Signs and treatments for obstructive sleep apnea in children

Obstructive sleep apnea in children may be missed due to misdiagnosis of symptoms such as hyperactivity, tossing and turning, and irregular breathing at night.

Is your hyperactive child having trouble learning at school? Does your son constantly toss and turn at night? Can you hear your daughter's irregular breathing during sleep?

All of these symptoms could be the result of obstructive sleep apnea, a serious but treatable disorder that can lead to health problems, behavioral issues and learning difficulties in children and adolescents.

"One to 4 percent of all children have obstructive sleep apnea, but many go undiagnosed and untreated because people do not recognize the symptoms," says Dr. Rochelle Goldberg, director of sleep medicine services at Main Line Health and an associate professor at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

Further complicating matters is that some children with sleep apnea are misdiagnosed with attention deficit hyperactivity disorder because, unlike adults, disrupted sleep makes kids hyperactive, experts say.

"As many as 25 percent of children diagnosed with ADHD may in fact have obstructive sleep apnea," says Tracy Nasca, executive director of the American Sleep Apnea Association, a nonprofit organization based in the District of Columbia.

Blocked Airways Impede Breathing

Sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. People with untreated sleep apnea stop breathing repeatedly during sleep, often waking or almost waking multiple times during the night.

"The result is fragmented sleep that can impact every aspect of your life," Goldberg says.

Sleep apnea can occur at any age, but the prime ages for children to develop the condition is between 4 to 7 years, when the tonsils and adenoids are largest, Goldberg says. Those most at risk include males, children with special needs and youth who are obese.

"With increasing childhood obesity comes increasing risk for sleep apnea," Goldberg says, noting thatobesity among youth has skyrocketed in the past three decades. Obesity rates in children ages 6 to 11 increased from 7 to 18 percent from 1980 to 2012, while the rate in youth ages 12 to 19 jumped from 5 to 21 percent, according to the Centers for Disease Control and Prevention.

Hyperactivity in Sleepy Children

Diagnosing sleep disorders in children requires special expertise because youngsters respond differently than adults when it comes to a lack of sleep, says Amber McAfee, a pediatric nurse practitioner at the Sleep Center at Seattle Children's Hospital.

"Adults with sleep apnea may feel sluggish during the day," McAfee says. "But children with sleep apnea are quite active and may even be hyperactive. They may also start experiencing learning difficulties at school because they can't remember things as well."

Adds Goldberg: "Unfortunately some of these kids get mislabeled by their well-meaning teachers as having ADHD and start taking medications they don't need." She advises parents to seek the expertise of a pediatrician and pediatric sleep specialist before assuming their child has ADHD.

In recent years, more parents have been requesting sleep evaluations for children diagnosed with ADHD, McAfee says. "We have seen an improvement in hyperactivity after treatment and we have parents who report taking their children off medication for ADHD because their hyperactivity was related to sleep apnea," she says.

Nighttime symptoms between children and adults vary, too. Kids are more likely to be restless and wake up. "The symptoms are a little more subtle in kids because their brains are responsive," McAfee says. "The brain alerts them that they aren't breathing well."

Some children may sleep with their head hanging from the end of the bed as a way to extend their neck and open their air pathway, Goldberg says. At times, children with sleep apnea may experience increased bedwetting or a recurrence of bedwetting.

Expert Diagnosis and Treatment

Experts recommend that parents whose children are experiencing sleep problems or sudden difficulties at school visit a certified pediatric sleep specialist for evaluation and testing, including an overnight sleep study, to rule out or confirm a diagnosis.

"We do a lot of hand holding and comforting," says Nasca, who assures parents that pediatric specialists can provide a child-friendly diagnostic experience. "Many pediatric sleep labs allow a parent to spend the night in the testing room and also encourage the children to bring a favorite 'blankie' or stuffed animal to create a more home-like sleep setting."

At Seattle Children's Hospital, parents are welcome to stay at the Sleep Center while their children are monitored overnight. Monitors gather information about brain activity, oxygen levels, heart rate, sleep quality and stages, eye movement, air flow, limb movement and more.

"I tell kids they're going to sleep like a robot for one night," McAfee says. The Sleep Clinic conducts approximately 200 sleep studies a month.

For many youngsters, surgically removing the tonsil and adenoids can resolve sleep apnea. Children who are overweight or obese may also need to focus on weight loss, experts say.

Some children find relief by wearing a nasal mask that uses continuous positive airway pressure, also known as CPAP. "CPAP is 100 percent effective in improving your breathing," McAfee says. "But only about 40 percent of the pediatric population wear the mask effectively through the night."

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Short sleep and breathing issues increases obesity risk in children

A child's risk of obesity is increased by sleeping for short amounts of time and breathing issues while sleeping.

Too little sleep has officially been linked to an increased risk of obesity, particularly among young children. Recent findings published in The Journal of Pediatrics reveals a high connection between sleep-related breathing problems and obesity.

For the study, researchers analyzed data from 1,900 children in England and followed the participants for about 15 years. Study results showed that those who got the least amount of sleep between the ages 5 and 6 had between a 60 percent and 100 percent increased risk of obesity by age 15.

"In recent years, lack of sleep has become a well-recognized risk for childhood obesity," said lead study author Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women's health at Einstein, in a news release. "Sleep-disordered breathing, or SDB, which includes snoring and sleep apnea, is also a risk factor for obesity but receives less attention. These two risk factors had not been tracked together in children over time to determine their potential for independently influencing weight gain. Our study aimed to fill in that gap."

Furthermore, researchers found that children with the most severe sleep-disorder breathing (SDB) had the highest obesity risk. Children whose SDB levels peaked at around 5 to 6 years old still had a 60 to 80 percent increased risk of obesity, but fared better overall.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented. With childhood obesity hovering at 17 percent in the United States, we're hopeful that efforts to address both of these risk factors could have a tremendous public health impact," Bonuck concluded.

A common cause of sleep-related breathing problems in children is oftentimes due to enlarged tonsils or adenoids, which can be removed with surgery if a problem occurs. Misalignment of jaws or teeth can also cause issues.

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Study: Older women with sleep disordered breathing find it harder to perform activities

A study shows that older women who have sleep disordered breathing find it harder to perform daily activities.

Older women with disordered breathing during sleep were found to be at greater risk of decline in the ability to perform daily activities, such as grocery shopping and meal preparation, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of California, San Francisco.

The study was published Nov. 6 in the online edition of the Journal of the American Geriatrics Society.

The findings are notable given the aging of the population -- an estimated 3.7 million Americans will turn 65 in 2015, and by 2030, 19 percent of the U.S. population will be 65 or older -- and the fact that sleep-disordered breathing is treatable. Older adults are as much as four times as likely as middle-aged individuals to have problems with breathing during sleep.

Sleep-disordered breathing involves repeated interruptions or decreases in breathing during sleep, which often leads to fragmented sleep and hypoxemia, or low blood oxygen levels. Doctors rate the severity of sleep-disordered breathing with the apnea-hypopnea index (AHI), which reflects the number of breathing interruptions (apneas) and the number of significant decreases in breathing (hypopneas) per hour of sleep.

The study found that women with an AHI on the moderate to severe side, with 15 or more breathing disruptions per hour of sleep, had a 2.2 times greater odds of decline in daily activity functions during the evaluation period, which averaged five years between baseline evaluation and follow-up.

"Because sleep-disordered breathing can be treated effectively, it is possible that treatment could help prevent decline in important areas of functioning that allow older adults to remain independent," says Adam Spira, PhD, an associate professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health and the study's lead author. "As is often the case, more research is needed to investigate this possibility."

Because the study was observational, the researchers can't conclusively state that sleep-disordered breathing caused the functional decline, but the research does point to a strong link.

Earlier studies involving older men have linked sleep-disordered breathing with frailty and death. The authors believe this is one of the first studies to assess the impact of sleep-disordered breathing on decline in older women's ability to perform basic functions associated with independent living.

The study included 302 women, with a mean age of 82.3 years. At the start of the study, participants underwent an in-home sleep evaluation. They were also asked whether they had any difficulty performing daily activities, including heavy housework, shopping and preparing meals, or any challenges with mobility, such as walking several blocks or climbing or descending stairs. Participants' self-reported daily activities and mobility were assessed once again in a follow-up evaluation.

The researchers say they believe it is the low blood-oxygen levels caused by sleep-disordered breathing that cause the trouble with daily tasks, and not sleep fragmentation, which is also increased by sleep-disordered breathing.

The authors note that women who reported no difficulties with daily activities during their baseline evaluation but a moderate-to-high AHI had a somewhat higher risk of reporting deterioration in daily-activity function in the follow-up evaluation. No links between sleep-disordered breathing severity and decline in mobility were observed.

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Is sleep apnea harmful for health?

This article describes in what ways sleep apnea is harmful to a person's health.

Sleep apnea is a sleeping disorder that occurs when a person’s breathing is interrupted during sleep. These breathing pauses typically last between 10 to 20 seconds and can occur up to hundreds of times at night. This chronic sleep deprivation results in daytime sleepiness, slow reflexes, poor concentration, and an increased risk of accidents.

Sleep apnea can also lead to serious health problems over time, including diabetes, high blood pressure, heart disease, stroke, and weight gain. But with treatment you can control the symptoms, get your sleep back on track, and start enjoy being refreshed and alert every day.

Sleep apnea Symptoms:

l If pauses occur while you snore, and if choking or gasping follows the pauses, these are major signs that you have sleep apnea.

l Morning headaches

l Memory or learning problems and not being able to concentrate

l Feeling irritable, depressed, or having mood swings or personality changes

l Waking up frequently to urinate

l Dry mouth or sore throat when you wake up

Treatment of sleep apnea:

l Weight loss: People who are overweight have extra tissue in the back of their throat, which can fall down over the airway and block the flow of air into the lungs while they sleep. Losing just 10% of body weight can have a big effect on sleep apnea symptoms. In some cases, losing a significant amount of weight can even cure Sleep Apnoea.

l Quitting smoking.

l Avoiding alcohol, sleeping pills, and sedatives,

l Avoiding caffeine and heavy meals within two hours of going to bed.

l Maintaining regular sleep hours.

l Bariatric Surgery: Choosing Surgery is not a simple decision and it is not for everyone who struggles with sleep apnea. It is for individuals who have exhausted other options for treatment and have got excess weight.

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Does weight gain cause sleep apnea, or does sleep apnea cause weight gain?

This article discusses the link between sleep apnea and weight gain, and other serious consequences of untreated sleep apnea.

When you know that "apnea" is the Greek word for "without breath," you begin to understand how scary sleep apnea can be. Sleeping without breath? That just can't be good for you … and it's not. Because its main symptoms (snoring and daytime fatigue) are easily overlooked, it is one of the most undiagnosed sleep disorders in the country, according to Health Magazine.

Sleep apnea has been shown to be related to a host of health concerns, including hypertension and heart disease, but when it comes to the relationship between sleep apnea and weight gain, which comes first? Does weight gain cause sleep apnea, or does sleep apnea cause weight gain?

In one of those great anatomical double-whammies, the answer to that question is "yes" and "yes." The National Heart, Lung, and Blood Institute explains that sleep apnea happens when you're asleep and your upper respiratory passages relax. For most of us, that's no big deal. For some people, though, that can cause problems. It may be because their airways are more narrow, their tongues are too big, or their tonsils are too large. And it may be because they are overweight. If you're carrying extra soft fat tissue, it can actually thicken the walls of your windpipe, making it narrower and increasing your risk for sleep apnea. So yes, gaining weight can contribute to getting sleep apnea.

But it doesn't stop there. Because sleep apnea means that you never (and I mean, never) get a good night's sleep, the idea of any exercise seems absurd. It would be like having a newborn baby that doesn't ever grow up. Actually, it would be worse than that because even newborns will let you sleep for a couple of hours at a time. Sleep apnea doesn't. You can wake up gasping for breath every few minutes all night long, or you can just snort and snore and roll over many times in the course of sleep cycle. Either way, you don't ever run a full sleep cycle; your body never really gets the rest it needs to rebuild or rejuvenate. You are exhausted all the time. You know you need to exercise to lose some weight so you can sleep better, but you're out of breath just walking to your car; how in the world are you going to walk around the block or take the stairs instead of the elevator?

And just to add insult to injury, a 2004 PLOS study revealed that sleep-deprived people had higher levels of ghrelin, the hormone our body produces to stimulate appetite, and reduced levels of leptin, the hormone our bodies make to suppress appetite. So, yes, sleep apnea can contribute to gaining weight.

So what's an overweight, sleep-deprived person to do? Don't despair; there are options. Traditional sleep apnea treatments such as CPACs (continuous positive airway compressors) can be helpful. Some people learn to sleep with them all night, every night. Others can never really get quite comfortable with it, but it might be just enough to get them moving in the right direction. Even just walking to the end of the street helps, and many sleep apnea patients enjoy bike riding because it lessens the pressure on their joints. The key is to tackle both issues – weight gain and sleep apnea – together, as improvements in one condition often yield improvements in the other. Just as the two worsen together, so they also improve together. Small changes can make a big impact over time, so the important thing is to talk to you doctor, don't give up, and take it one small step at a time.

If you feel like you never get a good night's sleep, sleep apnea could be to blame. Ask your doctor for more information, and remember that St. Francis offers a Sleep Disorder Center that can help identify the source of your sleeplessness.

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Sleep apnea risk factors

This article discusses different risk factors for obstructive sleep apnea.

Obstructive sleep apnea is a deadly sleep disorder. Those with obstructive sleep apnea may feel lethargic after a good night's sleep or you may snore loudly. But, there are certain risk factors associated with obstructive sleep apnea. We explore these risk factors.

Risk factors of obstructive sleep apnea:

1) Age: Obstructive sleep apnea is mainly associated with age. Those above 60 are prone to obstructive sleep apnea, but there are other risk factors that bring down the age group for sleep apnea.

2) Males: Having the X and Y chromosomes can make you prone to obstructive sleep apnea.Yes, males have a higher chance of developing apnea.

3) Weight: Excessive weight can result in obstructive sleep apnea. Over weight individuals tend to have thicker necks which make it difficult to breath. But obstructive sleep disorder can also affect individuals who are thin.

4) Genes: Family history of obstructive sleep disorder and narrow airway that you may have inherited are risk factors for obstructive sleep apnea.

5) Menopause: Though obstructive sleep apnea is prone to men, it can affect women after their menopause, especially is they are overweight.

6) Difficulty is breathing: Individuals who have nasal congestion and allergies associated with the respiration system are likely to develop obstructive sleep apnea. But it also depends on the breathing with correlation to the above mentioned risk factors.

7) Smoking: Smoking tends to build up water in the upper airway and also results in inflammation of the air way. These are the risk factors of developing obstructive sleep apnea.

8) Relaxed muscles: Sedatives that relaxes the muscles is a risk factor for obstructive sleep apnea.

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The Dangers of Sleep Apnea

This article discusses what exactly sleep apnea is and why it is a dangerous condition.

If you suffer from sleep apnea, you may be unaware of the fact. Sleep apnea is a sleep disorder whereby a person suffers from repeated interruptions to their sleep because of breathing difficulties. The patient typically stops breathing for around 10 seconds before the brain is forced to wake up and kick start the breathing process again. Most people with sleep apnea also snore heavily.

Symptoms of Sleep Apnea

Unless your partner has told you that you snore and stop breathing on a regular basis, look out for the following signs of sleep apnea:

• Sore throat in the morning
• Feeling very tired when you wake up
• Waking up repeatedly during the night gasping for air
• Anxiety and depression
• Men may suffer from impotence

Snoring is No Joke

Snoring is often considered to be a bit of a joke, but the reality is that excessive snoring and associated sleep apneais no joke whatsoever. It is bad for your health and extremely bad for your close relationships—most people find it very taxing to sleep with a partner who snores heavily and wakes up multiple times per night snorting and gasping for oxygen. Even if you felt romantic when you first went to bed with them, after a few nights of snoring and snorting, the passion will soon be long gone.

Health Problems Caused by Sleep Apnea

Sleep apnea is linked to a number of serious health problems, including:

• Weight gain –   Gaining weight can lead to snoring, which in turn can exacerbate sleep apnea. Unfortunately, poor sleep affects the endocrine system and the body is more likely to crave sugary and starchy foods, which leads to weight gain. So it all becomes a vicious circle.
• Heart disease – People with sleep apnea are much more likely to suffer from heart attacks. This could be as a result of low oxygen levels, but research has also found that some sleep apnea patients have irregular heart rhythms.
• Strokes – Having sleep apnea puts you at greater risk of suffering from a stroke because oxygen deprivation has an effect on blood flow through the arteries and brain.
• High blood pressure – Frequent patterns of interrupted sleep can play havoc with the endocrine system, which affects blood pressure. Oxygen deprivation can also cause spikes in blood pressure.
• Type 2 diabetes – There is no definite link betweensleep apnea and type 2 diabetes, but at least 80% of diabetic patients suffer from sleep apnea.

Other Complications of Sleep Apnea

Aside from the serious health problems listed above, sleep apnea can be hazardous to your wellbeing in a number of other ways. As we have already mentioned, sleep apnea can lead to impotence in men, which is unlikely to be great for your long-term relationships. Excessive tiredness can also contribute to problems at work, or in extreme circumstances, directly cause car accidents if you end up falling asleep whilst driving.

If you suspect you may be suffering from sleep apnea, it is a good idea to make an appointment for a full medical check-up. Ignoring the problem is not likely to make it go away, whereas if you seek treatment, you could be on the way towards obtaining a CPAP breathing machine and seeing a significant improvement in your sleep patterns.

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What Are Common Sleep Problems in Toddlers?

This article discusses five common sleep issues in toddlers such as breathing pauses, sweating, nightmares, teeth grinding, and twitching, jerking and restlessness. This article also gives solution to the sleep problems.

It’s a lovely idea to think you can put your toddler to bed and night and not worry about them until morning. But as many parents of toddlers already know all too well, that’s not always the case.

Things like teeth grinding, breathing pauses, sweating, twitching and jerking, and nightmares can keep toddlers from getting a restful night’s sleep, and when they don’t sleep well or enough, it can lead to problems during the day.

Here are five common toddler sleep problems, according to BabyCenter.com, as well as potential solutions for all of them:

Breathing Pauses

Some toddlers might experience breathing pauses while they’re asleep. It could be a sign of sleep apnea, which, according to the Mayo Clinic, is a potentially serious sleep disorder.
However, occasional breathing pauses (along with snoring and snorting) aren’t necessarily a cause for concern. Breathing patterns can change during sleep and many toddlers also sigh in their sleep, which might make them appear as if they’ve stopped breathing for a brief time, but it can, in fact, be normal.
If you suspect your toddler might have sleep apnea, a doctor should be consulted so that potential complications such as a heart problem can be diagnosed and treated.

Sweating

Despite the room temperature being perfect comfortable and their bedding and pajamas being seasonally appropriate, some toddlers will still sweat enough at night to wake up soaked through.
Nighttime perspiration is usually nothing to worry about because it’s probably a sign that the body is "restoring itself". For toddlers who sweat a lot a night, light cotton clothes are recommended for sleeping and rooms should be kept on the cool side.
Livestrong.com advises that “if a toddler is sweating excessively and it appears unrelated to body temperature control, speak to your pediatrician to rule out medical conditions like hyperhidrosis.”

Nightmares

Toddlers aren’t too young to have nightmares, which are often caused by stress and anxiety and occasionally by fevers or medication. They tend to happen later at night when they are deeply asleep.
The Cleveland Clinic advises ensuring toddlers who experience nightmares get adequate sleep, have a bedtime routine that is light, happy and fun, discuss the nightmares during the day, and are comforted, coddled and reassured so that they can sleep more peacefully.

Twitching, Jerking and Restlessness

It’s not uncommon for some toddlers to twitch or jerk or flex their ankles for a few seconds a couple of times a minute for as long as a few hours while falling asleep or while they’re already sleeping. It won’t hurt them, but it might prevent them from getting a peaceful night’s sleep.
The twitches and jerks could be a sign that their levels of iron or folic acid are insufficient, which can be discussed with their pediatrician.
It can also be a sign of restless legs syndrome, which, according to the U.S. National Library of Medicine, is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations.
Techniques such as gentle stretching exercises, massage and warm baths can help muscles relax and lead to a more relaxed night’s sleep.

Teeth Grinding

Bruxism is the medical term for teeth grinding or the clenching of jaws, and according to KidsHealth.org, two to three out of every 10 kids will do it, although most outgrow it.
Kids grind their teeth as a result of tension, anxiety, pain from an earache or teething, allergies, or their teeth not being properly aligned.
Teeth grinding isn’t harmful, but it’s worth mentioning to the dentist to double check there are no problems.
Soothing a toddler who grinds their teeth at bedtime with a bath, backrub or extra cuddling might help alleviate the problem.

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