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  • Updated 09.25.2021
  • Released 06.06.1994
  • Expires For CME 09.25.2024

Sleep and intellectual disability



Sleep disturbances, including insomnia, hypersomnia, and sleep-disordered breathing, are common in individuals with intellectual disability, including children with neurodevelopment disorders. Measures for the management of sleep disorders are a part of the multidisciplinary approach to intellectual disability. This article describes the etiology, diagnosis, and management of various disorders of sleep in syndromes associated with intellectual disability.

Key points

• Strategies for management vary according to etiology and manifestations of sleep disorders in various syndromes associated with intellectual disability.

• Hypnotics and sedating medications are of limited value in the treatment of sleep disorders in intellectually impaired individuals, but melatonin is useful in the treatment of sleep disorders due to disturbances of the sleep-wake cycle.

• Behavioral techniques for insomnia should be tried before medication in children with intellectual disability.

• Excessive daytime sleepiness and REM sleep abnormalities of Prader-Willi syndrome may be manifestations of hypothalamic dysfunction rather than purely secondary to sleep-related breathing disturbances.

• Sleep apnea and its adverse effects may improve with continuous positive airway pressure, but obstructive sleep apnea, which may be due to abnormalities in upper airways, usually requires procedures such as adenotonsillectomy.

Historical note and terminology

Sleep disturbances, including insomnia, hypersomnia, and sleep-disordered breathing, are common in individuals with intellectual disability, previously referred to as mental retardation and defined as a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18 (03). Criteria for the diagnosis of intellectual disability are described in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (04). An equivalent term to describe involvement of impaired brain functioning early in life is intellectual developmental disorder. Sleep disturbances of various types and degrees are reported in numerous disorders associated with intellectual disability, but will be briefly described in the following conditions where they are significant:

• Angelman syndrome

• Autism spectrum disorders

• Cerebral palsy

• Down syndrome

• Kleefstra syndrome

• MBD5 haploinsufficiency syndrome

• Mowat-Wilson syndrome

• Prader-Willi syndrome

• Rett syndrome

• Smith-Magenis syndrome

Epileptic encephalopathies, which include epilepsy with continuous spike-wave during slow sleep, eg, Landau-Kleffner syndrome, are beyond the scope of this article, but are described elsewhere in Medlink Neurology. According to a study, comorbidities rather than functional disorders, eg, recurrent pain, frequent seizures, and prescription of sleep medications, were associated with poorer sleep and suggested that the prescription of sleep medications and sleep quality should be further investigated (22).

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