Treating sleep apnea helps children behave

According to this article, treating sleep apnea helps children behave.

Obstructive sleep apnea makes it nearly impossible to get a good night's sleep. Imagine air stopping in your throat, prompting you to choke anobesity, AHDH, and heart disease. If that weren't reason enough to seek treatment, maybe this will: A recent study conducted by the University of Michigan Health System found remedying a child’s sleep apnea improves their behavior, no matter if they have a low or high IQ.

"When a clinician sees a pediatric patient who has a problem in school, they ask about sleep," said Dr. Ronald Chervin, neurologist and director of the University of Michigan Sleep Disorders Center, in a statement. "We wondered, in high-performing children, do we still need to worry about snoring or sleep issues?"

Chervin and his colleagues recruited 147 children between the ages of 3 and 12 who were scheduled to undergo an adenotonsillectomy — a procedure that removes the patient’s tonsils and adenoids. Adenotonsillectomy is usually performed when children are suspected of having obstructive sleep apnea, which is characterized by enlarged tonsils and adenoids that stop children from breathing up to ten seconds throughout the night.

Researchers conducted sleep tests that monitored brain wave patterns, eye movements, heart rhythm, muscle activity, airflow out the nose and mouth, chest movements, and snoring. They then asked parents to grade their child's behavior with regard to inattention, hyperactivity, social problems, and perfectionism. The results showed children from both low and high IQ groups experienced similar behavioral improvements when they were reevaluated six months after the adenotonsillectomy.

"Regardless of intellectual level, we can expect to see some behavioral improvement along with better sleep," said Dr. Bruno Giordani, a professor of neurology, psychiatry, psychology, and nursing. "Once behavior improves, attention in school improves, and emotional ability and behavioral and impulsivity control improve."

Although children with high IQs were included in the study, identifying children with high IQs and obstructive sleep apnea is difficult in practice because they don't typically show problems with school performance. Spotting a child who is struggling from a lack of good sleep is a lot tougher than an adult who almost certainly will appear to be tired the next day, if not outright complain about it. Children, on the other hand, often react to a lack of sleep by being hyperactive the next day.

"Children with obstructive sleep apnea are fidgeting and not able to stay on task, because they're doing anything they can to stay awake," said Dr. Seockhoon Chung. "Even when those behavioral problems are minimal, improvement is still possible."

Studies have shown improved behavioral problems related to sleep apnea is imperative to ensuring these behaviors don't carry over into teenage years. A study presented at SLEEP 2012 found children with untreated obstructive sleep apnea suffered more from long-term behavioral problems, including aggression, hyperactivity, difficulty in controlling their behavior, and many other social and behavioral problems.

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Sleep apnea and heart problems

This article explains heart problems that can be caused by obstructive sleep apnea.

A common sleep problem is bad for your heart, and the number of people that have it has increased by double digits over the past decade.  Studies suggest as many as 26 percent of all Americans may have mild to severe sleep apnea, and only about 10 percent are aware that they have it.
So, as many as 75 million people have a condition that many of know little about.  Sleep apnea is a condition that intrudes into daily living by causing snoring, daytime sleepiness, headache, and poor concentration, but it also can lead to potentially deadly cardiac issues.
Let’s take a look at some of the heart problems that studies have shown sleep apnea can cause:

1. Atrial fibrillation.  Traditional treatment for the irregular heart rhythm called atrial fibrillation consists of blood thinners, medications, and an invasive, expensive procedure called ablation.  There may be a more natural approach.  Atrial fibrillation has been cured in people who are overweight and have sleep apnea.  The treatment consists of weight loss, and sometimes using a device called CPAP to improve oxygen levels during sleep.  According to the Sleep Heart Health Study, the likelihood of developing afib if you have untreated sleep apnea increases fivefold, and treatment improves the likelihood that your rhythm will stay regular into the future.   
2. Hypertension.  There is no doubt that undiagnosed and untreated obstructive sleep apnea can result in high blood pressure.  In addition, apnea can make hypertension very difficult to treat with medication, and one-third of people with a condition called resistant hypertension have undiagnosed sleep apnea. Again, weight loss and using a CPAP mask as prescribed by a sleep specialist can make a huge difference
3. Stroke.  Obstructive sleep apnea (called OSA), has been shown to increase the risk of both stroke and premature dementia.  An analysis published just this month in the journal PLOS One demonstrated that treating the condition with CPAP was associated with a lower incidence of stroke and cardiac events.       
4. Coronary artery disease.  Not only does untreated OSA worsen atherosclerotic coronary disease  (the blockages that cause heart attacks), it also messes with metabolism, worsening cholesterol and sugar levels. This can lead to fatal heart attacks.   Reggie White, the Philadelphia Eagle great, died at age 43, most likely from OSA.
5. Pulmonary hypertension. This condition, in which blood pressure in the lungs can be markedly elevated, is another cardiovascular disease with a well-established relationship to OSA.  Sleep apnea is also associated with congestive heart failure, and inflammation that may have an impact on other non-cardiac problems such as Parkinson’s disease.

Obstructive sleep apnea is often associated with being overweight, and losing weight can be a cure.   If you are a guy with a neck size over 18 inches, or a woman with a neck measuring more than 17 inches, there is an increased chance that you may have OSA.  It is more common in men than women, with up to 34% of men and 17% of women having undiagnosed OSA.

Central sleep apnea, the less common type, and is not related to weight. 

The only way to diagnose sleep apnea is to have a sleep study.  For years, this had to be done in a clinic, but now more people are being screened at home.

Treatment with a CPAP machine requires wearing a mask over your nose or mouth while sleeping, a deal breaker for many.  Newer technologies including smaller masks and mouth appliances have improved treatment, so if this fear has prevented you from getting checked out, it may be a good time to reconsider.

Seeing a sleep specialist now may avert the need to see a cardiologist in the future. 

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Study: CPAP use may reverse negative changes in brain stem activity

A study shows that treating sleep apnea with a CPAP may reverse brain stem activity. -JR

Sleep apnea treatment may reverse changes in brain stem activity associated with increased risk of heart disease, a new study suggests.

The findings "highlight the effectiveness of CPAP treatment in reducing one of the most significant health issues [heart disease] associated with obstructive sleep apnea," the researchers concluded. CPAP stands for continuous positive airway pressure.

Previous research suggests that people with obstructive sleep apnea have greater activity in nerves associated with stress response, which can lead to high blood pressure and heart problems. This increased nerve activity is due to altered brain stem function caused by sleep apnea, earlier studies have shown.

In this small study, published recently in the Journal of Neurophysiology, Australian researchers found that CPAP treatment reduced that nerve activity by restoring normal brain stem function.

The study included 13 sleep apnea patients who were assessed before and after six months of CPAP treatment.

"These data strongly suggest that functional and anatomical changes within the brain stem, which we believe underlie the elevated sympathetic activity in individuals with untreated obstructive sleep apnea, can be restored to healthy levels by CPAP treatment," the University of Sydney researchers wrote.

In obstructive sleep apnea, muscles in the airway collapse during sleep and block breathing. A CPAP device keeps airways open by delivering a steady flow of air while patients sleep.

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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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Poor sleep affects you over a lifetime

New research indicates that poor sleep not only affects you the next day, but over a lifetime.

A poor night's sleep can affect performance at work the next day, but over time, could disrupted sleep affect brain function in a permanent way? New evidence suggests it could.

A new study found that patients with issues like sleep apnea or heavy snoring developed problems with cognition around 10 years earlier than those without sleep-breathing troubles.

"Abnormal breathing patterns during sleep such as heavy snoring and sleep apnea are common in the elderly, affecting about 52 percent of men and 26 percent of women," explained the study's lead author, Ricardo S. Osorio, M.D., of the NYU School of Medicine in New York, in a press release.

In sleep apnea, breathing starts and stops repeatedly over the course of the night. Osorio and team wanted to see whether sleep apnea and other abnormal breathing patterns (called sleep-disordered breathing) were tied to cognitive issues.

To do so, these researchers looked at data from the Alzheimer’s Disease Neuroimaging Initiative, which involved over 2,000 adults between the ages of 55 and 90. Some patients had no cognitive problems, while some developed Alzheimer's disease or mild cognitive impairment (MCI). In MCI, cognitive issues have developed beyond what is expected in normal aging but not far enough to be considered dementia.

Osorio and team found that patients who had sleep-disordered breathing started showing signs of cognitive problems an average of 10 years earlier than those who did not have issues with abnormal breathing patterns during sleep.

When looking only at patients with cognitive issues, those with sleep-disordered breathing started showing signs of MCI at an average age of 77. The same was true for those without the breathing troubles at an average age of 90.

In this group of patients, Alzheimer's disease was also seen earlier -- at an average age of 83 among those with sleep-disordered breathing, compared to an average age of 88 among those without breathing issues.

Osorio and team also looked at the effects of treating abnormal breathing patterns with continuous positive airway pressure (CPAP). CPAP delivers air pressure through a mask during sleep, helping to keep the airways open.

Treatment with CPAP seemed to reduce the risk of developing cognitive issues earlier, Osorio and colleagues found. Patients who used CPAP developed MCI at an average age of 82, compared to an average age of 72 among those who did not receive treatment for their sleep-disordered breathing.

"These findings were made in an observational study and as such, do not indicate a cause-and-effect relationship,” Osorio noted. “However, we are now focusing our research on CPAP treatment and memory and thinking decline over decades, as well as looking specifically at markers of brain cell death and deterioration.”

This study was published online April 15 in the journal Neurology.

Several study authors received industry support within the past two years and held patents involving procedures related to the study. A number of groups funded this research, such as the Foundation for Research in Sleep Disorders and the Alzheimer’s Disease Neuroimaging Initiative.

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New quality measures for treating childhood sleep apnea

New quality measures for treating childhood sleep apnea have been developed to ensure that assessing and treating the condition are followed.

A work group of physicians from leading academic medical centers across the country, including NYU Langone Medical Center, has developed new quality measures for the detection and treatment of childhood obstructive sleep apnea (OSA), a potentially morbid, life-altering condition that affects hundreds of thousands of children and adolescents nationwide. The measures, commissioned and endorsed by the American Association of Sleep Medicine (AASM), are published on March 15 in a special section of The Journal of Clinical Sleep Medicine.

Several different practice guidelines already exist for diagnosing and treating childhood OSA. The newly proposed measures, however, differ from existing guidelines in that they measure and track the quality of services provided by clinicians. According to Pediatric OSA Workgroup lead author Sanjeev V. Kothare, MD, Director of the Pediatric Sleep Program at NYU Langone Medical Center, the new metrics will help to ensure that guidelines for assessing and treating childhood OSA are actually followed.

"Guidelines recommend a course of action, but quality metrics document what is actually done," says Dr. Kothare

The new quality measures have important implications for both providers and patients, according to Dr. Kothare. "Providers, especially those who don't regularly diagnose OSA as part of their clinical practices, will have greater guidance in utilizing optimal detection and treatment processes," he says. "Likewise, parents of OSA patients, as they become aware of the new metrics, will be more likely to confirm that the recommended steps are being taken by their child's physician. And payers will benefit, too. They will be able to better monitor providers' documented clinical processes. By observing the AASM-recommended quality metrics, providers also will avoid being penalized by insurers."

Currently, there is no standardization of methods for detection, management and assessing outcomes for pediatric OSA across clinical disciplines. Children with OSA may be seen by a number of different physicians: general practitioners, pediatricians, otolaryngologists, and sleep specialists, all of whom may have different approaches to assessing symptoms, performing physical exams, and creating different action plans. A primary care physician, for instance, might refer the patient to a specialist, a sleep specialist might order a polysomnogram (PSG), and an otolaryngologist might perform surgery. Each of these actions is endorsed by the American Academy of Pediatrics' clinical practice guidelines.

Recognizing this variability, the Pediatric OSA Workgroup focused on offering choices and flexibility to clinicians while ensuring that certain minimal practice standards are maintained. To develop the new metrics, the workgroup examined a total of 960 peer-reviewed journal articles that addressed quality care or metrics in OSA, concentrating on the articles that provided either an empirical basis for selection of outcome measures, or which linked processes to outcomes. The papers were graded on the strength of association between processes and desired outcome.

Through this analysis, the workgroup was able to define five desirable processes for pediatric patients with suspected OSA: 1) assessment of symptoms and risk factors, 2) initiation of an action plan, 3) evaluation of high-risk children, 4) reassessment of OSA within 12 months, and 5) documentation of positive airway pressure (PAP) adherence.

Following these processes, the researchers conclude, should lead to two desirable outcomes: 1) improved detection, and 2) reduced signs and symptoms of childhood OSA. Justifications for exceptions to each process were noted and classified as having medical, patient, or system reasons.

Pediatric OSA is thought to affect up to 5 percent of children in the U.S., although experts think the actual prevalence may be greater because OSA symptoms often go unrecognized. In the disorder, the upper airway continually collapses during sleep, leading to oxygen deprivation and multiple partial awakenings. Because OSA interferes with the deep, restorative slow wave sleep that is vital for normal childhood growth and development, it can have lingering complications that can persist through adulthood. Children with OSA may become moody and irritable and have learning and behavioral problems, including difficulty paying attention and hyperactivity, mimicking ADHD. They can develop the symptoms of metabolic syndrome, including hypertension, abnormal blood lipid levels, and type 2 diabetes. Adults whose OSA went untreated as children are at increased risk of having earlier onset for heart attacks.

OSA also creates imbalances in the body's appetite-controlling hormones, ghrelin and leptin. In a vicious cycle, the hormonal imbalance increases appetite, leading to weight gain, which can exacerbate OSA.

The most common symptom of childhood OSA is frequent snoring, sometimes accompanied by gasping or choking. Other nighttime symptoms include tossing and turning in bed, labored breathing, night sweats, and need to urinate many times throughout the night. The main causes of pediatric OSA are large tonsils or adenoids, obesity, cranio-facial abnormalities, and genetic disorders, such as Down syndrome.

An example of how the new metrics could improve care is that existing guidelines recommend that children at high risk of OSA, such as those with Down syndrome, be evaluated by having a sleep study every year. That recommendation, however, is not always followed. With adoption of the new metrics that guideline is more likely to be heeded because clinicians will risk being penalized by payers if it is not.

"Quality measures are now in place in neurology and several other specialties," says Dr. Kothare. "Other medical disciplines will soon follow. Metrics are the mantra of the future, and will help ensure that patients are getting the best care possible."

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Childhood sleep disorders could hurt a child's heath

When you think of sleep disorders in children, the first types likely to spring to mind are night terrors, nightmares and sleepwalking. These fall into a class of sleep disorders known as parasomnias.

It is estimated that up to 6.5% of children - particularly those aged 4-12 years - experience night terrors, defined as episodes of intense fear, screaming and flailing during sleep. Approximately 3% of preschool and school-aged children experience nightmares, while up to 15% of children aged 4-12 years sleepwalk.

Perhaps less associated with children and adolescents is insomnia and obstructive sleep apnea. In fact, insomnia, the inability to fall asleep or frequent awakening, is estimated to affect around 25% of children and teenagers. Obstructive sleep apnea - when an individual stops breathing for long periods during sleep - affects around 2-4% of children.

What are the causes and symptoms of childhood sleep disorders?

There are a number of factors that can cause childhood and adolescent sleep disorders.

Just like adults, children and teenagers can experience stress, which can interfere with sleep. Consumption of energy drinks - which contain caffeine - is also known to disrupt sleep, as is use of certain medications, such as antidepressants and corticosteroids.

Children and adolescents are also more likely to develop sleep disorders if they have a family history of such conditions, and poor sleep habits, or poor "sleep hygiene" - such as going to bed at irregular times or attempting to sleep in an inadequate environment - can negatively affect sleep quality.

Increasingly, researchers are pointing to the use of technology as a driver for sleep disorders. Last month,Medical News Today reported on a study published in BMJ Open that found children are 50% more likely to have problems getting to sleep if they spend 4 hours a day or more using media devices.

"In adolescents, with the increase in popularity of technology, many teens are staying up very late communicating with friends on smartphones and tablets. The stimulation and light exposure from these devices are associated with late bedtimes and insomnia," Dr. Neil Kline, a sleep physician and internist at the American Sleep Association, told MNT.

Although often harmless, snoring can be a major indicator for a sleep disorder in children and adolescents. It can be a sign of sleep apnea or disturbed sleep quality.

Other symptoms of sleep disorders to look out for include difficulty getting to sleep, daytime fatigue, poor memory, lack of concentration, reduced attention span, irritability and mood swings, hyperactivity and depression.

"If there is any concern for a sleep problem, such as a child taking longer than 20-30 minutes to fall asleep, not sleeping through the night after about age 1 year, or snoring, it is important to discuss this with the child's pediatrician, health care provider or a sleep doctor," Dr. Shalini Paruthi, a spokesperson for the American Academy of Sleep Medicine (AASM), told us.

Children and teenagers are not getting enough sleep

According to recently updated recommendations from the National Sleep Foundation (NSF), the number of hours sleep children and adolescents need is as follows:

Over the past 20 years, the number of hours teenagers sleep each night has fallen.

• Newborns (0-3 months): 14-17 hours a day
• Infants (4-11 months): 12-15 hours
• Toddlers (1-2 years): 11-14 hours
• Preschoolers (3-5 years): 10-13 hours
• School-age (6-13 years): 9-11 hours
• Teenagers (14-17 years): 8-10 hours.

However, it seems many children and teenagers are failing to meet sleep recommendations.

A 2014 poll from the NSF, which asked parents to estimate how much sleep their child gets on a school night, found that children aged 6-10 are only getting around 8.9 hours sleep a night, while 13-14-year-olds are only getting around 7.7 hours sleep each night.

More recently, MNT reported on a study published in the journal Pediatrics revealing that the number of hours teenagers sleep each night has declined over the past 20 years.

The study, which involved more than 270,000 adolescents, found that 72% of 15-year-olds were getting at least 7 hours or sleep each night in 1991, but this fell to only 63% in 2012.

"Declines in self-reported adolescent sleep across the last 20 years are concerning and suggest that there is potentially a significant public health concern that warrants health education and literacy approaches," said lead study author Dr. Katherine W. Keyes, of Columbia University's Mailman School of Public Health.

But why is lack of sleep among children and adolescents a public health concern?

Sleep deprivation linked to obesity, diabetes and heart problems

Sleep deprivation can cause a number of health problems for children and adolescents, both in childhood and adulthood.

In 2011, a study published in The BMJ claimed that children who do not get enough sleep are at significantly higher risk of becoming overweight, compared with children who get sufficient sleep.

Another study published in The Journal of Pediatrics in December 2014 reported a similar finding, associating severe lack of sleep and sleep-disordered breathing in early childhood with increased risk of obesity.

The researchers found that children with the shortest sleep time at the ages of 5 and 6 years were at 60-100% increased risk of obesity by the age of 15, compared with children with sufficient sleep times.

"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," commented lead study author Prof. Karen Bonuck, from the Albert Einstein College of Medicine of Yeshiva University in New York, NY.

In March last year, another study published in the same journal found that overweight adolescents who do not get enough sleep may be at increased risk of diabetes, heart disease and stroke.

Past studies have also associated sleep apnea in children with delayed growth and heart failure.

Lack of sleep 'makes it nearly impossible for children to reach their full potential'

It is widely accepted that sleep is important for learning and memory. In June 2014, MNT reported on a study that suggested as such. It found that sleep after learning boosts growth of connections between brain cells, helping them to communicate with each other.

A more recent study found that sleep is particularly important for infants' learning skills. Published in theProceedings of the National Academy of Sciences, the researchers revealed that infants aged 6-12 months who had at least one 30 minute nap within 4 hours of learning a new skill were much more likely to demonstrate the skills they learned once they awoke.

With findings such as these, it is no wonder that lack of sleep and poor sleep quality has been associated with poor learning and educational attainment among children and adolescents.

A 2013 study conducted by researchers from Boston College in the UK found that sleep deprivation was a major contributor to poor grades in numerous countries. While taking literacy tests, 76% of American 9-10-years-olds were identified as sleep-deprived, and these students were found to have poorer results.

"I think we underestimate the impact of sleep. Our data show that across countries internationally, on average, children who have more sleep achieve higher in maths, science and reading. That is exactly what our data show," study co-author Chad Minnich told BBC News.

Dr. Paruthi believes sufficient sleep is crucial for a child's overall health and development. She told MNT:

"Sleep disorders in children and teens can hinder them in school, in social situations, in development and nearly every other aspect of their lives, with the negative impact potentially extending into adulthood. Without healthy sleep, it will be nearly impossible for children to reach their full potential."

Parents should not assume children will 'grow out' of sleep disorders

It is possible that as a child or teenager gets older, symptoms of their sleep disorder may ease. This is most likely for parasomnias, such as sleepwalking and night terrors.

But in some cases, sleep disorders can persist well into adulthood. "For example, children who have sleep apnea are more likely to develop sleep apnea as adults," noted Dr. Kline.

As such, sleep physicians say parents should not ignore signs of sleep disorders in children with the assumption they will "grow out" of them.

"Parents should never assume that their child will grow out of a sleep disorder," Dr. Paruthi told us. "Parents should talk to their child's doctor about how their child sleeps and discuss any potential sleep problems. It is important for a doctor to monitor sleep problems during childhood, identify any underlying causes and prescribe appropriate treatment when necessary."

Depending on what form of sleep disorder a child has, there are a number of treatments available. Doctors may recommend a melatonin supplement, for example. Melatonin is a natural hormone made by the body that helps regulate sleep.

Cognitive behavioral therapy may also be useful, in which psychological approaches - rather than medication - are used to improve a child's sleep time and quality.

Tips to improve a child's sleep

But while there are a number of therapies that can help treat symptoms of sleep disorders, there are many things the NSF say parents can do to improve the likelihood of their child getting a good night's sleep:

The NSF say parents should ensure their child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep.

• Make sleep a primary health priority in your family
• Talk to your child about the importance of sleep for their health and well-being
• Set regular bedtimes for yourself and your children and stick to them
• Be aware of how your child is using media devices in the bedroom and set boundaries for use before bedtime
• Ensure you and your child are educated on how light from media devices may impair sleep
• Rather than watching TV, playing video games or browsing the Internet before bedtime, encourage your child to read a book or listen to music
• Ensure your child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep
• Talk to your child's teacher to find out about their alertness during the school day, and ask them to inform you if they fall asleep in lessons.

To find out more about how to improve your child's sleep, visit the NSF website. Our Knowledge Center articles provide more general information on specific sleep disorders, including obstructive sleep apneaand insomnia.

What should I know about sleep apnea?

This article gives information on the different types of sleep apnea and the available treatments.

Sleep apnea is a type of sleep disorder characterized by interruptions or pauses in breathing during sleep. These interruptions can be significant and can be potentially life threatening. Because of this, the disorder can have an important impact on quality of life as well as the health of a patient.

Kim LaJack, Director of the Sleep Disorders Center at Opelousas General Health System, says symptoms of sleep apnea might include loud snoring, excessive daytime sleepiness and feelings of exhaustion upon awakening, as if sleep had never taken place. Other symptoms include depression, irritability, morning headaches, loss of sex drive, lack of concentration and memory problems.

If untreated, sleep apnea can lead to accidents due to drowsy driving as well as health issues such as hypertension, heart attacks, diabetes and strokes, according to LaJack. 

The Three Types of Sleep Apnea 

1. Obstructive sleep apnea: OSA is essentially breathing that is interrupted by a physical block to airflow despite respiratory effort, causing complete or partial closure of the airway during sleep. The three causes for OSA are enlarged tonsils blocking the airway, an enlarged neck or a large tongue blocking the airway. 

2. Central sleep apnea: This type of sleep apnea occurs when the brain fails to send the appropriate signal to the muscles responsible for initiating breathing. “We see this with patients who have neuromuscular disorders or who are on a lot of pain medication,” LaJack explains. “Sometimes patients with heart failure also experience central sleep apnea.” 

3. Complex sleep apnea: This type of sleep apnea encompasses a combination of obstructive and central sleep apnea, with the airways closed off and breathing suspended. 

“While there are three different kinds of sleep apnea, the most frequently treated at Opelousas General is obstructive sleep apnea,” LaJack says. 

Diagnosis and Treatment

Giving the history of symptoms to a qualified physician is the only way to determine if a patient's experience requires a sleep study, says LaJack. Patients who have undergone initial evaluation spend an evening at the Sleep Disorders Center at Opelousas General Health System, where their sleep is closely monitored. 

“Monitoring involves obtaining information about sleep stages, including heart rate, respiratory effort and oxygen and carbon dioxide levels,” LaJack says. 

The treatment for sleep apnea varies depending on the cause. OSA in adults involves initiation of continuous positive airway pressure (CPAP) therapy. The CPAP machine delivers a pressure into the patient's airway by way of a mask and tubing, acting as a splint to hold the airway open. LaJack says OSA in children is generally treated with tonsillectomy. On occasion, children will need to be treated with CPAP, and with family support, it often is successful. In regards to central sleep apnea, PAP therapy involves an added element of delivering a breath during pauses in breathing. 

Dr. Joseph Y. Bordelon, Medical Director of the Sleep Disorders Center, emphasizes, “No matter the cause of the sleep apnea, the goal of therapy is to maintain an open airway so that the patient can have a more restful night of sleep, experience improved quality of life, and to prevent complications associated with untreated sleep disordered breathing. If we can delay someone's premature trip to the funeral home or nursing home, then we have been successful.”

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Sleep apnea linked to bone loss, study claims

A study shows that sleep apnea is linked to bone loss and osteoporosis.

Sleep apnea is tied to osteoporosis and bone fractures, new research finds. 

About 54 million Americans over the age of 50 are affected by low bone mass, and about 10 million of them have osteoporosis, which leads to brittle bones and fractures. 

Obstructive sleep apnea is a sleep disorder that occurs commonly in this population as well, and has been linked to multiple adverse health effects, including high blood pressure, heart disease. and depression.

Researchers at Oregon Health and Science University in Portland theorize that sleep apnea may be an unrecognized cause of osteoporosis because it seems to affect bone remodeling, a process necessary for bone health. During remodeling, mature bone is removed from the skeleton and new bone tissue is rebuilt, even while we sleep.

The authors of the new study reviewed research that deals with bone metabolism and found important indications that sleep apnea interrupts the bone remodeling process.

"If sleep disorders like obstructive sleep apnea affect bone metabolism, they may have diagnostic and therapeutic implications for many patients, including those affected by sleep apnea in their early, bone modeling years," said lead author Dr. Christine Swanson.

The study is published in the Journal of Bone and Mineral Research.

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