Transcription:
Sleep Disorders in Children

Bill Klaproth (Host): Could a sleep disorder be the root cause of your child’s struggles in the classroom? The most common sleep disorders that affect children include obstructive sleep apnea, restless leg syndrome, periodic limb movement disorder, and narcolepsy as well as insomnia and delayed sleep phase syndrome. If any of these issues exist with your child, when is it time for them to undergo a sleep study? We’re here to address these and other concerns related to sleep disorders in children as Lewis Milrod, M.D. a pediatric, neurology, sleep medicine physician at the Children’s Hospital at St. Peter’s University Hospital in New Brunswick, New Jersey. Dr. Milrod, thank you so much for being on with us. We all know sleep issues with adults. We hear of those all the time. But sleep issues with children? How common is this?

Dr. Lewis Milrod (Guest): It’s very common. At least 2 in 10 children have some kind of sleep problem.

Bill: Interesting. Now, we all know about restful sleep, of course, and the positive effects it has on the body. Is that more so with children? Do they need this more than adults?

Dr. Milrod: Children, usually, when they sleep normally, they’re the most well rested they’ll ever be in their lifetimes. But naturally, all kids want to stay up late, so the most common cause of daytime sleepiness in kids is not getting enough sleep. And with the advent of electronics like cellphones, iPods, those things can keep people up at night.

Bill: Obviously, those certainly can be a distraction and be a hindrance to good sleep. So, what are the signs then that your child may have a sleep problem or a sleep disorder?

Dr. Milrod: The signs could be as simple as yawning, rubbing the eyes. But in kids, it’s a little bit more complicated. Kids won’t look as sleepy as an adult would. An adult who didn’t get enough sleep would be falling asleep at work or in their chair. A child, theoretically, might move around more and maybe be misdiagnosed as having an attention deficit disorder. The idea is that kids are restless and they’re trying to keep themselves awake to some extent.

Bill: So as a parent, what should we be looking out for? When do we go, “Okay, I’ve just been letting him stay up too late – time to cut that out”? When should a parent suspect that maybe it’s not that, maybe it’s something more?

Dr. Milrod: Yes, usually if a child is well rested, they’ll awaken on their own in the morning, for example, for school. If a child has to sleep very late on the weekends, assuming they’re not a teenager, that could mean that they’re not getting good quality sleep or enough quantity of sleep during the week. A child shouldn’t take naps after age five.

Bill: Say that again? A child shouldn’t take naps after age five.

Dr. Milrod: That’s correct.

Bill: So if my 10-year-old wants to take an hour nap in the afternoon, not a good sign?

Dr. Milrod: That’s right. It’s a sign that further evaluation needs to occur.

Bill: Okay. Now, is a sleep disorder, is that possibly hereditary?

Dr. Milrod: Yes. Oftentimes, kids with insomnia—trouble falling asleep at night—the parents will also report that they’re night owls also. So there can be that natural tendency for parents and children to want to stay up late, and their biological clock is telling them to stay up late. Their circadian rhythm will be telling them to go to sleep at 1 in the morning as opposed to 9 or 10.

Bill: Okay. So possibly a child has -- hereditary, it’s born with them. Let’s talk about then lifestyle as well. Is there a relationship between nutrition, exercise, and sleep?

Dr. Milrod: Yes. The more exercise children get, obviously it wears them out and they’re more able to fall asleep at night. There is some evidence that if a child exercises too close to bedtime, that actually may keep them up at night also. One of the signals for us that tends to happen as we get sleepy is that our body temperature falls. So if a child exercises, that may raise their body temperature if the exercise is too close to bedtime.

Bill: Same with adults then. So, Dr. Milrod, what is the amount of sleep then as a parent I should be expecting my child to get?

Dr. Milrod: School-age children need a minimum of 10 hours of sleep per night. In teenagers, that actually goes up a little bit. Most of them probably need somewhere between 8 ¼ and 9 ¼ hours of sleep per night. And a lot of teenagers don’t get that during the week, and that’s why they’re sleeping in on the weekends.

Bill: And what do you tell a teenager that says, “I don’t need sleep. I’ve got this. I’m good. I’ve got energy. Don’t worry about me. I don’t need all this”? What do you tell a kid that says that to you?

Dr. Milrod: I usually tell them that the weekend is something that we invented. Our bodies, our circadian rhythms are the same from day to day. So kids that want to stay up late on the weekend, it’s like they’re travelling to California. They’re staying up ‘till 2 or 3 in the morning, and then Sunday nights, it’s like they arrive back on the East Coast and they’re trying to fall asleep at a regular time and they can’t. Also, using caffeine can lead to further trouble with awakenings during the night and having trouble falling asleep. So kids that don’t get enough sleep will then ingest more caffeine. Some of them will take naps after school, and taking naps after school does not give you the same quality of sleep that you would otherwise get if you had all your sleep continuously at night.

Bill: So would you recommend that children stay away from caffeine, teenagers, 14-, 15-, 17-year-olds stay away from caffeine?

Dr. Milrod: Yes, definitely. I would absolutely limit it as much as possible.

Bill: And what else can a child do to improve sleep habits?

Dr. Milrod: Mostly trying to get up roughly the same time every day. So on weekends, obviously, children may not get up as early as they do for school, but we try to say just don’t sleep more than an hour later, because the wake-up time is really what synchronizes the time for falling asleep at night. We also like for them to have a calm bedtime routine, so they don’t watch too many things that involve light or they’re not doing electronics that would keep them up at night. Electronics can be stimulating, but also, the light itself suppresses the production of melatonin, and melatonin is the hormone that goes up at night that signals that it’s time for our bodies and brains to fall asleep.

Bill: And then, what are the most common sleep disorders if a child does have an actual sleep disorder? What are the most common sleep disorders among children?

Dr. Milrod: The most common sleep disorders include obstructive sleep apnea syndrome, restless legs syndrome, and narcolepsy. Obstructive sleep apnea is usually accompanied by snoring, and snoring we don’t regard as normal any longer. The American Academy of Pediatrics advises pediatricians to screen for snoring. If a child snores and if they have another problem, if they have a problem in school or if they have a problem with being sleepy, then that usually is something that we’d investigate through a sleep study. The most common cause of sleep apnea in preschool and school-age kids is the size of the tonsils and adenoids. So often, removing them can alleviate the obstruction and lead to resolution of sleep apnea. Sleep apnea, basically, what happens is that the throat closes during sleep. It’s not as dramatic as in adults, so the kids, you don’t tend to hear the gasping and the choking that you might with an adult. But the kids have more shallow breathing that can nevertheless affect them during the day.

Bill: So if a parent hears snoring, that’s certainly a sign that something may not be correct. Is that right?

Dr. Milrod: That’s right.

Bill: Okay. So would the next step be taking your child to your physician, and then they can confirm whether or not a sleep study is in order?

Dr. Milrod: That’s correct.

Bill: And talk to me about the sleep study a little bit. So I suspect my child may have this. I go to my medical doctor and he says, “Yeah, let’s get him or her into a sleep study.” What can I expect in that? What do I tell them? They may be scared, like what are you doing to me? Tell us about that process a little bit.

Dr. Milrod: Well, the first thing is that the child doesn’t go to the sleep study alone. One of the parents would accompany the child. The rooms are decorated to look just like your bedroom at home, and there’s T.V. to watch initially, if that’s what occurs at home. We encourage the kids to bring other favorite stuffed animals or pillows to make it as much at home as possible. If the children are scared, the sleep technicians often wait until the children fall asleep and then put the wires on. Most of the kids, as you know, enter very deep or stage 3 sleep as they first fall asleep, and that’s why toddlers, you can often carry them into their rooms and they have no recollection of how they got there in the morning. So we can take advantage of that during the sleep study. In terms of the wires and leads that are used, there’s usually a belt that goes across the chest and one across the belly to measure respiratory effort during sleep. And then there is the usual fingertip sensor that lights up and tells us what the child’s oxygen level is. There is a lead that goes on the upper lip that measures airflow through the mouth during sleep. And then we have another monitor that goes a little bit into the nose, kind of like a nasal cannula for oxygen that measures airflow through the nose. And that way, we can tell if an obstruction occurs in the nose, through the throat, and we can measure if there’s an oxygen desaturation, so if the oxygen level goes down with a holding of the breath in sleep.

Bill: So if a child is diagnosed with sleep apnea, how do you treat it? Is that with a CPAP machine or medication? What do you do then? Or is every case different, I imagine?

Dr. Milrod: In kids, the leading cause of sleep apnea is the size of the tonsils and the adenoids. So that’s usually the first step. So your ears, nose, and throat physician would evaluate the results of the sleep study and then help to decide whether the adenoids and tonsils should be removed. CPAP is used for severe cases or kids that still have sleep apnea after their adenoids and tonsils have been removed, or kids that may not be candidates for that procedure.

Bill: Okay. Is medication ever used, prescribed for children?

Dr. Milrod: Medication is not used for sleep apnea itself. We don’t yet have medications that would be of assistance. In adults, there are medications that can help to awaken people with sleep apnea, but that’s not the primary modality. That’s only used if the adult doesn’t respond to the use of CPAP. In kids, we do use medication sometimes for restless legs syndrome. Restless legs syndrome in kids is often misdiagnosed as growing pains. But if you try to look up growing pains in any pediatric textbook, it’s very hard to find. But the clues to restless legs syndrome are that the child experiences discomfort in their legs. It comes on more so at night than during the day. It increases with lying down, so a child may not complain about their legs until they lie down. The discomfort is relieved by movement, by getting up and walking around. And in kids, the first step before we consider medications is to check an iron level called the ferritin level. And if that level is low, then treating with iron for three months can usually result in resolution of that creepy crawly feeling that the children have.

Bill: Right. Dr. Milrod, as we finish up, what’s your best advice then for a parent who thinks her child may have a sleep disorder?

Dr. Milrod: If you have, as a parent, any suspicion, I would run it by their pediatrician first. And if their pediatrician is okay with it, they can order the sleep study themselves directly or they can always direct the child to a pediatric sleep center to be evaluated.

Bill: Dr. Milrod, thank you so much, very informative. We really appreciate your time today. And for more information, please visit saintpetershcs.com. I’m Bill Klaproth, and this is Saint Peter’s Better Health Update. Thanks for listening.