Childhood sleep disorders
What is keeping your child up at night can range from night terrors and nightmares to the even more frightening – sleep apnea, the temporary cessation of breathing during sleep. And while some sleep issues may seem like a common childhood experience, if they are frequent and disruptive they could lead to problems and should be taken seriously.
“Sleep disorders in children often go unnoticed, undiagnosed and untreated,” says pediatric sleep specialist Jonathan Warren, M.D., a private practice physician in Arlington Heights, Illinois. “Parents often don’t become aware that their children’s sleep is being disrupted until their own sleep becomes disrupted.”
Sleep-deprived children will often have poor school performance. Grades start to deteriorate; the child can no longer focus and often shows signs of ADHD (Attention Deficit Hyperactivity Disorder). Warren says that it is estimated that nearly half of ADHD cases are really cases of undiagnosed sleep disorders.
There are several signs parents can watch for to gauge if their child has sleep problems, including daytime sleepiness, overall irritability and moodiness. Dr. Warren says that chronic bedwetting beyond potty training stages can also indicate that a child is suffering sleep disruption and is being awakened during the wrong stages of sleep.
One reason for a child’s sleepiness could be parasomnias, which occur during REM (rapid eye movement) or NREM (non-rapid eye movement) stages of sleep. They are characterized by partial arousal (wherein the child seems to be both asleep and awake at the same time) and by physical and verbal behaviors. Parasomnias include sleepwalking, talking in one’s sleep, grinding teeth, night terrors, and nightmares/dream anxiety attacks (different than night terrors because with night terrors you have little or no recollection, whereas with nightmares/dream anxiety attacks, recollection is often possible). Warren says that parasomnias are due to arousals, whether external or internal, during key stages of sleep.
Parents should beware of snoring. Many consider snoring as normal. But Warren says that snoring is not normal. “If your child is snoring – it means there is a problem. If the child has a cold and the snoring is temporary, then you don’t need to worry. But if your child snores all of the time you should have it checked out.”
Warren says that snoring along with daytime fatigue is a sign of sleep apnea. Often it means there is some kind of blockage in the child’s breathing. The first line of defense is to have the child’s tonsils and adenoids checked. According to the National Center for Health Statistics, more than 263,000 children in the U.S. have tonsillectomies each year, citing the major reason as sleep apnea.
According to The American Sleep Apnea Association, there are actually three types of sleep apnea – obstructive, central, and mixed. Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. Central sleep apnea is caused when the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea is a combination of the two. When the breathing is interrupted during an apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing. This causes extremely fragmented sleep.
Insomnia and pre-sleep disorders are also a problem for many kids. Kids can suffer from general insomnia, restless leg syndrome (the irresistible urge to move legs due to a crawling, prickling sensation) or from periodic limb movement disorder preventing them from falling asleep in the first place. Dr. Warren says that parents should take note if their kids kick their legs repeatedly and complain of leg discomfort. Leg discomfort is not normal and the existence of “growing pains” is questionable.
Dr. Warren says that many times a child’s pre-sleep issues are parent-related – learned and brought on by the parents. “We see symptoms of this in younger children who are unable to calm or self-sooth. The child is used to inappropriate crutches, TV, music, lights left on, mom having to be at the beside ... these types of actions foster poor sleep habits.” Too much caffeine during the day can also affect a child’s sleep.
When should a parent seek medical help? Dr. Warren says that most parasomnia sleep disorders will go away on their own by puberty, but if the child is suffering from sleep apnea or if sleep patterns are negatively affecting their (or the family’s) life, seek help.
“A nightmare or night terror every once in awhile probably isn’t a big deal,” says Dr. Warren, “six times a week is.” While no one truly understands some of these phenomenons, many (even night terrors), are treatable and the younger you treat, the better. Parents should first talk to their pediatrician, but seek out a sleep expert if they feel they aren’t getting anywhere with the pediatrician.
The recommended amount of sleep needed each 24-hour period:
• Toddlers (1-3 years): 12-14 hours
• Preschoolers (3-5 years): 11-13 hours
• School-aged kids (5-12): 10-11 hours
• Adolescents (12-18): 8.5-9.25 hours
Source: National Sleep Foundation, http://www.sleepfoundation.org
By Jean Dunning