Snoring

CHILDREN AND SLEEP APNEA

We have discussed many times the signs and symptoms of sleep apnea in adults. Let’s take a look at how to know if a child has a sleep disorder.

We all know that many children are not good sleepers. But how do you know what is normal and what is not? As an adult, we can tell that we are tired or had a bad night’s sleep, but because children cannot quantify their sleep quality, it is important for a parent or guardian to be alert to some of the signs and symptoms of sleep apnea. Sleep apnea in children oftentimes manifests itself differently than would be expected. Although some children do snore or have pauses in breathing, the signs often are more subtle.

Here are the signs to look out for in Children for Sleep Apnea

1. Anger and Aggression

Some children will act out as a result of being sleep deprived. They fight with their siblings, they don’t get along well with other children, they are disagreeable to everything, at times it’s as though they don’t even like themselves. Some are so disagreeable that they have been labeled as having ADHD and are drugged as a result. Many children who have sleep apnea are so tired that they act out and cannot explain why.

2. Poor School Performance

Children who suffer from sleep apnea often do not do well in school. Although they are bright and capable children, they have trouble concentrating and focusing as a result of sleep deprivation. They normally fail their morning classes as they are too sleepy to perform. Some can even be found sleeping during class. Again, bearing the label of “ADD” or “ADHD”, these children are put into special classes or are labeled to be “problem” children, slow or poor learners.

3. Snoring

Snoring is a sign that something is obstructing the airway. In children, it is normally anatomical structures, such as enlarged tonsils or adenoids that crowd the airway and cause snoring. With children, especially if the airway is crowded in that way, surgery to remove the tonsils and/or adenoids usually fixes the problem. Snoring is never normal in a child and needs to be investigated.

4. Obesity

Increases in weight can also affect the caliber of the airway, exacerbating the crowding. We already know that childhood obesity is out of control in this country. Many children these days come from single-parent households or live in areas that are dangerous. As a result, these children spend more time indoors. With the advent of technology, many children don’t go out and play like the generations before them, they spend their free time on computers and playing video games. They get very little exercise. Also, many households will use fast foods or high-calorie foods as a quick or convenient meal. If your child is overweight and snores, it’s time to have a conversation with the pediatrician.

What do you do if you do suspect that your child is suffering from a sleep disorder?

First, contact your child’s pediatrician and make an appointment to discuss your concerns. Make sure to detail the doctor on all of the signs and symptoms that you have noticed. If the doctor feels that your suspicions are correct, he/she will have the child tested in a sleep laboratory that specializes in pediatric sleep medicine. Depending on the age of the child, the parent may be able to sleep in the same room with the child during testing.

Once testing is completed, a diagnosis will be made based on the test results and a treatment plan will be discussed with the parent and child. If the doctor feels that the problem is overcrowding in the airway due to anatomical structures, he may refer you to an ENT (ear, nose, and throat doctor) who will determine if surgery to remove the tonsils and/ or adenoids is warranted. Often, the removal of those structures fixes the problem.

Some children will not be candidates for surgery and will need to go on PAP therapy. This can be a difficult treatment for adults, never mind a surly, non-compliant child who has no idea why this is necessary. If PAP therapy is administered, there are many new advances in masks that make it a bit more acceptable to the user. I have set up many children on PAP devices as a respiratory therapist. The successful ones are the ones who have a parent or guardian who is willing to be persistent in making sure the child is compliant with the therapy. It is not an easy task.

What can you do to help your child sleep better overall?

1. Limit drinks close to bedtime

This can help with nocturnal enuresis and multiple awakenings to use the bathroom.

2. Limit sugary snacks

In the evening opt for easily digestible snacks and foods that help induces sleep such as apples, bananas, blueberries, peaches, chicken, turkey, milk products like yogurt cheddar cheese, and cottage cheese, and grains like brown rice, barley, corn, and oats.

3. Refrain them from using electronic gadgets

No computers, cell phones, or electronics in the bedroom at night. The light from the computer/phone screens can simulate daylight in our brains, this will cause the brain to want to stay awake. Also, children, today are tuned into their devices waiting for the next text/email/photo, etc. which can cause awakenings as well as delaying the ability to fall asleep. Keep high-energy activities to daytime, try a quiet time or quiet activities before bedtime.

4. Try to get children to take a warm bath before bed

This helps to relax the body and prepare it for sleep. Do not use OTC medications or supplements for sleep without consulting with your child’s physician. Some can actually do more harm than good or interact with other supplements or medications. You also do not want your child to be dependent on having to take something to fall asleep every night.

5. No scary movies or stories before bedtime

Many children cannot separate fiction from reality. Imagine trying to sleep thinking that there is a monster hiding in your closet! Try to develop good nighttime habits for your child and keep bedtimes consistent even on weekends if possible.

6. Use age-appropriate bedtimes

As children age, limit or eliminate naps. Be aware that if the child is still very young and napping, you need to be mindful of how long you let them nap and what time they are taking naps. Long naps and naps close to bedtime will make it harder for the child to sleep in the evening.

7. Letting children sleep in their own beds

This one is controversial, it is a big temptation to have your child sleep with you especially when they are babies. This can create a bad habit that can go on for years and affect your relationship with your bed partner as well as affect the quality of sleep you and your child are getting.

8. Self-soothing

Your children should learn to soothe themselves at a young age and learn to initiate sleep on their own. Comfort and reassure your child that they are safe in their own rooms and that you are only down the hall. Now, having said this, there are new studies centered around the “self-soothing” method and why it may not work, this is new research and should be explored by the parent. Asking the pediatrician about these new studies is probably the best avenue if you are struggling with this issue. And lastly,

9. Sleeping with lights off

Try to get your children to sleep with the lights off. This is a hard one for some families. Some children are just really afraid of the dark. If you have to have some light in the bedroom at night, opt for a dim nightlight or lamp. Light can trick the brain into thinking it is daytime and wake the child up.

Helping your child develop good sleeping habits at a young age will help to ensure a lifetime of quality sleep. However, if despite all of your best efforts your child is still not sleeping properly, is snoring or gasping for air during sleep, or is exhibiting some of the signs and symptoms above, seek medical advice. Sleep is a very important, restorative process for the human body. Lack of sleep can lead to multiple health problems that can last a lifetime. Monitor your child's sleep health like you would any other function of their body.

 

Author Profile: Laura Castricone, Respiratory Therapist

 

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