Scheduled Awakenings Research Articles

NOCTURNAL BLADDER EMPTYING:: A SIMPLE TECHNIQUE FOR REVERSING URINARY TRACT DETERIORATION IN CHILDREN WITH NEUROGENIC BLADDER

In this preliminary study we sought to determine the effect of instituting nocturnal bladder emptying (NBE) in children with neurogenic (NGB) or nonneurogenic neurogenic bladder (NNGNGB) in whom urinary tract deterioration developed despite optimal daytime clean intermittent catheterization (CIC) and urotropic medications. We hypothesize that a syndrome of nocturnal overdistention of the bladder (SNOB) can cause urinary tract deterioration through increased nighttime storage pressures manifested by recurrent urinary tract infection (UTI), worsening incontinence, hydronephrosis and/or decreasing bladder compliance and capacity, and may be reversed by NBE. A total of 19 children with NGB (17) or NNGNGB (2) who displayed urinary tract deterioration while on CIC and urotropic medications were started on NBE. Of the patients 15 used a continuously draining nighttime catheter while 4 had scheduled awakenings during the night to perform CIC. The primary indications for NBE were recurrent symptomatic UTI in 5, new or progressive hydronephrosis in 7, and decreasing bladder capacity and compliance in 7. At a mean followup of 23 months 15 (79%) patients showed improvement or complete resolution of 1 or more signs or symptoms of hydronephrosis (7), increase in bladder capacity (5), recurrent UTI (6) and worsening incontinence (3). The remaining 4 patients had no response to NBE. No adverse effects were observed with 10 hours or less of nightly indwelling catheter time. Patients with NGB or NNGNGB on idealized daytime programs of CIC and urotropic drugs may have high intravesical pressures and experience urological deterioration because of an unrecognized SNOB. NBE is a simple technique for treating this condition and reversing the pathophysiological changes. The observation that NBE alone may increase bladder compliance and capacity sufficient to avoid bladder augmentation suggests that development of decreased bladder compliance and capacity in children with NGB may not simply represent normal progression of NGB disease. These changes may be avoidable consequences of untreated SNOB. Early institution of NBE may prevent urinary tract deterioration from developing in this population.

Decreasing self‐injurious behavior associated with awakening in a child with autism and developmental delays

AbstractDirect observation data revealed that self‐injurious behavior (SIB) emitted by a young boy with autism occurred primarily within one hour after waking versus all other times of the day. Experimentally manipulated scheduled awakenings supported the hypothesized relation between waking and SIB. A faded‐bedtime procedure was then implemented to stabilize his sleep patterns, which reduced awakenings by 81% and post‐waking SIB by 82%. Copyright © 2004 John Wiley & Sons, Ltd.

Treating Sleep Terrors in Children with Autism

Sleep terrors manifest themselves as a sudden arousal from slow wave sleep accompanied by screaming, crying, and other signs of intense fear. Children with autism spectrum disorders may be more likely to display problems with sleep, and some children experience such sleep difficulties as sleep terrors on a chronic basis. This nighttime disruption can lead to a great deal of concern, as well as disruption in sleep for other family members. In this first study of the treatment of sleep terrors among children with autism, the effectiveness of one behavioral intervention (scheduled awakenings) was evaluated. Scheduled awakenings involved arousing the child from sleep approximately 30 minutes before an expected sleep terror episode. Results through a 12-month follow-up using a multiple baseline across three children indicated that this intervention quickly and durably reduced the frequency of their nighttime difficulties. Scheduled awakenings is a potentially useful nonmedical intervention for chronic sleep terrors among children with autism.

Interventions for Infant and Toddler Sleep Disturbance: A Review

ABSTRACT Sleep disturbance affects nearly 25% of infants and toddlers, resulting in fatigue, stress, and family dissatisfaction. This review describes empirically-based treatments for infant and toddler sleep disturbance involving difficulty settling and night waking, including behavioral and pharmacological approaches. Pharmacological interventions included antihistamines, chloral hydrate, benzodiazepines, and melatonin. Behavioral interventions included extinction and its many variants, positive bedtime routines, scheduled awakenings, and disassociating feeding from sleep-wake transitions. Advantages and disadvantages of each approach are discussed and suggestions offered for future research.

Empirically supported treatments in pediatric psychology: bedtime refusal and night wakings in young children

To review the literature for empirically supported treatments for bedtime refusal and night wakings in young children. An extensive review of the literature resulted in the inclusion of 41 studies that were evaluated according to the criteria established by the Task Force on Promotion and Dissemination of Psychological Procedures (1995). Evidence exists indicating that extinction and parent education on the prevention of sleep problems can be considered well-established treatments. Furthermore, graduated extinction and scheduled awakenings are probably efficacious treatments, with positive routines a promising intervention. A discussion of effectiveness, treatment feasibility, cost-effectiveness, and methodological limitations of the studies is provided. Recommendations for future directions for research in the treatment of these two common sleep disorders are presented.

Behavioral intervention for childhood sleep terrors

Sleep terrors involve a sudden arousal from slow wave sleep accompanied by screaming, crying, and other manifestations of intense fear. Although many children exhibit isolated sleep terror episodes, a few experience these sleep difficulties on a chronic basis. These frequent sleep terrors can lead to a great deal of concern as well as disruption in sleep for other family members. We conducted a study of the effectiveness of one behavioral intervention (scheduled awakenings) for the sleep terrors of three young boys. The boys (5, 6, and 9 years old) had a several-year history of sleep terrors, each more than 2 years. Scheduled awakenings involved arousing the child from sleep approximately 30 minutes before expected sleep terror episodes. Results through a 12-month follow-up using a multiple baseline across children indicated that this intervention quickly and durably reduced the frequency of their nighttime difficulties. Scheduled awakenings are a potentially useful nonmedical intervention for chronic sleep terrors.

Management of infant sleep disturbance: A review

Infant sleep disturbance affects between 15 and 35% of infants and their parents. Despite the significance of the problem there exists little guidance for clinicians dealing with this group. Interventions advocated by the literature range from spanking to medication. Normal sleep state development in infants and the influence of temperament is described, as are infancy and infant sleep disturbance. Treatment regimes that have been subjected to some degree of empirical evaluation are reviewed. These have been the pharmacological approaches, and from a behavioral perspective, scheduled awakening, extinction and its modifications, stimulus control, and finally studies employing a variety of methods. Treatment outcomes using these techniques are discussed in relation to practical considerations, side effects, and acceptability to parents. The single prevention evaluation is described, as is the need for further research in this area.

Infant and Toddler Sleep

A telephone survey was carried out to determine the prevalence of infant and toddler sleep disturbances. Parents of all 12- to 35-month-old children listed in one community were contacted, and 81% participated. Many children resisted going to bed (42%) or woke and cried during the night (35%). Approximately half the parents had changed their child's diet, naptime, or bedtime and about half these parents found changing routines helpful. Parents frequently reported that pacifiers or bottles in the crib quieted their children. Crying it out, scheduled awakenings, and progressive delay responding were all effective (70% or better) for parents who were aware of these procedures. Satisfaction did not necessarily correspond with effectiveness. Finally, parents were more likely to seek information about sleep from relatives, friends, or books and magazines than from their physician or from a psychologist.

Amelioration of infant sleep disturbances: II. Effects of scheduled awakenings by compliant parents

Twelve infants and toddlers who exhibited spontaneous awakening and crying episodes during the night were subjected to scheduled awakenings by their parents. Scheduled awakenings were determined from individual baseline data, and these consisted of awakening, feeding, and consoling the child about 15 to 30 minutes before typical spontaneous awakening times. Once spontaneous awakenings were precluded, scheduled awakenings by the parents were faded out and posttreatment data were collected. The technique appeared effective for most children when the parents complied with the procedure.