Sleep Therapy: Keys to Improving Rest in People with Down’s Syndrome
Good sleep is a fundamental biological need. Restorative sleep contributes to brain development, memory consolidation, emotional balance, immune system strength and overall health. However, in people with Down’s syndrome (DS), sleep problems are very common and can affect not only their quality of life but also their physical, cognitive and social development. For this reason, it is essential to address the issue of sleep therapy in this group, identifying the main difficulties and exploring effective strategies to promote adequate rest.
Sleep in Down’s Syndrome: particularities and challenges
People with Down’s syndrome present biological and anatomical characteristics that increase the likelihood of experiencing sleep disturbances. Among the most relevant factors are:
- Muscle hypotonia: reduced muscle tone affects the stability of the airway, facilitating apnoea or hypopnoea episodes during sleep.
- Particular craniofacial anatomy: relatively larger tongue, hypertrophic tonsils, enlarged adenoids and a narrow palate all contribute to obstruction of the upper airway.
- Higher risk of obesity: excess weight worsens breathing problems and contributes to obstructive sleep apnoea.
- Associated conditions: cardiac pathologies, gastro-oesophageal reflux, hypothyroidism and recurrent ear infections also influence sleep quality.
- Alterations in circadian rhythms: some studies suggest that people with DS present irregularities in melatonin production, which makes it more difficult to fall asleep and maintain sleep.
The most common consequence of these conditions is obstructive sleep apnoea (OSA), which may occur in over 50% of people with Down’s syndrome. However, insomnia, frequent awakenings, periodic limb movements or excessive daytime sleepiness are also observed.
Impact of sleep disorders
Lack of restorative rest does not only cause tiredness. In people with Down’s syndrome, the consequences can be even more significant:
- Cognitive difficulties: poorer attention, memory problems and slower learning.
- Behavioural alterations: irritability, hyperactivity, impulsivity and difficulties with emotional self-regulation.
- Physical health problems: risk of pulmonary hypertension, heart disease and obesity.
- Reduced quality of life: for both the person and their family, whose own sleep is often disrupted by nocturnal awakenings.
For this reason, sleep therapy should not be considered secondary but rather a pillar of the comprehensive care of people with DS.
Strategies for improving rest
Sleep therapy in people with Down’s syndrome requires a multidisciplinary approach, integrating doctors, sleep therapists, psychologists, educators and families. The main keys are outlined below:
- Early diagnosis and specialist follow-up
The first step is recognising the presence of a sleep disorder. This involves:
- Clinical questionnaires and family interviews to identify symptoms such as snoring, breathing pauses, frequent awakenings, night sweats or daytime sleepiness.
- Polysomnography studies in specialised centres, which detect obstructive sleep apnoea and other disturbances.
- Regular reviews throughout life, as sleep problems may appear or worsen at different stages.
- Medical and surgical treatment
Depending on the cause, treatment may include:
- Adenoidectomy and tonsillectomy: often the first option when there is obstruction of the upper airways.
- CPAP devices (continuous positive airway pressure): recommended in cases of moderate or severe obstructive sleep apnoea. Although their use may initially be challenging, with support and gradual adaptation many people succeed in using them.
- Treatment of hypothyroidism, obesity or reflux, to improve associated factors.
- Sleep hygiene
Routines and habits are essential to consolidate good rest. Some recommendations include:
- Keeping regular schedules: going to bed and waking up at the same time every day.
- Creating an appropriate environment: a quiet bedroom, comfortable temperature, minimal light and no technological distractions.
- Establishing pre-sleep rituals: calm reading, soft music or relaxation exercises.
- Avoiding stimulants such as caffeine, excess sugar or screens before bedtime.
- Behavioural and psychological interventions
Some people with DS may experience anxiety or resistance at bedtime. In such cases, behavioural strategies can be very useful:
- Positive reinforcement when they follow the sleep routine.
- Relaxation training to reduce bedtime anxiety.
- Behaviour modification techniques, such as ignoring inappropriate nocturnal demands and reinforcing suitable behaviours.
- Complementary therapies
Additional interventions may also prove beneficial:
- Respiratory physiotherapy to strengthen the muscles involved in breathing.
- Speech and language therapy focused on orofacial muscle tone, helping reduce airway obstruction.
- Regular physical activity to improve sleep quality and reduce the risk of obesity.
- Melatonin under medical prescription, in some cases, to help with sleep initiation.
Role of the family and environment
Family involvement is crucial in sleep therapy. Carers play key roles such as:
- Observing and recording sleep habits.
- Implementing routines and reinforcing sleep hygiene.
- Supporting adherence to medical treatment (use of CPAP, medical check-ups, balanced diet).
- Promoting a positive emotional atmosphere, avoiding bedtime becoming a source of conflict.
Schools also need to be informed. Daytime sleepiness may affect academic performance and behaviour, making coordination between teachers, specialists and families essential.
Advances in research and future perspectives
Science continues to advance in the study of sleep in Down’s syndrome. Current research is exploring areas such as:
- New, less invasive devices to replace or complement CPAP.
- Mobile applications and portable devices to monitor sleep simply and continuously.
- Genetic and pharmacological therapies aimed at improving neuromuscular function and respiratory control.
- Early intervention programmes that integrate sleep as a central dimension of development.
The goal is to offer increasingly personalised and accessible solutions that enhance the quality of life of people with DS and their families.
Conclusion
Sleep therapy in people with Down’s syndrome is a fundamental aspect of their comprehensive care. Sleep problems should not be underestimated, as they directly affect physical health, cognitive development, behaviour and quality of life.
With early diagnosis, appropriate treatments, good sleep hygiene, family support and a multidisciplinary approach, it is possible to significantly improve night-time rest and, in doing so, to foster the capacities and general wellbeing of people with Down Syndrome.
Sleeping well is not a luxury: it is a right and a necessity that deserves to be prioritised.
