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Sleep Conditions We Treat

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.

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. The most common cause for OSA in children are enlarged tonsils and adenoids.  Children may also have sleep apnea related to Down syndrome, achondroplasia, cerebral palsy, neuromuscular problems, or craniofacial abnormalities. Noticeable symptoms include:

  • loud snoring/snorts
  • difficulty breathing
  • respiratory pauses
  • restless sleep

Overnight polysomnograms 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

Excessive sleepiness is not a disorder in itself. It is a symptom that can have many different causes. The common causes are poor sleep habits, an irregular sleep schedule, a sleep disorder like obstructive sleep apnea, side effects from certain medications, and other underlying medical conditions, such as narcolepsy or idiopathic hypersomnolence. Once your child’s doctor has determined the cause of the excessive sleepiness, you can create a treatment plan together. For some children, that involves changing sleep habits and improving behaviors and elements of the sleep environment. For others, further medical tests or sleep studies may be indicated. Many of these problems may be evaluated with a polysomnogram to rule out other sleep problems. A multiple sleep latency test (MSLT) may be required to assess sleepiness and aid in the diagnosis. Treatments may consist of individualized medication management, scheduled naps and modifications of work/school schedules.

Narcolepsy/Idiopathic Hypersomnolence

Narcolepsy and Idiopathic Hypersomnolence are disorders of excessive sleep (hypersomnolence).

Narcolepsy 

Narcolepsy is a neurological sleep disorder characterized by overwhelming daytime sleepiness and sudden attacks of sleeps.  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
  • disrupted nighttime sleep.

Idiopathic Hypersomnia

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.  It is different from narcolepsy because it doesn’t usually involve suddenly falling asleep or losing muscle tone due to strong emotions.  Naps are not as refreshing as in Narcolepsy.

Both of these problems may be evaluated with a polysomnogram to rule out other sleep problems followed by a multiple sleep latency test (MSLT) which evaluates the sleepiness of the child. 

Treatments may consist of individualized medication management, scheduled naps and modifications of work/school schedules.

Insomnia

Chronic insomnia or disorders of initiating and maintaining sleep 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.

Parasomnias

Parasomnias are a group of sleep disorders that involve undesirable physical events or experiences that occur while falling asleep, during sleep, or while waking up from sleep.  Parasomnias may be classified by sleep state.  Some such as sleepwalking, sleeptalking, confusional arousals, and night terrors may occur in non-rapid eye movement (NREM) sleep.  Others such as nightmares and REM-behavior disorder occur in rapid eye movement (REM) sleep. These events are most common in young children and gradually decrease in frequency over time.  Healthy children that present with parasomnias only require a focused sleep history and physical exam for diagnosis. In most cases, treatment is usually not necessary.   You may need to take safety precautions to protect the child during these episodes.  Medication is prescribed in some cases if the parasomnias are frequent or having a negative impact in a child’s daily activities.

Sleep-Related Movement Disorders

Periodic Limb Movements

Periodic limb movement disorder (PLMD) are repetitive limb movements that occur every few seconds during sleep.  It usually occurs in the legs, but can also affect the arms. The movements don’t wake the child, but may cause sleep disruption.  The sleep disruption may lead to daytime sleepiness symptoms.  Most children and adolescents are not aware of the movements during sleep.  PLMD may be associated with restless leg syndrome (RLS).  Presence of PLMD may prompt further evaluation with polysomnography and lab tests for ferritin levels. 

Restless Legs Syndrome

Restless legs syndrome (RLS) is a movement disorder characterized by an uncomfortable sensation or irresistible urge to move your legs that occurs while awake and relaxing.  This urge usually happens at bedtime, but can occur at other times when your legs have been inactive, such as sitting still for a long period of time such as riding in a car or watching a movie.  To relieve the “creepy, crawly” sensations in the legs, the child or adolescent moves or stretches their legs, tosses and turns or gets up and walks around. The relief is usually immediate upon moving the legs.  The cause is unknown but it, too, may be related to low ferritin levels.  RLS sometimes runs in families and is thought to be genetic. 

Sleep Hygiene/Behavioral Issues

Infants, children and adolescents may develop bad sleep habits surrounding bedtime. These may include delayed bedtimes, difficulty falling asleep, frequent arousals/waking during the night, and difficulty waking up in the morning.   The need for intervention by parents/ caregivers to provide rocking, soothing or bed sharing may add to the behavior. Having good sleep hygiene can help your child both to fall asleep and to stay asleep.  There are several things that parents can do to aid this. Education and tips can be provided to families and patients on how to improve sleep hygiene.