University of Virginia Health System

Eye-Opening

Sleep disorders are common in children but often overlooked. Know the signs.

When Kathy's 8-year-old son, Scott, began having problems in school, the mom was dumbfounded. Scott's teacher said he was either hyperactive or ‘spaced out'-behaviors that had never been brought to her attention before. When the teacher advised Kathy to have her son evaluated for ADHD [attention-deficit/hyperactivity disorder], the mom was stunned.

She turned to their pediatrician, who referred Scott to the University of Virginia Health System's Pediatric Sleep Disorders Program. "Scott is typical of the patients who come to us," says Pearl Yu, M.D., the program's director and only board-certified pediatric sleep specialist practicing in Virginia. He had a history of snoring that had recently worsened, and he had difficulty waking in the morning. He also had repeated strep infections, and his tonsils were huge-nearly touching.

"These are classic symptoms of childhood obstructive sleep apnea syndrome, which is a common sleep disorder that is often overlooked in children," says Yu. "All children may sometimes have trouble falling asleep or staying asleep. But some children have a more serious sleep disorder that requires treatment."

 

Uncovering the Problem

With obstructive sleep apnea syndrome (OSAS), the upper airway repeatedly collapses during sleep, causing the child to momentarily stop breathing many times throughout the night. With each event, the brain needs to briefly wake up in order to resume breathing, resulting in fragmented and poor-quality sleep. Childhood OSAS typically affects children between 2 and 8 years old, when the tonsils and adenoids are large relative to the airways. Infections can cause the tonsils to swell, further restricting airflow. Childhood obesity can also narrow the upper airway and lead to OSAS.

Snoring and gasping for air are the most obvious symptoms of OSAS, but these symptoms often go unnoticed for years. "Parents will comment that the child sleeps down the hall with the door closed-so they just don't hear it," Yu says. "There are also some kids with OSAS who don't snore loudly. So it's important that parents take note of excessive sleepiness or hyperactivity during the day. Problems with behavior or academic performance can be a tip off to an underlying sleep problem."

Yu, along with her colleague Gabriele Ford, a nurse practitioner, also sees children and adolescents with parasomnias, hypersomnias, circadian rhythm disorders, insomnias and sleep-related movement disorders. Parasomnias are sleep-related events such as sleepwalking or sleep terrors. Hypersomnias (such as narcolepsy) cause excessive sleepiness. Circadian rhythm disorders such as delayed sleep phase syndrome involve a sleep period out of sync with the rest of the world. "Long sleepers" often come to Yu for the first time in adolescence, when increased school and social demands begin to deprive them of the 10 or more hours of sleep they need each night to adequately function during the day.

 

Finding Answers

For many of Yu's patients, an overnight sleep study reveals the full extent of the medical problem. Electrodes placed on the child record sleep details-from brain function and breathing patterns to eye activity and muscle tone. Yu used a sleep study to confirm Scott's suspected apnea. His mother, who stayed with him during the study, was relieved by the diagnosis.

Like most children with OSAS, Scott's apnea was resolved by removing the tonsils and adenoids. In some cases of sleep apnea, a therapy called continuous positive airway pressure ventilation-or CPAP-can help. During sleep, the patient wears a mask that delivers airflow through the nose to hold open the upper airway. "This therapy must be introduced very carefully by an experienced member of a sleep team. Otherwise, the child will develop an aversion to the treatment," cautions Yu.

Sleep disorders other than OSAS often can be treated with medication, behavioral therapy or a combination of the two. "Sleep disorders can be very complicated, with multiple contributing factors. This is why a proper diagnosis is the key to managing the problem," adds Yu.

 

A Good Night's Sleep for All

"Sleep problems can affect the whole family. When one family member isn't sleeping well, the rest of the family doesn't sleep well either," says Pearl Yu, M.D., of the University of Virginia Health System. Fortunately, many common sleep problems can be resolved by adopting good "sleep hygiene." Yu suggests:

• Maintain a regular wake time and bedtime every day.
• Adopt a bedtime routine such as reading a relaxing book or taking a warm bath.
• Keep bedroom dark, quiet, cool and comfortable (use a night light if your child is afraid of the dark).
• Don't have a TV or video games in the bedroom.
• Avoid caffeine and heavy eating several hours before bed.
• Exercise regularly but not too close to bedtime.

Concerned about your child's sleep? Talk to your child's doctor. Or learn about Pearl Yu, M.D., who specializes in childhood sleep disorders.

This article appeared in the Fall 2007 issue of Vim & Vigor, a family health magazine sponsored by the University of Virginia Health System. To receive Vim & Vigor at home four times a year, subscribe today. It's FREE.

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