Cerebral Palsy and Sleep Issues
This article has been fact checked by a Board Certified Pediatric Nurse Practitioner. Sources of information for the article are listed at the bottom.
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Sleep issues are a common occurrence among children with cerebral palsy. There are a number of reasons that they can manifest, and identifying the underlying cause is an important step in developing a treatment plan to improve sleep quality as much as possible.
What is a Sleep Issue?
A sleep issue can include impairments in the quality and duration of sleep, as well as trouble initiating sleep in the first place. Children with mild sleep disorders can usually regulate their sleep pattern over time, but other sleep disorders are so serious that they can interfere with many aspects of a child’s life, including learning, mental functioning, emotional, function, and social functioning.
Between 23% to 46% (depending on the study) of children with cerebral palsy suffer from sleep problems, which is a much higher average than children who aren’t disabled (20% have sleep issues).
Sleep issues can arise from disrupted melatonin secretion, “sleep-breathing” disorders, involuntary teeth grinding, excessive daytime sleeping, and nightmares.
Sleep issues not only affects the child’s development, but it also causes a disturbance within the entire family. Close to 40% of children with cerebral palsy require attention from parents or caregivers at least once a night, almost every night. This can result in parents having issues with concentrating and functioning the following day.
Children with Cerebral Palsy: Common Reasons for Sleep Disorders
Drooling is a common problem for children with cerebral palsy, and unfortunately, it’s an associated condition that can also disturb sleep. Excessive drooling can result in children having difficulties breathing while trying to sleep and choking on excessive saliva. Depending on the child’s weight, ability to change sleep positions, and muscle tone of the throat and airways, obstructive sleep apnea can also be an issue.
Gastro-esophageal Reflux Disorder (GERD)
According to a study performed by the University of Alberta’s Faculty of Rehabilitation Medicine, there is a high incidence of children with cerebral palsy developing GERD, a digestive disorder that affects the lower esophagus. Symptoms include:
- Difficulty swallowing
- A burning sensation in the chest area
- Sore throat
- Hoarse voice
- Acid reflux
Around 80%–90% of children with severe cerebral palsy will develop GERD or other similar gastrointestinal issues. GERD symptoms can be exacerbated when lying flat, making sleeping difficult or impossible due to epigastric pain and discomfort.
Body pain is one of the most common side effects of cerebral palsy. Muscles spasms, involuntary muscle movement, abnormal posture, and spasticity are among a few of the reasons that pain is so prevalent.
Pain can hinder anyone from getting rest, but more so for people with cerebral palsy, who may not be able to maneuver themselves properly to alleviate muscle and body pain. In a study conducted by Breau and Camfield, results indicated that kids who suffered from pain also had more overall sleep issues, night wakings, parasomnias, sleep-disordered breathing, and a shorter sleep duration.
Alex, a blogger at Cerebral Palsy Guidance, who was diagnosed with CP at the age of two, stated that sleep problems have followed him into adulthood, mainly due to stiff muscle pain.
“I find that unless I am extremely relaxed, I can’t get comfy in bed because my back and shoulder muscles feel tense. It sometimes takes me 20 minutes between lights out (usually 10:30 p.m. M-F) until I drift off to Dreamland. And turning from one side to another is not easy, either. If I’m only half-asleep, turning over hurts, and I wake up.”
Respiratory problems generally come from associated conditions such as drooling and GERD, and these problems can make it extremely difficult for children with cerebral palsy to stay asleep through the night. If not treated, respiratory issues can lead to aspiration pneumonia, lung injuries, and even chronic lung disease.
Skin ulcers occur more so with children who depend on a wheelchair or similar aids to get around. Pressure and skin ulcers are caused by a lack of blood supply to the affected parts of the body, which may be the legs, backs, arms, or any other part that’s constantly rubbing against something (such as the back being against the seat of a wheelchair for long periods of time).
Skin ulcers are often painful and if left untreated, they can become life-threatening.
Bowel problems, particularly constipation, occur frequently for people with cerebral palsy. A number of factors can cause constipation, including reduced mobility, not enough fluid intake, weak stomach muscles, and certain medications. Abdominal discomfort and bloating can disrupt quality sleep.
Noise is a major risk factor that influences the quality of sleep children with CP will have, as a number of kids have noise sensitivities. Noises that others make in the home, such as running a dishwasher, conversations, vacuuming, etc., can be detrimental to kids with cerebral palsy who have sensitive ears.
The effects that sounds and noise have on sleeping may result in a delay in sleep onset, difficulties moving into the deeper stages of sleep, waking up more frequently, restlessness, and an overall shorter time of total sleep.
Children with cerebral palsy who’re affected by sounds while trying to sleep are at risk of developing other physical and emotional health problems, due to constant lack of sleep.
Seizures are another common associated symptom of cerebral palsy. Some kids with cerebral palsy and seizures have no problems sleeping through the night, whereas others have “triggers” that can set off seizures, such as lack of sleep. In many situations, children who experience seizures likely have irregular sleep patterns, as seizures are prone to happen at anytime, night or day. In turn, this disrupts sleep, leading to exhaustion, which then triggers more seizures.
All of the aforementioned problems can lead to children experiencing problems with their sleeping, which can range from mild to serious. It’s important to speak with your child’s healthcare provider if you suspect any sleep issues. In the majority of cases, the sleep issues are mild, but it’s always recommended to talk with your child’s doctor to rule out other, more serious sleep problems.
Facts to Remember and Initial Treatment Options
- Sleep issues are common in children without cerebral palsy, but much more common in children with the disorder.
- Sleep issues not only affect children, but parents and other family member as well.
- Sleep hygiene, such as maintaining a dark quiet environment and limiting screens 60 minutes prior to bedtime is typically the first line treatment to help sleep issues.
- Melatonin may be effective in helping children fall asleep, but it may not improve the quality or duration of sleep.
- Other medications, such as sedatives and hypnotics, are available for children with sleep issues; however further research trials are needed to assess their efficacy and safety.