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Abstract
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INTRODUCTION Insomnia is common among children and adolescents and is associated with adverse effect on physical, emotional, and behavioral health.1 Problematic sleep in childhood is associated with subjective measures of emotion dysregulation or reactivity.2 There is physiologic evidence of cortical hyperarousal in adolescent insomnia and greater likelihood of hypothalamic-pituitary-adrenal (HPA) axis activation in children with insomnia and short sleep duration.3, 4 There is a high frequency of sleep concerns in children with co-morbidities including those with Attention-Deficit/Hyperactivity Disorder (ADHD)5 and those with history of maltreatment such as abuse and neglect.6
The underlying mechanisms of sleep disturbances in children with comorbidities are complex. For ADHD, there is evidence for an overlap in central nervous system centers and neurotransmitter pathways that regulate sleep, attention and arousal.7 There is a reciprocal relationship between sleep and emotion regulation in youth with and without ADHD, but this association is stronger for those with ADHD and their differences in sleep problems and emotion dysregulation persist over time.8 For children with history of maltreatment, there is a bidirectional relationship between chronic stress or trauma and sleep disruption, in which stress or hyperarousal and sleep disruption can form a self-reinforcing feedback loop.9 As hyperarousal plays an important role in the pathogenesis of insomnia, therapeutic option is aimed to reduce arousal by pharmacologic and non-pharmacologic interventions. One of non- pharmacologic interventions is the use of weight items that may reduce the body's physiologic levels of arousal and stress through consistent sensory input.10
Weighted blankets (WB) have been used in sensory integration interventions for self-regulation and are hypothesized to improve sleep by providing deep pressure stimulation (DPS) resulting in relaxation through activation of the parasympathetic nervous system or modulation of serotonin or cortisol to induce feelings of calm and security.11 There is evidence of using WB for insomnia in adults and children with ADHD, autism spectrum disorders (ASD), and psychiatric disorders, but the overall data are limited. The small number of available studies are largely limited to qualitative and case series reports, and controlled trials have mixed results between ASD studies and ADHD studies.11-15 A meta- analysis concludes that WB may reduce anxiety but there is not enough evidence for insomnia treatment.11 A recent literature review states that WB may be a promising tool for sleep interventions but more high-quality and large-scale randomized controlled trials are needed.16 There are no known studies on the use of WB for sleep in childhood maltreatment and other types of interpersonal traumas. ...
Language: en |