Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians

Table 1 Showing majority of sleep disorders can be grouped into 6 main categories

Category	Description		Conditions and causes, some examples
Insomnias	Inability to fall asleep or stay asleep		Environmental: Poor sleep hygiene, bedroom noise, bright light. Behavioural insomnia of childhood (sleep onset/limit setting/combined). Psychiatric, trauma and substance misuse: Anxiety, depression, OCD, PTSD, abuse or neglect, bullying, drug and substance misuse. Medical: Pain (headaches, joint pains), lung problems (asthma, cystic fibrosis), skin (eczema, allergies), neuromuscular, obesity, medication side effects
Sleep related breathing disorders	Breathing difficulties during sleep		Obstructive sleep apnoea. Central sleep apnoea
Central disorders of hypersomnolence	Excessively sleepy		Narcolepsy
Circadian rhythm sleep-wake disorders	Sleep times are out of alignment		Delayed sleep phase syndrome. Jet lag
Parasomnias	Unwanted events or experiences that occur at the time of falling asleep, sleeping or waking up	During NREM sleep	Confusional arousals. Sleep terrors. Sleep-walking
		During REM sleep	Nightmares
		Others	Enuresis
Sleep related movement disorders	Unusual body movements during sleep		Bruxism. Restless legs syndrome. Periodic limb movement disorder. Rhythmic movement disorder (head banging, body rocking)

OCD: Obsessive-compulsive disorder; PTSD: Post traumatic stress disorder; NREM: Non-rapid eye movement; REM: Rapid-eye-movement.

Table 2 Showing positive effects and negative consequences

Positive effects of adequate and good quality sleep	Negative consequences of lack of adequate and good quality sleep
Promotes growth. Strengthens immunity. Helps cell growth and body repair. Consolidates memory (https://www.sleepscotland.org/support/gateway-to-good-sleep/why-is-sleep-important/). Promotes learning and cognitive development[69]. Maintains physical health and emotional wellbeing	Increased association with excess weight gain and obesity[69]. Impairs immune function. Affects physical coordination. Affects ability to learn new information and problem solve. Affects mood and emotional regulation and increases risk of mental health problems e.g., mood or anxiety disorder, suicidal ideation

Table 3 Showing National Sleep Foundation’s sleep duration recommendations (https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times)

Age of the child	Recommended	May be appropriate	Not recommended
Pre-schoolers (3-5 yr)	10-13 h	8-14 h	Less than 8 h or more than 14 h
School-aged children (6-13 yr)	9-11 h	7-12 h	Less than 7 h or more than 12 h
Teenagers (14-17 yr)	8-10 h	7-11 h	Less than 7 h or more than 11 h

Table 4 Below illustrates some useful resources

Users	Resources	Free access	Website links
Parents and carers	CEREBRA-Sleep Advice service	Free access	https://cerebra.org.uk/get-advice-support/sleep-advice-service/
	Sleep for better day ahead-leaflet	Free access	https://www.qvh.nhs.uk/wp-content/uploads/2020/08/Sleep-for-a-better-day-ahead-0127.pdf
	Sleep hygiene in children and young people: Information for families-leaflet	Free access	https://media.gosh.nhs.uk/documents/Sleep_hygiene_F1851_FINAL_Jun20.pdf
	Encouraging good sleep habits in children with learning disabilities-leaflet	Free access	https://www.oxfordhealth.nhs.uk/wp-content/uploads/2014/05/Good-sleep-habits-for-children-with-Learning-Difficulties.pdf
	Sleep problems and sleep disorders in school aged children	Free access	https://www.sleephealthfoundation.org.au/sleep-problemsand-sleep-disorders-in-school-aged-children.html
	Further useful facts sheets and resources-website	Free access	https://www.sleephealthfoundation.org.au/fact-sheets.html
	Other websites	Free access	https://www.nhs.uk/live-well/sleep-and-tiredness/healthy-sleep-tips-for-children/; https://www.sleepscotland.org/
Adolescents	How to sleep well and stay healthy-A guide for teenagers. This is an interactive guide with animations, sounds and external links to useful educational video clips	Free access	https://books.apple.com/gb/book/how-to-sleep-well-and-stay-healthy-a-guide-for-teenagers/id1397176909
	Sleep tips for teenagers	Free access	https://www.nhs.uk/live-well/sleep-and-tiredness/sleep-tips-for-teenagers/
Children	Sleep poster: Interactive pdf for children and parents/carers	Free access	https://www.cambscommunityservices.nhs.uk/docs/default-source/Luton---NDD-Webpages/Sleep/sleep-poster76ddec06f4f66239b188ff0000d24525.pdf?sfvrsn=2
	I see the animals sleeping: A bedtime story-an app	Free on Google play, App store and Kindle store	http://school.sleepeducation.com/childrensapps.aspx
	The animal sleep: A bedtime book for biomes-an app	Free on Google play, App store and Kindle store	http://school.sleepeducation.com/childrensapps.aspx; https://www.youtube.com/watch?v=zLQ3bkn8Gu8

Table 5 Showing drugs used to treat insomnia[17]

Pharmaceutical	Class	Mechanism of action	Half life (h)	Site of metabolism	Peak concentration	Interactions	Effect on sleep
Diphenhydramine	Antihistamine	H1 agonist. Crosses blood-brain barrier	4-6	Hepatic	Fast absorption. Fast onset of action. Peak at 2-4 h	CNS depressants	Reduces latency. May decrease quality
Hydroxyzine	Antihistamine	H1 agonist. Crosses blood-brain barrier	6-24	Hepatic	Fast absorption. Fast onset of action. Peak at 2-4 h	CNS depressants	Reduces latency. May decrease quality
Melatonin	Neuro-hormone	Hypnotic	90% excreted in 4	Hepatic	30-60 min	Unknown	Reduces latency. Maximum circadian effect
Clonazepam	Benzodiazepine	Central GABA receptors	30-40	CYP 450 3A oxidation	60-240 min	Fluoxetine	Suppresses slow-wave sleep. Reduces arousal
Flurazepam	Benzodiazepine	Central GABA receptors	2-100	CYP 450 3A oxidation	30 min to 13 h	Fluoxetine	Suppresses slow-wave sleep. Reduces arousal
Zolpidem	Z-drug	Benzodiazepine-like	2.5-3	CYP 450 3A oxidation	90 min		Reduces latency. Weak effect on sleep architecture
Clonidine	Alpha agonist	Inhibits noradrenaline release	6-24	50%-80% in urine	Fast absorption 100% bioavailability. Onset of action: 1 h. Peak effect: 2-4 h		Reduce REM. Reduces slow-wave sleep

REM: Rapid-eye-movement; CYP: Children and young people.