Sleep Health Issues for Children with FASD: Clinical Considerations

Abstract

This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research.

Dysregulation of the cortisol diurnal rhythm following prenatal alcohol exposure and early life adversity

“…These data lend support to the robustness of effects shown in the present study, and to the hypothesis that diurnal cortisol secretion patterns may provide a biological marker of dysregulated HPA function in children following PAE + ELA. Additional indicators of difficulties with self-regulation and adaptive function seen in children with PAE, such as problems with executive functioning and sleep (Jan et al, 2010; Rasmussen, 2005), are known to be linked with abnormal cortisol levels in typically developing children, children with ADHD, and those from low-income backgrounds (Blair, Granger, & Peters Razza, 2005; Blair et al, 2011; El-Sheikh, Buck-halt, Keller, & Granger, 2008; Scher, Hall, Zaidman-Zait, & Weinberg, 2010). Further research evaluating the complex interplay between HPA axis activity and self-regulatory mechanisms following PAE may offer a more complete understanding of the challenges in daily functioning faced by children with FASD.…”

Developmental ethanol exposure-induced sleep fragmentation predicts adult cognitive impairment

“…Beyond the initial wave of ethanol induced damage such as cell death, there is a cascade of cellular, synaptic and network consequences induced by early ethanol exposure – some as a direct result of the ethanol insult, and some as a secondary response to cellular changes induced by that initial insult. One of the many functions that are disrupted by early ethanol exposure is sleep-wake structure (Criado et al, 2008, Pesonen et al, 2009, Jan et al, 2010, Wengel et al, 2011, Volgin and Kubin, 2012). …”

Salivary cortisol levels are elevated in the afternoon and at bedtime in children with prenatal alcohol exposure

“…Neuropsychological effects resulting from PAE include impairments in cognitive and motor function, hyperactivity, and problems in adaptive function (Mattson, Crocker, & Nguyen, 2011). In addition, individuals with FASD are at high risk for mental health problems such as depression and anxiety disorders (Kodituwakku, 2007;O'Connor et al, 2002), and sleep disorders (Jan et al, 2010).…”