Sleep and Developmental Disabilities: Lessons for All Children

Presenter: Lawrence W. Brown, MD
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This talk will reviewed normal sleep and common problems that disrupt sleep or lead to daytime sleepiness in normally developing and children with neurological disorders. Dr. Brown discussed strategies in combating sleep problems from turning off the TV/video games to medications.


  1. MichelleJ1970 says:

    My 4 yr old was dx with HFA last year and recently with OSA and CSA, nightmare disorder and had significant PLMS during his sleep study. Also we revealed he has low ferritin (15 mcg/L) but had begun supplemented with iron for 4-6 weeks prior to sleep study (shouldn’t his iron stores have built up by the time of the sleep study, thus lessening the PLMS if due to low iron stores)? Also curious about not using diphenhydramine for him as we had just started using last week and he stopped complaining of “pains in legs” every night and morning immediately after starting it. He has taken 1 mg of melatonin as suggested by developmental pediatrician when dx for HFA was given (and I lowered it to 1/2 mg melatonin since starting the benadryl)Thoughts?

    • Dr. Brown says:

      Lots of really good questions. Replacing iron should be easy but the amount of elemental iron needs to be calculated and it isn’t easily absorbed; that is why we supplement with vitamin C at the same time. The proof is whether ferritin is elevated, preferably above 50. In terms of the improvement in leg discomfort after Benadryl, he probably had less arousability with more sleep, but that is unlikely to last. The dose of melatonin is appropriate, and it is reasonable to taper it if there is no longer a problem in sleep onset.

  2. KelleyT says:

    Speak a little about warm milk and its touted benefit, is there any evidence to support that.

    • Dr. Brown says:

      Milk has traces of tyramine which is a precursor to serotonin and melatonin. Sounds impressive, but the amounts are too small to make a difference. My understanding is that is an old wive’s tale.

  3. KelleyT says:

    In your experience is there a beneficial bedtime snack that you would recommend?

    • Dr. Brown says:

      Despite my answer to the last question, milk and cookies have always worked in my house. Whatever the snack, avoid caffeine and limit related chemicals like chocolate and don’t give too much fluid. Beyond early infancy, children have adequate energy supplies to last through the night, so it is more part of the bedtime ritual than a nutritional necessity.

  4. KelleyT says:

    Can you address Syntonics?

    • Dr. Brown says:

      I never heard of it until now – apparently it is an optometric phototherapy program using specific bands of light for various conditions. I would have to read more about it before commenting.

  5. KelleyT says:

    How do you know for sure if a child is in a DEEP sleep for a long enough period of time?

    • Dr. Brown says:

      There is no reason to question if a child is receiving adequate deep sleep if he is healthy and growing, sleeping restfully and alert during the day.

  6. KelleyT says:

    Any thoughts/research on aroma therapy or dietary considerations i.e. food alllergies?

    • Dr. Brown says:

      I do not have any knowledge of the possible benefits of aromatherapy. However, the internet is replete with testimonials but no scientific studies in peer-reviewed journals. Allergies that interrupt sleep are always a consideration, but there are usually symptoms like congestion, wheezing, etc.

  7. KelleyT says:

    How many times on average is it typical for a school age child to briefly wake (but not remember waking) each night?

    • Dr. Brown says:

      It depends what you mean by “wake”. Most people are surprised that normal is less than 15 arousals PER HOUR, but most of those are extremely brief EEG shifts from sleep to wakefulness, often following a short apnea or in response to noise, etc. Very few of these lead to awakening, and even those tend to be brief and usually forgotten by morning.

  8. KelleyT says:

    Is bad for anxious kid to use classical music radio station if it helps him sleep and stay in bed all night?

    • Dr. Brown says:

      Not at all. Quiet, soothing music can be very helpful for some individuals. I would not recommend heavy metal or rap, however.

  9. KelleyT says:

    Is there a differential regarding when sleep terrors or disturbance is related to abuse?

    • Dr. Brown says:

      There is no way that I can imagine to distinguish night terrors caused by physical, emotional or sexual abuse from other causes of recurrent parasomnias. A good history and examination is necessary to understand possible factors leading to frequent disruptions of sleep.

  10. KelleyT says:

    My 16 year old has had sleep issues since infancy. He has ADD, OCD, Depression and Tourettes. Going for a sleep study with nuerologist in few weeks. What should we expect from an effective sleep study for him with these comorbid conditions.

    • Dr. Brown says:

      Like with any new situation, it makes sense to coach him through the novel challenge by familiarizing him with what to expect, preferably walking through the test situation with one of the doctors or technologists, and allowing him to ask questions to minimize anxiety. A sleep study is a little strange and awkward but it is neither painful nor physically demanding. We ask parents to fill out a questionnaire in the morning, and almost never do they complain about discomfort or emotional stress on the child.

  11. KelleyT says:

    My son seems to immediately go into a very deep sleep, and does not cycle to lighter sleep. He therefore has Enuresis. Can not cycling out of deep sleep affect his development or cause other difficulties?

    • Dr. Brown says:

      The observation that a child is a sound sleeper does not preclude normal cycling within sleep. It is true that younger children have a greater percentage of deep non-REM sleep that predisposes them to enuresis, and families who are deep sleepers have later acquisition of night dryness, but that does not correlate to cognitive or emotional delays in development.

  12. KelleyT says:

    What is accuracy of short term sleep studies (1-2 days) due to sleeping in strange environment, electrodes hooked up etc..

    • Dr. Brown says:

      As strange as it seems to be wired for sleep, almost all children sleep relatively naturally in the laboratory environment. In fact, pediatric sleep studies do not typically use a night of acclimation since the kids sleep so normally. When repeated studies are done there is some night to night variability in findings, but important parameters like apnea are quite stable.

  13. Tricia says:

    I have a chicken or egg question: Is the child having sleep difficulty due to low iron, or is iron low due to lack of sleep?

    • Dr. Brown says:

      Unlike the riddle, in this case the chicken comes first. Or rather it is the iron depletion that causes sleep problems by its effect on dopamine in the brain and perhaps other central mechanisms. Sleep disruption does not lead to reduced iron absorption or anemia.