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A Good Night's Sleep

Posted on Jun. 2, 2012 ( comments)

In adults, poor sleep can lead to poor work performance, increased risks of accidents and even increased risk of premature death.

The "work" of children, though, is to play and learn. Recent work has demonstrated that poor sleep in children is associated with behavioral problems, learning difficulties, poor school performance and weight gain. In children with undiagnosed sleep-disordered breathing, long-term negative effects in these behavioral and learning realms are now being recognized.

For some children, the problem is that their upper airway collapses during sleep and partially obstructs their air flow — called obstructive sleep apnea, or OSA. In OSA, the child struggles to inhale against a closed airway, with increasing effort each breath, until enough force is generated to get air moving through, often with a "heroic snort" or a gasp.

During the period of little to no airflow, carbon dioxide levels can go up, and oxygen levels can go down, stressing the cardiovascular system. And to successfully breathe, the child must wake up partially. It is this lack of sustained, relaxed sleep that takes its toll on children with OSA.

For most children medical or surgical intervention (most often tonsil- or adenoidectomy) can relieve their sleep apnea. Some require continuous positive airway pressure, or CPAP, delivered through a face mask (CPAP masks are often the first line of treatment in adults).

The diagnosis of OSA needs to be made by polysomnography, or a sleep study. A sleep study can show if a child has OSA or simply benign snoring. Other problems a sleep study might show include periodic limb movement disorder, where a kicking or jerking of the legs leads to restless instead of restful sleep.
A carefully obtained history by a physician trained in sleep medicine can often help a family or referring physician decide if a sleep study is indicated. No single historical fact, or physical exam finding, can show if a child does or does not have OSA (though OSA is quite unlikely if no snoring is heard). If there are doubts, a sleep study can resolve those doubts.

Additionally, a sleep medicine evaluation often will find simple behavioral problems in how a family has structured bedtime. Other diagnoses that are often made in a sleep clinic include:

  • Behavioral insomnia of childhood, where a child suffers from not having an enforced bedtime (allowed to get up repeatedly after going to bed, staying up as late as they can, and so on).
  • Circadian rhythm disorders, where the child’s “internal body clock” is at odds with his or her external sleep schedule.
  • Sleep onset association disorder, where a child connects the ability to fall asleep with "something in the environment" (such as being held by his parent; being rocked to sleep; watching television, and so on) so that when that thing is not there the child can’t fall asleep.
  • Simple sleep deprivation. For example, most teenagers average a two-hour per night deficit in their sleep, often trying to catch up on the weekend.

Poor sleep in children is a "family disorder" — the entire family is certainly affected by it. Whether listening to a child with OSA snore, or dealing with yet another "curtain call" in behavioral insomnia, parental sleep quality can suffer every bit as much as the child with the problem. With just a single visit to a sleep clinic, such as the MultiCare Mary Bridge Health Center sleep clinics found throughout the area, solutions to a child's sleep problems can be often found.

Timothy Murphy, MD, is a specialist in pediatric pulmonary and sleep medicine. He recently joined David Ricker, MD, in Pediatric Pulmonary and Sleep Clinic at MultiCare Mary Bridge Children’s Hospital & Health Center. His addition to the clinic, as well as the pediatric sleep disorders services provided by George Makari, MD, in the Pediatric Neurology Clinic, increases the options available for pediatric patients with suspected sleep disorders. Patients can be seen in Tacoma, or at our Mary Bridge satellite clinics in Olympia, Puyallup and Silverdale.

Posted in: General Vitals

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Dr. Timothy Murphy
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