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Return to Rest Easy: Help is Available for Children with Sleep Disorders Overview

More on Rest Easy: Help is Available for Children with Sleep Disorders

Rest Easy: Help is Available for Children with Sleep Disorders

New York (May 15, 2009)

Girl sleeps on stack of books

At one time or another, most parents have coped with a child who refuses to sleep. Eventually, most children will outgrow their resistance to nap or go to bed at night. However, there are a number of more serious sleep-related disturbances, including obstructive sleep apnea (a condition characterized by loud snoring and sometimes pauses in breathing), parasomnias (unusual sleep behaviors such as sleepwalking and night terrors), and excessive daytime sleepiness, for which help is available. The Pediatric Sleep Disorders Center at NewYork-Presbyterian Morgan Stanley Children's Hospital provides the diagnosis, management, and treatment of sleep disorders in newborns, children and adolescents.

Sleep specialists take a focused and multidisciplinary approach to helping children with sleep disturbances. The Pediatric Sleep Disorders Center, directed by pediatric sleep specialist Carin I. Lamm, MD, calls on a team of pediatric pulmonologists, a nurse practitioner, behavioral therapists, and nutritionists to evaluate and treat children with all types of sleep disorders. Pediatric specialists in neurology, endocrinology, cardiology, psychiatry, otolaryngology, oral and maxillofacial surgery, bariatric surgery, and cardiology are also consulted as needed.

Common Pediatric Sleep Disorders

The most common of sleep problems include:

  • Sleeplessness – Includes bedtime problems, poor napping, and nighttime awakening.
  • Parasomnias – Includes sleepwalking, night terrors, bedwetting, and confusional arousals and are most common between the ages of 4 and 12 years. Education, reassurance, and improved sleep habits can help control these disorders, which usually improve with age.
  • Sleep schedule abnormalities – Problems that affect the timing and quality of sleep during the night and day, and therefore affect the ability of the child to sleep during normal sleep periods and function normally when awake.
  • Obstruction of the airways – Often leads to sleep apnea and can result in oxygen deprivation and disrupted sleep. Symptoms are loud snoring, struggling to breathe and restless sleep. Sleep apnea can also lead to heart failure and neurocognitive difficulties, such as learning problems and hyperactivity. Children at higher than average risk include those with facial deformities, Down Syndrome, a history of lung or neuromuscular disease, and obesity. Surgical and medical treatments are available.
  • Excessive daytime sleepiness – A common problem of adolescence, it is usually caused by insufficient sleep, but may be associated with serious conditions such as narcolepsy, (falling asleep suddenly many times during the day), sleep apnea or the delayed sleep phase syndrome (an inability to fall asleep until 3 or 4 am, and trouble getting out of bed in the morning). Treatment for delayed sleep phase syndrome includes encouraging good sleep habits, strict scheduling, phototherapy, and sometimes medication.
  • Behavioral sleep problems – These issues are characterized by either difficulty falling asleep and/or waking up many times during the night. A thorough evaluation of a child's sleep history determines the therapy, which is tailored to the needs of the child and the family.

Diagnosis and Treatment for Sleep Disorders

In order to diagnose a sleep disorder, the sleep specialist performs a comprehensive sleep history and exam. For certain problems (such as sleep apnea or narcolepsy) additional laboratory procedures may be required.

The Pediatric Sleep Disorders Center offers state-of-the-art computerized equipment that permits a wide variety of evaluation techniques. "For selected patients, we perform a polysomnogram, an overnight sleep study in a comfortable and child-friendly sleep lab," says Dr. Lamm. "Parents stay overnight with their child, while technicians monitor the child continuously and also provide one-on-one care for physical and emotional support."

During a sleep study, the child is monitored for multiple brain and body activities, including brain waves (EEG), eye movements, limb movements, muscle activity, and heart rate. Other monitors measure breathing, chest and abdominal respiratory movements, airflow at the nose and mouth, and oxygen and carbon dioxide levels.

In many instances, behavioral interventions and schedule changes are used to help normalize sleep and sleep patterns. "For sleep apnea, treatment recommended may include weight loss, nighttime respiratory support (CPAP – continuous positive airway pressure), or surgery, for example tonsillectomy and adenoidectomy," says Dr. Lamm. "Treatment for narcolepsy may require a multi-component approach that includes medication, behavior modification, and environmental management."

Importance of Early Intervention in Sleep Disorders

"Sleep disorders can affect a child's mood, memory, concentration, and academic performance," adds Dr. Lamm. "Parents should talk to their child's doctor about any ongoing sleep problems. Early diagnosis and treatment will promote their child's long-term health and well-being."

Faculty Contributing to this Article:

Carin I. Lamm, MD, Director, Pediatric Sleep Disorders Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, and Associate Clinical Professor, Columbia University College of Physicians and Surgeons.

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