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Sleep Disturbance
Child/Adolescent
| Question | Answer |
|---|---|
| Sleeping in the same bed or room as your child is damaging to children's psyches. T/F | False (children must still learn to fall asleep on their own - even in a family bed) |
| What happens when parents continue to soothe children to sleep or back to sleep? | leads to more awakenings and fracturing of a normal night's sleep |
| The only situation in which sleeping with an infant or child is potentially dangerous is: | when parent has been drinking, using drugs, or taking meds that impair their ability to awaken easily. (increases risk of SIDS - may roll over on and suffocate infant) |
| Sleep-phase Disorders | sleep cycle becomes shifted to later in the evening |
| Sleep-phase disorders can lead to: | severe difficulties awakening on time for school or other activities |
| Sleep problems are ___________ in psychiatric disorders. | True |
| Children with _______ and __________. | ADHD, Autism |
| Dyssomnia | Sleep disorders that involve difficulty staying or falling asleep |
| Parasomnia | Sleep disorders where abnormal behaviors occur during sleep such as sleep walking, night terrors, or bedwetting |
| Children with mood disorders may exhibit: | anxiety or resistance at bedtime, early and middle insomnia, desire to sleep with parents because of fears/bad moods, enuresis, nightmares, etc. |
| Over ______% of __________ adolescents report difficulties with falling and staying asleep. | 50; depressed |
| Adolescents who report sleep problems are more likely to report symptoms of depression, anxiety, poor self-esteem, lethargy, irritability, eve in the absence of a ________ ____________ __________-. | proper mood disorder |
| Adolescents who report sleep problems are more likely to consume _________, ____________, ___________, and __________, which themselves cause difficulties with sleep. | caffeine, nicotine, alcohol, drugs |
| Sleep problems should be viewed as a potential early marker for adolescents at risk of developing some sort of psychopathology. T/F | True |
| The clinical presentation of anxiety in children includes nighttime fears that commonly take the form of _____________ and age-appropriate ____________ ______________. | animals; fictitious characters (witches/monsters) – may also fear kidnapping/being teased by peers |
| Anxiety appears to predispose children to _______________ and _________. | parasomnias and nightmares |
| Electroencephalography (EEG) allows us to define: | various sleep stages |
| The brain primarily emits these while awake. | Beta waves |
| These waves appear regardless of drowsiness and represent a lack of focus and decreased visual processing. | Alpha waves |
| Someone resting will experience and ___________ in alpha waves. | resting/relaxing |
| Stage 1 sleep is characterized by Theta waves: | brain waves of greater amplitude and lower frequency (3-7 Hz) |
| Theta waves commonly appear when: | doing a repetitive task (e.g., freeway driving), daydreaming; or automatic task from which you can mentally disengage (e.g., teeth brushing, yoga, meditation) |
| Stage 2 sleep is characterized by: | high-amplitude waves (12-16 Hz) and sleep spindles |
| Sleep spindles are: | jagged runs on an EEG |
| K-complexes | larger spikes on an EEG; thought to suppress cortical arousal and aid in sleep-based memory consolidation |
| Stage 3 sleep is characterized by high-amplitude slow: | delta waves (0.5-2 Hz) (aka deep sleep); aid in hormone release, declarative memory formation |
| Parasomnias (e.g., sleep terrors, bruxism, sleepwalking) occur most often during | deep sleep (stage 3) |
| This is the final stage of sleep: | REM (aka dream sleep) |
| REM sleep is characterized by: | low-voltage random waves in a periodic sawtooth pattern (look most like waves during awake state) |
| REM constitutes _______ % sleep in infants, decreasing to ______% by age 5 | 55; 25 |
| Which two stages of sleep are homeostatic, meaning when deprived of sleep, body will default to these stages once sleep is allowed. | REM and stage 3 |
| Alpha, beta, theta, and delta waves are present at all stages of sleep. T/F | True, even if in trace amounts (vary at different stages, but present in all) |
| Sleep latency | the period of time required to fall asleep (enter stage 1) |
| REM latency | amount of time between onset of sleep and first REM period |
| REM density | Number of eye movement bursts or frequency of eye movements per minute of REM sleep |
| REM rebound | body's preference for REM when in sleep-deprived state |
| Sleep-onset REM period occurs when: | REM is entered immediately upon falling asleep (Stages 1, 2, and 3 are bypassed) – occurs with narcolepsy |
| Elderly (esp. over 70) experience little stage ____ sleep, particularly toward ____ ___________. | 3; the morning |
| The neurochemicals serotonin, norepinephrine, dopamine, histamine, glutamate, aspartate, acetylcholine, and gamma-aminobutyric acid (GABA) all play a role in sleep. T/F | True |
| The neurochemicals serotonin, norepinephrine, dopamine, histamine, glutamate, aspartate, acetylcholine, and gamma-aminobutyric acid (GABA) all play a role. T/F | True |
| Orexin | a pair of excitatory neuropeptide hormones |
| Orexigenic activity | appetite-stimulating |
| Hormones involved in narcolepsy. | Orexin |
| This hormone is synthesized by the pineal gland and released at night. | melatonin |
| What stage of sleep is growth hormone released in children? | Stage 3 |
| These contribute to energy conservation during sleep. | Reduced core body temperature and slowed metabolism |
| Anything that heats our core in the evening generally has the effect of fracturing or delaying our sleep. T/F | True (e.g. hot bath) |
| For each hour we are awake we incur a sleep debt of about _______ minutes. | 30 |
| Invdividuals only dream during REM. T/F | False, they dream in other stages; though the dreams are more fragmented and not as well remembered |
| We have significant data on the neurocognitive effects of sleep disruption on children's memory and attention. T/F | False; we have limited data on this |
| What is the most common cause of sleep-disordered breathing (SDB)? | sleep apnea |
| Roughly ______ % of children/adolescents suffer from a sleep problem at one point in childhood. | 25 |
| Narcolepsy is most often diagnosed in this decade of life. | second (though not uncommon for it to be diagnosed in third or fourth either) |
| Cataplexy | sudden loss of muscle tone |
| Cataplexy occurs more often than emotional triggers (e.g. sudden laughter) in children with narcolepsy. T/F | False; cataplexy occurs secondary to emotional triggers |
| Sleep disorders (all) are about ________ times more common among children with _________ than healthy peers and siblings, or those with other psychiatric disorders. | 5; ADHD |
| Roughly ___% of children with sleep problems in infancy will later meet criteria for _________. | 25; ADHD |
| Up to 86% of children with _______ suffer sleep problems. | ASD |
| Sleep problems are short-term, they come and go. T/F | False; they are long-standing and chronic |
| Those who tend to demonstrate increased sleep problems are often: | younger and/or have more significant cognitive delay/disability |
| Up to ____% of those with Asperger's continue to report sleep problems. | 90 |
| Commonly comorbid with sleep problems: | mood disorders |
| Insomnia is common (up to 2/3 of children) with this diagnosis: | major depressive disorder |
| Insomnia ceases once depression is treated and has lifted. T/F | False; about 10% of people continue to experience it at this point |
| Night time fears are reported by 75% of _________ children. | typical |
| Most sleep disorders in children are developmental and decrease over time. T/F | yes, for typical children/adolescents |
| SDB in children is most often due to: | enlarged tonsils/adnoids - as children age, tonsils naturally shrink |
| Primary insomnia is typically ______ onset and continues due to _________ conditioning and development of poor sleep habits. | sudden; negative |
| Gold standard of sleep studies | Polysomnogram (PSG) |
| PSG | conglomeration of tests employed to study a person during sleep |
| What measures are involved in a sleep study: | videotaped observation, EEG, EMG (monitors muscle movements), EOG (monitors eye movements), vitals, possibly heart rate |
| Actigraphy | method that allows sleep study to be performed in home (device worn on wrist) |
| SIDS requires all other: | possible causes of death to be ruled out prior to diagnosis |
| Number of general categories of sleep disturbances in the DSM-5 | 11 |
| In order to be considered a diagnosis, this must be present. | significant functional impairment |
| Behavioral insomnia | sleep difficulties arising from inadequate limit-setting by parents or allowing them to fall asleep to TV |
| Symptoms of narcolepsy may begin all at once or over a series of years. T/F | True |
| Circadian rhythm sleep-wake disorders | category for variety of difficulties of sleep disruption related to misalignment of circadian rhythm and sleep-wake schedule (e.g., shift work, etc) |
| With non-REM parasomnias, automatic arousal is characteristic as is complete __________ of the event. | amnesia |
| Hallmark of a sleep terror is: | rapid increase in pulse, blood pressure, heart rate, profuse sweating |
| Most severe REM parasomnia | occurs when body is not sufficiently paralyzed during REM sleep (more common in elderly) - act out dreams |
| Sleep paralysis (another REM parasomnia) | occurs when awaken during REM period while body is paralyzed |
| Nightmares are considered pathological if they occur twice per month. T/F | False; only if once or more per week and causes daytime functional impairment due to drowsiness |
| Nightmares are often a by-product of __________ and ___________. | anxiety and depression |
| Restless Leg Syndrome is also known as | Willis-Ekbom disease |
| Restless leg syndrome represents a neurological disorder with 4 characteristics: | 1)symptoms worse at night, 2)overwhelming urge to move affected limbs, 3) symptoms triggered by rest/relaxation/sleep, 4) symptoms relieved with movement |
| Enuresis occurs in which stage of sleep | Both REM and non-REM stages |
| For diagnosis, bed-wetting must occur: | at least twice per week for at least 3 months or must result in significant distress/functional impairment and child must be at least 5 yrs old |
| Enuresis is either primary or secondary, meaning: | primary=child has never been regularly dry; secondary=occurs in child who was previously dry for at least 6 months |
| Prior to treatment for sleep disorders, it is critical to obtain: | a complete sleep history |
| Key components of a complete sleep history include: | # of hrs child sleeps daily (incl. naps), bedtime, latency to sleep, notable awakenings, rituals to put them to sleep |
| When treating sleep, special attention should be given to difficulties with: | falling asleep, staying asleep, and awakening too early |
| early insomnia | difficulties falling asleep |
| middle insomnia | difficulties staying asleep |
| late insomnia | awakening too early |
| A ________ _______ is helpful for parents in tracking a child's sleep. | sleep diary |
| Useful tool for pediatric clinicians | BEARS (bedtime, excessive daytime sleepiness, awakenings during night, regularity of nighttime sleep and morning awakenings. |
| These reduced modifiable risk factors for infants have decreased the incident of SIDS. | sleeping in a prone position, overbundling, and secondary smoke exposure |
| When treating narcolepsy, methods to __________ ___________ _________ are key. T/F | increase daytime alertness |
| When treating insomnia (adult or child), it is important to: | collect a history of the environment in which the person sleeps and lives; other psychiatric disorders, illnesses, meds that can interfere with sleep |
| Proper sleep hygiene is sometimes curative for insomnia. T/F | True, and this should be reviewed with caregivers as a first intervention |
| The first-line treatment for insomnia (often helpful when treating other sleep disorders) is ___________. | Cognitive behavioral therapy for insomnia (CBT-I) |
| CBT-I encompasses the following techniques: | sAnything that heats our core in the evening generally has the effect of fracturing or delaying our sleep, such as a long hot shower or bath before bed. |
| CBT-I is effective for both adults and adolescents whether delivered: | 1:1, in a group, or through telehealth |
| Sleep hygiene alone has or has not been shown to be effective in treating insomnia. | has not |
| Sleep hygiene: | Routine wake/sleep times; Exercise daily, avoid caffeine, alcohol, cigarettes 6 hrs before bed; Engage in relaxing bedtime ritual; use bed only for sleep; Wake time at sunrise; Set desirable room temp |
| Effective behavioral method to use when parents have set maladaptive bedtime pattern: | leaving child alone in their room for 1 additional minute each night until child can fall asleep on own |
| If an adult or child with insomnia is having difficulty falling or staying asleep, they should not read (or be read to) in bed; rather they should | get up and read under a dim light for 10-15 minutes in another location; for children, parents should read to them before bed in another room, comfortable setting, under dim light |
| Most commonly prescribed for insomnia in children/adolescents | Melatonin (if ineffective, next step is typically antihistamines) |
| Medications prescribed for adult insomnia can also be used to treat insomnia in children. T/F | False |
| Treatment of breathing-related sleep disorders and OSA in children often involves: | a tonsillectomy and adenoidectomy |
| Parasomnias first-line treatment is: | psychoeducation; modifying antecedents (e.g., limiting fluid intake before bedtime) |
| Medications are often necessary to treat non-REM parasomnias. T/F | False; they are rarely necessary |
| Nightmare and sleep paralysis are typically treated with: | psychoeducation |
| When should a board-certified sleep specialist be consulted? | For rare cases of REM sleep disorders |
Created by:
hdemerly