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Sleep Disorders

Sleep disorders treated at the Sleep Disorders Center include:

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is a condition where breathing is affected during sleep due to obstruction of the upper airway. This occurs during sleep because the muscles in the airway relax and the airway partially closes. Obstruction results in disturbance of sleep and may cause either a drop in the blood oxygen or increase in the carbon dioxide or both. The obstruction is resolved when either the increased work of breathing or low blood oxygen causes the brain to arouse or the muscle tone in the airway to increase, relieving the obstruction. As a result of OSA, children usually have poor quality sleep and hence may have daytime problems including inattention, hyperactivity, behavior problems, poor school performance, mood problems or daytime sleepiness. They may also not get enough oxygen, which may stress the heart and other organs and cause long-term medical problems like high blood pressure and cardiac issues. We often see babies/children that may have sleep apnea caused by Down Syndrome, achondroplasia, Cerebral Palsy, neuromuscular problems, or facial abnormalities such as small jaw, receding jaw, large tongue, cleft palate and/or deviated septum. Noticeable symptoms 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 positive airway pressure (PAP) (a mask that is worn at night which keeps the airway open with a small amount of positive pressure) is also very effective. The addition of oxygen may sometimes be necessary. Weight loss, medications and other treatments are sometimes recommended.

Excessive Daytime Sleepiness

Disorders of excessive sleep (hypersomnolence) include narcolepsy and idiopathic hypersomnia. Excessive daytime sleepiness is more commonly seen due to poor nighttime sleep. The patient may be getting inadequate sleep either due to unhealthy sleep habits or a primary disorder of reduced sleep. It is also possible that he/she may be having adequate but disturbed sleep due to other sleep problems like sleep apnea. 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, 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 other sleep problems, followed by a Multiple Sleep Latency Test (MSLT) to evaluate how sleepy he/she is and if he/ she enters into the rapid eye movement (REM) stage of sleep easily. Treatments may consist of individualized medication management, scheduled naps and modifications of work/school schedules.

In Idiopathic Hypersomnia, a person feels a constant need to sleep. They may able to refrain if they must. Some people may sleep an excessive amount at night and yet be difficult to waken. They may appear confused and disoriented upon awakening.

Insomnia

Disorders of initiating and maintaining sleep, or chronic insomnia, are often managed in our clinic. Insomnia may cause adverse daytime symptoms that 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.

Parasomnia

Parasomnia is a dysfunction associated with sleep, sleep state or partial arousal. It includes problems like sleepwalking, sleeptalking, confusional arousals and night terrors. These problems are often developmental in nature and worsen with stress or sleep deprivation. Most cases require education, removal of the causes of parasomnias and behavioral interventions. Medication is prescribed in some cases.

Periodic Leg Movements

Repetitive leg movements, when they occur every 15-40 seconds, may cause a person to suffer from frequent awakening or non-refreshing sleep. Roommates/bed partners may complain of the sufferer kicking during the night. Periodic Leg Movements during sleep (PLMS) are associated with restless legs syndrome. Presence of PLMS may prompt further evaluation including blood testing for iron levels.

Poor Sleep Hygiene

Infants and/or children may develop poor sleep habits. These may include difficulty falling asleep; late sleep onset time; the need for intervention by parents/ caregivers like rocking/patting/bed sharing; frequent arousals during the night that require intervention and difficulty waking up in the morning. 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.

Restless Legs 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.