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Snooze it or Lose It

This article explores the need for sleep and its impact on various aspects of health, including physical, mental, and emotional wellbeing. It discusses the effects of sleep deprivation on learning, coordination, behavior, and family stress. The article also highlights the connection between poor sleep and obesity, diabetes, and cardiovascular disease. Additionally, it provides information on sleep duration recommendations for different age groups and discusses the prevalence of sleep disturbances in children and individuals with developmental disabilities. The article concludes with positive sleep practices to improve sleep quality.

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Snooze it or Lose It

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  1. Snooze it or Lose It by Annie O’Connell Senior Occupational Therapist, Sleepwise Project RISE, November 2010

  2. Need for sleep

  3. Snooze it or lose it • Health • Emotional wellbeing • Sensory processing • Learning • Coordination • Behaviour • Family Stress

  4. Motor vehicle accidents • Fatigue is a factor in up to 30 per cent of fatal crashes • Not sleeping for 17 hours has the same effectas Blood Alcohol 0.05 • Not sleeping for 24 hours has the same effectsas Blood Alcohol 0.10

  5. Poor sleep in adults Linked to: • Obesity (leptin and ghrelan) • Diabetes • Cardiovascular disease Research now links similar health outcomes with adolescents and children.

  6. The Sleep Diet • Neurotransmittors • Leptin – register food, stop eating • Ghrelin – need to eat more • Study sleep restriction from 8hr to 5 hrs 15.5% decrease in Leptin and 14.9% increase in Ghrelin • !?!Perhaps the best diet to suggest is SLEEP!?!

  7. Average typical sleep time New born 16–18 hours Young child 12–14 hours Child 10–12 hours Teenager 8–10 hours Young adult 7.5–8.5 hours Adult 7–8 hours Older adult 6–6.5 hours

  8. USA (Carskadon 2007) 40% had 4+ electronic devices: slept 30 minutes less Australian (Dollman et al 2007) 10–15 yr olds: sleep less with age Obese/overweight: sleep 20–30 minutes less Compared with 1985–2004: sleep average 30 minutes less SA (Reynolds 2010) 14–16 yr old girls: sleeping less than 9 hours and linked with mobiles, email, computer and TV/DVD SA (Short 2010) Years 9,10,11 wanted more than 9 hours but fewer than 20% achieved this 1/3 overslept by 2 hours or more on weekends Adolescents

  9. Epworth Sleepiness Scale • 0 = would never doze • 1 = slight chance of dozing • 2 = moderate chance of dozing • 3 = high chance of dozing

  10. Epworth Sleepiness Scale Situation Score (0-3) • Sitting and reading _____ • Watching TV _____ • Sitting inactive in a public place(for example, in a theatre or a meeting) _____ • As a passenger in a car for an hourwithout a break _____

  11. Epworth Sleepiness Scale Situation Score • Lying down to rest in the afternoon when circumstances permit _____ • Sitting and talking to someone _____ • Sitting quietly after lunch without alcohol _____ • In a car, while stopping for a few minutesin the traffic _____ Total ___/24

  12. Epworth Sleepiness Scale Score 0–4 satisfactory daytime functioning 5–9 daytime tiredness, lack of energy >10 excessive daytime sleepiness, possible underlying medical condition

  13. Prevalence of sleep disturbance Sleep disturbance is more common in children than previously known: • 25–30 per cent of toddlers • 15–30 per cent of preschoolers • 37 per cent of younger school-age children • 40 per cent of adolescents

  14. Prevalence of sleep disturbance Jan, J. E., Owens, J. A., Weiss, M., Johnson, K., Wasdell, M., Freeman, R. D., & Ipsiroglu, O. (2008). ‘Sleep Hygiene for Children With Neurodevelopmental Disabilities’. Pediatrics, 122, 1343–1350 Sleep disturbance is extremely common(80 per cent) in the children and adults with developmental disabilities, often with a combination of sleep problems.

  15. Prevalence of sleep disturbance • People with autism spectrum disorders present with greater difficulty with getting to sleep and staying asleep • People with Down syndrome present with more sleep-related breathing disturbance Certain groups present with higher occurrence of types of sleep disturbance;for example:

  16. Parents of children with ASD • Increased stress related to child’s sleep and severity of diagnosis (Hoffman 2008) • Parents (ASD group) had more sleep problems than parents (TD group)

  17. BEARS Sleep Screening • Bedtime problems • Excessive daytime sleepiness • Awakenings during the night • Regularity and duration of sleep • Snoring Adapted from Mindell & Owens, A Clinical Guide to Paediatric Sleep—Diagnosis and Management of Sleep Problems (2003)

  18. Parent-directed question Bedtime problems: Does your child have any problems at bedtime? Yes No

  19. Parent-directed question Excessive daytime sleepiness: Does your child have difficulty waking in the morning, seem sleepy during the day or take naps? Yes No

  20. Parent-directed question Awakenings during the night: Does your child seem to wake up a lotat night? Any sleepwalking or nightmares? Yes No

  21. Parent-directed question Regularity and duration of sleep: What time does your child go to bed and get up on school days? Weekends? Do you think your child is getting enough sleep? Yes No

  22. Parent-directed question Snoring: Does your child have any loud or nightly snoring or any breathing difficulties at night? Yes No

  23. Three basic types of sleep disturbance Quantity—not enough or too many hours of sleep (duration) Quality—sleep is disrupted or fragmented Timing—sleep‑wake rhythm is not well established

  24. Positive Sleep Practices • Set a regular bed and wake time • Consistent bedtime routine • Keep the hour before bedtime relaxing • Spend time outside and exercise during the day • Keep TV viewing and use of technology in check • Avoid large meals close to bedtime, provide snack

  25. Positive Sleep Practices • Provide a comfortable bed ‘nest’, warm to cool in temperature, quiet and dark (night light if needed) • Go to sleep in the same place where you sleep all night • Limit naps to 15–20 minutes • Open curtains in the morning to signal it is time to wake up • Positive modelling of sleep habits by parents (make sleep a priority)

  26. Tryptophan • Turkey • Tuna • Almonds, cashews, walnuts, natural peanut butter • Cottage cheese, hard cheese, yoghurt, cow’s milk, soymilk • Tofu, soybeans, eggs • Bananas and avocados

  27. Avoid or limit caffeine [Caffeine] is…the only psychoactive drug legally available to children.Carroll, M. in Handbook of Substance Abuse, 1998 Maximum daily intake • children 4–6 years: 45mg/day • children 7–9 years: 62mg/day • children 10–12 years: 85 mg/day • Adults: 400–450mg/day

  28. Caffeine • Coffee (drip) (240ml) 210mg • Coffee (instant) (240ml) 110mg • Coffee (espresso) (shot) 95mg • Tea (5 minute steep) (240ml) 95mg • Tea (3 minutes steep) (240ml) 55mg • Hot chocolate (240 ml) 15mg • Regular or diet Coke (356ml) 45mg • Most other soft drinks (356ml) 0mg • Small chocolate bar 25mg

  29. Sleepwise: A Resource Manual Divided into sections • General information • Workshops 1–3 • Guidelines for individual sleep plans • Information booklet for parents • References for A–H workers • Bibliography

  30. The Sleepwise Approach—for young people with DD Sleepwise Workshops: • Sleep • Sleep Disturbance • Strategies to Reduce Sleep Disturbance Actions: • Complete sleep diary • Score Sleep Disturbance • Complete sleep interview at home • Medical check/referral for specific sleep disorders • Assess family readiness Ongoing Support: • Ongoing support over approximately 8–12 weeks from allied health worker

  31. Strategies to reduce sleep disturbance 1. Establish a routine 2. Sensory cues/needs 3. Communication cues/level • Behavioural • Timetabling of sleep • Change the bedtime • Change bedtime when not asleep • Restrict sleep • Gradual distancing of parents • Ignoring • Standard • Gradual • With parents present • Schedule awakening • Desensitisation

  32. Results N=26 Ages of children: 1yr 1mth to 7yrs 1mth Diagnosis: GDD (15) ASD (6) Other syndromes (5)

  33. Sleep Disturbance N=26

  34. Communication Strategy

  35. Sensory Strategies

  36. Behavioural Strategies

  37. No of weeks to achieve short term sleep goals

  38. Outcomes 6 months +

  39. Medical Referral Sleep problems related to • epilepsy • breathing • movement during sleep • pain • severe anxiety

  40. Where to from here Adults 1. Discuss with your GP • Home base or sleep laboratory assessment • Referral to psychologist or programme for example, Insomnia Treatment Programme, Adelaide Institute for Sleep Health at the RGH 8275 1187 2. www.adelaidesleephealth.org.au • On line quiz for sleep, apnoea and BMI calculator

  41. Where to from here Young people (0–18 years) • Disability SA (group workshops and individual) • Discuss with GP and paediatrician • Private psychologists • SOMNIA Sleep Services www.somnia.com.au • Paediatric Sleep Clinic clinic@sleepeducation.net.au

  42. Sleepwise Contact: annie.oconnell@dfc.sa.gov.au 08 8348 6500

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