Sleep issues in kids
When it comes to a good night's rest, age is irrelevant
He was no stranger to breathing problems. Diagnosed with asthma at 18 months old, he had been rushed to the doctor more times than his mother cared to remember, particularly whenever he caught a cold. But once he began an effective regimen of prescription medications, the asthma was under control.
Until the snoring set in. Every night.
Sleep had never been an issue for him, and certainly not snoring, except for the occasional episode when he was extra tired or a little congested, or that trying time when he came down with pneumonia.
Intermittently, his snoring would stop; but it seemed like the pause was more of a break in his breathing than a moment to catch his breath.
Still, it was unusual enough that 8-year-old Mark Rimas became the first child patient of the Community Hospital Sleep Disorders Center when he was enrolled in an overnight sleep study in March 2008. The goal was to determine the cause of his snoring. The result was a good night’s sleep and a diagnosis of sleep apnea.
The breathing disorder causes loud snoring and often halts breathing during sleep, resulting in a true awakening or at least some level of sleep disturbance anywhere from once to hundreds of times a night. According to the American Academy of Sleep Medicine, some 12 million Americans suffer from sleep apnea. An estimated 10 million others remain undiagnosed. And an estimated 2 percent of children, mostly preschool ages, have sleep apnea.
"As in adults, the main reason to do a sleep study with a child is for sleep apnea, an underrecognized issue among children," says Dr. Richard Kanak, a board-certified sleep medicine specialist and medical director of the Sleep Disorders Center. "In children, enlarged tonsils and adenoids blocking the airway are the most common cause of sleep apnea. Abnormal development of the hard palate is another cause. Tonsillectomy resolves sleep apnea in about 80 percent of children who undergo the procedure. Orthodontic procedures to reshape the hard palate are also helpful for some children."
"In Mark’s case," Kanak adds, "asthma may contribute to breathing problems at night."
Dressed in their favorite pajamas, Mark and his mother, Dali Dalizon, arrived at the sleep center armed with anticipation, a little trepidation, and a shark movie.
The technologists are trained in sleep-study procedures, and though Mark was their first child patient, they were ready. The goal is to help young patients and their families feel as comfortable as possible.
During a sleep study, a collection of electrodes are typically attached to the patient, and a strap around the chest/abdomen area measures breathing. About a dozen parameters are monitored, including brain waves, eye and muscle movement, and nasal and oral airflow.
"In order to monitor Mark’s sleep," says Dalizon, "they had to put sensors with wires all over his body. I don’t think he was nervous; in fact, he was kind of excited and saw it as an adventure. But I was nervous, wondering how he would sleep with all those wires coming off him.
"I was grateful that they brought in a bed for me to sleep right by him. They explained everything they were going to do and were so attentive and friendly that they made us both feel comfortable."
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Mark snored his way through the night, stirring at times but quickly slipping back into a deep sleep. By morning, he was full of energy and hope that he could have another night’s stay in the comfortable surroundings. He also had a preliminary diagnosis of sleep apnea and a plan for follow-up care.
While the approach is similar, the coping skills, perspective, and bedtime routine appropriate to a child direct the protocol for pediatric sleep studies. Even before the study begins, technicians work to create a positive experience for the child and parents by scheduling a phone call to discuss what they can expect during the study.
Because the Sleep Disorders Center recognizes that the medical environment can seem like a foreign country, particularly to a child, technicians adjust content and vocabulary to offer age-appropriate explanations.
Since Mark’s sleep study, the center has conducted a study on a 4-year-old girl, and the staff anticipates a growing number of studies among children as their parents and physicians become more aware of the symptoms that warrant a sleep study. Those issues include sleepwalking, night terrors, and restless leg syndrome, but sleep apnea is the most common problem.
"Unfortunately," says Kanak, "the effects of sleep apnea in kids get associated with a variety of behavioral and learning issues, including hyperactivity and difficulty in focusing, when the problem may actually be that the child isn’t getting a good night’s sleep."
Fortunately, diagnosing and treating sleep apnea can address some of these issues.