Sweet Dreams: Better Sleep for Your Child

According to the National Sleep Foundation (NSF), a child will spend 40 percent of his or her childhood asleep by the age of two. However, the NSF also reports that many youngsters suffer from insomnia and other sleep problems. In one survey of children in pediatricians' waiting rooms, more than 40 percent were reported by their parents to experience difficulty falling or staying asleep, and early morning awakenings.

Sleep difficulties in children are especially problematic because their sleep directly impacts mental and physical development, reports Barry A. Cohen, M.D., a board-certified physician in pediatrics, pediatric pulmonology and sleep medicine who has been treating children with sleep disorders for 20 years.

“Daytime behavior worsens if the child does not sleep well at night,” says Dr. Cohen, who treats adults and children with sleep disorders at The Kazmir Center for Sleep Disorders at Saint Barnabas Medical Center. “Sleep-deprived children often display restless behavior. Hyperactivity is one manifestation of fatigue.”

Children who display any of these behaviors may be referred for evaluation for a sleep disorder: falling asleep in school, low energy level, dropping grades, mood changes or depression, snoring, awakening at night or difficulty falling asleep.

Although there are 80 different sleep diagnoses, Dr. Cohen reports that sleep problems in infants, children and adolescents generally fall into four categories:

DIAGNOSING AND TREATING SLEEP DISORDERS
A Sleep Study
The Division of Pediatric Pulmonology, located at the Saint Barnabas Ambulatory Care Center, often includes sleep studies for theevaluation of young patients. A sleep study is an overnight recording of sleep patterns and behaviors that is used to determine what stages of sleep an individual achieves and whether any sleep-related abnormalities are present.

Sensors are applied to the body's surface to record brain waves, eye movements, muscle tone, body movements, heart rate, and breathing. Audiovisual recordings are also made. The sensors used are not painful or invasive.

Snoring and Sleep Apnea
Almost one in five preschoolers and school age children snore, according to NSF's 2004 Sleep in America poll. Snoring can be caused by enlarged tonsils or adenoids or be a sign of sleep apnea, a more serious sleep disorder. About one to three percent of children not only snore, but also suffer from breathing problems during their sleep.

“Contributing factors to sleep apnea include obesity, allergies, asthma, gastroenterological reflux disorder and an abnormality in thephysical structure of the face or jaw,” reports Dr. Cohen.

If your child snores regularly, stops breathing or gasps for breath, he may have sleep apnea. Children with sleep apnea can stop breathing several times or more an hour and cannot sleep well with these disruptions. The lack of good sleep, or enough oxygen, is suspected to increase risk for poor school performance, daytime sleepiness and hyperactivity.

Children with craniofacial abnormalities, including those with Down Syndrome, experience obstructive sleep apnea at a higher rate. Dr. Cohen recommends immediate sleep studies for any child with conditions that include cleft palate and enlarged tongue with a small jaw.

Depending on the cause of the sleep disordered breathing, treatments may include a tonsilectomy, facial surgery, use of a CPAP mask, weight loss and other options.

DURING THE DAY, CHILDREN WITH SLEEP APNEA MAY: Have behavioral, school and social problems Be difficult to wake up Have headaches during the day, but especially in the morning Be irritable, agitated, aggressive, and cranky Be so sleepy during the day that they fall asleep or daydream Speak with a nasal voice and breathe regularly through the mouth

Restless Legs Syndrome
Uncomfortable, tingling sensations in the legs may be a symptom of restless legs syndrome (RLS). This disorder creates discomfort and causes the child to move his or her legs even while falling asleep. Though the cause is unknown, it may run in the family or be due to iron deficiency.Children should be evaluated for treatment.

“Children with symptoms of RLS sleep an hour less a few times a week and are twice as likely to wake up during the night,” says Dr. Cohen.

Behavioral Sleep Disorders
Many parents approach Dr. Cohen with the complaint that their child is exhibiting a problematic and unusual behavior surrounding sleep time. Frequently Dr. Cohen’s first response is to let them know that plenty of other children do what their child does.

“Children vary in their need for sleep and even a good sleeper will be asleep only 90 percent of the time,” says Dr. Cohen. “For a child who sleeps 10 hours a night, that is 60 minutes of awake time in between. It is normal to wake up between sleep cycles, even for adults. Most adults wake, adjust the pillow and go back to sleep. Children have to learn how to fall back to sleep.”

Some sleep problems may occur as a result of the family’s lifestyle. Dr. Cohen has counseled parents who work late and keep their child up beyond a healthy bedtime; teens whose vigorous exercise activitiesright before bed make it difficult for their bodies to relax into sleep; and parents who have a drastically different bedtime routine for their children on weekdays and weekends.

“Some of the family’s habits interfere with their child’s sleep,” says Dr. Cohen. “Many problems occur because the parents don’t know how to say no and sleep becomes a struggle. Parents can change the situation by introducing good sleep hygiene habits.”

Nightmares and sleep walking
Occasional nightmares are a normal part of development, says Dr. Cohen. Unlike a nightmare, sleep terrors occur earlier in the night and do not fully awaken the child. Sleep terrors lead to uncontrollable screaming that may continue as you comfort your child. An irregular sleep schedule or stress may promote sleep terrors.

Sleepwalking, often occurring very early in the night, is most common for children between the ages of three and seven. Make sure your house is safe for your child’s wanderings and gently guide the sleepwalker back to bed.

Circadian rhythm disturbances
Circadian rhythm cycles undergo changes during puberty. At this time, increased daytime sleepiness is seen along with the development of sleep-phase delay. Early school start times can be associated with symptoms of daytime sleepiness, poor concentration, and impaired performance. Dr. Cohen often recommends that the use of bright lights be eliminated before bed. This includes television, video games and computers.