Sleep Challenges Children with Down Syndrome Face

Down syndrome is the most common genetic disorder affecting nearly 1 in 700 births in the United States each year. Unfortunately, children with Down syndrome also experience more sleep disorders than the average child with sleep apnea and insomnia being the most common.

We spoke with two professionals, Kyle Jones and Brittany Ferri, to get a better understanding of how to help children with Down syndrome get a better night’s sleep. Jones is an Associate Professor in the Department of Family and Preventive Medicine at the University of Utah with extensive knowledge and experience working with patients with developmental disabilities. Ferri is an occupational therapist at Simplicity of Health and healthcare consultant with experience treating children with Down syndrome.

Sleep Disorders that Affect Children with Down Syndrome

Dyssomnia

Dyssomnias are disorders related to initiating or maintaining sleep. They can also relate to excessive sleepiness plagued by symptoms that disturb the amount and quality of sleep a child receives. One common category of dyssomnias is sleep-wake disorders, also known as, circadian rhythm disorders. With natural development and positive caretaking, many dyssomnias will decrease or be eliminated over time.

Insomnia

Children with Down syndrome are often affected by anxiety, especially prior to bedtime. Anxiety, whether in those with Down syndrome or not, is the primary reason that people suffer from insomnia. Insomnia related to anxiety is often caused by stress, fear of the unknown, or worrying about the past and/or future.

Sleep Apnea

While sleep apnea may affect only 2 to 5 percent of average children, the number of DS children with sleep apnea can be as high as 60 percent. Much of this is due to the fact that children with Down syndrome often have predisposed physical characteristics. According to Ferri, “physical features such as an enlarged tongue, narrowed airway passages, and enlarged tonsils can also cause difficulty breathing during the night”. Due to the frequency of sleep apnea and the danger in children with Down syndrome it is recommended that they undergo a sleep study by the age of four.

How to Address Sleeping Challenges in Children With Down Syndrome

Routine

Routine is important to assist in your child’s social development. A regular wind-down routine helps to relax and prepare your child for bedtime while also relieving anxiety by providing a familiar process night after night. Your child’s bedtime routine may incorporate things like a warm bath, reading time, turning down the lights and various other calming activities. Ferri says “Simple tips such as avoiding eating, limiting electronic devices, and engaging in light activity several hours before bed can all improve sleep function”.

Positive reinforcement

Positive reinforcement such as stickers or stars for achieving sleep goals can help your child feel pride and reduce the anxiety they may face when going to bed. Positive reinforcement also provides your child with a sense of inclusion as they learn the importance of interaction and participation and are provided with a sense of belonging which helps to alleviate some of the anxiety they may feel at bedtime. However, it is just as important to remember that positive reinforcement does not mean using negative behavior when your child is not able to achieve the set goals.

Create an Environment That’s Safe and Conducive for Sleep

First and foremost, it is very important your child’s bedroom is styled for safety. Make sure the room is clear of any obstructions that may pose a tripping threat, hallways are lit with nightlights, and the bed has safety rails. These precautions should be taken to ensure your child’s safety if they wake in the night and exit their room to find you.

Jones and Ferri also stressed the importance of having an environment conducive for sleep. Additionally, you’ll want their sleep environment to be conducive for sleep. While you may not have control over the severity of your child’s sleep challenges, you can create a space that helps them feel calm and promotes sleep. For example, black-out curtains, comfortable blankets, and calming hues on the walls can all contribute to a comfortable atmosphere for your child.

The sleep position can also be extremely important. Jones says, “Given the physical characteristics that increase sleep apnea in children with Down Syndrome, sleeping on their back can worsen the condition. Encourage them to sleep on their side. If they naturally want to sleep on their back, you can try things such as putting regular pillows or a wedge pillow against their back when on their side to discourage rolling over.”

Gather The Proper Sleep Tools

While children with Down syndrome have a higher likelihood of facing sleeping challenges, the good thing is that treatment is similar to the average child. After a doctor’s visit, you may be introduced to several products that can help address specific sleep challenges. For example, a common recommendation is to find an appropriate mattress and bedding that is made of durable, hypoallergenic, and easy-to-clean fabrics. From backaches and bedwetting to twisting and turning, a proper mattress is important to help manage the sleep-wake disruptions. 

Related: Best mattresses for kids

Ferri explains, “Urinary incontinence is not an uncommon concern with this population, so waterproof mattress covers and other bedding can simplify the clean-up process when/if this does occur.” Other products such as white noise machines, anti-snoring products, and various bed rails and pads can help with specific sleeping events and challenges.

If a CPAP machine is needed, Jones recommends easing your child into using it. “Techniques to desensitize to the mask, such as slowly introducing it, having them wear it for a time during the day, and offering positive rewards for wearing it consistently at night can be helpful.”