2016 CAPHC Annual Conference October 23-25, 2016 Halifax, NS Sleep Disorders in Canadian Children: What Can We Do to Ensure Better Nights and Better Days for Children and their Families? Penny Corkum, PhD, Registered Psychologist Professor, Department of Psychology & Neuroscience; Psychiatry Dalhousie University IWK Scientific Staff; CEH ADHD Clinic Shelly Weiss, MD FRCPC, Pediatric Neurologist Professor, Faculty of Medicine, Hospital for Sick Children, University of Toronto 1
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Oct 25 CAPHC Concurrent Symposium - Sleep Disorders - Dr. Penny Corkum and Dr. Shelly Weiss
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2016 CAPHC Annual Conference
October 23-25, 2016
Halifax, NS
Sleep Disorders in Canadian Children:
What Can We Do to Ensure Better Nights and Better
Days for Children and their Families?
Penny Corkum, PhD, Registered Psychologist
Professor, Department of Psychology & Neuroscience; Psychiatry
Dalhousie University
IWK Scientific Staff; CEH ADHD Clinic
Shelly Weiss, MD FRCPC, Pediatric Neurologist
Professor, Faculty of Medicine,
Hospital for Sick Children, University of Toronto
1
Outline
Introductions & Objectives
Xavier’s story
Importance of sleep
Access to services in Canada
Barriers to care
Guidelines for pediatric sleep
Service delivery models
Introduction to Better Nights, Better Days
Discussion/Questions
2
Main Goal for Workshop
Determine how we can all work together (as
administrators, policy makers, researchers,
clinicians, and families) to improve paediatric
sleep assessment and treatment in Canada so that
there is access to services for all in need, no matter
Currently no route to certification for subspecialist physicians who practice sleep medicine in Canada
As of July 2016, there will be a AFC (Area of Focused Competence/Diploma) in sleep medicine
1 year – include ongoing maintenance of certification
Eligible for physicians who are specialists in : ENT, respirology, psychiatry, neurology, developmental pediatrics
34
Guidelines for
Pediatric Sleep
http://sleepfoundation.org/ho
w-sleep-works/how-much-
sleep-do-we-really-need
Suggestion: Monitor sleep
amounts and mood over a few
days during which time the
child is allowed to sleep until
he/she awakens
spontaneously (during
vacation is best)
Concern: Sleep duration
recommendation for school-
aged children previously was
10-11 hours but now 9-11 and
even 7-12
36
Participation 2016 Report Card37
38
Recommended hours of sleep
Age 5-13 years: 9-11 hours
Age 14-17 years: 8-10 hours
39
• Healthy sleep is the goal for all infants, children and adolescents
• Guidelines to evaluation and treatment of sleep disorders
• Position statement endorsed by College of Family Physicians, Canadian Psychiatry Association and Canadian Sleep Society
• Endorsement by Canadian Pediatric Society (pending)
Published Jn Can Acad Child and Adol Psychiatry, Vol 23 (3), 2014
40
41
What do you see as the
main barriers to sleep
services in your
communities?
42
Service Delivery Models
Current Service Delivery
Large differences between provinces and regions
(urban/rural)
Focus on obstructive sleep apnea
Use of medications that do not have efficacy data to
support their use in children
Limited access to behavioural treatments
44
Measurement of Sleep
PSG ActigraphySleep Diary
Questionnaires
Interviews
Objective Subjective
45
Best Practices – Assessment
• PSG/MLST
• Actigraphy/ Videography
• Interviews/ Sleep Diaries
• Screening/ Questionnaires
46
Best Practices – Assessment
• PSG/MLST
• Actigraphy/ Videography
• Interviews/ Sleep Diaries
• Screening/ Questionnaires
47
Best Practices –Treatment
• Medication
• Specific behavioural sleep interventions
• Implement healthy sleep practices
• Psycho-education
48
Best Practices –Treatment
• Medication
• Specific behavioural sleep interventions
• Implement healthy sleep practices
• Psycho-education
49
Suggested Model: Stepped Care
Individualized intervention provided by sleep medicine
specialist
Individualized intervention by highly trained health professional
(non-sleep specialist)
Manualized in-person individual or group intervention provided by trained health
professional (non-sleep specialist)
Self (parent) administered interventions with human support (non-specialist)
Self (parent) administered interventions (no direct human support) BNBD-TD / BNBD-NDD
Public education/ prevention/ screening
*adapted from Espie, C.A. (2009). “Stepped Care”: A health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep, 32(12), 1549-1558.
• As of Oct 21, 2016, we have had:– 852 parents express interest in the study– 503 consent to screening– 293 consent to participate in the study– 204 deemed eligible– 196 start baseline
• Recruiting 400 English-speaking parents/guardians from 4 Canadian regions (Atlantic, Central, Prairies, West Coast/Northern) – 100 parents per region– Atlantic Canada region has met quota and is not closed
• Recruiting 100 French speaking parents across Canada (Winter 2017)
58
Discussion/
Questions
How to improve awareness and knowledge of the
importance of sleep?
How to train health care providers in sleep assessment
and treatment?
How to increase equitable accesses to services and
resources?
How to work together to to improve paediatric sleep
assessment and treatment in Canada so that there is
access to services for all in need, no matter where they
live?
What would you need to make a stepped care model
for pediatric sleep work in your service?60
Thank you
Web Resources
Canadian Sleep Society http://www.css.to/
National Sleep Foundation http://www.sleepfoundation