Sleepless in B.C.
A new app has been developed by The Children’s Sleep Network to help doctors diagnose sleep disorders in children. Experts say often sleep disorders go undetected in children leading to doctors misdiagnosing them with attention deficit disorders and subsequently given medication they don’t need.
A new app developed by sleep experts in Vancouver to help doctors screen kids for sleep problems could reduce the number of patients misdiagnosed with attention deficit disorders.
The Children’s Sleep Network, in collaboration with the Peter Wall Institute for Advanced Studies, has completed a sleep wake behaviours app (SWAPP,) the first of its kind, that delivers a set of questions for each of the most common sleep problems children face.
It also scans for medications and functional diagnoses and provides all information in a printout to the parents and health care professionals.
The app still must undergo testing and provincial approval, but experts believe it will become standardized practice as an aid for doctors to determine whether a child is suffering from a sleep disorder.
Often sleep disorders such as restless leg syndrome or sleep-disordered breathing go undetected in children, said Dr. Osman Ipsiroglu, a University of B.C. pediatrician and lead researcher in developing the app. Most doctors don’t know what to look for, he said, and attention deficit disorder often becomes a catch-all diagnosis.
This can have serious consequences because those kids are being prescribed anti-anxiety medication or other mood-altering drugs, like Ritalin, that they don’t need.
If a child with a sleep problem or disorder is treated with Ritalin it will only worsen the problem, and the resulting lack of sleep could cause severe health issues later on in life, such as obesity or diabetes.
The tool was created to develop a “shared language” with parents and doctors, to look at kids’ problems from a holistic approach rather than just narrowing in on one problem, Ipsiroglu said.
He said pediatricians and child psychologists must rule out sleep disorders before making either an attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) diagnosis.
But they need support to do so, he said, and that’s where the app comes in.
“Sleep deprivation leads to certain daytime consequences. Kids who don’t have restorative sleep resemble kids with ADHD,” he said.
While sleep-deprived adults typically feel sluggish and sleepy in the daytime, children overcompensate and speed up, often showing excessive daytime behaviours that mimic ADHD.
Young people with ADHD typically have trouble sitting still, staying focused, controlling their behaviour and emotions; all of which can lead to lower social skills, isolation, dependence and poor performance in school.
“So we are advocating for a thorough screening before the diagnosis of ADHD is made.”
The problem, Ipsiroglu said, is that health care standards in B.C. have not evolved to support children with chronic and ongoing sleep problems, or their sleep deprived families.
Decision-makers within the health care system have not yet recognized sleep as a priority, possibly due to the fact that sleep in a 24/7 working society is associated with sluggishness or laziness, he said.
“There is enough evidence that sleep disorders can be successfully screened and treated, but instead of doing that, we solely screen for disruptive daytime behaviours and exclusively treat these, but not the underlying sleep disorder,” he said.
“This practice has to change.”
The technology will also help medical professionals sort out whether a child is dealing with behavioural issues related to sleep health habits, or a possible disorder such as restless leg syndrome or sleep apnea.
The app was developed using questions from a screening questionnaire developed in part by the network called Vancouver-Polar-BEARS (B for Bedtime Issues, E for Excessive Daytime Sleepiness, A for Night Awakenings, R for Regularity and Duration of Sleep, and S for Snoring.)
“The app allows not only assessing sleep/wake behaviours, but also captures the medications. This is the added value, as many kids whose sleep problems are missed get medicated,” Ipsiroglu said.
Once doctors determine a child has a sleeping problem, they can send the child to the appropriate specialist; for example, a respirologist if a child screens for breathing issues or an occupational therapist for anxiety.
Jennifer Garden, an occupational therapist with the Vancouver-based Sleepdreams, said she believes the screening tool is imperative for doctors because, once identified, sleep disorder can be easy to treat and manage, often with simple behavioural changes.
“Absolutely, everyone needs to be asking these questions,” she said. “If these kids are exhausted, how effective are our treatments? First and foremost we should always be asking how is sleep going, because if it is not going well then it should be, I think, one of the very first things addressed.”
Although there is no data on how many kids are misdiagnosed with ADHD, an estimated three to five per cent of children in Canada are diagnosed with the disorder, according to Mental Health Canada.
Up to 25 per cent of healthy children have difficulties falling asleep and staying asleep, while more than half of kids with physical and mental health problems have trouble sleeping, according to the Canadian Sleep Society.
Wendy Hall, a professor in UBC’s school of nursing who has conducted sleep studies, says societal change may be partly to blame for sleep dysfunction in children. With both parents working longer hours, they may be pushing back bedtimes in order to spend more time with their children.
Studies show a trend over time of both parents and children getting fewer hours of sleep as society seems to value it less. Also, kids may be staying awake longer if they have distractions in their bedrooms such as video games and mobile phones.
After testing of the screening tool with parents over the next six months, the network will send a report to the provincial government by spring in hopes it will eventually become a standardized practice in B.C.
Details of the report on how well the app works will be presented to the public on March 18 at the B.C. Sleep Science Conference being held at Thompson Rivers University in Kamloops.
The app has been funded in part by donations from the B.C. Children’s Hospital Foundation.
firstname.lastname@example.orgWith a file from Erin Ellis
Tips for healthy sleeping habits in children
1. Go to bed at the same time every night, so as to allow your child to get enough sleep.
2. Have and age-appropriate nap schedule for children up to the age of 4.
3. Establish a consistent bedtime routine.
4. Make your child’s bedroom sleep conducive — cool, dark and quiet.
5. Encourage your child to fall asleep independently.
6. Avoid bright light at bedtime and during the night and increase light exposure in the morning
7. Avoid heavy meals and vigorous exercise close to bedtime.
8. Keep all electronics — including television, computers and cellphones — out of the bedroom and limit the use of electronics.
9. Avoid caffeine.
10. Keep regular daily schedule, including consistent mealtimes.
Source: The Canadian Sleep Society