Children with Sleep Children with Sleep Problems: A 24 hr concernProblems: A 24 hr concern

Dr. Manisha Witmans

Objectives

• Common myths about sleep

and their implications

for every day life• The public health burden of

care and sleep issues• Questions

Myths

Sleep is a WASTE of time, money & energy, in our 24/7 society!!!

I can do whatever I want to my sleep and still be able to

function

Desperate for Sleep

Obesity

• One in four Canadians are obese (2007-2009)

• 6-17 yrs, 8.6% obese• Cost: $3.9 billion in 2000 when linked to 8

diseases, $4.6 billion in 2008, up to $7.1 billion linked to 18 chronic diseases

The Burden…Obesity Costs

http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/oic-oac/econo-eng.php#figure-15

Risk Factors for Obesity

Nutrition and Health Symposium: Chaput JP et al. Int J Obesity 2011

Adults Risk Factor Children Risk FactorRR RR

Just Do It!!

The Vicious Truth

• Obesity is a risk factor for sleep apnea• Poor sleep is a risk factor for obesity• Lack of exercise leads to obesity• Obesity makes exercising much more

challenging and difficult• Obesity is a risk factor for many medical

problems

Behavioral Insomnia of Childhood

• Limit setting and/or sleep onset association • Influenced by: psychosocial, medical,

genetic, environmental, cultural factors• Very common, affects as many as 10-30% of

children– What happens: irritability, mood swings, hyperactivity, depressed

mood, aggressiveness, a decreased attention span, memory problems

Pediatric Sleep ProblemsChronic pediatric sleep problems may result in:

– Negative impact on child’s and family’s functioning

– Physical consequences– Emotional and cognitive

consequences– Decreased social functioning– Exacerbation of a medical,

psychiatric or developmental disorder

ADHD: Etiological Factors

If ADHD Persists …..Spectrum of Effects

• School achievements – employment• Impulsivity - impulsive life decisions• Experimentation with drugs etc – substance abuse• Carless or risky behavior – accidents and injury• Oppositional defiance – antisocial personality disorder• 50% will continue to meet ADHD criteria at age 20 years

Average Sleep Duration in Kids

Moore et al, Chest, 2006.

Age Group Recommended, hours/24 hrs

Study findings, hours/24 hrs

Infants (3-11 mo) 14-15 12.7

Toddlers (12-35 mo) 12-14 11.7

Preschoolers (3-6 yrs)

11-13 10.3

School age (1st-5th grade) 10-11 9.5

Teens (6th-12th grade) 9.25 7

Prevalence of Sleep Disorders in Children

Sleep Disorder Prevalence per study*

ADHD children

Behavioral insomnia of childhood – “learned insomnia” (bedtime refusal and night waking)

10-30% Up to 80%

Nightmares 10-50% ? similar

Night terrors 17.3% ? similar

Sleep walking 13.8% ? similar

Insomnia in children 1-6% Up to 60%

Obstructive Sleep Apnea 1-3% Up to 10%

Restless Legs and Periodic Limb Movement Disorder

2% Up to 25%

Insomnia

• $63 billion annually in lost productivity• 7,428 employees surveyed:

– 23% had insomnia• 7.8 days of work missed• $2,280 per person• WHAT ABOUT KIDS?

I think I can…..I think I can…..I think I can…..

….6450, 6451, 6452….

Sleep Time

School start times

Social pressures

Substance abuse

Hormonal influence,

obesity

Genetic predisposition

Delayed sleep phase

Drowsy Driving and Auto Accidents• The peak age group for fall-asleep driving

accidents is 20 years

www.car-accidents.com/pages/accident_story/3-8-04.html

Time of Day

Nu

mb

er

of

Cra

sh

es

100

150

200

50

250

300

350

400

450

0

0:002:00

4:006:00

8:0010:00

12:0014:00

16:0018:00

20:0022:00

Escalating occurrence of accidents across the night shift from 0:00hr to 8:00hr

Pack, A. I., Pack, A. M., Rodgman, E., Cucchiara, A., Dinges, D. F., & Schwab, C. W. (1995). Adapted 2007

Clues to Increased Need for Sleep

• Need an alarm clock to wake up daily• Excessive use of stimulants• Need or take naps• Falling asleep at unexpected times/situations• Sleeping in on weekends• Noticeable change in ability to function when

given opportunity to sleep

Sleep IS ImportantSleep deprivation can cause: • Impaired cognitive, social and behavioral performance• Poor school performance and lower grades • Tardiness and absence from school/work• Difficulty remaining alert, less ability to concentrate• Irritability and impaired mood• Increases in substance abuse• Drowsy driving, injury and possibly, death

– Being sleep deprived is as dangerous as DRUNK DRIVING

Sleep Disrupters• Caffeine• Nicotine• Alcohol• Medications• “Busy bedroom”• Exercising before bed• Eating large meals before bed• Watching television to fall asleep

Data About Television and Sleep

• Preschool children that watch television before bed have:– More disrupted sleep – More nightmares – More awakenings– More bedtime resistance

• Can cause behavioral sleep issues in children

Take care of your sleep

National Sleep Foundation; www.kidssleep.org

Sleep Promoting Tips• Consistent bedtime routine• Regular exercise earlier in the day• Avoid a busy bedroom• Avoid bright light at night• Avoid stimulating activities before bed• Avoid the sleep disrupters• Establish good sleep habits even in your children• A cool, dark, quiet bedroom

Costs Savings: Invest in the Future

• Promoting the health of young children, before five years of age, could save society up to $65 billion in future health care costs, according to an examination of childhood health – Bernard Guyer, Johns Hopkins Bloomberg

School of Public Health

Strategies to combat sleep problems

• Strategies to combat sleep problems that address the environments that encourage sleep health require:

• Massive public education about sleep and sleep health;

• health services and clinical interventions that target individuals;

• community-level interventions that directly influence individual and group behaviours;

• public policies that target broad social or environmental determinants;

• Access to specialized services for medical sleep disorders.

• Like quitting smoking, effectively preventing and treating sleep problems requires a multifaceted, long-term approach involving complementary and integrated interventions that operate at multiple levels.

Summary

• Sleep is important and worthy of being nurtured for good health– Good sleep habits are essential no matter how

old you are

• Sleep can impact many others facets of life and should not be taken for granted

• Everyone in this room can contribute to sleep health!