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Never underestimate the value of a good night’s sleep; why do people with a learning disability sometimes suffer with sleep disorders?
For anyone who has had trouble sleeping, the consequences of not getting a good rest are all too clear. Sleep is an essential part of being well; without it, we soon become prone to irritability, lose focus and concentration and risk susceptibility to physical illness. It can be caused by a variety of factors and can be acute or chronic.
If you have worked night shifts supporting people with learning disability, you will probably have experienced sleep problems in those you work with. For people with intellectual disabilities it is estimated that prevalence of sleep disorder ranges from 9% to 34%, compared with about 1 in 10 of the general population. The more severe the disability, the higher the prevalence.
So what can cause sleep disorders?
Anxiety is cited by many people as a cause of sleeplessness. We may all from time to time struggle with going off to sleep the night before a big exam or when there are worries and problems on our minds. It is of course ludicrous to suggest that people with learning disabilities are not just as likely to have their rest disturbed by worry. Even if they are not able to explain what they are troubled about, consideration should be given to helping people become less anxious in order to relax.
For some people, restrictions in the airway can lead to obstructive sleep apnoea (OSA). It is estimated that this condition affects around 2% to 4% of adults but rises to as high as 55% of people with Down’s syndrome. This is due to the facial abnormalities linked to this condition, but also relate to obesity and to the low physical tone associated with Down’s. During sleep, the airway relaxes to the point where breathing is disturbed, which frequently wakes the sleeper, reducing the quality of sleep overall.
There are ways to help support people with sleep apnoea, including encouraging them to sleep on their side, using pillows to prop them up and avoid them laying flat, or special bite raisers which are designed to slip over the teeth to prop the mouth slightly open and help keep the airway open. In extreme cases, machines called CPAP (continuous positive airway pressure) involve a mask over the nose that quietly blows air and keeps the throat open.
I recall the worst insomnia I suffered with was when I was very heavily pregnant, due to the lack of comfortable positions I could get myself into. Consider those who are profoundly disabled and imagine how it could be that being uncomfortable in bed, but unable to turn or adjust your position independently would prevent you from achieving sound sleep. More seriously, pressure areas can develop if people are not assisted to move position overnight.
Although it may seem that going to turn and reposition people with physical disabilities would actually wake them, the positive benefits of doing this outweigh the minor disturbance. If this is difficult due to their condition, then pressure reliving mattresses or sleep systems can help tremendously. Advice from an OT or physiotherapist can help here.
Lifestyle and environment
If you have a busy lifestyle, generally you are more likely to sleep well due to the physical tiredness you experience. However, many people with learning disabilities don’t do much during the day, either mentally challenging or in terms of physical activity. This can lead over time to a reduced need for rest and this in turn creates sleep problems. Getting up ridiculously early is a feature of people who have had enough sleep to meet the needs of an inactive lifestyle, as night workers will testify!
Moreover, where there are people active around you during the night, the constant noise and presence of others can seriously mess up your sleep quality. If you have ever spent a night in hospital, you will know that even the most hushed night staff, torches, lights and the sounds of fellow sleepers can stop you from resting properly.
So, having explored sleep problems, what can we do? Lots of advice is available from the following sites, or you can ask the GP for a referral to a sleep clinic if you are really concerned. Medication can be helpful, but if there are other ways, then these can be explored first, since medication can have side effects and create other problems.
Ginny Tyler – QCS Learning Disability Expert Contributor