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THE PEDIATRIC SLEEP HISTORY Stephen H. Sheldon, D.O., F.A.A.P Professor of Pediatrics Northwestern University Feinberg School of Medicine Director, Sleep.

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Presentation on theme: "THE PEDIATRIC SLEEP HISTORY Stephen H. Sheldon, D.O., F.A.A.P Professor of Pediatrics Northwestern University Feinberg School of Medicine Director, Sleep."— Presentation transcript:

1 THE PEDIATRIC SLEEP HISTORY Stephen H. Sheldon, D.O., F.A.A.P Professor of Pediatrics Northwestern University Feinberg School of Medicine Director, Sleep Disorders Center Children’s Memorial Hospital

2 Does the Child have a Sleep Problem? YES o 90% have a sleep problem o 5% have symptoms suggesting problem NO o 10% will have significant sleep disorder o 71% have symptoms suggesting sleep problem

3 Recording the Sleep History Bedtime Sleep Onset Latency Nocturnal waking o Number o Frequency o Length o Interventions Morning Sleep Offset Sleep-offset Latency Diurnal Naps o Number o Frequency o Length o Timing

4 Sleep Environment Description Location Roommate Bed Partner Ambient Light Noise Level Temperature

5 Bedtime Rituals and Associations? Activities 1-2 hours surrounding bedtime Bath? Sleep Onset Associations

6 Recording Data Short-cut for Notations

7 Assessing Daytime Sleepiness Is the child sleepy? o Typical manifestations = Profound Sleepiness o Paradoxical Manifestations Impulsive Short Attention Span Distractible Doesn’t Finish Tasks Motor Restlessness More

8 Napping Behaviors Are naps appropriate? o Age o Developmental Level o Nocturnal Sleep Habits o Other Sleep-related disorder/pathology

9 Other Searching Questions Rocking, Head Banging, Feet Kicking o During Wake/Sleep Transitions? o During Sleep? o Stereotypic? Bruxism o State of the Crowns of Teeth? o Headaches/TMJ Dysfunction

10 Unusual Motor Activity During Sleep Somnambulism o Quiet o Agitated o Seizures? Restless Sleep o Amnesia o Vivid Dreaming o Somniloquy

11 Unusual Dreams/Nightmares Nightmares o Anxiety Dreams o Mild Autonomic Discharge o Clear Dream Mentation Sleep Terrors o Intense Autonomic Discharge o Brief o Amnesia for Event

12 Restless Sleep? Very Difficult to Evaluate o Sleep Disordered Breathing OSA UARS o PLMS o Idiopathic o Normal Developmental Phenomenon?

13 Sleep Related Enuresis Primary o Maturational Secondary o Psychological o Organic Other Sleep-Related Dysfunction/Pathology

14 Snoring Sleep Disordered Breathing o OSAS o UARS IT IS CLEARLY NOT NECESSARY TO HAVE A COMPLAINT OF SIGNIFICANT SNORING FOR SLEEP DISORDERED BREATHING TO BE PRESENT!!!

15 Children Speak a Different Language 7 years old female 2 older cousins Always received straight “A’s” in school Sleep terrors after her first report card.

16 Children Speak a Different Language Grades:

17 Children Speak a Different Language Grades: Reading: a Writing: a Arithmetic: a Citizenship: a

18 Children Speak a Different Language What’s wrong with her grades?

19 Children Speak a Different Language What’s wrong with her grades? None of her grades were “straight”

20 Children Speak a Different Language What’s wrong with her grades? A

21 Children Speak a Different Language What’s wrong with her grades? A ≠ a

22 BEARS QUESTIONNAIRE Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

23 BEARS QUESTIONNAIRE BEDTIME Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

24 BEARS QUESTIONNAIRE BEDTIME o Any problems going to bed? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

25 BEARS QUESTIONNAIRE BEDTIME o Any problems going to bed? o Any problems falling to sleep? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

26 BEARS QUESTIONNAIRE BEDTIME o Any problems going to bed? o Any problems falling to sleep? o How long does it take to fall to sleep? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

27 BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

28 BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

29 BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? o Feel sleepy during the day? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

30 BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? o Feel sleepy during the day? o Falling to sleep at odd times during the day? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

31 BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? o Feel sleepy during the day? o Falling to sleep at odd times during the day? o Have difficulty paying attention? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

32 BEARS QUESTIONNAIRE EXCESSIVE DAYTIME SLEEPINESS o Any difficulty waking in the morning? o Feel sleepy during the day? o Falling to sleep at odd times during the day? o Have difficulty paying attention? o Have difficulty sitting still? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

33 BEARS QUESTIONNAIRE Awakenings Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

34 BEARS QUESTIONNAIRE Awakenings o Awakening frequently during the night? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

35 BEARS QUESTIONNAIRE Awakenings o Awakening frequently during the night? o Sleepwalk or sleep talk? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

36 BEARS QUESTIONNAIRE Awakenings o Awakening frequently during the night? o Sleepwalk or sleep talk? o Any trouble falling back to sleep after waking up in the middle of the night? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

37 BEARS QUESTIONNAIRE Regularity and duration of sleep Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

38 BEARS QUESTIONNAIRE Regularity and duration of sleep o Has a regular sleep schedule been established? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

39 BEARS QUESTIONNAIRE Regularity and duration of sleep o Has a regular sleep schedule been established? o When does the patient get into bed? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

40 BEARS QUESTIONNAIRE Regularity and duration of sleep o Has a regular sleep schedule been established? o When does the patient get into bed? o What time does the patient awaken? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

41 BEARS QUESTIONNAIRE Regularity and duration of sleep o Has a regular sleep schedule been established? o When does the patient get into bed? o What time does the patient awaken? o Any significant differences in bed time and wake time between weekdays and weekends? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

42 BEARS QUESTIONNAIRE Snoring Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

43 BEARS QUESTIONNAIRE Snoring o Does the patient snore more than 3 nights per week? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

44 SUMMARY

45 SUMMARY If you talk to a patient long enough …

46 SUMMARY S/he will tell you exactly what is wrong.

47 THANK YOU


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