PANS

Why, Oh Why, Won't You Go To Sleep?

We've all been there...it's 9:30 pm and you have just spent the past two hours singing, rocking and reading to your child.  The good news?  You think he's finally asleep, so you settle in with that cup of tea and a good book - only to get through two sentences - and then you hear the pitter patter of little feet.  The door opens and their he is (again!) wide awake, whining, "I'm not tiiiirreeed..." You're exhausted and wonder, why, oh why, won't you go to sleep???

Dr. Barbara J. Howard of Johns Hopkins University School of Medicine recently addressed this common "bedtime battle" in Pediatrics.  She speaks about the issues that weary sleep deprived parents face when their child does not want to go to bed at night.  Howard talks about healthy bed time routines, problems with new siblings, toilet training, the beginning of the school year or school week as possible issues facing the child, which may affect their sleep.  Her recommendations are basic good suggestions, including changing the bed time, sleeping with a favorite stuffed toy, pet or even sibling, reassuring the child that the parent will check on them after they fall asleep, avoiding stimulating medicines, caffeine, watching exciting games, media or exercise within 2 hours of bedtime. 

As a physician, I question whether or not these sleep and separation anxiety issues that present at bedtime may be better served if other possible explanations are investigated.  

In my practice most of the children on the autism spectrum experience sleep disturbances.  They have trouble falling asleep and in many cases remaining asleep. This experience leads me to believe that without investigating other possible infectious triggers, including PANDAS/PANS syndromes, disturbance in the adrenal function, neurotransmitter production and utilization, environmental triggers and even toxic exposure (usually unknown to the parent) or seizures,  that the underlying cause for the sleep issues will never be understood - inevitably making the advice of the family's medical provider ineffective.  

While in a lot of cases, enforcing a consistent bedtime routine and creating a calm environment at night will encourage your child to snuggle up and drift off to sleep, in others we may need to "dig a little deeper." I believe that it is our job, as doctors, to take detailed histories,  perform physical exams and do the necessary lab work, and MRI's of the brain to determine which - if any -  of these factors is playing a role in the cause of sleep issues.