Re: Question about sleeping patterns with apraxia

[Guest guest]

My son (turned 5 in June) has always had trouble sleeping also. He

does not have arthritis issues (that I know of anyway - he has a high

tolerance for pain - I don't know much about arthritis so I wouldn't

know what to look for). He would wake 3 times a night until about

age 3 and a half at which time I mentioned this to his OT who started

giving me ideas to help him sleep. We have used soft music, a

weighted blanket, therapeutic brushing protocol (deep pressure

massage, joint compression and brushing), vibrating massage and

chiropractic adjustments. Each of these helped a little bit. I

found that one would work for a few nights, then it wouldn't work

anymore so I began to rotate these things. This helped some.

Two and a half weeks ago I began giving my son melatonin (a natural

supplement) and this has worked better than any of the above items.

He doesn't always sleep through the night, but as far as going to

sleep at bedtime, he falls asleep within 10 to 20 minutes of taking

the melatonin. If he wakes up during the night, it is only once and

he usually goes right back to sleep once I put him back in bed. Now

last night was a perfect night. He took melatonin at 8:15 pm, was

asleep by 8:30 pm and didn't wake up until 7:15 am! Before the

melatonin, this almost never happened. And melatonin is inexpensive

also - only 10 cents per capsule. He takes one capsule at night.

The brand we use is Allergy Research Group ChronoSet which was

recommended by an MD.

Hope this helps.

Amie

>

> My 3 year old (3 in May) may or may not be apraxic, she is at the

very

> least a late talker, and is in speech therapy.

>

> She is a horrendous sleeper - always has been and continues to be -

she

> wakes up several times throughout the night, and is absolutely

> miserable in the morning (I have other children, they sleep fine -

they

> have routine, we are extremely consistent, so that's not the

issue).

> Additionally, she was recently diagnosed with Juvenile Rheumatoid

> Arthritis, just one joint is affected, her left knee.

>

> My question is: does anyone else have sleeping issues, and/or has

> anyone else had a similar issue with arthritis? I only ask because

my

> gut tells me that all issues with her are related, but I want to

figure

> out the link and how I can help her. Is it dietary, fish oils,

> therapy, etc....

>

> Thanks for any input you may have.

>

[Guest guest]

My son had sleep issues as well. We have been doing melatonin at night for

over a year and he now sleeps fine. You can purchase it over the counter as it

is a natural supplement. We started out with 1mg. They have it in liquid,

strips, and pill form. It also comes in several different flavors. We

recently did a neurotransmitter test and found that he has extremely

low levels of serotonin. This affects melatonin production. So, now we have

started other supplements to try and balance this issue out so that hopefully he

will not need the melatonin at night. You can visit our website and read about

what the supplements we have him on do. The address is

www.ethanslifewithapraxia.com

I hope that helps!

~

[ ] Question about sleeping patterns with apraxia

My 3 year old (3 in May) may or may not be apraxic, she is at the very

least a late talker, and is in speech therapy.

She is a horrendous sleeper - always has been and continues to be - she

wakes up several times throughout the night, and is absolutely

miserable in the morning (I have other children, they sleep fine - they

have routine, we are extremely consistent, so that's not the issue).

Additionally, she was recently diagnosed with Juvenile Rheumatoid

Arthritis, just one joint is affected, her left knee.

My question is: does anyone else have sleeping issues, and/or has

anyone else had a similar issue with arthritis? I only ask because my

gut tells me that all issues with her are related, but I want to figure

out the link and how I can help her. Is it dietary, fish oils,

therapy, etc....

Thanks for any input you may have.

[Guest guest]

You might be interested in this article.

Vol. 18 •Issue 10 • Page 6

Apraxia & Obstructive Sleep Apnea

Is There a Link?

By Mosheim

Do you have any children with severe childhood apraxia of speech

(CAS) on your caseload who aren't making significant gains in

treatment? If so, it may be wise to pull the parents aside and ask

them about their child's sleeping habits.

The role of sleep appeared to have had a pivotal role in the unusual

case of a boy named Max who had childhood apraxia of speech and a

seizure disorder and was found to have obstructive sleep apnea (OSA)

as well. The series of events he endured, which eventually ended with

a routine but life-changing operation, left Max cured of his sleep

apnea and making considerable gains in speech production.

Max was diagnosed with CAS at an early age and began an intensive,

five-day-a-week speech therapy schedule with Sue Caspari, MA, CCC-

SLP, a private practitioner in Swarthmore, PA. Max didn't have a

single functional word in his vocabulary when she first met him.

Despite various treatment adaptations, he made no functional gains in

speech production over the next few years. By age 6 Max had fewer

than five functional words.

However, his language development, while delayed, was moving along

nicely. Equipped with an augmentative and alternative communication

(AAC) device, Max could string together long sentences and had no

trouble communicating his needs. But his functional speech remained

at a standstill.

" He seemed to make some gains within a session. You felt like you

were making very slow progress over the course of a few weeks, but

nothing carried over, " Caspari told ADVANCE. " We sought out every

piece of advice we could along the way. I even advised the family to

try another speech-language pathologist. "

His family first suspected that Max might have OSA when he was 4.

They requested a sleep study, but hospital staff refused, assuming

that the little boy's nighttime awakenings were related to his

seizure disorder.

Eventually, the family convinced the doctors to perform a sleep

study. Although the study was problematic, because the measuring

devices kept falling off Max while he was trying to sleep, the

doctors said the results showed that the boy did not have sleep

apnea.

" But he still had all the symptoms, " said Caspari. " He had a lot of

nighttime awakenings, he was a heavy snorer, and he was sleepy during

the day. The parents weren't convinced that he didn't have apnea. "

Other symptoms of sleep apnea include deficits in vigilance or

maintaining attention over an extended period of time and compromised

executive functioning, which includes working memory, mental

flexibility, planning and organizing thoughts, behavioral inhibition

and problem-solving.1

During sleep, the flow of oxygen to the brain is either reduced or

completely shut off, typically by an obstruction in the airway that

disrupts normal ventilation. The person is awakened and immediately

resumes breathing. The most common treatment for sleep apnea is

removing extra tissue or mass in the throat, such as the tonsils.

Because enlarged tonsils are the most common cause of sleep apnea,

Max's family wanted his removed. The hospital offered to take out his

adenoids but refused to perform a tonsillectomy due to concerns about

having the boy be under general anesthesia for a long period of time.

In addition, the medical staff still was not convinced he had sleep

apnea.

" The sleep study didn't show it, and his tonsils didn't look

unusually large, " said Caspari.

Other than a noticeable reduction in nighttime seizures, very little

changed for Max following the adenoidectomy. He still was having at

least one arousal per night, was still sleepy at school, and made no

gains in speech production.

When Max was 6, Caspari suggested that the family obtain a second

opinion regarding his speech and neurological status at the Mayo

Clinic, in Rochester, MN, where Caspari was working that summer.

Edythe Strand, PhD, CCC-SLP, a consultant in the Division of Speech

Pathology, Department of Neurology, at the facility, confirmed that

Max had CAS and fewer than five functional words. Neurologists

confirmed his seizure disorder and conducted a sleep study. The

results showed that Max had moderate OSA, and they recommended and

performed a tonsillectomy.

When he returned home from the Mayo Clinic, something strange

happened.

" He just started to talk, " said Caspari. " He has been making better

gains in therapy, and he's able to hold on to the gains from one

session to another. He's able to blend his sounds and syllables more

easily. It's one of those things where it's unfolding before your

very eyes. You find yourself thinking, 'What's going on?' "

Max continued to receive intensive daily intervention, and he soon

began using even more words than before. " I did a speech sample and

tallied up about 17 words, " she recalled.

The number of functional words grew to 48 by last fall, a tenfold

increase over six months. Caspari was so excited that she went into

Max's kindergarten class and put the words on the walls of the room

so his teacher could give him the opportunity to use them.

" It's comical now because by December we couldn't count the number of

words. He was beginning to combine two to three words in sentences, "

she said. She conducted another speech sample and got a tally of more

than 100 words in one day.

Caspari began to wonder about Max's sudden progress. " You can have

spurts in speech, but that's usually when you're 2 or 3. You don't

usually have a sudden onset of speech in cases where speech ability

remained static for six years. The only thing we could pinpoint was

the tonsillectomy, " she said.

She sent Max back to the Mayo Clinic for a follow-up sleep study,

which confirmed that he no longer had OSA. However, nothing else had

changed. He still was following a ketogenic diet for his seizure

disorder, taking allergy and reflux medications, and participating in

the same therapy regimen.

" The question that came to my mind was 'What on earth do OSA and

removing tonsils have to do with speech?' " Caspari said.

She searched the medical literature but found little related to

pediatrics, except that children with OSA often have a hyponasal

voice quality.2 However, there were a few studies on adults,

including one that found individuals with OSA had a prominent speech

disorder—characterized by deficiencies in articulation, phonation and

resonance—that might be a marker for the condition.3

She also found research that compared brain magnetic resonance images

(MRIs) of adults with and without sleep apnea. Researchers found one-

sided reductions in gray matter in the brain regions responsible for

upper-airway control and motor speech in the individuals with OSA.

They also noted a higher incidence of stuttering and motor speech

disorders in people with OSA, which led the researchers to

hypothesize that a pre-existing brain abnormality in childhood may

contribute to a speech disorder that leads to the development of

OSA.4

" These studies suggest that some kind of speech disturbance is a

marker for sleep apnea, but there has not been enough research to

establish what these relationships might be, " Caspari said. " My case

report may be supportive evidence that the two conditions are linked

somehow. This is just one case report, but it's an intriguing series

of events. It raises important questions of causality. This would be

a fruitful area for research. "

Now when she sees a new client with childhood apraxia of speech,

Caspari asks about sleep. Does the child have any symptoms of sleep

apnea?

" If so, I encourage the parents to get a definitive diagnosis, " she

said. " If there's a chance that these two conditions are linked more

closely than just co-existing and if it's even slightly possible that

having OSA could prevent a child with this motor speech disorder from

making speech gains, I want to find out sooner rather than later. "

If a child has a motor speech disorder and symptoms of sleep apnea,

it's important to get a sleep study done as early as possible. A

child diagnosed with OSA needs to be treated immediately.

" The stakes are so high, " said Caspari. " Becoming a verbal

communicator changed Max's life. He is now able to participate in

school and make friends in a way he never could as an AAC

communicator. Just imagine if these changes had come about when he

was 3 or 4 & #65533;when the brain is primed to learn speech and

language & #65533;instead of when he was 6. "

Clinicans can't afford to wait, Caspari said. " That is the take-home

message here. We as speech-language pathologists need to recognize

OSA as a possible co-morbidity in motor speech disorders like

apraxia, encourage and help the family, and work with the doctors and

ENTs to help them provide more definitive diagnoses as early as they

can, especially if children have a speech disorder. "

In working with children who have motor speech disorders, the

principles of motor learning are a big part of Caspari's therapy

approach. The principles stem from research about movements in the

rest of the body regarding motor learning and how to practice learned

skilled actions.5

" Those of us who work with this population want to incorporate the

principles into what we're doing, " she said. " The first principle

is 'practice makes perfect.' Like any motor skill, you've got to

practice the movement sequence over and over again in order to

perfect it. "

Another principle of motor learning guides clinicians in how to

provide feedback during practice. With Max she provided feedback

about performance (i.e., " close your mouth a little " or " do it

tighter " ) after each attempt to help him get closer to saying the

word correctly during the next trial. As his accuracy improved, she

began to provide less specific feedback less frequently to facilitate

motor learning.

There's still too much that isn't known about apraxia, she said, " but

the consensus among people who work with these disorders is that it

is helpful to use multimodality cueing. "

Caspari helped Max as much as she needed to. " If we were working on

the word 'go,' I would reach in and round his lips when he got to

that part because he couldn't round his lips for the 'o' sound, " she

said. Since apraxia is a movement disorder, " the trick with this kind

of therapy is to try to help him change how he's moving his mouth

during speech—it always has to be during speech. "

Caspari's approach is based on the Dynamic Temporal and Tactile

Cueing approach to treating childhood apraxia of speech, which was

developed by Dr. Strand.6 This approach incorporates the principles

of motor learning and provides lots of practice opportunities.

Caspari used a core list of words with Max such

as " go, " " back, " " dad " and " mom. " Each session involved intensive

practice trials where he attempted to say each word while she

provided support with tactile, visual or auditory cues.

Therapy always involved a game or fun activity. For example, Max

could race cars down a ramp for every five or 10 trials he completed.

Once Max could say a word successfully, Caspari had him repeat it 10

to 20 times. She withdrew her tactile cues over time, and eventually

Max was able to repeat the word on his own.

" The other day I overheard his mother telling him to be quiet, "

Caspari said, " and it just made me smile. "

References

1.Beebe, D.W., Groesz, L., Wells, C., et al. (2003). The

neuropsychological effects of obstructive sleep apnea: A meta-

analysis of norm-referenced and case-controlled data. Sleep, 26 (3):

298-307.

2.American Academy of Pediatrics. (2002). Clinical practice

guideline: Diagnosis and management of childhood obstructive sleep

apnea syndrome. Section on Pediatric Pulmonology and Subcommittee on

Obstructive Sleep Apnea Syndrome. Pediatrics, 109: 704-12.

3.Fox, A.W., Monoson, P.K., , C.D. (1989). Speech dysfunction

of obstructive sleep apnea: A discriminant analysis of its

descriptors. Chest, 96: 589-95.

4.Macey, P.M., , L.A., Macey, K.E., et al. (2002). Brain

morphology associated with obstructive sleep apnea. American Journal

of Respiratory and Critical Care Medicine, 166: 1382-87.

5.Strand, E., Skinder, A. (1999) Treatment of developmental apraxia

of speech: Integral stimulation methods. In A. Caruso and E. Strand,

(eds.), Clinical Management of Motor Speech Disorders of Children.

New York: Thieme Publishing Co.

6.Strand, E., Stoeckel, R., Baas, B. (2006). Treatment of severe

childhood apraxia of speech: A treatment efficacy study. Journal of

Medical Speech Pathology, 14: 297-307.

For More Information

Sue Caspari, e-mail: casparisuematt@...

Childhood Apraxia of Speech Association of North America, online:

www.apraxia-kids.org

Mosheim is an Associate Editor for ADVANCE. He can be contacted

at jmosheim@....

[Guest guest]

---

I do not know if this helps at all but my son has not been diagnosed

with anything but he is only saying few words (3 maybe 4) but he

signs. SO there is definatly something there whether it be apraxia or

just a late talker as well. I am very new to all this my self but my

son is one of those that does not sleep he gets up between every 2 to

2 1/2 hours...... I am not sure if it is associated but I have read

that it is.....Atleast poor sleep patterns that is.... Sounds like

your house is like mine in the morning.... Hope this helps maybe a

little bit...

Rapsodie

In , " evloew4 " <evloew4@...>

wrote:

>

> My 3 year old (3 in May) may or may not be apraxic, she is at the

very

> least a late talker, and is in speech therapy.

>

> She is a horrendous sleeper - always has been and continues to be -

she

> wakes up several times throughout the night, and is absolutely

> miserable in the morning (I have other children, they sleep fine -

they

> have routine, we are extremely consistent, so that's not the

issue).

> Additionally, she was recently diagnosed with Juvenile Rheumatoid

> Arthritis, just one joint is affected, her left knee.

>

> My question is: does anyone else have sleeping issues, and/or has

> anyone else had a similar issue with arthritis? I only ask because

my

> gut tells me that all issues with her are related, but I want to

figure

> out the link and how I can help her. Is it dietary, fish oils,

> therapy, etc....

>

> Thanks for any input you may have.

>

[Guest guest]

I don't know much about sleep patterns as that's not our issue, but skin

disorders and gluten and speech are all linked in our case, so your gut feeling

is probably right. I didn't expect that either, but her gluten /casein

intolerances are affecting her neurologicaly and her immune system--hence skin

disorders. I've heard that all autoimmune issues are potentially affected by

food intolerances with gluten being at the top. A biomedical approach to

diagnosis and treatment may be warranted for your child too, as you want to

avoid the harmful painkillers and antiinflamatory drugs prescribed by doctors in

general for arthritis.

Also the fish oil should do a world of good as it is a natural antiinflamatory.

But see if you can find a good biomedically trained doctor in your area and

you'll most likely see results in all areas of concern. Remember, biomedicine

works with the individual's whole body, not just symptoms and separate organs

and parts. Particularly for neurological and immune system dysfunctions, I

would say it's the only way to really address the underlying problems before

things get worse.

All the best to you and your family.

-Elena

evloew4 <evloew4@...> wrote: My 3 year old (3 in May) may or may not

be apraxic, she is at the very

least a late talker, and is in speech therapy.

She is a horrendous sleeper - always has been and continues to be - she

wakes up several times throughout the night, and is absolutely

miserable in the morning (I have other children, they sleep fine - they

have routine, we are extremely consistent, so that's not the issue).

Additionally, she was recently diagnosed with Juvenile Rheumatoid

Arthritis, just one joint is affected, her left knee.

My question is: does anyone else have sleeping issues, and/or has

anyone else had a similar issue with arthritis? I only ask because my

gut tells me that all issues with her are related, but I want to figure

out the link and how I can help her. Is it dietary, fish oils,

therapy, etc....

Thanks for any input you may have.

------------------------------------

[Guest guest]

I would find a DAN! for this child

- arghhhhh - I am so horified to read all these new Mom's describing

over and over again - more of the New Childhood Epidemics - don't

walk, run, get a DAN! he will see your kids sleep problems in a much

different light than a non trained DAN!.

Mother of a recovering (via DAN!) vaccine injured child dx: apraxia

the new label du jour - but is really heavy metal

poisening/neurological damage - and completly missed by all

mainstream Dr.s.

>

> My 3 year old (3 in May) may or may not be apraxic, she is at the

very

> least a late talker, and is in speech therapy.

>

> She is a horrendous sleeper - always has been and continues to be -

she

> wakes up several times throughout the night, and is absolutely

> miserable in the morning (I have other children, they sleep fine -

they

> have routine, we are extremely consistent, so that's not the

issue).

> Additionally, she was recently diagnosed with Juvenile Rheumatoid

> Arthritis, just one joint is affected, her left knee.

>

> My question is: does anyone else have sleeping issues, and/or has

> anyone else had a similar issue with arthritis? I only ask because

my

> gut tells me that all issues with her are related, but I want to

figure

> out the link and how I can help her. Is it dietary, fish oils,

> therapy, etc....

>

> Thanks for any input you may have.

>

[Guest guest]

My son has apraxia as well as autism.

He had his tonsils and adnoids removed at age 2 due to extreme

obstructive sleep apnea - the kid was waking everytime he got into a

deep sleep because his throat would relax and he'd be unable to

breathe. He woke up every single morning SCREAMING!! Every nap -

SCREAMING. He made significant gains in gross motor skills after the

surgery - and slept somewhat better. Only woke every 90 minutes

instead of every 15-20 minutes (not a joke). He sleeps better now

when his stomach is working well. " Disrupted sleep patterns " is a

symptom of mercury toxicity as well.

All my best,

>

> My 3 year old (3 in May) may or may not be apraxic, she is at the

very

> least a late talker, and is in speech therapy.

>

> She is a horrendous sleeper - always has been and continues to be -

she

> wakes up several times throughout the night, and is absolutely

> miserable in the morning (I have other children, they sleep fine -

they

> have routine, we are extremely consistent, so that's not the

issue).

> Additionally, she was recently diagnosed with Juvenile Rheumatoid

> Arthritis, just one joint is affected, her left knee.

>

> My question is: does anyone else have sleeping issues, and/or has

> anyone else had a similar issue with arthritis? I only ask because

my

> gut tells me that all issues with her are related, but I want to

figure

> out the link and how I can help her. Is it dietary, fish oils,

> therapy, etc....

>

> Thanks for any input you may have.

>