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Helping Children Sleep Better V. Mark Durand, Ph.D. USF St. Petersburg Slide 2 Slide 3 Slide 4 Slide 5 Slide 6 Developmental Issues By 3 months - you can fade nighttime feedings By 6 months - infants can sleep through the night Slide 7 Slide 8 Daily Schedules You can trick the brain into a different time schedule by organizing daily activities Meals Dressing Washing Slide 9 Bright Light Therapy Different devices Brightness controversial Slide 10 Melatonin Can effect circadian rhythms and initiate sleep Temporary effects No long-term outcome studies Slide 11 Assessing Sleep Problems Polysomnographic (PSG) evaluation - includes assessment of airflow, leg movements, brain wave activity, eye movements, muscle movements, and heart activity Multiple Sleep Latency Test (MSLT) - naps at 2 hour intervals Slide 12 Slide 13 Slide 14 The Good Sleep Habits Checklist Establish a set bedtime routine Develop a regular bedtime and a regular time to awaken Eliminate caffeine 6 hours before bed Limit alcohol Try milk Eat a balanced diet Do not exercise at bedtime Exercise earlier Restrict activities in bed Slide 15 The Good Sleep Habits Checklist Reduce noise in the bedroom Reduce light in the bedroom Avoid extreme temperature changes in the bedroom Slide 16 Medication for Sleep Common medications Benadryl - contains antihistamines which cause drowsiness Clonidine - blood pressure medication - side effect is as a sleep aid Not generally recommended for long-term use (more than 2-4 weeks) Slide 17 Herbal Remedies Valarian root and Hops No outcome studies Slide 18 Choosing Interventions Slide 19 Selecting Sleep Interventions Questionnaire (SSIQ) Designing the treatment plan to fit the needs of the family Administered with child sleep assessments Slide 20 Graduated Extinction Gradually increase the time between visits to the childs room. Parents are still allowed to check on their child, but are not allowed to pick up their child. They are asked to keep interactions to a minimum. Slide 21 Slide 22 Slide 23 Scheduled Awakening The parent arouses and consoles the child 15-60 minutes before a typical sleep interruption. Upon elimination of the sleep problem, the scheduled awakenings are gradually reduced. Slide 24 Slide 25 Sleep Restriction The new sleep time for the child should be approximately 90% of his/her previous average sleep time. Adjust bedtime or time child is awakened to create new schedule. For each successful week, adjust schedule by 15 minutes. Slide 26 Slide 27 Slide 28 Slide 29 Sleep Better! Durand, V.M. (1998). Sleep better!: A guide to improving sleep for children with special needs. Baltimore, MD: Paul H. Brookes. How To book written for families Slide 30 Sleep Protocols Durand, V.M. (2008). When children don't sleep well: Interventions for pediatric sleep disorders, Therapist guide. New York: Oxford University Press. Durand, V.M. (2008). When children don't sleep well: Interventions for pediatric sleep disorders, Workbook. New York: Oxford University Press. Slide 31 Additional Information Durand, V.M. & Hieneman, M. (2008). Helping parents with challenging children: Positive family intervention, Facilitators guide. New York: Oxford University Press. Durand, V.M. & Hieneman, M. (2008). Helping parents with challenging children: Positive family intervention, Workbook. New York: Oxford University Press.