oct 25 caphc concurrent symposium - sleep disorders - dr. penny corkum and dr. shelly weiss

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  • 2016 CAPHC Annual Conference

    October 23-25, 2016

    Halifax, NS

    Sleep Disorders in Canadian Children:

    What Can We Do to Ensure Better Nights and Better

    Days for Children and their Families?

    Penny Corkum, PhD, Registered Psychologist

    Professor, Department of Psychology & Neuroscience; Psychiatry

    Dalhousie University

    IWK Scientific Staff; CEH ADHD Clinic

    Shelly Weiss, MD FRCPC, Pediatric Neurologist

    Professor, Faculty of Medicine,

    Hospital for Sick Children, University of Toronto

    1

  • Outline

    Introductions & Objectives

    Xaviers story

    Importance of sleep

    Access to services in Canada

    Barriers to care

    Guidelines for pediatric sleep

    Service delivery models

    Introduction to Better Nights, Better Days

    Discussion/Questions

    2

  • Main Goal for Workshop

    Determine how we can all work together (as

    administrators, policy makers, researchers,

    clinicians, and families) to improve paediatric

    sleep assessment and treatment in Canada so that

    there is access to services for all in need, no matter

    where they live

    3

  • Importance of Sleep

  • Causes of Sleep

    Disorders/Problems

    Prevalence

    25% of typically developing children

    80% of children with physical and

    mental health disorders

    Causes

    Sleep disorders

    Lifestyle factors

    5

    http://images.google.ca/imgres?imgurl=http://stopsleepapnea.info/blog/wp-content/uploads/2009/08/child-asleep-on-stiars.jpg&imgrefurl=http://stopsleepapnea.info/blog/7/&usg=__N8CuFl4M1juFyieK09d3tsyG_4A=&h=289&w=300&sz=70&hl=en&start=3&itbs=1&tbnid=5Zx8rglmMtmjjM:&tbnh=112&tbnw=116&prev=/images?q=child+sleep+apnea&gbv=2&hl=enhttp://images.google.ca/imgres?imgurl=http://stopsleepapnea.info/blog/wp-content/uploads/2009/08/child-asleep-on-stiars.jpg&imgrefurl=http://stopsleepapnea.info/blog/7/&usg=__N8CuFl4M1juFyieK09d3tsyG_4A=&h=289&w=300&sz=70&hl=en&start=3&itbs=1&tbnid=5Zx8rglmMtmjjM:&tbnh=112&tbnw=116&prev=/images?q=child+sleep+apnea&gbv=2&hl=enhttp://images.google.ca/imgres?imgurl=http://farm2.static.flickr.com/1035/1344902986_c01a3e54a4_o.jpg&imgrefurl=http://sani-journal.blogspot.com/2007/09/junk-sleep.html&h=338&w=505&sz=30&hl=en&start=6&um=1&tbnid=0uHWrvfeRYm3GM:&tbnh=87&tbnw=130&prev=/images?q=sleep+at+computer+teenage&um=1&hl=enhttp://images.google.ca/imgres?imgurl=http://farm2.static.flickr.com/1035/1344902986_c01a3e54a4_o.jpg&imgrefurl=http://sani-journal.blogspot.com/2007/09/junk-sleep.html&h=338&w=505&sz=30&hl=en&start=6&um=1&tbnid=0uHWrvfeRYm3GM:&tbnh=87&tbnw=130&prev=/images?q=sleep+at+computer+teenage&um=1&hl=en

  • Classification

    DSM-5 (2013) / ICSD-3 (2013)

    10 different sleep disorders/sleep disorder groupings

    1) Insomnia Disorder

    2) Hypersomnolence Disorder

    3) Narcolepsy

    4) Breathing-related sleep disorders

    5) Circadian rhythm sleep-wake disorders

    6) Nonrapid eye movement (NREM) sleep arousal disorders

    7) Nightmare disorder

    8) Rapid eye movement (REM) sleep behavior disorder

    9) Restless legs syndrome

    10) Substance/medication-induced sleep disorder

    6

  • Insomnia

    Most common sleep disorder in TD children and children with mental health and physical health disorders

    Criteria

    Reports of difficulties falling asleep, staying asleep, and/or early waking

    Daytime consequences of sleep problem

    Adequate opportunity for sleeping

    Frequent (3x/wk) and chronic (3 mos)

    Not explained by another sleep-wake disorder, medical condition or mental health disorder

    7

  • Lifestyle Factors

    People of all ages are sleeping less now than ever before

    Sleeping about 1 hour less now than at the beginning of

    the century

    Reasons

    Electronics

    Sleep not seen as a priority

    Extra-curricular activities

    Social activity

    School start times

    Results in a Social Jet Lag & Sleep Debt

    8

  • Factors Affecting Sleep in Children

    Sleep

    Genetics

    Sleep Environ-

    ment

    Family/ Parents

    Health

    Develop-ment

    Social Emotional

    Social Cultural

    Sleep Practices

    Slide courtesy of Jodi Mindell

    9

  • Chronicity of Sleep Disorders

    Transient and persistent sleep problems

    Genetics may play the largest role in stability of

    sleep problems

    Stability depends in part on the type of sleep

    problem and the treatment provided

    Even when a sleep problem does not persist it

    predict later behavioral/mental health problems

    10

  • Cognition/

    Learning

    Mental

    Health

    Physical

    Health

    Quality

    of Life

    Consequences of Sleep Disorders 11

  • Consequences of Sleep Disorders

    Community

    School

    Family

    Child

    12

  • Importance

    Sleep problems could put individuals at risk for mental

    health or physical health disorders

    Sleep problems could mimic mental health disorders and as

    such need to be considered as a differential diagnosis

    Sleep problems could exacerbate mental health

    problems/increase symptoms severity and chronicity

    Treatment of sleep problems may reduce impairment and

    may even act as an enhancement therapy (e.g. make other

    therapies more effective)

    The treatment of mental health problems with medication

    may increase sleep problems

    13

  • How could poor sleep in

    children affect your

    service?

    14

  • Access to Services

    in Canada

  • Facts about the gaps in

    Canadian resources for sleep

    Despite high prevalence of sleep

    disorders/problems, chronicity, and significant

    impact, they are often unrecognized and under

    treated by clinicians

    Main Reasons

    Limited awareness and knowledge of the importance

    of sleep

    Limited skills in this area for health care providers

    Limited access to services and resources/tools

    16

  • Access to services to diagnose

    Obstructive Sleep Apnea in

    Canadian children

    What is the gold standard for diagnosis?

    Where are the sleep clinics?

    Where are the pediatric sleep practitioners?

    17

  • PSG is gold standard to

    diagnose OSA

    18

  • Canadian Sleep Society Clinic Map

    www.css-scs.ca

    19

  • Western Canada 20

  • Eastern Canada21

  • 22

  • Pediatric sleep resources for

    OSA in Canada

    Survey study of pediatric sleep practitioners and sleep

    laboratories

    Results

    No sleep practitioners (for OSA) or PSG available in

    Yukon, NWT, Nunavut, Saskatchewan, Nova Scotia, New

    Brunswick, PEI, NFLD/Labrador

    Wait time for PSG varied from < 1 months to 1.5-2 years

    Lack of resources and services for pediatric sleep

    disordered breathing has great geographical disparity

    23

  • 24

  • Service Providers

    CSS listing for sleep clinics, insomnia treatment providers, dentists (searchable by province)

    https://css-scs.ca/resources/types-of-providers

    Diagnosis

    Physicians

    Psychologists

    Treatment

    Physicians

    Psychologists and other allied health professionals

    Dentists

    Sleep Consultants

    http://goodnightsleepsite.com/toronto/

    Others (e.g., naturopath, chiropractor)

    Main concern Lack of regulation of field and some service providers!

    25

    http://goodnightsleepsite.com/toronto/

  • Barriers to Care

  • Limited awareness and

    knowledge of the importance of

    sleep

    27

  • 28

  • 29

  • 30

  • Methods

    124 Canadian health care providers were surveyed

    about barriers and facilitators

    Included: physicians, nurse, psychologist, social

    workers

    31

  • 32

  • 33

  • New RCPSC initiative in sleep

    education

    Currently no route to certification for subspecialist physicians who practice sleep medicine in Canada

    As of July 2016, there will be a AFC (Area of Focused Competence/Diploma) in sleep medicine

    1 year include ongoing maintenance of certification

    Eligible for physicians who are specialists in : ENT, respirology, psychiatry, neurology, developmental pediatrics

    34

  • Guidelines for

    Pediatric Sleep

  • http://sleepfoundation.org/ho

    w-sleep-works/how-much-

    sleep-do-we-really-need

    Suggestion: Monitor sleep

    amounts and mood over a few

    days during which time the

    child is allowed to sleep until

    he/she awakens

    spontaneously (during

    vacation is best)

    Concern: Sleep duration

    recommendation for school-

    aged children previously was

    10-11 hours but now 9-11 and

    even 7-12

    36

  • Participation 2016 Report Card37

  • 38

  • Recommended hours of sleep

    Age 5-13 years: 9-11 hours

    Age 14-17 years: 8-10 hours

    39

  • Healthy sleep is the goal for all infants, children and adolescents

    Guidelines to evaluation and treatment of sleep disorders

    Position statement end