Transcription:

Bill Klaproth (Host): According to the American Academy of Family Physicians, up to 50% of children will experience a sleep problem. Maybe your child is one of them. And the lack of sleep can have serious health consequences. This is a very important topic. So, let's learn more about pediatric sleep and how your children can achieve healthier sleep with Dr. John Levri, Board Certified in Sleep Medicine by the American Osteopathic Board of Family Physicians and a Sleep Specialist at UPMC. This is Healthier You, a podcast from UPMC in central Pennsylvania. I'm Bill Klaproth. Dr. Levri, thank you so much for your time. As I mentioned, this is such an important topic so let's start with this; why do kids need sleep and how much do they need?

Dr. Levri: Great question. Children as well as adults need sleep just for survival. But there are a lot of vital functions that occur during sleep. For example, growth hormone, which children need to grow appropriately and healthfully is released during a special stage of sleep called slow wave sleep, and kids have more slow wave sleep than even adults because they need this growth hormone help them grow healthfully. But even things like sugar control, thyroid hormone and appetite hormones are regulated in sleep. Now the question of how much they need. That depends more on age. So, I actually have a breakdown if you want me to go through that?

Okay. So, the first three or four months of a child's life, it just kind of whenever the baby is going to sleep basically. It's not super organized. This is why some kids are sleeping through the night by four months and some others aren't. But somewhere between four to 12 months, babies need about 12 to 16 hours of sleep. And that is including the daytime naps. So not just all at night, but including naps during the day.

Then once we transition from maybe to like a toddler age. One to two years, that goes to 11 to 14 hours again, including naps. The next age group would be three to five years. And they go down to 10 to 13 hours, including naps. And then about age of six, children may still nap. They may not, but from six to 12, the total number of hours that's recommended is nine to 12 hours.

Then finally, in the age group, the teenage years, 15 -18, that looks a little more closer to a regular adult at eight to 10 hours.

Host: Okay. That's really interesting how you break that out. How slowly the amount of sleep they need decreases as they age. I was interested to hear you say, when I asked you, why do kids need sleep? And you said, it's a matter of survival. That really is crystal clear on how important sleep is. And then you mentioned, of course, this helps with their growth hormone. So, for them to grow, they need sleep. And then what happens to children that don't get enough sleep. Tell us about that.

Dr. Levri: Interesting question, because this is a growing public health concern, not just a curiosity question. Sleep deprivation in children can lead to things like poor school performance, obesity, metabolic dysfunction, heart problems, even mood and behavior problems like increased suicidal thoughts, risk taking behaviors. And then increased accidents. So, injuries on the sports field, motor vehicle accidents. Those sorts of things. That's what you can expect if your child is not getting enough sleep.

Host: When you say this is survival and a matter of life and death, these things really can impact a child's quality of life and their childhood. Poor school performance. You mentioned obesity, metabolic dysfunction, heart problems, even mood and behavior problems. So, getting enough sleep is really, really important. So, then the next question would be that how can parents encourage good sleep in their children? Because it is so important.

Dr. Levri: Absolutely in the sleep field, we kind of see it as a perfect storm of things, keeping children from getting enough sleep. I mean especially it becomes more of an issue once you get to the high school or teenage years. Children normally their bodies want to go to sleep later at night than they used to. Okay. So, maybe the child was going to sleep at eight or 9:00 PM. Just normally now they're going to want to go to sleep at 10, 11, 12, and it has nothing to do with self-control. It's just that's what their body is going to require. Then compounding that problem you have school start times. Okay. That you're competing with right? If you know that the child has to be up by 6:30 or 7:00 AM every morning, or even earlier, in some cases, and their body's not gonna want to go to sleep till 11. I mean, that's a hard limit, a hard cap on how much sleep that the child can get. And then you have things like caffeine and energy drinks that are becoming more and more common in the pediatric population. The electronic devices that are becoming more prevalent even earlier in earlier that work against sleep in two ways. The light from the electronic device, of course tells the brain to stay awake. And then you have the social reward of keeping up with friends and staying involved and the good social things that we like about our devices also stimulate the brain to stay awake and then we have curricular and extracurricular activities.

So, why I mentioned those things without actually answering the question is, is that's how parents can combat all these pressures of their child's not getting enough sleep. And so the first thing I'd say is lead by example, if sleep is important to the parent and the parents' health is important, kids tend to pick up on that. So, be really careful and prioritize sleep, especially when you're making a schedule for later in the day activities. Make sleep a priority, make sure there's an appropriate window of sleep. So, maybe not just allowing for eight hours in the bed, but maybe 10 hours because it takes a while, maybe an hour to unwind and then an hour to wake up in the morning. So, maybe making sure your child's schedule allows for 10 hour window to be sleeping, even if they're only sleeping about eight of it.

Another thing that can be done is being very strict about the electronic devices. That is every teenager in the world probably hates to hear that. But I mean, we are seeing it become almost its own pandemic in a way of kids that are staying up all night on their devices or maybe even more prevalent on video games. I think this is one of the biggest, biggest detractors from sleep in our adolescent population. So making it a priority, leading by example, and then limiting the schedules and the electronic devices, it would be my recommendation to parents and how to help their child get a better night's sleep.

Host: Yeah, all of that really makes sense. And especially lead by example, your kids are always watching you. So, if you model good sleep hygiene, they'll pick it up too. Which is really important. So, as a parent, we've all experienced, you know, bad sleep night with children. At what point does a parent need to consider seeing a sleep specialist?

Dr. Levri: Good question. So, I'd say if it's just that one off night, that's not so much of a big deal. And I do try to because people have a lot of ingrained thoughts and beliefs about sleep. So, I actually, a lot of times with my patients, parents, and children and adult patients is try to reframe how they think about sleep. And I think a lot of people get very worked up and anxious about that one bad night of sleep and I've even shifted my own focus when I get a bad night of sleep, but that's actually helped because what that does is it actually sets the process in motion for the next night to be a better night's sleep. And just kind of knowing that and taking some of the anxiety out of it, I think helps a lot of people. And it personally helps me to say, okay, I'm going to get through my day. It was a bad night and I'm going to get through my day. I've done it before, and this is actually gonna help me sleep better tonight. So, I'd say that's where to start.

Now, if the child continues maybe for a month, they have restless sleep, trouble falling asleep, trouble staying asleep; that's a good time to either see a sleep specialist or get into the pediatrician or start with the pediatrician. Some other things that can be concerning other than just sleeplessness in pediatric patients are things like snoring. Daytime sleepiness. Even daytime behavior. It's estimated that up to 50% of pediatric patients that are diagnosed with ADHD either have a comorbid sleep disorder or really it was the sleep disorder that was causing a daytime lack of focus and concentration. So, I'd say any focus, any daytime behavior, those are big red flags I think for parents that their kid actually might be dealing with a sleep issue, more than like a behavioral health issue.

Host: Right. So, if sleeping issues continue for more than a month, then it's a good time to consider seeing a sleep specialist and then even look out for, you know, snoring, sleep apnea in kids. We don't often think about that in children, but if you hear your child snoring, or you think your child might have sleep apnea, that's another good reason to go see a sleep specialist. So, in talking about sleep apnea, we always think of adults and sleep apnea. What is different about treating kids and adults when it comes to sleep issues?

Dr. Levri: This is a very excellent question. I'll start with sleep apnea and then talk about some of the other sleep disorders. I think this is important because a lot of people have an ingrained notion of the sleep apnea patient and what we're learning more and more is that there's a very big genetic component to sleep apnea and not every patient presents the same way. And especially when it comes to children, there are some significant differences in sleep apnea at diagnosis and management. So for a child, they're often going to have snoring and then daytime behavior problems like lack of focus, acting out, things like that. They don't necessarily get sleepy like an adult would with sleep apnea. It tends to manifest mostly as behavior issues. And so up to 5% of the pediatric population has sleep apnea. So, more common than I think a lot of people think.

And a lot of times the issue what's true between adults and pediatrics is sleep apnea is basically a space issue. There's not enough space in the back of the throat. And for children this is often due to the tonsils. So, if the tonsils are really large and a child is snoring, and they're having issues at school during the day, that is like a great patient that should see a sleep specialist. And then a sleep study would be performed to make the diagnosis. And if the child has sleep apnea, whether it be mild, moderate, or severe, they can then go see an ear, nose and throat surgeon to have a tonsillectomy or removal of the tonsils.

And a lot of time, children's focus, concentration and behavior during the day will improve, as well as they'll sleep more soundly at night. That is a big difference. Another big difference in sleep apnea between children and adults, children don't tend to drop their oxygen levels as much with sleep apnea. But they do tend to at a higher rate than adults, at least, retain carbon dioxide. So, it's almost physiologically a different process in terms of how it can cause harm to the patient. Adults they tend to present with snoring. Not everyone has to snore to have sleep apnea, but that's the most common symptom and then daytime sleepiness. So, instead of getting kind of hyper and their behavior being an issue, they tend to have sleepiness, maybe nodding off at work at their desk, or while driving. Very unsafe. But, hopefully they'll get checked out and they can be treated for that.

There are some sleep disorders that tend to present in childhood before adulthood. One I'm thinking of there is narcolepsy, very rare condition. It's actually one out of 200 people. So, more common than you might think. And often the way this presents is it's a disorder of hypersomnolence or sleeping a lot. And so children will often have a hard time staying awake in school, usually in their teenage years. That's who picks it up the teenager, the teacher alerts the parent. And they're struggling in school struggling to stay awake, sleeping maybe 12, 13 hours at night and still needing maybe a three or four hour nap during the day. That's a big difference. Now we do see a little bit of an uptake in diagnoses in narcolepsy and in the third decade for adults and that tends to be similar in that the adult isn't performing like they'd like to at work. And so that's when they go seek care. But typically this is thought to be able to be picked up in teenagers, that's when that one tends to present.

Host: And are there scenarios then the children may need to stay overnight for a sleep study. We hear about that with adults all the time. I'm curious about children and if so, how young can this be done?

Dr. Levri: In my fellowship at the University of Maryland Medical Center, there were newborns that we would do sleep studies on. There are a few rare sleep disorders, breathing issues that even a newborn can have with certain congenital anomalies. So, it is possible to do it on a newborn. There's still a lot to be learned about that process, but we can diagnose certain diagnoses of sleep apnea, not all sleep apnea is the same. So, there are subcategories that we can diagnose as early as the first day of life. More commonly though at UPMC in the central Pennsylvania region here, we actually have in our sleep lab that capability to study children as young as three years old.

And that would be at our Harrisburg location. And our other sleep labs in Mechanicsburg and Carlyle, we're increasingly training our technicians, our sleep technicians to take younger and younger children because this is often an unmet need in the community to be able to provide sleep diagnostics for our pediatric colleagues. And so we're working to get the age younger at the other locations, but certainly in Harrisburg we can perform a sleep study overnight for children as young as three. And the reasons to do this would be to diagnose sleep apnea, to diagnose narcolepsy, or if the patient is presenting with some odd behaviors in their sleep. There's a group of sleep disorders called parasomnias that tend to be higher in children than adults. And sometimes these can even be linked to a very rare diagnosis of nocturnal seizures, meaning the patient is actually having seizures while they're asleep.

And oftentimes a sleep study while not a full diagnostic modality for seizures, we can see seizure activity on the sleep study and make the diagnosis. But very rare, but is something that can be seen.

Host: Well, this has really been eye opening. Pardon the somewhat pun, as we talk about sleep disorders and having issues trying to stay awake. This has really been interesting. Dr. Levri what's your last message as we wrap up for parents? Again, we don't often think of sleep issues in children. We think about it when it comes to adults. What's your last message for parents listening to this podcast?

Dr. Levri: I would say as a society, we really need to value sleep more. I think a lot of the chronic disease we see as adults and certainly some of the chronic disease we see as children, while it wouldn't solve everything, but it would go a long ways if we prioritize healthy sleep and healthy prioritization of a good night's sleep in our children and it would lead to better health overall, better performance in school and even less accidental deaths behind the wheel. And that has been studied and proven that sleep deprivation in teenagers causes a lot of motor vehicle accidents. So, prioritize sleep. It's going to help the overall health of your child and maybe even save their lives.

Host: Prioritize sleep. What a great message to wrap this up. Dr. Levri, thank you so much for your time. This really has been informative and we appreciate your time today. Thank you so much.

Dr. Levri: It was my pleasure Bill. Thank you very much.

Host: And that's Dr. John Levri. And visit upmc.com/centralPAsleep Once again, upmc.com/central PAsleep to learn more about the sleep services at UPMC. It's very, very important. And if you found this podcast helpful, please share this on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.