Cerebral Palsy and Sleep Issues

Fact Checked

Sleep issues are common in children with cerebral palsy. There are a number of reasons for this that vary by child. Identifying the underlying cause is an important step in developing a treatment plan to improve sleep quality as much as possible.

What Are Sleep Issues?

Sleep issues 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 patterns over time. Still, other sleep disorders are so serious that they can interfere with many aspects of a child’s life. These include learning, mental functioning, emotional regulation, and social functioning.

Children with cerebral palsy are more likely to have sleep difficulties than children without cerebral palsy. Studies show that between 23% and 46% of children with cerebral palsy struggle with sleep.[1]

According to a study published by a team of physicians that studied sleep patterns in children with CP, over 40% of children with cerebral palsy had an abnormal sleep pattern score.[2]

Sleep issues can arise from disrupted melatonin secretion, “sleep-breathing” disorders, involuntary teeth grinding, excessive daytime sleeping, and nightmares.

Sleep issues not only affect the child’s development but also cause 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 concentrating and functioning the following day.

Children with Cerebral Palsy: Common Reasons for Sleep Disorders

Many aspects of living with cerebral palsy can negatively impact sleep, from symptoms to associated disorders.

Drooling

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.

Gastroesophageal Reflux Disorder (GERD)

Children with cerebral palsy have a high risk of developing gastrointestinal conditions. The most common of these is GERD. This digestive disorder affects the lower esophagus.[1] Symptoms of GERD 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 worsen when lying flat, making sleeping difficult or impossible due to epigastric pain and discomfort.

Pain

Pain is one of the most common symptoms of cerebral palsy. Muscle spasms, involuntary muscle movement, abnormal posture, and spasticity are among 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 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 Issues

Respiratory problems often stem from associated conditions, such as drooling and gastroesophageal reflux disease (GERD). 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

Children who use wheelchairs and other mobility aids and assistive devices have an increased risk of developing skin conditions. These include skin ulcers, also known as pressure ulcers or bed sores.

Pressure and skin ulcers result from 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 against the seat of a wheelchair for long periods of time).[3]

Skin ulcers are often painful, and if left untreated, they can become life-threatening.

Constipation

Digestive problems, particularly constipation, frequently occur in people with cerebral palsy. Several factors can cause constipation, including reduced mobility, insufficient fluid intake, weak stomach muscles, and certain medications. Abdominal discomfort and bloating can disrupt quality sleep.

Sound

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. Noise that others make in the home, such as running a dishwasher, conversations, or vacuuming, can be detrimental to kids with cerebral palsy who have sensitive ears.

The effects that sound 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 total sleep time.

Children with cerebral palsy who are affected by sounds while trying to sleep are at risk of developing other physical and emotional health problems due to a constant lack of sleep.

Seizures

Seizures are another commonly 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 they can happen at any time, night or day. This disrupts sleep, leading to exhaustion, which then triggers more seizures.

How to Improve Sleep for a Child with Cerebral Palsy

Helping a child with cerebral palsy sleep can be more challenging than helping other kids. Talk to your pediatrician and specialists about how you can make it easier and help them sleep better. Here are some tips to keep in mind:

• Sleep issues are common in children without cerebral palsy, but are much more common in children with CP.
• Sleep issues affect not only children but also parents and other family members.
• Sleep hygiene, such as maintaining a dark, quiet environment and limiting screens 60 minutes before 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.

It’s important to speak with your child’s healthcare provider if you suspect any sleep issues. In most cases, the sleep issues are mild, but you should always talk with your child’s doctor to rule out other, more serious sleep problems.