Arshad Abbasi, M.D., Sleep and Alertness Center
"We have known for some time that children have sleep disorders, as do adults, but the presentation of disorders in children may be completely opposite that of adults. For example, obstructive sleep apnea (brief breathing lapses during sleep, and snoring) in adults may be expressed as daytime sleepiness. In children, OSA often shows up as hyperactivity. In fact, this hyperactivity may be misinterpreted as attention deficit hyperactivity disorder (ADHD).
Dr. Abbasi offers his son’s experience as an example: "My son wasn’t doing as well in school as we knew he could. I wondered if he had a sleep disorder. So, I observed his sleep throughout the night. When he snored, his breathing lapsed briefly. So, he wasn’t getting a sufficient night’s sleep. From my work as a sleep specialist, I knew that removing tonsils can sometimes resolve sleep apnea. He had his tonsils removed, and now, he sleeps soundly through the night. His schoolwork has significantly improved, and his social interactions have been much more positive."
This supports research by University of Michigan neurologist Dr. Ronald Chervin, and Dr. Stephen Sheldon, a sleep specialist at Children’s Memorial Hospital in Chicago. Both Chervin and Sheldon agree that between 4 and 12% of school-age children have sleep pathology that cause daytime symptoms virtually identical to ADHD.
"Obstructive sleep apnea and other sleep disorders in children are just now catching the attention of pediatricians and family practice physicians, says Dr. Abbasi. "We think between seven and eight million children suffer from some type of sleep disorder. If it goes undiagnosed and untreated, it can lead to performance and social problems in school, and in later life, can trigger Congestive Heart Failure, right-sided heart failure, and pulmonary hypertension.
"Parents," he adds, "can get a lot of information about their child’s life just from observing their sleep – the sleep environment, their position during sleep, their breathing, whether they wake up briefly or frequently during the night, whether they experience night terrors or nightmares, or restless legs during sleep. Keeping a sleep diary for just one night can provide a wealth of information that should be discussed with the child’s pediatrician or family physician.
"There are sleep behaviors parents need to address early on. Parents need to be firm that the child sleeps in their bed, not their parents’ bed. The child learns to rely on their parent to fall asleep, rather than their own ability to fall asleep independently. Most children need nine hours of sleep. Getting a youngster ready for sleep by following a routine schedule, weekdays and weekends, can promote healthy growth of bones, muscles and body tissues. The immune system is refreshed during sleep. If young people don’t get sufficient sleep, they are more susceptible to infection and illness. The brain is more active during sleep, allowing the child to be mentally alert the next day.
"Each child and each adult has their own Circadian rhythm that governs sleepiness and wakefulness. We have become a "stay-awake" culture, and many families have trouble establishing limits for sleep. I suggest to parents that they set a quiet, consistent bedtime routine for their children. Start early, but set a defined sleep period. A light, non-sugar snack can start the process. Within an hour or so of bedtime, encourage quiet activities – listening to soft music, reading, playing a quiet game. After a time, the youngster associates these activities with falling asleep. Rules should be changed only for very special occasions.
"There are three broad areas of sleep disorders in children," adds Dr. Abbasi:
- Physical or neurological: Three examples -- Obstructive sleep apnea, narcolepsy (falling asleep when one should be awake and alert); and restless leg syndrome (where legs move on their own and keep a person awake).
- Arousal Disorders: Five examples: sleepwalking, sleep-talking, night terrors, bedwetting, and teeth grinding.
- Behavioral Health: Four examples – insomnia, separation anxiety, night fears and nightmares.
"In all three areas, the parent is the first line of defense in observing their child during sleep. If they notice anything unusual in their child’s sleep patterns, bring it to the attention of the family physician or pediatrician. Many treatment interventions can make a positive difference in the child’s performance and behavior.
"I would be remiss if I didn’t say that our Sleep & Alertness Center is ready and capable of conducting sleep studies on children over two years old. We have set aside special rooms and times for youth and adolescent sleep studies. Parents are invited to sleep over if they wish. All three sleep physicians – myself, and Drs. Kashyap and Gera, are taking special training in pediatric sleep diagnosis and treatment. Special technologists have been trained to work children’s in conducting the sleep study.
"We are becoming more aware that quality of sleep has everything to do with quality of performance and behavior in daily life, both in adults and children." As with other diseases and disorders, the earlier the diagnosis, the better the long-term outcome."
Note: Arshad Abbasi, M.D., is board certified in sleep medicine. He is taking courses in pediatric sleep medicine offered by Dr. Stephen Sheldon.. Dr. Abbasi is also a pulmonologist with Pulmonary Consultants, P.C., 405 W. Greenlawn. For more information about pediatric sleep studies, contact the Center at (517) 975-3375.