Sleep Disturbances in Children with Disabilities

• By Lunzeta Brackens
• Jun 01, 2008

Sleeping soundly is typically a dream for children with disabilities. Children with cerebral palsy (CP), neurological conditions and acquired brain injuries usually have problems breathing during the night, according to Sue McCabe, senior occupational therapist and CP tech, at The Centre for Cerebral Palsy in Coolbinia, Western Australia.

There are a number of reasons why these children have a hard time breathing while asleep: impaired muscle tone (either increased, decreased or fluctuating); reduced respiratory function due to distorted chest shape; decreased compliance of the chest wall and muscles involved in breathing; increased saliva function and cough reflex; poor movement control; moving into positions that make breathing difficult and that are hard to get out of; and central apneas that may occur because of disturbed neurological function.

There is a higher risk for obstructive sleep apnea in children with certain types of disabilities because of these factors.
“We know that all people with sleep apnea have disturbances to their sleep architecture,” McCabe says. “The apnea events can cause awakenings or arousals that disturb the sleep at different stages.”

The adverse effects of inadequate sleep amplify the everyday challenges of the disability, and conversely, the challenges of the disability amplify the effects of inadequate sleep, McCabe says. It may be more difficult to get a child with a disability to do new tasks or even everyday ones. Activities as basic as sitting up straight, holding the head up, chewing and swallowing, paying attention in class and interacting with classmates become major tasks. Inadequate sleep can cause children with epilepsy to have increased severity and frequency of seizures.

A number of sleep disturbances can occur throughout the night, depriving a child with cerebral palsy, brain injury, epilepsy, autism, vision impairment and intellectual disabilities from getting the amount of sleep needed. These disturbances may include:

Pain and discomfort caused by muscle spasms and muscle tone pulling limbs into uncomfortable positions.

Pain and discomfort due to inability to change positions. Uncontrolled movements that startle the child awake can cause limbs to move into awkward (or dangerous positions) or can cause them to hit their arms or legs against the wall or side rails of the bed, which will cause them to awaken.

Breathing difficulties related to impaired cough, swallow, saliva control or reflux

Gastro-intestinal problems

Many children with cerebral palsy have difficulty with oral intake.

Effects of the feeding regime, such as irritation due to nasal gastric tubes and interruptions due to specific feeding schedules, including nighttime feedings

Discomfort due to incontinence, temperature regulation difficulties, impaired autonomic function or effects of high activity/movement level

Circadian rhythm disturbance (affecting the internal clock) caused by neurological impairment

Effects of seizures on the sleep schedule, including daytime sleepiness caused by seizures or medication and nighttime sleeplessness. Seizures also can affect the ability to sustain deep sleep.

Inability to manage the sleep environment, such as being unable to remove blankets, etc.

Many children with CP and similar difficulties miss out on physical activity and morning sunlight that are conducive to sleep.

Poorly established settling routines. Children may have difficulties settling into sleep at the beginning of the evening or when they awaken during the night. Parents may find it difficult to establish strong evening settling routines because of communication or behavior difficulties; concerns regarding the child’s pain, safety or well-being; or frequent hospitalization.

Effects of medications, splinting, serial casting or surgery

Effects of anxiety or depression

Difficulty managing levels of arousal/alertness due to sensory regulation

Effects of general health issues. Children with disabilities may be vulnerable to general health conditions, including ear infections, colds, chest infection, etc.

“It’s important to make it clear that each child will be different, as will their family, social and environmental circumstances, which all have an impact on how (children) sleep,” McCabe says.

This article originally appeared in the Respiratory Management June 2008 issue of HME Business.