Paeds Vivas · respiratory-sleep-and-airway
Behavioural insomnia and circadian rhythm disorders — branching viva
Branching viva from the classification of behavioural insomnia of childhood and the circadian rhythm disorders, through the two-process and melatonin physiology, the sleep history and diary, behavioural treatment of the toddler, the delayed-phase adolescent with school refusal, and the child with autism and chronic insomnia.
On this page
Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a general and community clinic. The consultant asks you to work through four children: a 15-month-old who wakes repeatedly and can only be rocked back to sleep, a 15-year-old who cannot fall asleep until 2am and cannot wake for school, a 6-year-old with autism and chronic difficulty settling, and a family from a remote community with limited access to a sleep service.
Station opening
Examiner: "Define behavioural insomnia of childhood and distinguish it from a circadian rhythm disorder." [1]
Strong candidate (must-hit)
- Defines behavioural insomnia of childhood as difficulty initiating or maintaining sleep that is learned and behavioural, present despite adequate sleep opportunity, with daytime consequences; names the sleep-onset association and limit-setting subtypes; and contrasts this with a circadian rhythm disorder, in which sleep quality is normal but the clock is set to the wrong time, delayed sleep-wake phase disorder being commonest in adolescents. [1] [8]
Weak candidate
- "It is just a child who won't sleep; I would give melatonin or a sedative to fix it." [2]
References6ShowHide
- [1]Mindell JA; Kuhn B; Lewin DS; Meltzer LJ; Sadeh A Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 2006.PMID 17068979
- [2]Morgenthaler TI; Owens J; Alessi C; Boehlecke B; Brown TM; Coleman J; et al Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 2006.PMID 17068980
- [6]Bruni O; Alonso-Alconada D; Besag F; Biran V; Braam W; Cortese S; et al Current role of melatonin in pediatric neurology: clinical recommendations. Eur J Paediatr Neurol, 2015.PMID 25553845
- [7]Gringras P; Gamble C; Jones AP; Wiggs L; Williamson PR; Sutcliffe A; et al Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo controlled trial. BMJ, 2012.PMID 23129488
- [8]Auger RR; Burgess HJ; Emens JS; Deriy LV; Thomas SM; Sharkey KM Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med, 2015.PMID 26414986
- [9]Crowley SJ; Wolfson AR; Tarokh L; Carskadon MA An update on adolescent sleep: New evidence informing the perfect storm model. J Adolesc, 2018.PMID 29908393