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THE PEDIATRIC SLEEP HISTORY

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. Does the Child have a Sleep Problem?. YES 90% have a sleep problem

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THE PEDIATRIC SLEEP HISTORY

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  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 aSleep Problem? • YES • 90% have a sleep problem • 5% have symptoms suggesting problem • NO • 10% will have significant sleep disorder • 71% have symptoms suggesting sleep problem

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

  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? • Typical manifestations = Profound Sleepiness • Paradoxical Manifestations • Impulsive • Short Attention Span • Distractible • Doesn’t Finish Tasks • Motor Restlessness • More ..........

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

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

  10. Unusual Motor ActivityDuring Sleep • Somnambulism • Quiet • Agitated • Seizures? • Restless Sleep • Amnesia • Vivid Dreaming • Somniloquy

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

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

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

  14. Snoring • Sleep Disordered Breathing • OSAS • 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 • Any problems going to bed? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

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

  26. BEARS QUESTIONNAIRE • BEDTIME • Any problems going to bed? • Any problems falling to sleep? • 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 • Any difficulty waking in the morning? Owens, JA and Dalzell V. Sleep Medicine 6(2005):63-69

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

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

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

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

  36. BEARS QUESTIONNAIRE • Awakenings • Awakening frequently during the night? • Sleepwalk or sleep talk? • 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 • 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 • Has a regular sleep schedule been established? • 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 • Has a regular sleep schedule been established? • When does the patient get into bed? • 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 • Has a regular sleep schedule been established? • When does the patient get into bed? • What time does the patient awaken? • 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 • 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 • If you talk to a patient long enough… S/he will tell you exactly what is wrong.

  47. THANK YOU

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