.org/
https://sleepcouncil.org.uk/
https://sleep.org/
https://www.adhdfoundation.org.uk/
https://witherslackgroup.co.uk/
https://www.sensorydirect.com/
https://www.rompa.com/
https://www.multi-sensoryworld.co.uk/collections/unflavoured-toothpaste
Thank you.
Facebook: adhdfoundation
Twitter: @ADHDFoundation
WWW: adhdfoundation.org.uk
