In a study using adolescent sleep wake scale, sleep hygiene, pre-sleep arousal questionnaires a relationship observed between chronic pain and insomnia, 53% in 100 samples complaints total sleep problems. In an age and sex-matched subjects, people having persistent pain experienced poor quality sleep on actigraphy.
2 studies that used PSG in children of juvenile fibromyalgia syndrome also complaints all sleep problems.
Behavioral exams and PSGs studies consistently reports that children and youngsters with chronic pain have more or less totally poor sleep quality.
Pain-sleep relationship clearly demands that it is needed to do researches and clinical implications, for this the following model was designed to show complicated bi-directional connection between sleep, pain, physiology, mood, growth, sex, race, socio-contextual factors and functional outcomes in this population.
Mood influences sleep, children with chronic pain displayed depressive signs and mood swings, with respect to pain intensities and this depression inturns effects sleep. It was also observed that positive moods results in better sleep quality either in diseased children.
Developmental stage also effects sleep, studies suggests that adoloescents experienced more disrupted sleeps due to hormonal and psychophysiological changes thin body than children.
Some studies reported that sex differences shows different frequencies in headaches, but these were reported in very small populations, so these findings needs further researches.
Race, culture, socio-economic status and environment have a drastic impact on sleep patterns of chronically ill children.
Some studies identified that pain-sleep relation effects functional outcomes, children with JIA supposed to have poor sleep as well as poor rapid visual processing, and disrupted sleeps predicts more slower in their reactions.
As stated previously, studies proved high pain and disturbed sleep, as well as many of reported that even after treat certain causative factors still high pain in there resulting in poor sleep.
In subjects of controlled groups for age, sex, race, genotypes in SCDs, headaches and JIAs poor sleep, higher sleep anxiety, more bedtime resistance, parasomnias, sleep-walking, bruxism were reported, they concluded that higher pain intensities severely effects their sleep habits. Another finding suggests that these children may use sleep for pain relief.
In uncontrolled trials of cognitive behavioral therapy in adolescents with juvenile fibromyalgia syndrome taking some sleep-pain treatments reports remarkable improvement in their pain, fatigue, behavior and functional ability. Same as in headache’s group, if maintaining sleep hygiene or managing sleep routines results in reduced frequencies of headaches and somewhat better sleep.
Conclusively all these studies marks that additional measures should be taken in pediatric pain populations to improve their health and sleep quality, more investigations and further researches are required in this area to identify the steps which clinicians could take, because the reviewed studies reports that poor sleep quality due to chronic illness or pain results in their functional inability and poorer responses socially.
Due to limited literature of longitudinal designed study researches are unable to explain sleep patterns in this population, other lacking was observed in literature is less focus on mechanisms that are involved in disturbed sleeps in chronically ill children, in addition impact of mood, age, sex, race, culture, socio-economic status, environmental conditions is not studied on a broad spectrum, which is truly a need.
Clinically there is need to examine and manage sleep problems and nature of sleep in children having persistent pain, a handy tool is accessible “BEARS” Bedtime problems, Excessive sleepiness, Awakenings, Regularity of sleeping and Sleep disordered breathing.
Children with insomnia, heavy snoring, grasping and apnea should be given medicines of SDB, while other sleep complaints should be examined with PSGs, CSHQs, clinical interviews, and asks to maintains sleep hygiene, sleep habits like no caffeine intake in evenings, no use of electrical devices in night times, not taking naps, creating a sleep schedule.
Pediatrician should also conduct overnight PSG, multiple latency tests and sleep medicines should be given. Cognitive behavioral therapy may also be done because it showed significant effects on insomnia, with all these measures pediatricians can minimize the functional inability and help them to take good quality sleep in order to live healthy and to survive well with their chronic diseases.