Telemedicine May Be Helpful in the Treatment of Sleep Disorders

Telemedicine May Be Boon for Treating Sleep Disorders

Reimbursement uncertainty remains roadblock to wide adoption

by Salynn Boyles 
Contributing Writer.

Precedent suggests that there is a future for telemedicine in the treatment of sleep disorders but adoption of the technique has been slow. -JR

DENVER -- Telemedicine is a potentially game-changing strategy for treating patients with obstructive sleep apnea and other sleep disorders, but it is not yet widely utilized, an expert reported here.

Uncertainty about reimbursement remains a major roadblock to the wider use of telemedicine in sleep medicine, said Jaspal Singh, MD, of Carolinas HealthCare System, Charlotte, North Carolina.

ingh spoke about the potential for telemedicine to improve patient outreach and outcomes in an afternoon session delivered June 14 at SLEEP 2016, the 30th anniversary meeting of the American Academy of Sleep Medicine (AASM). He also co-authored a recently published AASM position paperin support of its use in the field.

"Telemedicine is coming, and if we as sleep providers don't offer it, someone else will," he said.

In an interview with MedPage Today, Singh said while reimbursement models have not been quick to adopt telemedicine, he expects that to change over the next few years.

"Sleep medicine is more suited to telemedicine than many other specialties because we don't rely as much on the physical examination of the patient," he said. "A lot of what we learn about a patient comes from talking with them and taking their history."

FULL ARTICLE HERE:

The link between sleep and children's mental health is...complicated...

A study indicates that a link exists between children with sleep disorders and their mental health.

Toddlers who take a long time to fall asleep or wake up many times during the night have put many a desperate mom and dad to the test. Tired parents are often told that night waking is part of toddlerhood, and that it will soon pass on its own, but this is not the case for everyone.

Researchers at NTNU's Department of Psychology have conducted a comprehensive survey of nearly 1,000 toddlers that shows that serious sleep disorders in young children can have long-term consequences.

The study shows that four-year-olds with sleep disorders have a higher risk of developing symptoms of psychiatric problems as six-year-olds, compared with children who sleep soundly.

At the same time, four-year-olds with psychiatric symptoms have a greater risk of developing a sleep disorder as six-year-olds, compared with children who do not have these kind of symptoms.

Reciprocal relationship

"It is common for children to have periods when they sleep poorly, but for some children, the problems are so extensive that they constitute a sleep disorder. Our research shows that it is important to identify children with sleep disorders, so that remedial measures can be taken. Sleeping badly or too little affects a child's day-to-day functioning, but we are seeing that there are also long term repercussions," says Silje Steinsbekk, an Associate Professor and Psychologist in NTNU's Department of Psychology.

Her previous research on the relationship between sleep disorders and psychological problems in children has shown that four-year-olds with sleep disorders often also show symptoms of psychiatric problems.

The new study, which was recently published in the Journal of Developmental & Behavioral Pediatrics, shows that the correlation between sleep disorders and psychiatric disorders is also found over time and that the relationship is reciprocal.

Thorough interviews and diagnoses

We know that 20-40 per cent of young children struggle with sleep in one way or another, but we lack data on how many of them are suffering from a diagnosable sleep disorder.

NTNU researchers conducted diagnostic interviews with the parents of the children participating in the study. The interview was based on the DSM-IV diagnostic manual, which contains the official diagnostic criteria for mental disorders.

One thousand four-year-olds participated in the study. Parents of around 800 of these children were interviewed again two years later. The comprehensive study is part of a longitudinal study in Trondheim that examines the incidence, progression and risk factors for the development of mental health problems in children. The project conducts follow-up visits with the children and their parents every other year.

"Previous studies of sleep problems in children have mainly used a questionnaire format, with questions like, "Does your child have trouble sleeping?" But what parents define as sleep problems will vary. In the diagnostic interview we ask parents questions until we are confident that we have enough information to assess whether a symptom is present or not. The information we've collected is more reliable than information obtained from the questionnaire," says Steinsbekk.

What comes first?

Can we say that poor sleep causes psychiatric problems -- or do psychiatric problems cause poor sleep? The findings from the study suggest that the relationship goes both ways.

One possible explanation for this reciprocity may be that both conditions are biologically determined, by common underlying genetics, for example.

Another explanation may be that insufficient sleep creates general functional impairment, and that the risk of other problems therefore increases -- in the same way that psychiatric symptoms often result in poorer everyday functioning, which in turn may negatively affect sleep.

Vicious cycle

Perhaps sleep disorders and mental health issues share the same risk factors. A child who shows signs of anxiety or a behavioural disorder may easily end up in a vicious cycle, where conflict with adults triggers anxiety and in turn leads to trouble falling asleep.

It may also be that difficult and negative thoughts steal both energy and sleep and make us restless and depressed if we fail to gain control over them.

"Given that so many children suffer from insomnia, and only just over half 'outgrow it,' it is critical for us to be able to provide thorough identification and good treatment. Perhaps early treatment of mental health problems can also prevent the development of sleep disorders, since psychiatric symptoms increase the risk of developing insomnia," says Steinsbekk, stressing that this is something that must be examined in further research.

Insomnia is most prevalent The study shows that insomnia is the most prevalent sleep disorder. Children who suffer from insomnia struggle with falling asleep and frequent waking. Insomnia was diagnosed in 16.6 per cent of the four-year-olds surveyed, and 43 per cent of these still had insomnia as six- year olds.

Insomnia in four-year olds increases the risk for symptoms of anxiety, depression, ADHD and behavioural problems as six-year-olds. After the researchers had taken into account the children's psychiatric symptoms at age four, the relationship between insomnia and ADHD disappeared.

Similarly, children who show symptoms of anxiety, depression, ADHD and behavioural disturbances as four-year-olds have a greater risk of developing insomnia as six-year-olds. When symptoms of insomnia at age four were adjusted for, the relationship between insomnia and anxiety disappeared.

Examples of other types of sleep disorders are hypersomnia, i.e. an extreme urge to sleep, and various cases of parasomnia, such as nightmares, night terrors and sleepwalking. These conditions are uncommon, and the study also shows that, with the exception of sleepwalking, they are shorter-lived.

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How sleep can affect your heart

This article describes the negative effects of getting a poor night's sleep, especially on your heart.

You might think that those nights when you don’t get a wink of sleep can’t do you any harm apart from the frustration you feel knowing that you have to work the next day and you might be asleep at the wheel.

However, sleep disorders have been associated with many conditions that you might develop later on in life. There are studies proving that insomnia or very few hours of sleep per night are linked to memory loss or to strokes as you become older.

Thus, it was proved that people who have the tendency to sleep less than seven hours every day are more likely to suffer a stroke.

A new research now shows that fewer hours of sleep every night might also be a cause for heart attacks later on in life.

The study conducted by researchers at World Health Organization revealed that sleeping disorders are as bad for your heart as smoking or leading a sedentary life.

“Sleep is not a trivial issue. Sleeping disorders were associated with greatly increased incidences of both heart attack and stroke. Poor sleep should be considered a modifiable risk factor for cardiovascular disease along with smoking, lack of exercise and poor diet,” said Professor Valery Gafarov.

He also added that a normal person should sleep between 7 and 8 hours every night and, if they don’t manage to do that, they should seek specialized help from a sleep doctor.

The study, which began in 1994, involved 657 men whose ages varied from 25 to 64 years old, from Russia. They had never suffered any heart attack or stroke and they did not have diabetes, which is a disease that can lead to these conditions.

Their sleep quality was rated according to the Jenkins Sleep Scale and it was regarded as either very bad, bad or poor for those who had a sleeping disorder.

They were monitored for heart attacks and strokes over the next 14 years and it was revealed that 63 percent of those who suffered a heart attack also suffered from a sleeping disorder.

Therefore, it was shown that people who had sleeping problems were more than 2 times more likely to have a heart attack and 1.5 to 4 times more at risk of having a stroke that those who had a  normal sleep every night.

These findings are extremely worrying, given the fact that the mortality rate associated with heart attacks is extremely high. It was estimated that it represents half of the causes of death all over the world, making it the leading cause in many countries, including the U.S.

This is why preventive measures are extremely important. We need to sleep well, exercise regularly, avoid smoking and drinking alcohol, eat healthy food and maintain a normal body weight.

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The link between insomnia and chronic pain

This study looks into a potential link between insomnia and chronic pain.

People who have problems sleeping may also be more sensitive to pain, thus potentially worsening the effects of chronic pain conditions, new research from Norway shows.

In the study, researchers measured pain sensitivity in more than 10,000 adults who were participants in the Tromsø Study, an ongoing public health study in Norway that began in 1974.

The results of the study showed that people who had insomnia were more sensitive to pain than people who didn't have sleep problems. In particular, people who were experiencing chronic pain and who also had insomnia showed a greater increased sensitivity to pain. Pain sensitivity was also linked to the amount of time it took to get to sleep.

The findings show that "the need to improve sleep among chronic pain patients, and vice versa, is evident," the study authors, led by Børge Sivertsen of the Norwegian Institute of Public Health in Bergen, Norway, wrote in their article.

In the study, the researchers first asked questions of the participants about their experience with insomnia, how long it took them to fall asleep and other sleep issues. For example, participants rated their experiences with insomnia during the previous year on a four-point scale, ranging from "never" to "more than once a week." Out of all of the participants, 10.5 percent had what the researchers considered an insomnia disorder.

The participants then completed the cold-pressor test — a standard method used to mimic chronic pain in which people are asked to place their hands in cold water for a set period of time. People who remove their hands early show a decreased tolerance to pain. In this study, the participants were asked to keep their hands in water at 3 degrees Celsius (37 degrees Fahrenheit) for 106 seconds.

The results showed that 42 percent of patients who had insomnia took their hands out of the water before the 106 seconds were up, whereas only 31 percent of all of the participants did so. This increased sensitivity to pain was greater in those with more severe or more frequent insomnia. For example, people who had insomnia once a week were 52 percent more likely to take their hands out of the water early, compared to those without insomnia. Moreover, patients who had insomnia monthly were 24 percent more likely to take their hands out of the water early.

The total amount of time that people spent sleeping showed no effect on their pain tolerance, according to the study.

The link between sleep problems and chronic pain appeared especially pronounced, according to the study. The patients with both severe insomnia and chronic pain were more than twice as likely to take their hands out of the water earlyas participants who had neither condition. This effect was "synergistic," meaning the two conditions combined had a greater effect than one would expect from just summing their individual effects, the study authors reported.

That synergy between chronic pain and sleep disorders suggests health care providers should consider jointly treating the two conditions in some patients, the authors stated. Both cognitive-behavioral therapy and medications are used to treat the two conditions separately, the authors noted, so further studies should look at using these methods to treat the conditions together.

Future research should look into not only clinical implications, but also the role of neurotransmitters in the co-occurrence of sleep disorders and pain, the authors said.

Read more here

Childhood sleep disorders could hurt a child's heath

When you think of sleep disorders in children, the first types likely to spring to mind are night terrors, nightmares and sleepwalking. These fall into a class of sleep disorders known as parasomnias.

It is estimated that up to 6.5% of children - particularly those aged 4-12 years - experience night terrors, defined as episodes of intense fear, screaming and flailing during sleep. Approximately 3% of preschool and school-aged children experience nightmares, while up to 15% of children aged 4-12 years sleepwalk.

Perhaps less associated with children and adolescents is insomnia and obstructive sleep apnea. In fact, insomnia, the inability to fall asleep or frequent awakening, is estimated to affect around 25% of children and teenagers. Obstructive sleep apnea - when an individual stops breathing for long periods during sleep - affects around 2-4% of children.

What are the causes and symptoms of childhood sleep disorders?

There are a number of factors that can cause childhood and adolescent sleep disorders.

Just like adults, children and teenagers can experience stress, which can interfere with sleep. Consumption of energy drinks - which contain caffeine - is also known to disrupt sleep, as is use of certain medications, such as antidepressants and corticosteroids.

Children and adolescents are also more likely to develop sleep disorders if they have a family history of such conditions, and poor sleep habits, or poor "sleep hygiene" - such as going to bed at irregular times or attempting to sleep in an inadequate environment - can negatively affect sleep quality.

Increasingly, researchers are pointing to the use of technology as a driver for sleep disorders. Last month,Medical News Today reported on a study published in BMJ Open that found children are 50% more likely to have problems getting to sleep if they spend 4 hours a day or more using media devices.

"In adolescents, with the increase in popularity of technology, many teens are staying up very late communicating with friends on smartphones and tablets. The stimulation and light exposure from these devices are associated with late bedtimes and insomnia," Dr. Neil Kline, a sleep physician and internist at the American Sleep Association, told MNT.

Although often harmless, snoring can be a major indicator for a sleep disorder in children and adolescents. It can be a sign of sleep apnea or disturbed sleep quality.

Other symptoms of sleep disorders to look out for include difficulty getting to sleep, daytime fatigue, poor memory, lack of concentration, reduced attention span, irritability and mood swings, hyperactivity and depression.

"If there is any concern for a sleep problem, such as a child taking longer than 20-30 minutes to fall asleep, not sleeping through the night after about age 1 year, or snoring, it is important to discuss this with the child's pediatrician, health care provider or a sleep doctor," Dr. Shalini Paruthi, a spokesperson for the American Academy of Sleep Medicine (AASM), told us.

Children and teenagers are not getting enough sleep

According to recently updated recommendations from the National Sleep Foundation (NSF), the number of hours sleep children and adolescents need is as follows:

Over the past 20 years, the number of hours teenagers sleep each night has fallen.

• Newborns (0-3 months): 14-17 hours a day
• Infants (4-11 months): 12-15 hours
• Toddlers (1-2 years): 11-14 hours
• Preschoolers (3-5 years): 10-13 hours
• School-age (6-13 years): 9-11 hours
• Teenagers (14-17 years): 8-10 hours.

However, it seems many children and teenagers are failing to meet sleep recommendations.

A 2014 poll from the NSF, which asked parents to estimate how much sleep their child gets on a school night, found that children aged 6-10 are only getting around 8.9 hours sleep a night, while 13-14-year-olds are only getting around 7.7 hours sleep each night.

More recently, MNT reported on a study published in the journal Pediatrics revealing that the number of hours teenagers sleep each night has declined over the past 20 years.

The study, which involved more than 270,000 adolescents, found that 72% of 15-year-olds were getting at least 7 hours or sleep each night in 1991, but this fell to only 63% in 2012.

"Declines in self-reported adolescent sleep across the last 20 years are concerning and suggest that there is potentially a significant public health concern that warrants health education and literacy approaches," said lead study author Dr. Katherine W. Keyes, of Columbia University's Mailman School of Public Health.

But why is lack of sleep among children and adolescents a public health concern?

Sleep deprivation linked to obesity, diabetes and heart problems

Sleep deprivation can cause a number of health problems for children and adolescents, both in childhood and adulthood.

In 2011, a study published in The BMJ claimed that children who do not get enough sleep are at significantly higher risk of becoming overweight, compared with children who get sufficient sleep.

Another study published in The Journal of Pediatrics in December 2014 reported a similar finding, associating severe lack of sleep and sleep-disordered breathing in early childhood with increased risk of obesity.

The researchers found that children with the shortest sleep time at the ages of 5 and 6 years were at 60-100% increased risk of obesity by the age of 15, compared with children with sufficient sleep times.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented," commented lead study author Prof. Karen Bonuck, from the Albert Einstein College of Medicine of Yeshiva University in New York, NY.

In March last year, another study published in the same journal found that overweight adolescents who do not get enough sleep may be at increased risk of diabetes, heart disease and stroke.

Past studies have also associated sleep apnea in children with delayed growth and heart failure.

Lack of sleep 'makes it nearly impossible for children to reach their full potential'

It is widely accepted that sleep is important for learning and memory. In June 2014, MNT reported on a study that suggested as such. It found that sleep after learning boosts growth of connections between brain cells, helping them to communicate with each other.

A more recent study found that sleep is particularly important for infants' learning skills. Published in theProceedings of the National Academy of Sciences, the researchers revealed that infants aged 6-12 months who had at least one 30 minute nap within 4 hours of learning a new skill were much more likely to demonstrate the skills they learned once they awoke.

With findings such as these, it is no wonder that lack of sleep and poor sleep quality has been associated with poor learning and educational attainment among children and adolescents.

A 2013 study conducted by researchers from Boston College in the UK found that sleep deprivation was a major contributor to poor grades in numerous countries. While taking literacy tests, 76% of American 9-10-years-olds were identified as sleep-deprived, and these students were found to have poorer results.

"I think we underestimate the impact of sleep. Our data show that across countries internationally, on average, children who have more sleep achieve higher in maths, science and reading. That is exactly what our data show," study co-author Chad Minnich told BBC News.

Dr. Paruthi believes sufficient sleep is crucial for a child's overall health and development. She told MNT:

"Sleep disorders in children and teens can hinder them in school, in social situations, in development and nearly every other aspect of their lives, with the negative impact potentially extending into adulthood. Without healthy sleep, it will be nearly impossible for children to reach their full potential."

Parents should not assume children will 'grow out' of sleep disorders

It is possible that as a child or teenager gets older, symptoms of their sleep disorder may ease. This is most likely for parasomnias, such as sleepwalking and night terrors.

But in some cases, sleep disorders can persist well into adulthood. "For example, children who have sleep apnea are more likely to develop sleep apnea as adults," noted Dr. Kline.

As such, sleep physicians say parents should not ignore signs of sleep disorders in children with the assumption they will "grow out" of them.

"Parents should never assume that their child will grow out of a sleep disorder," Dr. Paruthi told us. "Parents should talk to their child's doctor about how their child sleeps and discuss any potential sleep problems. It is important for a doctor to monitor sleep problems during childhood, identify any underlying causes and prescribe appropriate treatment when necessary."

Depending on what form of sleep disorder a child has, there are a number of treatments available. Doctors may recommend a melatonin supplement, for example. Melatonin is a natural hormone made by the body that helps regulate sleep.

Cognitive behavioral therapy may also be useful, in which psychological approaches - rather than medication - are used to improve a child's sleep time and quality.

Tips to improve a child's sleep

But while there are a number of therapies that can help treat symptoms of sleep disorders, there are many things the NSF say parents can do to improve the likelihood of their child getting a good night's sleep:

The NSF say parents should ensure their child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep.

• Make sleep a primary health priority in your family
• Talk to your child about the importance of sleep for their health and well-being
• Set regular bedtimes for yourself and your children and stick to them
• Be aware of how your child is using media devices in the bedroom and set boundaries for use before bedtime
• Ensure you and your child are educated on how light from media devices may impair sleep
• Rather than watching TV, playing video games or browsing the Internet before bedtime, encourage your child to read a book or listen to music
• Ensure your child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep
• Talk to your child's teacher to find out about their alertness during the school day, and ask them to inform you if they fall asleep in lessons.

To find out more about how to improve your child's sleep, visit the NSF website. Our Knowledge Center articles provide more general information on specific sleep disorders, including obstructive sleep apneaand insomnia.

Tips to beat insomnia

This article gives 10 tips to help you beat insomnia.

Insomnia is the inability to get enough sleep needed to wake up feeling refreshed and well-rested.  Millions of people are suffering from this sleeping disorder.   You can cure insomnia without the additional cost of medication with just little changes in your lifestyle.

1. What you drink and eat before bedtime are also factors that can induce insomnia.  Cut down on alcohol, and do not eat heavy meals before bedtime.  Stick to light snacks and chamomile tea.Cut the caffeine – caffeine is a stimulant.  Cut down on other drinks and foods that have caffeine also, like sodas, teas, and tiramisus.  Coffee should be drank in the morning or at least eight hours before sleep.
2. Keep a quite, dark, and cool bedroom – an uncomfortable sleeping area will not induce sleep. Noise, light, and heat interfere with sleep.
3. The bed is for sleeping and sex – train your brain and body that the bed is for sleeping and sex. Doing office work and reading in bed is a no-no.  The goal is to associate the bed with relaxation and sleep.  Avoid watching TV while lying down in bed, watching TV stimulates your brain to think.  It may make your eyes tired, but the brain is busy converting images to thoughts.  Better yet, transfer the TV to the living room.
4. Avoid naps – try hard not to get that super nap in the afternoon. Naps disrupts sleep at night.  If you really can’t avoid it, limit it to 30 minutes before 3 pm.
5. Quit Smoking – nicotine, like caffeine, is a stimulant. The more you smoke, the more awake you’ll be.  Aside from the hazards of smoking, quitting will do wonders on your sleeping habits.
6. Change the way you think about insomnia – self-defeating thoughts help fuel insomnia. Think positive.  Instead of thoughts like “It’s the same every night,  another night of misery’, think this way instead “This does not every nught, some nights I get enough rest.”  Don’t worry too much, quit this mental habit.
7. Do away with stressful situations before bedtime – avoid heated discussions, heavy mental activities, even strenious activities before bedtime. Try some relaxing activities instead, listening to soft music with keeping the lights low will help in relaxing the brain.
8. Ban Blue Light in the bedroom – Short waves from blue light interferes with sleep. Use devices that have blue light an hour before going to sleep.  This includes TV, cellphones, and digital clocks.
9. Fat or Flat – not the body types, this refers to pillows. The discomfort you give your necks affects the quality of sleep, aside from having a sore neck upon waking up.  Pillows should be just the right size.  Side sleepers should have their nose align with the center of the body while sleeping.  Stomach sleeping should be avoided as this cranes the neck.
10. Control your body clock – go to sleep and wake up around the same time daily, irregardless if its a holiday or a weekend the next day. Our bodies have biological clocks and it is light regulated.  Try getting a ray of sunshine the minute you wake up, for 5 to 30 minutes.

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Study shows many fire fighters have sleep disorders

A recent study reveals that many fire fighters suffer from sleep disorders.

Sleep disorders are independent risk factors for heart attacks and motor vehicle crashes, which are the two leading causes of death for firefighters in the United States. In a national sample of almost 7,000 firefighters, researchers at Brigham and Women's Hospital (BWH) examined the prevalence of common sleep disorders and their association with adverse health and safety outcomes and found that sleep disorders are highly prevalent, and associated with substantially increased risk of motor vehicle crashes and cardio-metabolic diseases among firefighters.

Findings of the study, led by Laura K. Barger, PhD, associate physiologist in BWH's Division of Sleep and Circadian Disorders, are published in the Journal of Clinical Sleep Medicine on November 13, 2014.

"Our findings demonstrate the impact of common sleep disorders on firefighter health and safety, and their connection to the two leading causes of death among firefighters," said Barger. "Unfortunately, more than 80 percent of firefighters who screened positive for a common sleep disorder were undiagnosed and untreated."

Based on specific criteria, 66 US fire departments were selected to participate in a workplace based sleep disorders screening and educational program. Approximately 7,000 firefighter participants were assessed for common sleep disorders. Firefighters were also surveyed about health and safety, and documentation collected for reportedmotor vehicle crashes.

Participants reported current health status, previous diagnoses of sleep and other medical disorders, the likelihood of falling asleep while driving, motor vehicle crashes, near crashes, and injuries.

Researchers found that a total of 37.2 percent of firefighters screened positive for sleep disorders including obstructive sleep apnea, insomnia, shift work disorder and restless leg syndrome. Firefighters with a sleep disorder were more likely to report a motor vehicle crash and were more likely to report falling asleep while driving than those who did not screen positive. Additionally, firefighters with sleep disorders were more likely to report having cardiovascular disease, diabetes, depression and anxiety, and to report poorer health status, compared with those who did not screen positive.

"Occupational sleep disorder screening programs can identify individuals who are vulnerable to adverse safety and health consequences, including those that are leading causes of death in firefighters," stated Charles Czeisler, PhD, MD, FRCP, chief, BWH Division of Sleep and Circadian Disorders. "This study provides the rationale for further research evaluating the effectiveness of occupational sleep disorders management programs on disease risk, mental health and safety outcomes."

Read more here

Sleep issues in children with mental health diagnoses

Sleep issues are common among children with mental health diagnoses, and may go undiagnosed due to the co-existing conditions.

Sleep difficulties, particularly problems falling asleep, are common among toddlers and preschoolers with mental health issues, according to a new study.

"Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschool adjustment, and problems of irritability, hyperactivity and attention," said the study's leader, John Boekamp, clinical director of the pediatric partial hospital program at Bradley Hospital in Providence, R.I.

However, he said, sleep disorders may be unrecognized and underdiagnosed in young children, particularly when behavioral or emotional problems are present.

The study, published online in Child Psychiatry & Human Development, involved 183 children aged 6 years or younger receiving outpatient treatment for psychiatric problems. The researchers examined the prevalence of sleep disorders among these children and the nature of the sleep problems.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings. Collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp in a hospital news release.

Recognized sleep disorders, particularly sleep onset insomnia, were more common than expected, the researchers found. Overall, 41 percent of children in the study met the criteria to diagnose a sleep disorder.

Sleep problems were most common in kids with disruptive behavior, and attention, anxiety and mood problems, the researchers found.

Early sleep problems could not only be the result of behavioral and emotional problems, but could also contribute to them, the researchers noted.

"Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms, and psychiatric symptoms affecting their sleep-wake organization," said Boekamp. "It is important for families to be aware of how important sleep is to the behavioral adjustment and well-being of young children."

Sleep problems can complicate treatment for challenging behaviors, such as aggression and attention and mood problems. Daytime sleepiness and fatigue can make these problems even worse, the study's authors noted.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp.

"Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment," he explained.

Read more here

Sleep and Childhood Concussion - Brain Injury. Often Problematic. Often Overlooked.

Following brain injury, sleep disorders are often overlooked in the care of children, teens and young adults. JR
Sleep disorders in children with traumatic brain injury: a case of serious neglect

1. Gregory Stores^1,* and
2. Rachel Stores²

Article first published online: 12 MAY 2013

"Findings in the following recent studies illustrate the frequent persistence of disturbed sleep, which clearly has implications for rehabilitation. Castriotta et al.[9] reported the presence of sleep disturbance in 46% of adult patients at least 3 months after TBI; Baumann et al.[10]described 72% of adults with TBI as having sleep disturbances 6 months after the injury that were not present before the accident; Fogelberg et al.[11] found persistent sleep difficulties in 44% of rehabilitation patients 1 year after TBI, and in the subsequent study by Baumann's group[12] such sleep problems were shown to be still present 3 years after injury in two-thirds of patients.

Studies of TBI and sleep disturbance in children are few, and the findings can be inconsistent.

 Using retrospective parental reports for pre-injury sleep and repeated prospective post-injury assessments up to 2 years, Beebe et al.[13] described children aged 6 to 12 years with severe TBI as being at increased risk for post-injury sleep problems compared with those with moderate TBI and a comparison group of children with only an orthopaedic injury. I

n contrast, a small group of 7- to 12-year-old children with a mild TBI 6 months before assessment were said to have greater sleep disturbance than children with orthopaedic injuries.[14] 

In a small-scale study, Kaufman et al.[15] found that adolescents who had suffered a minor head injury 3 years previously still complained of severe sleep disturbances and showed polysomnographic and actometry results in keeping with their complaints. 

Subsequently, researchers from the same group followed a larger number of adolescents who had suffered a minor head injury up to 6 years previously, and found that over a quarter still had subjective sleep disturbance.[16]

A more recent prospective study over 2 years of children aged up to 17 years of age who had experienced TBI confirmed a higher rate of sleep disturbance (with more prolonged duration) than comparison children who had experienced an orthopaedic injury.[17] 

Risk factors included pain, psychosocial factors, and mild TBI, which has been reported to be possibly more closely correlated with an increased likelihood of sleep disturbance than severe forms of TBI.[18] The counter-intuitive recurrent theme that mild TBI particularly seems to predispose to sleep disturbance is just one of the many current imponderables in this area of enquiry."

Aim

The aim of this study was to review the basic aspects of sleep disturbance in children with traumatic brain injury (TBI).

Method

A search was performed on reports of sleep disturbances in children who had suffered TBI. Adults with TBI were also considered to anticipate the nature and significance of such disturbances in younger patients. Types of reported sleep disturbance were noted and their possible aetiology and management considered.

Results

Sleep disturbance has consistently been associated with TBI but the literature suggests that this aspect of patient care is often inadequately considered and there has been little research on the subject, especially in relation to children. Excessive daytime sleepiness is often mentioned, less so insomnia and parasomnias, but there is little information about the specific sleep disorders underlying these problems.

Interpretation

Sleep disorders with potentially important developmental consequences have been neglected in the care of children with TBI. Screening for sleep problems should be routine and followed, if indicated, by a detailed diagnosis of the child's underlying specific sleep disorder, the possible aetiology of which includes neuropathology and potential medical, psychological, or psychiatric comorbidities. Appropriate assessments and modern treatment options are now well defined although generally underutilized. Further well-designed research is needed for which guidelines are available.

LINK to Full Article HERE