Sleep disorders with neurological disease: Viva

Opening question

Examiner: This boy with autism takes two hours to settle and wakes through the night. How do you approach the assessment, and what is the most likely category of sleep disorder here?

Candidate: I would start with a structured sleep history and a two-week sleep diary, asking separately about sleep onset latency, night wakings and their triggers, total duration, morning mood, and the daytime impact on behaviour and learning. In a child with autism, the most likely category is a dyssomnia, specifically chronic insomnia of the neurodevelopmental disorders, because bedtime resistance and night-waking are the commonest sleep complaint in autism, occurring in 40 to 80 per cent of these children. I would use the Sleep Disturbance Scale for Children to screen for the other clusters and to track response, because a sleep disorder here is the expected finding, not the exception. ^[9]

Examiner: Good. Before you reach for a drug, what non-pharmacological measures would you put in place? ^[9]

Candidate: The foundation for every child is sleep hygiene and behavioural therapy, and this layer alone resolves a large fraction of chronic insomnia, so it must never be skipped. I would build a consistent bedtime routine, a regular rise time, removal of screens and caffeine from the evening, and a behavioural programme such as graduated extinction or sleep scheduling, adapted to his developmental level and supported by his parents and his school team. ^[9]