Children with Sleep Problems: A 24 hr concern

1. Children with Sleep Problems: A 24 hr concern Dr. Manisha Witmans

2. Objectives • Common myths about sleep and their implications for every day life • The public health burden of care and sleep issues • Questions

3. 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

4. Desperate for Sleep

10. 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

11. The Burden…Obesity Costs http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/oic-oac/econo-eng.php#figure-15

12. Risk Factors for Obesity Adults Risk Factor RR Children Risk Factor RR Nutrition and Health Symposium: Chaput JP et al. Int J Obesity 2011

13. Just Do It!!

14. 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

15. 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

16. Pediatric Sleep Problems Chronic 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

18. ADHD: Etiological Factors

19. 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

20. Average Sleep Duration in Kids Moore et al, Chest, 2006.

21. Prevalence of Sleep Disorders in Children

22. 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?

23. ….6450, 6451, 6452…. I think I can….. I think I can….. I think I can…..

25. Hormonal influence, obesity School start times Social pressures Substance abuse Genetic predisposition Delayed sleep phase Sleep Time

28. 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

29. Escalating occurrence of accidents across the night shift from 0:00hr to 8:00hr 450 400 350 300 250 Number of Crashes 200 150 100 50 0 0:00 10:00 12:00 14:00 4:00 16:00 18:00 20:00 22:00 2:00 6:00 8:00 Time of Day Pack, A. I., Pack, A. M., Rodgman, E., Cucchiara, A., Dinges, D. F., & Schwab, C. W. (1995). Adapted 2007

30. 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

31. Sleep IS Important Sleep 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

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

33. 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

34. Take care of your sleep National Sleep Foundation; www.kidssleep.org

35. 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

36. 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

37. 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.

38. 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!