Individuals with mental handicaps may have a variety of sleep issues. Although there are no large studies, these individuals are noted to have SRBD and frequently require treatment. Over half of children with Down's syndrome have obstructive or central sleep apnea (15). Although these patients frequently have anatomical features contributing to the obstruction, the brain dysfunction may also play a role in their SRBD. Patients with other etiologies for chronic encephalopathies such as Prader-Willi syndrome also appear to have a high prevalence of SRBD (16).
Many of these individuals can undergo evaluation and initiation of treatment requiring only few additional explanations, while others, may create significant challenges. Technologists and healthcare providers must be sensitive to the patient's limitations and strengths. Individuals may respond to positive rewards to reinforce the behaviors that allow the testing to occur and adherence with therapy. Healthcare providers should be willing to take extra time in reviewing the procedures and to utilize multiple teaching aids to help the patients and their families understand the diagnosis and therapy. Some patients will have cognitive strengths in specific areas. The healthcare provider can employ teaching aids directed toward these strengths to maximize the patient's understanding. Including a family member or familiar caregiver in the discussion in conjunction with placing familiar personal objects in the testing environment will improve the likelihood of the success. In some very problematic individuals, the technologist may need to wait until the patient is behaviorally asleep before applying the remaining sensors.
In our experience, CPAP can be used effectively in patients with mental handicaps. Individuals usually have improved behavior and are less irritable following successful employment of therapy. Patients may respond well to positive reinforcement and incentive programs such as star charts rewarding adherence with therapy. The healthcare provider should insist upon the inclusion of the therapy into the daily routine. If possible, the patient should be involved in the general cleaning of the device and given a sense of ownership. Over time, these individuals adapt to and comply with the therapy. We have noticed that many of these patients will have improved behavior, less aggressive outbursts, and heightened engagement with others.
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