In our latest update, Louise Wilkinson, Head of Information and Learning at the Child Brain Injury Trust, shares valuable information and insight into sleep challenges for children following acquired brain injury.
Louise explores the challenges with sleep, not only because of the injury, but in relation to such a significant change in a young persons life such as long stays in hospital as well as how the family can help to settle the child or young person and how the challenges are presented.
Why is sleep important?
Sleep is essential to life and comprises about one third of our activity over the course of our lives. Without is we will gradually fail to function properly at all levels and, if we fail to get absolutely no sleep for 264 hours (approximately 11 days), we would eventually die. Although we do not yet know how precisely, sleep has a restorative quality and dreaming sleep appears to be involved in the consolidation of memory and learning.
How much sleep do we need?
Studies of how much sleep we need show that this varies with age. Babies and very young children need more sleep and often and multiple times during the day (i.e. they may sleep in the morning and in the afternoon as well as night) than older children and adults.
Although there is always variation between one person/child and another. Here is a general guide to how much sleep we need depending on our age:
Why does Acquired Brain Injury affect sleep?
Studies show that injury to the brain can disrupt the sleep-arousal brain system so that normal sleep patterns are altered, and the quality of sleep is affected, and sleep is disturbed. This is especially so for children with more severe neurological problems, but it is also possible that those with a mild injury may also not sleep as well.
It’s also important to remember that following an ABI the usual sleep pattern can get interrupted because of a long stay in hospital. For example, a child may well be in intensive care for some time. Perhaps after an initial induced coma following the injury/operation, they may be kept in an induced coma to help their recovery. They may be woken at regular times throughout the day and night to undergo certain important procedures or observations. Once this is over, their sleep/wake cycle may be controlled by drugs, particularly if they are confused and disorientated. This can all impact on a child’s normal sleep pattern.
What does this mean when my child gets home?
This all means that once your child had recovered enough to return home their sleeping may continue to be disrupted. Studies show that for parents sleep disturbance is once of the principle issues along with mood and behaviour problems following childhood brain injury.
How will I know if my child is not sleeping well?
It is important to remember that after brain injury, your child may feel very tired. As a result, one of the first things you might notice is that your child complains that they are all tired all the time, even if they are going to bed and sleeping adequately, this is also partly because the physical process of healing takes up a lot of energy and due to fatigue being a major symptom of ABI. You may also notice that your child’s bedclothes are untidier and tumbled about in the morning than they used to be, and this may be a sign that the pattern and quality of their sleep is disrupted.
Different types of sleeping problems
Aside from disruptions to the quality of children’s sleep, there are often more obvious sleep problems associated with the following difficulties:
• Going to bed, e.g. refusal to go to bed, not feeling sleepy before bed, anxiety about and avoidance of going to bed.
• Going to bed but not sleeping.
• Waking in the night.
These difficulties are likely to have an impact on your energy levels and sleep, as you might not be able to get to bed early enough to have a good night’s sleep, or maybe you are woken in the night when they wake, either because they seek you out or because of the noise they make when they are awake.
What should I do?
Here are some basic suggestions:
• Make sure the child has a comfortable bed
• Preferable to have thick curtains that don’t let light in
• Use a duvet or bedcover suitable to time of year
• Make sure there is a reasonable room temperature
• The bedroom should be free of any visual or audio stimulus, making sure the room is a place for sleep.
• Turn the light off or a night light to reassure nervous children.
• In the hour before bedtime, make sure activities are calm and quiet.
• Establish a regular bedtime routine, so the child knows (1) what to expect at bedtime and (2) that this is the start of going to bed and going to sleep.
• Keep to an agreed bedtime – even at weekends.
• If the child is distressed about being left, then sit quietly by the bed to reassure them until they fall asleep.
• If you can see that your child is worrying about going to bed and not sleeping, it can be helpful to come up with a plan together about ways of relaxing their body and mind that can be practiced and used routinely. Some ideas include:
- A warm (not hot) bath.
- Milky drink before bed, only if part of normal routine (milk can act as stimulus to digestive system).
- Listening to a story or music at bedtime.
- Remembering their favourite memory or place or holiday and thinking about this as they fall asleep. It can sometimes be helpful for your child to draw their favourite memory and have this drawing by their bed so that they can look at it as they fall asleep.
- Learning to relax their muscles in bed, e.g. clenching and relaxing the hands, pointing the toes upwards and relaxing them, hunching the shoulders and relaxing them, tensing the tummy muscles after breathing in and relaxing them after breathing out.
Ensure that they do not turn on the TV or computer. Prompt them to engage in calm, quiet activities like reading a book, relaxing their muscles, breathing in and out slowly and thinking about their favourite memory. It is usually not a good idea to let crying children go on for too long so go to them. Sit by them quietly to reassure them, either until they fall asleep or until you can see that they are calm, relaxed and sleepy. Although this is tempting if they are little or are very distressed, do not take them to your room unless this is really what you want. It may set up a comforting pattern that is difficult for you and your child to get out of a later date.
Tiredness during the day
If you notice that your child is tired during the day because their sleep is disturbed at night and / or because they are still recovering, and their brain is having to work hard all of the time, it might be helpful to look at the Factsheet on Fatigue.
What if I’ve tried all of these ideas and my child’s sleep is still disturbed?
If sleeping problems continue, we would recommend a visit to your GP to talk through your concerns and to get specialist help and advice. In addition, if your child has nightmares which relate back to a traumatic injury/event or the procedures surrounding this, they may have Post-Traumatic Stress Disorder (PTSD) and again professional help might be needed via a referral from your GP. Pain may also be a factor in understanding your child’s disturbed sleep and we would recommend a visit to your GP if your child is experiencing and / or complaining of pain. Disturbed sleep can feel debilitating and overwhelming and so it is important that any sleeping problems are dealt with, not only for your child, but also for the whole family. No one can function at their best if they are tired.