Transcription:
Sleep Disorders in Children

Melanie Cole: Welcome. I'm Melanie Cole and today we're discussing sleep disorders in children. Joining me is Dr. John Prpich. He's a Pediatric Pulmonologist with BayCare. Dr. Prpich, I'm so glad to have you on - kids and sleep. What a great topic. What a huge topic right now. How common are sleep problems in kids?

Dr. Prpich: Well, thank you know, it and I think anyone who has children will attest that that sleep problems are having a hard time in terms of navigating sleep in children it's very common, right. And it's estimated up to 40% of kids are going to have some type of difficulty with regard to sleep before they're even into their school age period. But often these, these challenges, these problems go unrecognized and very often I find the families don't really talk to their pediatricians about them or they're just not sure is it something important that they should be bringing up, you know, really to anyone when, when really sometimes depending upon what those concerns are, they really can be something that can be important and something that we need to address.

Host: Well, tell us a little bit, as you just said, they can often go unrecognized because parents don't mention it just like you just said, but what are some of the consequences that you're seeing from poor sleep in our children? And I mean they've got everything distraction now besides disorders. They've got all the electronics and the white lights and we're noticing as parents, we're noticing some of these consequences. Speak about that a little bit.

Dr. Prpich: Absolutely. So, regardless of the reason that they're having poor sleep, and I think later we'll talk into some of the different reasons why they may have poor sleep quality or not get enough sleep, but really if there's something that's interrupting their sleep, it can really have wide ranging impact, both in terms of behavioral challenges but also even neurocognitive issues. Really during sleep is a big part of where we consolidate a lot of the things that we've, that we've learned over the day. We kind of get some of that stuff sort of locked down in our brain. And so if we're not sleeping well, really can impact memory, can impact learning, can really cause challenges in terms of grades and poor school performance. And then in our younger kids, often you know, you think about a sleep problem is making someone too sleepy. But often our younger kids are overtired and it often presents more almost like ADHD in the sense of problems focusing kind of fidgeting and almost being hyper. And so it's almost seems kind of counterintuitive, but really behavior issues that are the opposite of being overly sleepy.

Host: So what kind of disorders are you seeing in children?

Dr. Prpich: You know, I think broadly you can think about some of these disorders really into falling into two big groups, right? Either problems falling asleep or problems that after you've fallen asleep, things that are either waking you up or having an issue in terms of maintaining sleep and then things that sort of lump under abnormal activities while you're asleep, things that are happening while you're asleep. And those are very broad categories but you know, there's a block of children and adults that have a hard time initiating sleep. And you had mentioned, you know, some of the kids with all of their electronic devices, some of them they're using for an entertainment. But now, especially with all of the homeschooling that we're needing to do and all of the computers where we're needing to use, there's a lot of light and a lot of external input that our children are being sort of put right in front of their faces. And that's going to really often get and kind of cause problems with their own sleep regulation. So having a hard time falling asleep, having a hard time in terms of regular sleep time, is a very common issue.

But then also just issues in terms of how long they're supposed to sleep, how well once they are asleep, are they able to, you know, wake up and put themselves back to sleep, especially in our younger kids can be an issue. And then probably the one thing that is the most significant that we can do something about is something we call sleep disorder breathing. And so this is the group of children that are snoring or having turbulent airflow and really having a difficult time in terms of their sleep and their breathing. And so that's also going to disrupt their sleep quality. As opposed to the sort of different activities that can happen while you're asleep. These are broadly known as our parasomnias and in general, most of these are normal, although they can often be alarming and other things like teeth grinding or nightmares or terrors that, that parents will come to me and be concerned about. You know, the, you know, nightmares often happen sort of kind of later in the evening as opposed to the night terrors that are earlier in the evening.

And you know, often if the kids are coming to you and they remember that bad dream, that's usually more of a nightmare versus a night terror. But then sleepwalking you know sleep paralysis and other movement disorders are also all qualified or come under that heading of kind of parasomnias and like I said, they're all considered normal, but if they're doing it more often, if they're having it where it really is frequently disrupting their sleep may indicate that there's an underlying problem like either seizures potentially or even sleep disorder breathing that's interrupting the normal rhythms in the normal movement in and out of our sleep stages, and putting them at increased risk for those parasomnias.

Host: Well, let's talk a little bit about sleep apnea in children. How is it different than adult apnea? And tell us a little bit about how it's diagnosed. With adults, you know, there are sleep studies. Do you do the same for children? How do we figure that out? And if a child's not necessarily sharing a room with somebody, we don't always know. I mean with adults, you know, usually it's a partner who says, Hey, you're snoring, you stop breathing. But with kids we don't necessarily know. How do you diagnose sleep apnea in kids and what are the treatment regimens for it?

Dr. Prpich: Absolutely. So, sleep apnea in children is very different than it is in adults. For a variety of reasons, probably the biggest reason is the most common cause for kind of sleep disorder breathing in terms of, you know, sleep apnea, it tends to be what we call soft tissue hypertrophy. So big tonsils, big adenoids obstructing the airway and causing problems when the child is asleep. In the adult kind of world, the most common reason is obesity. And you know, also causing that turbulent upper airflow. Now we do unfortunately have an ever growing problem with childhood obesity. So we certainly do have children that have problems breathing problems sleeping at night because of obesity. But the cause more often is related to big tonsils or big adenoids, maybe allergic rhinitis or other upper airway sources of obstruction. But it can be very, very subtle. And when we talk about sleep apnea in kids, we really have a lower threshold or lower bar.

And so often the symptoms, you know, we think about snoring and you think about that adult that has those loud episodes that the whole house knows that it's happening. But in children often it can be very subtle, sometimes quiet and not really that loud. The other challenge is that sometimes, very often they'll cluster their episodes in REM sleep, so when they're dreaming and during that peak, and they tend to have REM sleep later in the evening. So really after everyone has gone to bed is when they're having, you know, more of their problems. And so really the parents may not be aware that they're having any noisy breathing or snoring or anything like that. Often come summertime, I'll get families because they've gone on vacation and they've been sleeping in a hotel room and then they got to hear what their child sounds like, you know, at three o'clock in the morning, four o'clock in the morning. But more often it's looking for the symptoms of that interim of that poor sleep quality of that interrupted sleep.

And so typically that might be, you know, hard to get them out of bed in the morning. You're dragging them out of bed. It might be that they're falling asleep, you know, when they're in the car, just falling asleep very easily or having problems falling off in terms of grades, falling asleep in class, or maybe even some of those ADHD symptoms. So, if there are some of the impact on kind of daytime performance issues that might also be an indicator that there's something going on, you know, at night when they're asleep. And then in terms of diagnosis, you know, usually still the gold standard is the, is the sleep study. In adults, they, you know, they will do sleep studies at home. But in pediatrics we don't really do sleep studies at home because it's a lot of things that are attached to the child and it's not a very normal environment. And so it's very hard to do that at home and get a good study. So, we still do them in the sleep lab but it really is a very good test that gives us a lot of information about what's happening when they're asleep.

And allows us to determine whether there is that turbulent airflow, whether there is snoring and obstructive sleep apnea, and make sure there's not something else going on such as seizures frequent periodic limb movements or other things which may be disturbing sleep. And it's important because often in kids, when we're sleep apnea, especially if it is significant, the typical management is surgery, especially if they have large tonsils or large adenoids. And so when you're talking about a surgical procedure, you want to make sure that you've got good objective information to help you make that decision. And so that sleep study really helps provide that objective data so you can make that good informed decision.

Host: What great information, really so important. And in these days and certainly this unprecedented time, Dr. Prpich, our kids, like you said, are not necessarily in school. They think they're on vacation all the time. They're staying up late, they're not getting quality sleep. But even during the normal school year, their sleep cycle can be way thrown off. Circadian rhythms out the window. Give us your best advice please about sleep hygiene for our kids and how parents can get our kids, as you said, they even have to do schoolwork on their computers. How we can get our kids to practice good sleep hygiene because it's so important for them.

Dr. Prpich: Absolutely. So good sleep hygiene and getting you know, an adequate amount of sleep every night is so important. And by far and away the most common reason for me to see a child, especially a teenager, but really any child that seems, mom's bringing them in because they're sleepy during the day is going to be that they're not getting enough sleep, that still is always is the most common. And that's where taking a good history and trying to really figure out how much sleep they're getting is so key. And you know, over the years I felt like, you know, about twice a year I would always get calls from news stations to do stories about sleepy teenagers surround daylight savings time because of the shift of one hour. You know, and that people would talk about sleep hygiene and circadian sleep rhythms. But now with this new environment where, you know, everyone is at home and you know, all of our kids are doing their online school, but then I have three children of my own and two of them are avid X-Box players. You know, the nighttime is not what it typically was during our usual school year.

Our kids are, you know, even with our best intentions, they're doing a lot more video game playing and a lot more things that, that we're not used to because it's such a different environment. And so I think in terms of advice, and this is hard to do, and this is when the kids all look at me and they roll their eyes and in the room, but following a good schedule. So you know, you don't want to have, there's an idea that, well, if I just stay up a couple of nights late, I can get my catch up sleep on the weekend or I can get my catch-ups sleep after a couple of days. And that doesn't work very well. You want to have a good regimented bedtime, you want to go to bed same time. And you want to really minimize that external, especially light and even auditory stimulation, you know, for the 30 to 45 minutes or so before bedtime. You know, that the AAP recommends not having a television in the bedroom. The temptation is just too great to turn it on or to, or to use some of those electronic devices like an iPad.

And so, you know, just not even having those in the bed environment in the bedroom is key. Cause really, you know, and our youngest kids, you know, four to 12 months they should be getting 12 to 16 hours of sleep a night, but as you get older, the amount of sleep you need is a little bit less. But even into those, that six to 12 years of age, we still need about nine to 12 hours of sleep with our average middle school and high schoolers needing still eight to 10 hours of sleep. And I don't know if you have many conversations with middle schoolers or high schoolers, it's very rare to see them getting that amount of sleep, you know, in a typical night for a whole variety of reasons. So, trying to maintain a schedule, trying to have a normal bed routine in terms of going to bed at the same time every night and just making sure that we're getting enough sleep is really key and paying attention to that sleep hygiene in terms of what are they doing for that 30, 45 minutes or so before bedtime, you know trying to avoid the electronic devices in the bedroom is helpful but is often very hard.

Host: Well, it certainly is. Do you have any final thoughts about sleep disorders in children that you'd like the listeners to know and the care that they can receive at BayCare?

Dr. Prpich: Absolutely. So I mean, I think, you know, in general the sleep disorder breathing, like I said, is very common. It certainly can be more of a challenge in our special needs population, children and any of our children that have other reasons to have low muscle tone. So certainly any of our kids that have any chromosomal abnormalities or any neurologic abnormalities, they're at more risk to potentially have problems at sleep. And sometimes that will fly under the radar. But really all of our kids, we need to be making sure that we're paying attention to how much sleep they're getting, making sure we're paying attention to the quality of their sleep. And then talking to our pediatricians and primary care providers if we notice symptoms or problems. Cause very often the pediatricians are not always going to be asking you questions about how your child is sleeping. I think often people think, well, you know, dad snores and grandpa's snores and uncle snores. So it's just an inherited thing, and it isn't.

Snoring is not normal. And if your child is snoring, if your child is noisy or if your child is sleepy during the day that is not normal and needs to be brought up to the pediatrician. And then what's important is that then, you know, if there is a concern, you know, we have specialists like myself within the BayCare system that take care of children that have sleep disorders. We have a pediatric sleep lab there at St. Joseph's and we can provide you know, good diagnostic testing to help identify what truly is going on. And then based upon what we find, we have a wide range of services including pediatric specific ear, nose and throat physicians. We have cranial facial physicians, we've got you know, cardiologists that run, you know, weight reduction clinics. And so, so really I think within our BayCare System, we have a wide range of tools available to help us address what problems we may uncover.

Host: What great information you're an excellent guest, Dr. Prpich. Thank you so much for coming on and sharing your expertise and telling parents really what they need to hear about kids and sleep disorders, and our kids getting a good quality night's sleep. To learn more about BayCare's Children's Health services, please visit Baycare.org. And that wraps up this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and great advice like you just heard here, please follow us on your social channels. I'm Melanie Cole.