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 Nutrition and Health Symposium: Chaput JP et al. Int J Obesity 2011 Adults Risk FactorChildren Risk FactorRR

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. Age GroupRecommended, hours/24 hrs Study findings, hours/24 hrs Infants (3-11 mo)14-1512.7 Toddlers (12-35 mo)12-1411.7 Preschoolers (3-6 yrs) 11-1310.3 School age (1 st -5 th grade)10-119.5 Teens (6 th -12 th grade)9.257

21. Prevalence of Sleep Disorders in Children Sleep DisorderPrevalence per study* ADHD children Behavioral insomnia of childhood – “learned insomnia” (bedtime refusal and night waking) 10-30%Up to 80% Nightmares10-50%? similar Night terrors17.3%? similar Sleep walking13.8%? similar Insomnia in children1-6%Up to 60% Obstructive Sleep Apnea1-3%Up to 10% Restless Legs and Periodic Limb Movement Disorder 2%Up to 25%

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

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

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. Time of Day Number of Crashes 100 150 200 50 250 300 350 400 450 0 0:00 2:00 4:00 6:008:00 10:0012:0014:00 16:0018:0020:0022:00 Escalating occurrence of accidents across the night shift from 0:00hr to 8:00hr 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!