Developing Independent Sleep Developing Independent Sleep Initiation Skills and Decreasing Initiation Skills and Decreasing

Night Wakings: Night Wakings: A Case StudyA Case Study

Holly J. ZumpfeHolly J. Zumpfe

Munroe-Meyer Institute Munroe-Meyer Institute

12-19-0312-19-03

Pediatric Sleep ClinicPediatric Sleep Clinic

Brett Kuhn, Ph.D. DirectorBrett Kuhn, Ph.D. DirectorTreat common sleep problemsTreat common sleep problems– Bedtime ResistanceBedtime Resistance– BedwettingBedwetting– NightmaresNightmares– Night-time fearsNight-time fears– Night-time wakingNight-time waking– Sleep Terrors/Sleep WalkingSleep Terrors/Sleep Walking– Sleep-Wake Schedule problemsSleep-Wake Schedule problems– Compliance for medical Compliance for medical

proceduresprocedures

The 2-Second A to ZZZZ’sThe 2-Second A to ZZZZ’s

20 to 30% of Children experience sleep 20 to 30% of Children experience sleep disturbancesdisturbances

The ClientThe Client

11 year old female 11 year old female Mild Mental RetardationMild Mental RetardationMedicationsMedications– MethylphenidateMethylphenidate– ClonidineClonidine

Referral Concern: Referral Concern: – Requires parental presence to initiate and Requires parental presence to initiate and

reinitiate sleepreinitiate sleep– Experiences night time awakeningsExperiences night time awakenings

Assessment of Sleep ProblemsAssessment of Sleep Problems4 Major Areas4 Major Areas

Bedroom EnvironmentBedroom Environment Sleep ScheduleSleep Schedule

Daytime BehaviorDaytime Behavior Independent Sleep Independent Sleep Onset SkillsOnset Skills

Client assessmentClient assessmentMeasures for pre-treatment packetMeasures for pre-treatment packet– Background Information FormBackground Information Form– Sleep Disturbances Scale for Children (Bruni et Sleep Disturbances Scale for Children (Bruni et

al., 1996)al., 1996)– Parenting Stress Index-Short Form Parenting Stress Index-Short Form

(Psychological Assessment Resources, 1995)(Psychological Assessment Resources, 1995)– Pre-Treatment Sleep DiaryPre-Treatment Sleep Diary– Sutter-Eyberg Child Behavior InventorySutter-Eyberg Child Behavior Inventory– Child Behavior ChecklistChild Behavior Checklist

Results of Pre-Treatment DataResults of Pre-Treatment Data

Changes in Total Sleep Time

0

2

4

6

8

10

121 5 9 13 17 21 25 29 33 37 41

Nights

Ho

urs

TST

3 Phases of Data Collection3 Phases of Data Collection

Baseline (TST=7.77 hours/night)Baseline (TST=7.77 hours/night)

Behavior Intervention (TST= 9.06 Behavior Intervention (TST= 9.06 hours/night)hours/night)

Elimination of Clonidine (TST= 7.57 Elimination of Clonidine (TST= 7.57 hours/night)hours/night)

Changes in Night Wakings

0

1

2

3

4

5

1 6 11 16 21 26 31 36 41

Nights

Nu

mb

er

of

Wa

kin

gs

Night-wakings

ResultsResults

BaselineBaseline Behavior Behavior InterventionIntervention

Discontinue Discontinue Clonidine Clonidine

TSTTST 7.777.77 9.069.06 7.577.57

TIBTIB 8.778.77 9.699.69 8.468.46

Sleep Sleep EfficiencyEfficiency

88%88% 94%94%

WakingsWakings 1.21.2 00 00

LatencyLatency

Sample Data sheetsSample Data sheets

Why collectedWhy collected

Any Problems with dataAny Problems with data

How were used to make clinical How were used to make clinical decision?decision?

Previous ResearchPrevious Research

Empirical basis for treatmentEmpirical basis for treatment

Research studies to support our treatmentResearch studies to support our treatment

TreatmentTreatment

Steps involvedSteps involved

Tx integrityTx integrity

If changes made, how used to make If changes made, how used to make changeschanges

Problems encountered in implementationProblems encountered in implementation

EvaluationEvaluation

How were outcomes empirically verify?How were outcomes empirically verify?

Question/problems colleagues should Question/problems colleagues should considerconsider