Sleep problems

People with a learning disability often complain of poor sleep, with the reported prevalence ranging from 15 to 50 per cent. There are many potential causative factors, including:

• Poor sleep habits
• Disturbance of the sleep-wake cycle
• Poorly controlled epilepsy
• Brain damage
• Anxiety or other mental health disorder
• Sleep apnoea.

Poor sleep may lead to worsening of mood and behaviour that challenges which is often seen in a person with a learning disability. This will detrimentally impact on the person's quality of life, as well as significantly adding to the burden of care.

Many cases will be helped with simple sleep hygiene advice. You can advise people to:

• Try to exercise during the day
• Have a light snack before bedtime
• Make sure that their bedroom is as dark and quiet as possible €“ if sleep is particularly problematic in the summer months, then they could try blackout blinds or curtains
• Make sure that their bedroom is a comfortable temperature
• Try to go to bed and get up as near as possible to the same time each day and to avoid daytime naps
• Avoid alcohol, smoking and caffeine, which can all interfere with sleep.

The West London Mental Health NHS Trust have a leaflet for parents on Sleeping difficulties in children and young people with learning disabilities.

When sleep hygiene measures are not effective, medicines may be used. Zopiclone and zolpidem are first line treatments and have largely replaced the older benzodiazepines used as hypnotics, such as temazepam.

The use of the naturally occurring substance melatonin €“ a hormone secreted by the pineal gland in a circadian manner that promotes sleep €“ has been studied in people with a learning disability. There is a growing body of evidence describing abnormal melatonin secretion in children with neurodevelopmental disorders. Melatonin is thought to decrease sleep latency, advance sleep onset and increase the amount of sleep. More information on melatonin for sleep disorders is available from Medicines for Children.

Dysphagia

Dysphagia refers to difficulty in eating, drinking or swallowing. It can lead to malnutrition, dehydration, choking and reduced quality of life. In addition, 40 per cent of people who have a learning disability and dysphagia experience recurrent respiratory tract infections, the outcome of which can be fatal. Often the more complex and profound the disability, the more severe the dysphagia.

If a person is struggling to swallow their medicine, you can advise about different formats and options that may be available, such as smaller tablets, liquids or thickening agents, and then refer to the pharmacist.