Common Sleep Challenges in Children With Down Syndrome (And What to Do About Them)

by Lisa Smalls

Quality sleep is particularly hard to achieve for children with Down syndrome, where symptoms often persist into adulthood. According to the National Institute of Health, 76% of children with Down syndrome experience difficulty with the onset of sleep, their quality of REM sleep, and their ability to stay asleep. The sleep troubles children with Down syndrome face often affect other aspects of their development down the road. In fact, research conducted by Jaime Edgin, PhD suggests that lack of sleep in early childhood and infancy can negatively impact learning, memory, and language development. Impediments in language development are a particularly common result of sleep inefficiency in children with Ds.

There can be multiple causes of sleep deprivation in children with Down syndrome, and it is best to consult with your doctor first to discuss what is going on with your child. Two common causes of sleep disturbances in children with Down syndrome are physical, breathing-related sleep problems and behavioral sleep problems. We will be discussing these two types of causes in this article. The first step in diagnosing and treating your child’s sleep issue is through figuring out if the problem is physical or behavioral.

The most common physical, breathing-related sleep problem is obstructive sleep apnea, where according to a study by NIH,  31% of infants with Down syndrome have obstructive sleep apnea. A first step is to rule out sleep apnea, since it happens so frequently. According to NIH, obstructive sleep apnea is commonly responsible for restless sleep, snoring, and gasping as compared with typically developing children. This increased likelihood is caused by physical abnormalities associated with Down syndrome, such as narrower upper airways, larger tongues, and tonsils, looser muscle tone, and a propensity for being overweight.

My brother suffered from sleep apnea and the first step in treating the issue was taking him to a sleep study. Mass General Hospital recommends have a sleep study conducted by the age of four for children with Ds. After his sleep study, he was put on a CPAP machine to help keep his airways open.

A second common underlying cause of sleep deprivation are behavioral issues prevalent in children with Down syndrome. Most behavioral issues fall under the umbrella of sleep hygiene principles, where using adhering to these principles helps your child fall asleep and stay asleep. Create a plan that involves the following principles and keep following it:

• Establish a clear and regular routine. Establish a routine set of activities surrounding bed time. Children with Down syndrome respond most effectively to visual prompts, like photo cards or a homemade picture book of each stage of the routine. Consistency is everything – perform the same activities each night within the last hour prior to bedtime.
• Reward and reinforce good behavior. Note that while social rewards like praise and cuddling often work with children who have Down syndrome, for some kids they do not. In this case, you must be creative and find other incentives, like a small token gift. Reward systems that give stars or other positive tokens makes bedtime associated with less anxiety and positive emotions.
• Create a relaxing bedtime setting, as it is essential for reducing the anxiety caused by the physical and behavioral challenges associated with Down syndrome. Make his or her bedroom only for sleep, where it is kept cool, dark, and free of distractions. Consider white noise machines. Also, as part of a sleep-friendly environment, consider your child’s bedding and mattress as well by laying on your child’s bed and testing it out. Is it comfortable? While you don’t have control over your child’s behavior, you do have control over their environment so do your best to make it conducive to sleep.

Parents in turn also experience sleep deprivation, where it is paramount to ensure quality of life for both parent and child through addressing sleeping problems. This sleep deprivation of parents leads to a harder time implementing consistent and appropriate behavior management during the day, which in turn can lead to increased behavioral problems at night when trying to get your child to bed. There are several teaching and learning challenges of having a child with Down syndrome, where the resilience and strength of you as parents cannot be underscored enough. Use these sleep hygiene principles for the benefit of your entire family.

Lisa Smalls is a freelance writer from North Carolina. While she isn’t a medical professional, she grew up sharing a room with her brother who had Ds. In her free time, she is passionate about writing on the sleep issues Ds kids face and how families can best cope with these challenges.