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Down Syndrome: Overcoming sleep problems

Commonly suffered by people with Down Syndrome, obstructive sleep apnoea occurs when the walls of the throat narrow during sleep, causing interruptions to normal breathing – symptoms can include coughing, choking and restlessness. Apnoea can lead to regular sleep interruptions, which in turn has a huge impact on the quality of life of the person with Down Syndrome and the rest of the family.

The condition is most common among young people with Down Syndrome, with 43% of 7 to 11-year-olds being unable to settle at night and 51% waking at regular intervals. For youngsters aged 11 to 17 years, 26% find it hard to go to sleep and 34% awake quite often during the night.

What are the symptoms of sleep apnoea?

Studies have shown a link between the quality of children’s sleep and behavioural problems. The main causes of sleep interruption are physical, including breathing-related problems and these are particularly prevalent in children with Down syndrome.

Symptoms include:

  • Irregular breathing during sleep
  • Snoring
  • Coughing
  • Restlessness
  • Unusual sleeping positions
  • Sweating

There are periods when breathing may stop, suddenly resuming with rapid air-gulping. A significant sleep apnoea concern is the periodic reduction in oxygen in the blood, as this may have a detrimental effect on health and development.

What causes sleep apnoea?
Obstructive sleep apnoea is characterised by the partial obstruction of the airways – these tend to be smaller in children with Down Syndrome, due to enlarged tonsils and adenoids.

A child who suffers from sleep apnoea can be referred to a sleep laboratory for a detailed diagnosis to be made and in some cases, the cause of the obstruction can be treated through surgery.

How does sleep apnoea affect a Down Syndrome child?
A side-effect of sleep disturbance is the detrimental effect on the child’s daytime behaviour, leading to increased stress for parents – the child may be irritable, aggressive and hyperactive. Lack of sleep can also affect a child’s attention span and ability to learn.

Research has shown that Down Syndrome children with sleep problems have significantly worse daytime behaviour than those who have slept well. If the child is misbehaving in the daytime, it’s imperative to assess his or her sleeping patterns to determine whether this might be the cause.

How does this affect the rest of the family?
The child’s sleeping problems can lead to increased stress for the whole family, interfering with the child-parent relationship. It can lead to a lack of sleep for other family members and even marital discord.

Parents who are sleep-deprived, as the result of looking after a Down Syndrome child with sleeping difficulties, may find it harder to implement behaviour management strategies during the day. Treating sleeping issues is important to ensure a good quality of life for all family members.

What solutions can a parent put in place?
Experts suggest various strategies to help solve sleeping problems: First, make sure that the child’s room is at a comfortable temperature, quiet and dark. Keep a “sleep diary” so that if you seek medical help, you have a written record of the child’s sleeping patterns.

Decide on a precise bedtime routine that is effective for both parents and try not to break it. This can include systematic checking on the child at set time intervals after he or she has been put to bed – at each check, the child can be resettled if necessary but with minimum interaction to encourage sleep.

If the child is resistant to falling asleep the parent can make up a makeshift bed, even if it’s just a blanket and pillow on the floor. By lying still and pretending to fall asleep, keeping up the act even if the child tries to get their attention, it is then usually possible for the parent to sneak away when the child has drifted off.

Can adjustable beds help?
Sleep apnoea is a serious condition, so doctors have investigated the role of adjustable beds and how they might play a part in alleviating the symptoms.

When lying flat, the airway can collapse, cutting off the airflow and forcing the sleeping person to move to re-establish a breathing pattern. Elevating the bedhead can keep the airway and tongue in open positions – hence an adjustable bed is believed to promote sleep in a natural way. Using a pillow or cushion at the head of the bed can also help to keep the head elevated.

Resolving sleep problems in Down Syndrome children can help to improve child-parent relationships by alleviating behavioural issues, as these are generally associated with night waking. In fact, finding an effective way to manage sleep problems can improve the whole family’s quality of life.

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