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Understanding Sleep Challenges

Snoring, sleep, and special needs. Tips for tackling bedtime challenges.

It’s no surprise that a day spent parenting a child with special needs is equal parts rewarding, unique, exhilarating and exhausting. But the challenges of parenting a child with special needs at night often go unrecognized. In fact, many children with special needs face significant sleep challenges, a draining double-whammy that leaves millions of parents and children without much-needed rest.

The National Association of School Psychologists reports that as many as 30 percent of children may have a sleep disorder, but rates are much higher among children with special needs. Recent studies published in Pediatrics link childhood snoring and sleep apnea, or ‘sleep disordered breathing,” (SDB) to behavioral problems and an increased need for special education. In fact, SDB is strongly associated with conditions like Down syndrome and cerebral palsy.

What’s more, sleep problems can be especially devastating to children with special needs, because the resulting sleep deprivation can worsen the symptoms of their existing medical or behavioral problems, says Carole L. Marcus, M.D., director of CHOP Sleep Center in Philadelphia. And parents of children with special needs can wind up burned out.

Night Rumbles: snoring and sleep apnea

Childhood snoring is not rare: Most children snore once in a while, and 10 percent snore most nights. But these nighttime noises shouldn’t be dismissed as “normal.” Researchers now believe that snoring is on the same spectrum as sleep apnea, a disorder characterized by pauses in breathing that cause brief awakenings.

Left untreated, sleep apnea can contribute to behavioral problems and learning difficulties, even hyperactivity. A study by the American College of Chest Physicians found that children who snored loudly were twice as likely to have learning impairment. The potential impact is so severe that the American Academy of Pediatrics recommends that all children who snore be screened for sleep apnea, says Robert Heinle, M.D., of the Nemours/Alfred I. duPont Hospital for Children Sleep Lab in Wilmington, Delaware.

Other SDB warning signs include sleeping in strange positions, experiencing night terrors, bedwetting or perspiring during sleep, says Renee Turchi, M.D., board-certified pediatrician with St. Christopher’s Hospital for Children in Philadelphia.

How to help:

The good news: Nearly all otherwise-healthy children with sleep apnea respond well to having the tonsils removed, says Marcus. Back-sleeping can exacerbate snoring; regular snorers or those with sleep apnea should choose another position (“back to sleep” is still best for babies, though).

Beyond Snoring: sleep and special needs

Children with certain neurological conditions are more prone to sleep troubles stemming from differences in their muscles, bone structure and brain chemistry. According to multiple studies, over half of children with Down syndrome ages 7-11 wake during the night, and nearly 40 percent wet the bed. About two-thirds of children with Down syndrome have sleep apnea, says Marcus; a larger tongue, a small mid-face and lower muscle tone make these children more prone to SDB and apnea. Children with cerebral palsy, spina bifida and other conditions associated with low muscle tone also have higher rates of sleep apnea.

What’s more, children with autism can have difficulties with the circadian rhythm, the sleep-wake cycle that governs wakefulness and sleep, driving them to stay up too late and struggle to wake in the morning, says Marcus. “Our brains regulate sleep, so if the brain is abnormal for any reason, sleep is going to be impacted, too.”

How to help:

Though some special-needs sleep problems are physiological in nature, such as those related to low muscle tone, many are behavioral, such as habitual night wakings, waking too early in the morning, or fighting bedtime. “Often, parents may not set the same bedtime limits for children with special needs that they set for other children,” says Marcus.

Your child’s pediatrician may prescribe medication for sleep disturbances, or suggest non-pharmaceutical interventions, like melatonin supplementation, additional magnesium before bed (known to relax muscles and promote more restful sleep), or nutritional adjustments. And, as always, defining clear parameters for sleep—including when bedtime occurs, where a child sleeps, and what is an acceptable hour to wake in the morning—and gently yet firmly enforcing these household rules, night after night, can help get sleep on track for children with special needs.

Medications That Impact Sleep

Some medicines can negatively impact sleep for children with special needs. Talk to your pediatrician if your child experiences sleep problems and takes any of these medicines (do not discontinue a medicine or change dosage without discussing it with your child’s primary-care physician).

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