Friday, June 29, 2012

Children, like adults, are affected by sleep disorders

A good night's sleep is eluding an increasing number of people, and children are not immune.

The Centers for Disease Control has labeled "insufficient sleep" a public health epidemic. From bedwetting to loud snoring, a host of symptoms can indicate an underlying sleep problem in children. Many children suffer with disorders but are undiagnosed or misdiagnosed, says Dr. Larry Salberg, clinical associate professor of medicine at the Indiana University School of Medicine Northwest. "Approximately 2 percent of children have sleep apnea, and most of the kids are going undiagnosed," he says.

In some cases, children diagnosed with attention problems, such as ADD/ADHD, actually have a sleep disorder. Some of the symptoms are the same, such as changes in behavior and attention. "There are studies that show that up to 38 percent of our children who are on stimulant medication for ADD/ADHD do not have ADD/ADHD," Salberg says. "They have sleep deprivation or poor sleep, most of which is due to sleep apnea."

Any child that visits a doctor for possible ADD/ADHD should be screened for apnea or another disorder, says Salberg, founder of Neurological Institute and Specialty Centers in Merrillville.

People with sleep apnea have breathing that repeatedly stops and starts as they sleep, according to the Mayo Clinic. Common signs are loud snoring or feeling tired after a full night's sleep. Obese adults have an increased risk of sleep apnea, and the same rings true with children. "It's a common pathological problem," Salberg says. "It's easy to diagnose and it's easy to treat."

Left untreated, it can lead to serious health problems, such as high blood pressure. In adults, it can result in heart attacks, stroke, congestive heart failure and other maladies.

Good sleep helps reduce weight, but obesity causes poor sleep. "It's a vicious cycle," says Salberg, who has been practicing sleep medicine since 1978.

Dr. Muhammad Najjar, medical director for the Sleep Disorders Center of Franciscan Physicians Hospital in Munster, says sleep disorders in children are not new, but medical technology has improved. "Now we have the tools to treat them," he says.

The Munster center treats children, but the majority of its patients are adults. The facility just started accepting pediatric patients in February. "To the best of my knowledge, no one offers this in Northwest Indiana," Najjar says.

Aside from sleep apnea, children are susceptible to other sleep-related disorders, such as sleepwalking, insomnia, loud snoring and bedwetting. When a doctor recognizes symptoms of a sleep disorder in a child, the child may be recommended for a sleep study.

At Sleep Disorders Center, two rooms are designated for pediatrics. Designed to have a feel that's comfortable for children, it has toys, pictures on the wall and smaller beds. During a sleep study, a child spends the night in a sleep center, hooked to machines that monitor brain waves, eye movement, flow of air in the nose and mouth, heart and oxygen levels and more, Najjar says. The data are recorded and analyzed. It takes a few days to process the results and another appointment to discuss the best course of treatment.

In adults, prescribing a continuous positive airway pressure (CPAP) machine, which is a breathing mask worn at night, is a common treatment for sleep apnea.

For children with sleep apnea, a possible first step is to remove their tonsils and adenoids. If that does not correct the problem, then a doctor can explore nasal or orthodontic treatments or address a child's weight, if he is overweight, Najjar says. If fixing those issues does not work, then a CPAP machine is an option.

Salberg says children have to be re-studied in a sleep center after various treatments are tried, to ensure what appears to be working truly is working. "You have to prove that you've treated it. The only way you can document and make a diagnosis is by going through a sleep test."

If someone quits snoring, that does not mean the sleep apnea is gone. "One does not beget the other, necessarily," Salberg says.

Parents who think their child may have a sleep disorder should talk to the child's doctor. If the doctor ignores the concern or does not seem to know, parents should not be afraid to ask for a consultation with a board certified sleep specialist, Salberg says.

"We spend a third of our life sleeping," he says. "What we do during sleep has a lot to do with the day."

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