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{\phpg\posx2927\pvpg\posy758\absw7103\absh345\f4\b\fs30 Helping You and Your Child Get a Good Night\rquote s Sleep\par}

{\phpg\posx2400\pvpg\posy1135\absw7777\absh310\f7\fs27 By Craig Axelrod, Teacher Trainer, TSBVI, Texas Deafblind Outreach\par}

{\phpg\posx2971\pvpg\posy1468\absw6616\absh252\f5\fs22 A version of this article appeared in the April 1994 edition of {\i P.S. News!!!}\par}

{\phpg\posx1368\pvpg\posy2044\absw9807\absh264\f8\i\fs23 Editor\rquote s note: This article is based on information presented by Ray Condon at a workshop in July 1993.\par}

{\phpg\posx1080\pvpg\posy2620\absw10328\absh723\f5\fs21 \fi287 \ldblquote Oh those sleepless nights will break my heart in two.\rdblquote Truer words have ne\rquote er been spoken, particularly by \par\sb0\fi0 parents of children with disabilities. While anyone might find a night of restful sleep elusive, it can be a unique challenge for children with disabilities, and their families.\par}

{\phpg\posx1080\pvpg\posy3772\absw10306\absh965\f5\fs21 \fi287 When looking for causes and solutions to a problem like this, parents and school staff should work together as a team. A team will be best able to develop an intervention plan that succeeds. The kinds of stimulation provided at school during the day influence a student\rquote s ability to sleep at night, and a sleepy student has difficulty learning. A child\rquote s sleep problem is everyone\rquote s problem.\par}

{\phpg\posx1080\pvpg\posy5212\absw1966\absh264\f3\b\fs23 WHAT IS SLEEP?\par}

{\phpg\posx1080\pvpg\posy5620\absw10120\absh482\f5\fs21 \fi287 Identifying some common facts about sleep will help distinguish general characteristics that most people experience from problems unique to children with disabilities.\par}

{\phpg\posx1080\pvpg\posy6340\absw10132\absh724\f5\fs21 \fi287 1. The function of sleep is controversial. Some people believe sleep is an internally controlled period of non- responding, during a phase of the circadian cycle, that promotes energy conservation. Others think sleep is a restor- ative or balancing process that occurs after energy consumption. Everyone agrees that sleep is a state of consciousness.\par}

{\phpg\posx1080\pvpg\posy7444\absw10132\absh965\f5\fs21 \fi287 2. Sleep occurs in repeating 70 to 100 minute cycles of two states, REM and nonREM. In the REM state, when dreaming happens, the brain is active but the body is effectively paralyzed. In the nonREM state, muscles are relaxed but can move. This state (in 4 stages from drowsy to deep sleep) may serve a restorative function, and is most typically identified as sleep.\par}

{\phpg\posx1080\pvpg\posy8836\absw10475\absh1516\f5\fs22 \fi287 3. Circadian cycles are repeating biological cycles approximately 25 hours long, in which sleep, waking, alertness, activity, rest, changes in body temperature, hormone release and many other body functions take place. This cycle is reset daily to the 24 hour clock by internal processes and external cues such as daylight and darkness, mealtimes, social structures, bedtime and especially time of waking. Daily routines are critical for resetting the biological clock, because external cues influence a body\rquote s internal processes. Chronically delayed sleep can lead to reversal of a person\rquote s daily schedule.\par}

{\phpg\posx1080\pvpg\posy10804\absw10225\absh1010\f5\fs22 \fi287 4. Wakings and arousals, typically 3 to 7 per night, are normal for children and adults. They\rquote re most likely to happen at the end of a REM state and, among other things, enable us to change positions in bed. Usually we\rquote re unaware of them and resume sleeping within a few seconds. Problems can arise when a person has difficulty going back to sleep after an arousal.\par}

{\phpg\posx1080\pvpg\posy12196\absw10237\absh505\f5\fs22 \fi287 5. People require varying amounts of sleep and generally need less sleep with age. Fragmented or fitful sleep is more common after age 7, and especially for people over 45.\par}

{\phpg\posx1368\pvpg\posy13012\absw9508\absh241\f5\fs21 6. Most children sleep deeply during the first and last few hours of night, and more lightly between those times.\par}

{\phpg\posx1080\pvpg\posy13540\absw10180\absh965\f5\fs21 \fi287 7. Sleep/wake cycles can be easily disrupted in people sensitive to change. Irregular sleep/wake patterns lead to significant alterations in a person\rquote s mood, energy level, sense of well being and ability to learn new information. A tired child may not act tired, but be irritable, inattentive, impulsive, aggressive, hyperactive or socially withdrawn. Behav- ioral indicators like these might suggest a sleep problem.\par}

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{\shp{\*\shpinst\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpz1\shpleft11859\shptop4340\shpright11859\shpbottom7899{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 1}}{\sp{\sn lineWidth}{\sv 25907}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineDashing}{\sv 0}}}}

{\shp{\*\shpinst\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpz1\shpleft11360\shptop7899\shpright11859\shpbottom7899{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 1}}{\sp{\sn lineWidth}{\sv 25907}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineDashing}{\sv 0}}}}

{\shp{\*\shpinst\shpleft11520\shptop4710\shpright11888\shpbottom7385\shpz0\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt0{\sp{\sn fLine}{\sv 0}}{\sp{\sn shapeType}{\sv 202}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn txflTextFlow}{\sv 3}}{\shptxt \f10\b\fs32 PROGRAMMING\par}}}

{\phpg\posx5904\pvpg\posy14946\absw180\absh275\f5\fs24 9\par}

{\phpg\posx720\pvpg\posy748\absw10434\absh505\f5\fs22 \fi287 8. Causes of disrupted sleep differ between people. An individual\rquote s sleep history can be looked at to help identify patterns of problems.\par}

{\phpg\posx720\pvpg\posy1612\absw6146\absh264\f3\b\fs23 SLEEP PROBLEMS OF CHILDREN WITH DISABILITIES\par}

{\phpg\posx720\pvpg\posy2020\absw10386\absh758\f5\fs22 \fi287 Though much has been published about the sleep and sleep problems of adults and children, there\rquote s little informa- tion about sleep-related issues of children who are visually impaired or deafblind. A review of several studies, how- ever, indicates that children with disabilities are more likely than those without disabilities to have sleep problems.\par}

{\phpg\posx720\pvpg\posy3172\absw10198\absh2172\f5\fs21 \fi287 Our environment provides many cues that help us wake up, stay awake during the day and go to sleep at night. The communication difficulties often experienced by a child with multiple disabilities make understanding and appropriately responding to these cues more challenging. Other factors can also effect sleep. For example, the medication a child is taking may cause daytime drowsiness. A child with high or low muscle tone might be unable to independently change positions in bed, which is important for a good night\rquote s sleep. Some children with profound disabilities have difficulty intentionally regulating their levels of wakefulness and move through sleep, drowsiness, alertness and agitation, inde- pendent of environmental cues. Individuals who are totally blind experience a high incidence of sleep phase disorder (where days and nights are gradually reversed), in part because they don\rquote t receive the light cues that influence their circadian rhythms.\par}

{\phpg\posx720\pvpg\posy6052\absw10368\absh724\f5\fs21 \fi287 Some of the sleep concerns often identified by parents of children with deafblindness include night wakings, re- versed schedules (sleeping in the day), whether or not to use medication, irregular and fragmented sleep, difficulty falling asleep, short durations of sleep, night wandering, extensive screaming or crying at night, and sleeping with parents.\par}

{\phpg\posx720\pvpg\posy7204\absw10344\absh2172\f5\fs21 \fi287 Children may never outgrow their sleep problems, but many situations can be improved with intervention. It\rquote s important to see a sleep problem as symptomatic of one or more other problems, then identify and address those problems. Often there are no easy answers, but regular contact between the parents and professionals trying to \par\sb0\fi0 resolve a persistent sleep disturbance helps everyone on the team stay energetic and optimistic. An outside consultant can contribute objectivity and perspective to a team\rquote s overall game plan. In some cases, this may be all that\rquote s needed \par to solve a child\rquote s sleep problem. When seeking assistance from the medical profession, it\rquote s difficult to find a person with both an understanding of sleep disorders and experience helping children who have multiple disabilities. A knowledgeable professional, with the interest and willingness to work as part of a team, can be a valuable resource. \par The American Academy of Sleep Medicine has information about sleep disorder clinics in Texas, and can be contacted at:\par}

{\phpg\posx1008\pvpg\posy10084\absw3489\absh1263\f5\fs22 American Academy of Sleep Medicine 6301 Bandel Rd., Suite 101 Rochester, MN 55901 \par\sb0\fi0 Phone: (507) 287-6006 \par Website: \par}

{\phpg\posx720\pvpg\posy11812\absw3682\absh264\f3\b\fs23 EXPLORING SLEEP BEHAVIORS\par}

{\phpg\posx720\pvpg\posy12220\absw10260\absh529\f5\fs23 \fi287 Sleep disorders are behaviors, triggered and maintained for specific reasons. After the possible causes for a behavior have been identified, intervention strategies can be designed.\par}

{\phpg\posx721\pvpg\posy13084\absw10355\absh505\f3\b\fs22 \li287 \fi-287 Sleep Hygiene \par\sb0\fi0 \b0 As mentioned earlier, sleep patterns are influenced by external conditions and events. Setting up and maintaining\par}

{\phpg\posx720\pvpg\posy13768\absw10451\absh758\f5\fs22 good \ldblquote sleep hygiene\rdblquote is the first step in addressing a child\rquote s sleep problem. Factors that will improve sleep include good health, exercise, a meaningful and consistent daily schedule, a balanced diet and appropriate amounts of food, a bedtime environment that encourages sleep, and a pleasant, relaxing sequence of activities in the hour before bedtime.\par}



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