Sleep and people with learning disabilities

• People with learning disabilities experience more disturbed sleep when compared to the general population. Those with more severe learning disabilities experience higher levels of sleep disturbance again (1).
• Sleep disturbance is therefore common in people with learning disabilities, yet it is often overlooked.
• Research studies show that the prevalence of sleep disturbance experienced by children with learning disabilities is between 24% and 86% (2).
• Sleep disturbance is experienced by between 9% and 34% of adults with learning disabilities (2).
• There are a range of potential factors that increase sleep disturbance in people with learning disabilities.
• These include the use of psychotropic medication (medication used to treat mental health disorders), respiratory disorders (such as asthma, COPD, pneumonia) and mental health conditions.
• Sleep disturbances are common in children and adults with neurodevelopmental conditions including autism, and attention deficit and hyperactivity disorder, ADHD.

What do sleep problems look like?

• Sleep problems refer to a wide range of difficulties including:
  • Sleep deprivation, difficulty falling asleep, difficulty maintaining sleep, not feeling rested after sleep;
  • Sleeping at the wrong times of the day;
  • Nightmares or sleep terrors;
  • Bed wetting.
• Sleep itself may be an issue, however this is often accompanied by behavioural difficulties, such as:
  • Emotional outbursts related to bedtime;
  • Repeatedly getting out of bed;
  • Destructive behaviour in their bedroom.

Impact of sleep problems

• Effects on the family
  • Increase in family stress
  • Negative impact on the parent-child relationship
  • Negative impact on the parents own relationship and relationship with their other children
• Effects on the person with learning disabilities
  • Negative impact on emotional well being – e.g. causing low mood, irritability
  • Increase in difficult behaviours during the day such as aggression
  • Hyperactivity
  • Daytime sleepiness
  • Decline in motivation and concentration

How much sleep do we need?

• Everyone needs different amounts of sleep, however on average:
• adults need 7 to 9 hours
• children need 9 to 13 hours
• toddlers and babies need 12 to 17 hours.

Identifying sleep disturbance

• Carers are key in the assessment of sleep disturbance experienced by people with learning disabilities.
• Carers may need help and support from health professionals when their family member experiences sleep disturbance due to the impact that sleep problems can have on the whole family.
• Carers might complete sleep diaries over several weeks to identify sleep patterns.
• Physical assessments of conditions such as epilepsy and sleep apnoea may be preformed.
• Pulse oximetry (a test used to measure the oxygen level of the blood) and polysomnography (a test which records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements) might be used to test for epilepsy and sleep apnoea.
• Sleep disturbances can also be an indication of mental health problems so an assessment might be completed.

Improving sleep

• Due to the impact that sleep disturbances can have on people with learning disabilities and their families, it is important that we try to improve sleep.
• It may be helpful keep a sleep diary, to help track any trends or patterns in sleep – https://www.nhs.uk/livewell/insomnia/documents/sleepdiary.pdf
• Below is a range of ways that sleep can be improved.
  • Increasing light exposure during the day improves both the quality and duration of sleep and reduces the time taken to fall asleep.
  • Exercise is one of the best evidence-based approaches to improve sleep and overall health. Exercise should be taken during the day and avoided late in the evening before going to bed.
  • Avoid drinking large amounts of liquids before bed and try to use the toilet before bed.
  • Avoiding caffeine later in the day to reduce stimulation of the central nervous system thereby aiming to promote sleep.
  • Avoid large meals before bed.
  • A light snack a few hours before bed may help to promote sleep.
  • Alcohol intake at night can also affect sleep as it reduces melatonin production at night-time and can result in disturbed sleep.

• Sleep apnoea is one of the most common health conditions that may contribute to sleep disturbance. This is when your breathing stops and starts while you sleep.
• Advice and assessment should be sought from a medical practitioner or health professional if an underlying health condition affecting sleep is suspected.
• Melatonin is a sleep hormone that stimulates the brain to relax, thereby promoting sleep and can therefore be helpful in enabling sleep.
• A melatonin supplement may be an effective way to improve quality of sleep. Advice should be sought from a medical practitioner or health professional.
• Supplements have also been proven to promote relaxation and sleep, for example, magnesium and lavender.
• Advice should be sought regarding supplements from a medical practitioner or health professional.
• It is recognised that a short nap, of about 20-30 minutes, during the day can be beneficial.
• It is important to avoid long and irregular napping during the day as it can delay the onset and duration of sleep at night.
• To promote and improve the quality, duration and consistency of sleep, waking times in the morning is important.
• Going to sleep and waking at the same time can be effective in promoting sleep at night.
• The bedroom environment can impact upon sleep and sleep disturbance including external lights, noise, the arrangement of furniture and room temperature.
• To promote sleep at night it can be helpful to minimise external noise and light and ensure that the bedroom environment is quiet and relaxing.
• Room temperature has been found to affect sleep quality and it is suggested that 20°C is a comfortable temperature for most people, however this may vary for each individual.
• For some, relaxation techniques such as a hot bath, meditation and yoga may help people to fall asleep. Others may find a warm bath or shower before bed can assist in relaxation and improve the quality of sleep.
• From a practical perspective, the bed mattress and pillow may also impact upon the quality of sleep and may result in back and joint discomfort. Therefore, the quality of bedding and mattress should be reviewed every 5 to 8 years and, for those with health conditions, an additional assessment and special provision of bedding may be required.