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Behavioral treatment of sleep dysfunction in patients with the Rett syndrome
C C Piazza1, W Fisher, H Moser
1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Behavioral treatments, including bedtime fading and response cost, effectively regulated sleep patterns in girls with Rett syndrome. This approach increased nighttime sleep and reduced daytime sleep and nighttime behaviors.
Area of Science:
- Neuroscience
- Pediatrics
- Behavioral Science
Background:
- Rett syndrome is a rare genetic neurodevelopmental disorder primarily affecting girls.
- Aberrant sleep patterns, including difficulty with sleep onset and nighttime awakenings, are a common and challenging symptom in Rett syndrome.
- These sleep disturbances significantly impact the quality of life for affected individuals and their families.
Purpose of the Study:
- To investigate the efficacy of a behavioral intervention, specifically a bedtime fading procedure with response cost, for regulating problematic sleep patterns in girls with Rett syndrome.
- To assess the impact of the intervention on nighttime sleep onset latency, daytime sleep, and nighttime behaviors.
Main Methods:
- A case series involving three girls diagnosed with Rett syndrome was conducted.
- The intervention utilized a systematic bedtime fading procedure, delaying bedtime until sleep onset occurred.
- A response cost component was implemented, involving removal from bed for one hour if sleep onset was delayed.
- Daytime sleep was managed through scheduled naps and interruption of non-scheduled sleep.
- A subsequent fading procedure was used to advance bedtimes.
Main Results:
- The bedtime fading procedure with response cost successfully regulated the sleep patterns of the participants.
- Appropriate nighttime sleep duration increased, and latency to sleep onset decreased.
- Inappropriate daytime sleep was reduced, and problematic nighttime behaviors, such as night wakings, were diminished.
- The intervention led to more regular and consolidated sleep patterns.
Conclusions:
- Behavioral interventions, such as bedtime fading with response cost, show promise in treating dysfunctional sleep patterns in girls with Rett syndrome.
- These findings suggest that sleep disturbances in Rett syndrome may be responsive to targeted behavioral strategies.
- Further research with larger sample sizes is warranted to confirm these preliminary findings and explore long-term effects.
Abstract:
Aberrant sleep patterns are commonly experienced by girls with the Rett syndrome. In this investigation, the problematic sleep of three girls with the Rett syndrome was regulated using a bedtime fading procedure with response cost. The treatment involved systematically delaying the bedtime and utilized a response cost component, removing the child from bed for one hour, when the child did not experience short latency to sleep onset. Daytime sleep was interrupted, except during regularly scheduled naps. A fading procedure was then successfully utilized to advance the bedtimes. This treatment resulted in more regular sleep patterns for the girls by increasing appropriate nighttime sleep, reducing inappropriate daytime sleep and reducing problematic nighttime behaviors (e.g., night wakings). These preliminary findings are important because they suggest that the dysfunctional sleep patterns of girls with the Rett syndrome may be amenable to behavioral treatments.