從白天到晚上:一個特殊需要兒童睡眠模式調整的旅程

當孩子的睡眠模式不符合預期時,家長可能會感到困惑和無助,尤其如果孩子還需要上學與其它社交行為的時候,更往往會影響更大。今天我們就來分享一個治療成功的個案:一位9歲的男孩,因先天性疾病和視力問題而來訪門診,

 

個案介紹

 他的睡眠習慣自小就不同尋常:白天下午睡覺,夜間睡眠時好時壞。
根據家長提供的睡眠日誌(如下圖,黑色為家長記錄孩子睡著的時間),孩子晚上的最佳睡眠時段從晚上九點多至凌晨一點多,有時候卻是從凌晨三點睡到早上六點多。白天則可能從中午睡到傍晚六、七點,甚至一天內分好幾次睡。

 

 

 

這樣的情況指向了日夜節律失調的問題。在國際上,對於這類問題的治療建議包括行為治療、光線治療,以及使用褪黑激素藥物。然而,在台灣,褪黑激素藥物類型受到限制,通常建議用於55歲以上的患者,這與國際上的處理方式有所不同。

 

經過與家長的溝通與同意,我們花了約兩周的時間來確定最適合服藥的時間點(紅色圓圈是吃藥時間)。結果令人鼓舞,正確的給藥時間讓孩子的長時間睡眠轉移到了夜間,此後孩子的睡眠模式變得規律,至今維持了約七個月。

 


 


疾病簡介

人體的生理時鐘(日夜周期)在光線、食物、周邊環境的互動之下,大概是24小時。也就是白天維持清醒夜晚睡覺的情況,而夜晚睡覺的時間點大約可以保持一致。但是在視覺和中樞神經系統出問題、環境刺激不足(例如長期處在光照不足的地點)的情況下,日夜周期就沒辦法保持在一定的時間點上。

常見的障礙有幾種
  • 相位提前:還是會有一整段的長睡眠,但只是變成早睡早起。老年人常見。
  • 相位延後:還是會有一整段的長睡眠,但變成晚睡晚起。青少年常見(例如)。
  • 相位不規律:比較沒有大於4小時的長睡眠,每次睡都睡短短的,一天內亂睡,沒有固定時間點。
  • 非24小時相位:有一整段的長睡眠,但這個長睡眠時間點會愈來愈往後跑,可能在一個月之後又跑回原本的睡眠時間點。





給家長的建議

1. 注意觀察孩子的睡眠模式:當您發現孩子的睡眠時間不規律或有問題時,記錄下來,這對尋求專業幫助非常重要。(如何記錄睡眠日誌?)

2. 尋求專業建議:如果您的孩子有類似的睡眠問題,建議尋求專業醫生的協助,以獲得適合的治療方案。(掛號由此去)

3. 行為和環境調整:除了藥物治療,改變睡前行為和睡眠環境也可能有助於改善睡眠品質。確保睡眠環境安靜、舒適,並建立固定的睡前儀式。

4. 保持耐心和堅持:改變睡眠模式需要時間和持續的努力,保持耐心,與孩子一起努力。

 

個案的特殊點

特殊需求的孩子如果有睡眠問題,常常很困擾照顧者,在正確的診斷之下,給以藥物治療對於雙方都會很有幫助。



==========Translated by ChatGpt=============

When a child's sleep pattern doesn't match expectations, parents can feel confused and helpless, especially if the child has school and other social commitments, which can have a greater impact. Today, let's share a successful treatment case: a 9-year-old boy who visited the clinic due to congenital disease and vision problems.

Case Introduction

His sleeping habits have been unusual since childhood: sleeping in the afternoon during the day and having good and bad nights of sleep. According to the sleep diary provided by the parents (as shown in the figure below, black indicates the times the child fell asleep), the child's best sleeping period at night was from after 9 PM to past 1 AM, but sometimes he would sleep from 3 AM to after 6 AM. During the day, he might sleep from noon to 6 or 7 PM, or even have several naps throughout the day. 

This situation pointed to a problem with the circadian rhythm. Internationally, treatment suggestions for such problems include behavior therapy, light therapy, and the use of melatonin drugs. However, in Taiwan, the types of melatonin drugs are restricted, usually recommended for patients over 55 years old, which differs from international practices.

After communicating and agreeing with the parents, we spent about two weeks to determine the most appropriate time for medication (red circles indicate medication times). The results were encouraging; the correct timing of medication shifted the child's long periods of sleep to nighttime, and since then, the child's sleep pattern became regular, maintaining for about seven months. 

Disease Introduction

The human biological clock (circadian rhythm) operates on a roughly 24-hour cycle influenced by light, food, and surrounding environment, maintaining wakefulness during the day and sleep at night, with the timing of night sleep being relatively consistent. However, when there are problems with vision and the central nervous system, or insufficient environmental stimuli (such as long-term exposure to insufficient light), it's challenging to maintain the circadian rhythm at a certain point.


Common Disorders Include:

- Advanced Sleep-Wake Rhythm Disorder (ASWRD): the patient still has a long period of sleep but shifts to sleeping and waking up early. Common seen in elderly people.
- Delayed Sleep-Wake Rhythm Disorder (DSWRD): Still a long period of sleep but shifts to sleeping and waking up late. Common seen in teenagers.
- Irregular Sleep-Wake Rhythm Disorder (ISWRD): the patient can sleep, but their longest duration of each sleep is less than 4 hours of continuous sleep. Many short naps throughout the day with no fixed sleeping times are also occurred. 
- Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWRD): the patient may have a long continuous sleep , but the bedtime gradually shifts later, possibly returning to the original sleeping time after a month.

Advice to Parents


1. Observe the Child's Sleep Patterns: When you notice irregular or problematic sleep times, record them. This is very important for seeking professional help.

2. Seek Professional Advice: If your child has similar sleep issues, it's recommended to seek help from a professional doctor to get an appropriate treatment plan. 

3. Behavioral and Environmental Adjustments: Besides medication, changing pre-sleep behaviors and the sleep environment may also help improve sleep quality. Ensure the sleeping environment is quiet, comfortable, and establish a consistent bedtime routine.

4. Maintain Patience and Persistence: Changing sleep patterns takes time and continuous effort. Keep patient and work together with your child.


Special Note for the Case

For children with special needs who have sleep problems, it can be very troubling for caregivers. Proper diagnosis and medication treatment can be very helpful for both parties.

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