Sleep Problems Diagnosed and Treated
Sometimes, infants may stop breathing for longer time periods (longer than 15 seconds) or show a color change. This is called "apnea"; it is not normal and may indicate a serious medical condition that needs diagnosis and treatment. Premature infants are especially likely to have frequent or prolonged apnea, but apnea may also occur in full term infants. We may use a home heart/breathing monitor on the child, which sounds an alarm should the infant stop breathing or drop the heart rate below an age appropriate limit. Monitors are used in babies believed to be at risk for apnea and bradycardia (low heart rate). Modern infant monitors have a computer chip that records apnea or low heart rates, allowing a physician to download and review the information to see what occurred with the baby at the time the alarm sounded.
An Apparent Life Threatening Event (ALTE) is what used to be called "near-miss SIDS." An ALTE occurs when a baby or infant appears to stop breathing and turns blue, pale or sometimes red. Such episodes are very frightening to the observer who may fear that the infant is dead or is in danger of death.
Sudden Infant Death Syndrome (SIDS) is the sudden death of an apparently healthy infant 1 year of age or less that cannot be explained after a postmortem examination, clinical history and death scene investigation.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea (OSA) implies that breathing stops because of obstruction. This is more common during sleep, because the muscles in the throat relax and the throat partially closes. Obstruction results in a drop in the blood oxygen. The obstruction is resolved when low blood oxygen causes the brain to arouse and the muscle tone in the throat to increase, relieving the obstruction. As a result of OSA, children don't get enough oxygen, which may stress the heart and lungs, and may cause the child to have daytime behavior problems caused by their poor sleep. We often see babies/children that may have sleep apnea caused by Downs Syndrome, achondroplasia, asthma, Cerebral Palsy, seizures or facial abnormalities such as small jaw, receding jaw, large tongue, cleft palate and/or deviated septum. Noticeable symptoms might include loud snoring, difficulty breathing, respiratory pauses and/or snorts, restless sleep, daytime irritability, and occasional sleepiness. It is not normal for children to snore. Overnight studies are recommended for an accurate diagnosis of OSA. Treatment may be surgical, such as tonsillectomy and/or adenoidectomy. Mechanical treatment with a CPAP (a mask worn at night which balloons the throat open with a small amount of positive pressure) is also very effective. The addition of oxygen is sometimes necessary. Weight loss, medications and other treatments are sometimes recommended.
Parasomnia is a dysfunction associated with sleep, sleep state or partial arousal. It includes problems like sleep walking, nightmares and night terrors. These problems are often developmental in nature and worsen with stress. Severe cases require education, removal of the causes of parasomnias and behavioral interventions. Medication is prescribed in some cases.
Poor Sleep Hygiene
Infants and/or children may develop poor sleeping habits. These may include difficulty putting the child to sleep, late sleep onset time, frequent arousal that requires intervention and difficulty waking up. Poor sleep habits are more common in sick children with other medical problems including recurring ear infections and sleep apnea. Comprehensive education and training programs can be provided for families and patients on how to improve sleep hygiene.
Disorders of initiating and maintaining sleep, or chronic insomnia, are often managed in our clinic. Symptoms of insomnia may include daytime fatigue, irritability, anxiety, mild depression, difficulty in awake attention span and excessive daytime sleepiness. Behavior modification and medical therapy are often successful in the treatment of insomnia.
Disorders of excessive sleep (insomnolence) include Obstructive Sleep Apnea (OSA) & narcolepsy. OSA may result in daytime sleepiness because of disrupted night sleep. Narcolepsy is an unusual disorder of excessive daytime sleepiness originating in abnormalities in the sleep centers in the brain. Symptoms may include excessive daytime sleepiness, cataplexy (periodic inability to perform voluntary movements secondary to a sudden inhibition of muscle tone), daytime microsleep attacks with automatic behavior and amnesia, hallucinations, sleep paralysis and disrupted nocturnal sleep. Many of these problems may be evaluated with a Polysomnography (a sleep test where a child is monitored during his/her sleep) to rule out breathing related problems, followed by a Multiple Sleep Latency Test (MSLT) to evaluate how long it takes the child to fall asleep and enter into the rapid eye movement (REM) stage of sleep. Treatments may consist of individualized medication management, scheduled naps and modifications of work/school schedules.
Periodic Leg Movements
Repetitive leg movements, when they occur every 15-40 seconds, may cause a person to complain of frequent awakening or non-refreshing sleep. Roommates may complain of the sufferer kicking during the night.
Restless Leg Syndrome
This may occur while a person is awake and relaxing. It is described as an uncomfortable sensation or feeling within the legs. The feelings require movement to provide relief.
With this condition, a person feels a constant need to sleep, but, they are able to refrain if they must. Some people may sleep an excessive amount at night and be difficult to waken. They may appear confused and disoriented upon awakening.