Sleep Disorders in Childhood

Question 1

management of sleep onset association behavioural insomnia of childhood

Answer 1

o Reassurance, give opportunities to self-soothe o Healthy Sleep Practices
§ Physiologic: decrease caffeine, avoid screen time 1-2hr prior, keep electronics out, exercise § Scheduling: be consistent

Question 2

management of behavioural insomnia of childhood, limit-setting type

Answer 2

o Short bedtime routine (<30min) that is pleasant and consistent
o Praise + reinforcement for participation in routine
§ Sticker chart

Question 3

outline the sleep requirements for toddlers, newborns and for 6mo

Answer 3

Requirements: 16-18hr/day as a newborns; around 2-3mo will have increasing nocturnal consolidation; by 6mo typically 10-12hr/night + 2 daytime naps (total 12-16hr/d); toddlers need 11-14hr/d (including 1-2 naps)

Question 4

outline the sleep onset associatino vs limit-setting types of behavioural insomnia of childhood

Answer 4

sleep onset: frequent/prolonged night wakings. can be positive (independent, self-soothing), or negative (need for parental intervention)

limit setting: kid refuses to go to bed at an appropriate time, stalls despite being sleepy

Question 5

describe nocturnal consolidation

Answer 5

in infancy, the sleep-wake cycle is polyphasic and influenced by hunger/satiety. they sleep around the clock and wake up based on needs

• at around 2-3 months og age, nocturnal consolidation happens were most of the baby’s sleep happens at night: typically 10-12 hours of sleep at night with two day time naps, 1-3 hours each for a total of 12-16 hours a day.

Question 6

difference between nightmare disorder and non-rem parasomnia night terrors

Answer 6

nightmare disorders: usually kids remember, preseved recall, they awaken with no disorientation

non-rem parasomnia (night terror subtype): while they are having the night terror, it is very difficult to arouse them. they are usually screaming and very difficult to console.

Question 7

most common sleep disorder in adolesence. Complications, investigations and management

Answer 7

delayed sleep phase syndrome: Definition: habitual sleep-wake times delayed >2hr (relative to conventional clock times) leading to chronic sleep deprivation

Epi: 10% in adolescent

Investigations: r/o mood disorders

Complications: excessive daytime sleepiness (issues with reaction time, mood, attention, memory, behavioural control, motivation), academic problems, truancy, use of stimulants, increased risk-taking behaviours

Management: education on healthy sleep practices, relaxation strategies, sleep restriction, light therapy, chronotherapy (delayed sleep onset for 3hr/d until falling asleep at desired time), melatonin