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Sleep Issues in Kids with Special Needs

How to handle snoring and sleep disorders that can keep kids with special needs up all night

Sleep problems are a fact of life for many children with special needs, a draining double-whammy that leaves both parents and kids exhausted.

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. SDB is also strongly associated with 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 their existing symptoms, says Carole L. Marcus, MD, director of the Children’s Hospital of Philadelphia’s Sleep Center.

Sleep apnea linked to snoring

Most children snore once in a while, and 10 percent snore most nights. This figure skyrockets for kids with special needs, which is why it’s important not to dismiss nighttime noises as “normal.” If your child snores, have him screened for sleep apnea, a disorder characterized by pauses in breathing that cause brief awakenings.

Left untreated, sleep apnea can contribute to existing behavioral and learning difficulties, even hyperactivity. A study by the American College of Chest Physicians found that children who snore loudly are twice as likely to have a learning impairment.

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. According to multiple studies, over half of children with Down syndrome ages 7 to 11 wake during the night, and nearly 40 percent wet the bed.

SDB warning signs

Bedwetting is another SDB warning sign, as are experiencing night terrors and perspiring during sleep, says Renee Turchi, MD, a pediatrician with St. Christopher’s Hospital for Children in Philadelphia. The appearance of any of these symptoms is worth at least a discussion with your child’s pediatrician. SDB and apnea aren’t the only sleep issues that plague kids with special needs, however. 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, says Marcus. “Our brains regulate sleep, so if the brain is abnormal for any reason, sleep is going to be impacted, too.”

A better bedtime schedule

Though some of these sleep problems are physiological in nature, 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. The first step to sweet dreams: Set up a regular bedtime routine, then stick to it.

Discourage stimulation, including the use of electronics, for an hour before bedtime. Make sure your child’s room is dark, quiet, maintained at a comfortable temperature and conducive to sleep.

Defining clear parameters for sleep and gently yet firmly enforcing these rules, night after night, can help get sleep on track for children with special needs.

Malia Jacobson is a nationally published health journalist and author of Sleep Tight, Every Night.

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