Houston Area Pediatric Specialists

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Sunday, April 1, 2012

Sleep Disorders Increasing in Children

Sleep does not come easily for some children

By Paul Swiech pswiech@pantagraph.com 

Sleep disorders are more prevalent among children than most people realize, according to two Central Illinois sleep medicine specialists.
Sometimes, sleep disorder symptoms in kids are misdiagnosed and treated as other health conditions, including behavior disorders, meaning the underlying problem isn't addressed.
Sometimes, an untreated sleep disorder exacerbates symptoms of another medical condition, including attention deficit hyperactivity disorder.
"Thirty to 40 percent of kids 9 to 12 years old have difficulty falling asleep or staying asleep at least three days a week," said Dr. David Koh, a pulmonologist and critical care physician with Illinois Heart & Lung Associates, part of Advocate Medical Group. Koh figures the prevalence among children younger than 9 is similar.
While those children have sleep problems that should be addressed, not all have a diagnosable sleep disorder. Dr. Humam Farah of OSF Critical Care, Pulmonary and Sleep Medicine, said 4 percent of children have a sleep disorder.
Koh, medical director of the Midwest Center for Sleep Medicine, said the increasing numbers are partly because of improved diagnoses but he also thinks that more children have sleep disorders than a generation ago.
Farah, medical director of the Sleep Center of Central Illinois, said increased obesity is one reason for the increase. Obesity results in fat in the upper airways. Narrowed airways interrupt breathing and sleep and decrease oxygen to the brain.
Some children inherit a sleep disorder, such as restless leg syndrome (RLS) and periodic limb movement disorder.
RLS is a neurological condition characterized by the irresistible urge to move the legs, according to the RLS Foundation. The urge to move the legs is often accompanied by unpleasant sensations in the legs that worsen during periods of rest or inactivity and at night.
Periodic limb movement disorder is a rhythmic twitching of the legs after falling asleep, Koh said.
Both conditions prevent deep sleep and wake people up at night.
While RLS is generally associated with older adults, 2 percent of children have the condition. When either parent has RLS, the prevalence among children increases to 16 percent, Koh said.
In addition, many children with RLS or periodic limb movement disorder also have low iron levels, Koh said.
RLS is worsened by stimulants such as caffeine or chocolate.
When people are sleep-deprived and stressed, that increases the body's desire for fatty foods. Increased consumption of fatty foods prompts weight gain.
Sometimes, increased stress on the cardiovascular system prompts the kidneys to produce more urine, resulting in bed-wetting.
But many parents don't recognize their child has a sleep disorder. Instead, they focus on the daytime symptoms of lack of sleep: irritability, declining academic performance, weight gain and a wet bed.
Some children with a sleep disorder are assumed to have a behavior disorder. Others are diagnosed with ADHD.
Indeed, some have ADHD with a sleep disorder. Thirty percent of children treated for ADHD have a diagnosable sleep disorder, Koh said. When those 30 percent of children are treated successfully for their sleep disorder, about half of them are able to be weaned off their ADHD medicine.
Children who have trouble falling asleep and staying asleep should be taken to their pediatrician, Koh and Farah said. The pediatrician may refer them for a sleep study. The two sleep centers in Bloomington perform overnight sleep studies.
Some children are diagnosed with sleep apnea, a common disorder in which a person has pauses in breathing or shallow breathing while sleeping. Sleep is interrupted. Left untreated, sleep apnea increases long-term risk of heart disease and stroke.
For children, a common treatment for sleep apnea is removing enlarged tonsils or adenoids.
Some children are treated with continuous positive airway pressure masks, which supply a steady stream of air through the nose or mouth during sleep, Farah said.
Weight loss is a key for overweight children, Farah said.
For children diagnosed with RLS or periodic limb movement disorder, medicine such as Mirapex can lessen the symptoms and improve sleep, Koh said. Iron supplements can help boost iron levels.
Sleep tips
Newborns need 16 to 18 hours of sleep a day, toddlers 6 months to 1 year old need 14 hours of sleep a day, children ages 1 to 3 need 12 hours of sleep a day, preschoolers need 11 to 12 hours of sleep, school-age children ages 5 to 13 need 9 to 10 hours of sleep a day and teenagers need 9 hours of sleep a day. Many children and teens don't get that much sleep. Here are tips for children to get a better night's sleep:
-- Don't have caffeine and limit chocolate, which are stimulants.
-- Don't eat a meal or exercise at least two hours before bedtime.
-- Try to go to bed and get up about the same time each day.
-- No videos (television, video games, computer games) within two hours of bedtime.
-- No electronics (televisions, computers, cellphones) in children's rooms at night.
-- For young children who are older than 6 months, make sure they fall asleep in the same position in which they will wake up. In other words, don't let them fall asleep in your arms. Instead, go through your bedtime routine (bath, bedtime story, etc.), then put them to bed, wish them good night and leave their room. If they get up and come into your room, direct them back to their room politely but unemotionally. They should learn to fall asleep on their own.
-- For children who want some light, dim nightlights are OK.
-- For older children, don't tell them "Go to sleep." You can't force someone to go to sleep. Instead urge them to go to bed and relax.

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