Pediatric Sleep Disorders


Up to 30% of children today have some type of sleep disorder. Pediatric sleep disorders can lead to tired and cranky children, but also to a number of behavioral problems at home, in school, and in their social lives as well.


Signs and symptoms of sleep disorders in children might include:

  • Impulsiveness
  • Irritability
  • Difficulty focusing/concentrating
  • Hyperactivity
  • Snoring /gasping, pauses in breathing
  • Restless sleep
  • Nightmares / night terrors
  • Sleepwalking
  • Snorting, coughing or choking
  • Mouth breathing
  • Bed wetting (over the age of 5)
  • Unexplained decrease in daytime performance
  • Obesity
  • Grinding teeth during sleep
  • Trouble falling asleep due to leg discomfort

Infants and young children with obstructive sleep apnea don’t always snore. They might just have disturbed sleep.

Children who have sleep disorders may often exhibit symptoms (inattentiveness, over-activity, restlessness) similar to ADHD. Studies have suggested that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder (ADHD) may actually have symptoms of obstructive sleep apnea and that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep. Bed-wetting, sleep-walking, retarded growth, other hormonal and metabolic problems, even failure to thrive can be related to a sleep disorder. Several recent studies show a strong association between pediatric sleep disorders and childhood obesity. Children exhibiting these symptoms or other behavioral problems should be carefully assessed by a pediatric sleep medicine specialist to assess their sleep problems.

American Acedemy of Pediatrics Guidelines

The American Academy of Pediatrics (AAP) guideline recommends that children who frequently snore should be tested for obstructive sleep apnea.  The clinical practice guideline “Diagnosis and Management of Childhood Obstructive Sleep Apnea” was published in the September 2012 issue of Pediatrics. The guideline recommends in-lab polysomnography for children with daytime learning problems, labored breathing during sleep and disturbed sleep with frequent gasps, snorts or pauses. The guidelines also call for children and adolescents to be screened for snoring as part of routine physician visits. The AAP recommends adenotonsillectomy as the first-line treatment for children with sleep apnea. Pediatricians may also recommend weight loss in obese patients or CPAP if surgery is ineffective or not conducted. 


There are differences between pediatric obstructive sleep apnea and adult sleep apnea. While adults usually have daytime sleepiness, children are more likely to have behavioral problems. The underlying cause in adults is often obesity, while in children the most common underlying condition is enlargement of the adenoids and tonsils. However, obesity also plays a role in children. Other underlying factors can be craniofacial anomalies and neuromuscular disorders. Early diagnosis and treatment are important to prevent complications that can affect children’s growth, cognitive development and behavior.


  • Perform poorly in school
  • Have difficulty paying attention
  • Have learning problems
  • Have behavioral problems
  • Have poor weight gain
  • Be hyperactive


As in adults, a polysomnography (sleep study) is the only tool for a definitive diagnosis and assessment of the severity of pediatric obstructive sleep apnea. It needs to be conducted during an overnight stay in a sleep lab, with the test conducted by technologists experienced in working with children and the data interpreted by a sleep medicine physician with pediatric experience. In addition, since children’s sleep apnea is frequently most pronounced during REM sleep late in the sleep cycle, home sleep studies and daytime nap studies are not useful and can be misleading.


Comprehensive Sleep Care Center offers expert diagnosis, treatment, and care for pediatric sleep disorders for children from the age of 2 months and up with the goal of providing a better night’s sleep and a better day ahead for the entire family.

If you suspect your child might have a sleep disorder, contact our physicians at Comprehensive Sleep Care Center. We have a team of pediatric sleep medicine specialists on staff and ready to help.


Having Surgery? Why you need to be screened for Sleep Apnea.

Having Surgery?

Why you need to be screened for Sleep Apnea.

Sleep Apnea is a potentially serious sleep disorder that occurs when breathing is interrupted during sleep. People with untreated sleep apnea can stop breathing up to hundreds of times each night while sleeping. As many as 18 million Americans have obstructive sleep apnea. But over half of those experiencing obstructive sleep apnea (OSA) are unaware that they have the condition.

It is important for surgical patients to be pre-screened for sleep apnea. Patients with sleep apnea who are undergoing any type of surgery or invasive procedures under general anesthesia are at an increased risk for developing respiratory and cardiovascular complications. Complications can include irregular heart rhythms, oxygen deficiency, high blood pressure, diabetes, stroke, heart attack and even death. This holds true for both surgeries related to obstructive sleep apnea and unrelated surgery such as orthopedic or bariatric procedures.


Screening patients prior to surgery can be very simple. Patients fill out a short Patient Sleep Apnea Questionnaire, which helps their physician determine who is at high risk for sleep apnea. Based on your responses you may need to do a sleep study to confirm or rule out sleep apnea. This test can be done in a sleep laboratory or, in some cases, it can be done with an at-home kit.


If you test positive for sleep apnea you should receive treatment prior to scheduling any non-emergency surgery. The gold standard of treatment for OSA is Positive Airway Pressure (PAP). It is important to be compliant with your treatment (wearing the device for 6-8 hours a night) for two to four weeks before the surgery takes place.


Those patients on PAP should bring their own equipment to the hospital. You will receive PAP once your surgery is completed and you are in the recovery area. You should continue to use the unit if admitted to the hospital. It is extremely important to remain compliant with use of PAP therapy after surgery in order to help decrease complications.


Whether or not you are having surgery, sleep apnea can be dangerous if not diagnosed and adequately treated. The most common symptoms of sleep apnea are:

  • Snoring, chocking, or gasping during sleep
  • Daytime sleepiness
  • Morning headaches
  • Trouble concentrating, memory problems
  • Mood swings, depression

If you experience any of these symptoms you should speak to your doctor or call Comprehensive Sleep Care Center at 703-729-3420 to see one of our sleep medicine specialists.

Traveling with Sleep Apnea



As CPAP users we all know how beneficial our treatment is and how much better we feel after a good night’s sleep. The issue we face isn’t when we are home, but when we travel. Traveling with sleep apnea means dragging along your CPAP machine. If you’re like me you ask the question- do I pack my CPAP or not? To travel with a CPAP, we have to pull out the power cord that we have hidden behind the bed, find our CPAP travel bag, make sure that we pack every component we need (mask, tubing, filters). Even worse when we fly we must make sure to list the medical device as an extra carry on. Then sleep without our CPAP (keeping everyone awake with our snoring) while on the plane. Even thought I know better I tend to say “what a hassle, I will be fine without my machine for a few days” and leave it at home. Only to find that while I am on my trip, my daytime sleepiness and other sleep apnea symptoms start to show themselves. So why isn’t there a better solution? Well there is!

The new mini travel CPAP’s offer the same great therapy in a much smaller size. They even offer some great added benefits. Like USB charging ports, overnight battery options, FAA compliance for in-flight use, waterless humidification and continued insurance compliance with your CPAP machine.

MINI TRAVEL CPAP    resmed mini cpap

Comprehensive Sleep Care Center is now offering the opportunity for our patients to call in and schedule a free consultation to learn about our mini travel CPAP’s. We have two new models available from the best CPAP manufactures in the world. Come check out the small, lightweight, and inconspicuous device that allows patients to get the CPAP therapy they need while making traveling with sleep apnea easier.

Call Today 703-679-0598! To learn more about the Mini CPAP & how it can change the way you travel! For more information email Richard at

5 facts about sleep apnea and ED

5 facts about sleep apnea and ED

The side effects of sleep apnea—fatigue, high blood pressure, risk of heart disease and stroke—are well-known. But one issue that is not as widely talked about is sleep apnea and ED.

  1. Continued research finds that having sleep apnea can be a drag on your love life, causing erectile dysfunction in men as well as a loss of libido in women.
  2. Past studies in men have shown a spike in erectile dysfunction (ED) among men who suffer from the obstructive sleep disorder (OSA). A study done in Germany reported that 70 percent of men seeking sleep apnea treatment also suffered from ED.
  3. One study suggests that men with erectile dysfunction (ED) should be screened for obstructive sleep apnea (OSA). After adjusting for age and other health conditions, they found patients with ED were more than twice as likely to have sleep apnea than their counterparts
  4. In another study, Doctors assessed patients with ED for evidence of sleep disordered breathing. They found that a whopping 91.3% of men with ED also had OSA.
  5. The researchers have stopped short of recommending ED drugs for men with sleep apnea, but they note that using a continuous positive airway pressure (CPAP) machine to treat sleep apnea can help with erectile dysfunction.

 Making the decision to consult a physician is the first important step, one that unfortunately can still be a difficult one for some men. Men who are struggling with issues related to sexual function should have a sleep study evaluation.

The good news is that treatments for obstructive sleep apnea such as CPAP therapy, oral appliance therapy, weight loss etc. — are safe and effective and can usually get you back in the game.

4 Important Facts About Sleep Apnea and Heart Disease in Women

4 Important Facts About Sleep Apnea and Heart Disease in Women

While Sleep Apnea is often thought of as a men’s health issue, here are some important facts about sleep apnea and heart disease in women that you need to know.

  • Obstructive sleep apnea is thought to be more prevalent than both asthma and adult diabetes, possibly affecting more than 18 million Americans.
  • Public health advocates think it may be as big a public health hazard as smoking.
  • The National Commission on Sleep Disorders Research estimated that sleep apnea is probably responsible for 38,000 cardiovascular deaths yearly.
  • Obstructive sleep apnea increases the risk of heart failure by 140%, the risk of stroke by 60%, and the risk of coronary heart disease by 30%.

What is Sleep Apnea?

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain — and the rest of the body — may not get enough oxygen.

  1. Women’s Hearts are More Affected by Sleep Apnea Then Men’s.

A study found that women with moderate to severe sleep apnea had more than a 30 percent higher risk of heart problems than women without sleep apnea. The study found no significant link between sleep apnea and heart problems in men. The researchers also found that, compared to women without sleep apnea, women with the disorder had higher blood levels of troponin, a chemical signal of early heart damage.

  1. Menopause Increases the Risk of Sleep Apnea and Heart Disease in Women

Higher levels of estrogen and progesterone protect women prior to the onset of menopause. These hormones maintain the airway’s muscle tone and keep it from collapsing. However, as these levels decline during perimenopause and drop to their lowest levels as part of menopause, the incidence of sleep apnea climbs. This suggest that older women may be at greater risk for sleep apnea-related heart disease than men.

Data from the 2007 Sleep in America Poll of the National Sleep Foundation demonstrated evidence that 35 percent of women entering menopause could expect to face a higher risk for developing the most serious form of sleep-disordered breathing—obstructive sleep apnea (OSA)—by the post-menopause phase, compared to younger women.

  1. Women’s Sleep Apnea Symptoms can be Different from Men’s

Sleep apnea symptoms in women may or may not mimic those in men. Often, the classic symptoms that men with OSA present, do not show up in the same way in women. Women are more likely to have complaints of restless legs, fatigue, insomnia, morning headaches, or mood swings, rather than the loud snoring and choking that men experience.

  1. Women and Untreated Sleep Apnea are not a Healthy Combination.

Untreated OSA leads to a host of other problems that can plague women: gastroesophageal reflux disease (GERD), diabetes, depression, hypertension, and obesity

Sleep Apnea Complications

If you are struggling with any of the issues discussed in this article, contact Comprehensive Sleep Care Center for a consultation and say hello to sleep again.

Think you are caring for your CPAP correctly?

Think you are caring for your CPAP correctly?

Take this quiz to find out.

One of the most important factors in maintaining CPAP compliance is taking care of your CPAP equipment. Fortunately, caring for your CPAP equipment can be easy. By making it part of your morning routine you will keep your device and accessories working properly. And say hello to sleep again…

1. The water in the humidification chamber needs to be cleaned out daily?

         Yes      No

The answer is a resounding yes. Emptying out the water helps prevents bacteria and calcification build up.

  • Remove chamber from humidifier carefully so water doesn’t enter your CPAP machine.
  • Open chamber and wash with warm, soapy water.
  • Rinse well with water and allow to dry on a clean cloth or paper towel out of direct sunlight.

2. Once a week, the humidification chamber needs to be completely washed?

Yes      No

Again, the answer is YES.

  • Once a week the humidifier chamber should be soaked in a solution of 1-part white vinegar, 3-parts water for approximately 15-20 minutes before rinsing thoroughly.
  • Some humidifier chambers are dishwasher safe, but make sure to check your CPAP machine’s manual before cleaning in a dishwasher.
  • Humidifier chambers should be replaced every 6 months or as needed.

3. CPAP masks need to be washed daily?

Yes      No

The answer is Yes, (do you see a theme here?)

Most CPAP mask cushions are made of silicone. While silicone is a very comfortable material for masks, it doesn’t have a very long lifespan, and without proper care can breakdown even faster than expected. Therefore, cleaning your CPAP mask is crucial in making it efficient as possible. Here are some tips on CPAP mask cleaning and replacement:

  • Wash mask daily with warm water and mild, non-fragrant, soap or use unscented baby wipes. You can also purchase CPAP mask wipes.
  • Rinse with water and allow to air dry on a clean cloth or paper towel out of direct sunlight.
  • Before using mask at night, wash your face thoroughly and don’t use facial moisturizers. Facial oils and moisturizers can breakdown the silicone faster.
  • Once a week, soak mask in solution of 1-part white vinegar, 3-parts water before rinsing.
  • Headgear and chinstraps should be washed as needed by hand using warm soapy water, rinsed well, and air dried. Do not place headgear or chinstraps in washing machine or dryer.
  • When caring for your CPAP masks check both your manufacturer’s recommendations and your insurance allowance. However, for most masks it is recommended that you replace the cushions 1-2 times per month, and the mask every 3-6 months.
  • CPAP tubing should be cleaned weekly in a sink of warm, soapy water, rinsed well, and left to hang-dry out of direct sunlight.

4. Should you clean the non-disposable filter weekly? More if you have pets or smoke?

Yes      No

I think you know what the answer is.

Your filters are located near the back of the CPAP machine where the device draws air. Nearly all CPAP machines have a disposable filter and some have an additional non-disposable filter as well. Here are some cleaning tips for your CPAP filters:

  • Rinse non-disposable filters with water and allow to dry before placing back into your machine.
  • The re-usable filters should be replaced when it begins to look worn or after 6 months.
  • Replace disposable filters every 2 weeks or more frequently if it appears dingy or dirty.
  • Once a week, unplug device from outlet and wipe with a damp cloth.

Cleaning CPAP


  • Make caring for your CPAP equipment part of your morning routine.
  • Keep machine and accessories out of direct sunlight to avoid damaging them.
  • Never use bleach to clean accessories.
  • Place machine on a level surface and away from curtains that may interfere with the air intake.
  • Keep track of when you should order replacement parts for your mask and accessories so that you always get the most out of your CPAP.

If you have a CPAP, but are struggling with compliance, check out our no mask oral appliance, ApneaGuard, for mild to moderate sleep apnea.  Call and schedule a consultation with one of our sleep medicine physicians, or ask your doctor about a sleep referral to the Comprehensive Sleep Care Center.

If you are struggling with your CPAP or have sleep issues, contact Comprehensive Sleep Care Center for a consultation and Say Hello to Sleep Again…

5 Important Reminders About Caring for Your Oral Device

Are you one of the thousands of patients at Comprehensive Sleep Care Center using ApneaGuard℠ with SomnoDent Oral appliance therapy to treat their sleep apnea? Caring for your oral device is very important. Here are 5 tips for caring for your oral device.

Oral Appliance Therapy (OAT), also called Jaw Advancing Device (JAD) or Mandibular Advancement Device (MAD) is recommended by the American Academy of Sleep Medicine (AASM). Our ApneaGuard℠ with SomnoDent is a FDA approved. It is non-invasive, adjustable and a portable treatment for mild to moderate obstructive sleep apnea. It is also an alternative treatment in cases where patients are unable to tolerate CPAP therapy.

Caring for your Oral Device

  1. Always keep your device out of direct sunlight and at a temperature over 72 degrees Fahrenheit.
  2. Store your ApneaGuard℠ with SomnoDent per the device instructions. Keep it away from pets and small children. As they can find your device particularly interesting and unfortunately any damage caused is not covered under warranty unless it is a manufacturer’s defect.
  3. By storing in water, the material will not dry out and will help prevent cracks, corrosion and possible discoloration of the metal components (caused by buildup of salts and saliva). The device should be fully submerged. When travelling clean the device thoroughly, dry with a cloth and place in the storage container without water and place the lid on.
  4. Do not use toothpaste on the device as it contains abrasives and may damage device
  5. Never use hot water on the as it will damage the device

Additional Tips for Your Oral Appliance Therapy

  • At night, clean your teeth and mouth thoroughly before wearing your device
  • Always wear both upper and lower plates together; wearing only one plate renders the device ineffective
  • In the morning, you may find it helpful to chew gum or do jaw motion exercises to help alleviate any stiffness after wearing the device overnight

If you are interested in more information about ApneaGuard℠ go to or call us at 1.844.753.3790

If you have signs or symptoms of sleep apnea, take the first step.  Call and schedule a consultation with one of our sleep medicine physicians, or ask your doctor about a sleep referral to the Comprehensive Sleep Care Center.

If you are struggling with any of the issues discussed in this article, contact Comprehensive Sleep Care Center for a consultation and Say Hello to Sleep Again…

The Ultimate Cheat Sheet on Sleep Apnea and Weight Loss

The Ultimate Cheat Sheet on Sleep Apnea and Weight Loss

The relationship between sleep and weight is a strong one. Over the years there have been a variety of studies to show the importance of quality sleep and the link between sleep apnea and weight loss.

  • Large population studies show that both adults and children are more likely to be overweight and obese the less they sleep at night
  • In smaller, controlled studies, scientists found that when people can sleep eight hours one night and then half that amount the next night, they end up eating more on the days when they’ve had less sleep
  • One pivotal study showed that losing just 2-3 hours of sleep a few nights in a row caused people to gain an average of two pounds
  • There are three hormones that have an impact on good sleep: cortisol, leptin and ghrelin. Without these hormones, your appetite isn’t suppressed, you start craving starchy carbs, and your metabolism plummets
  • Studies have shown that, for some patients, losing excess weight has greatly improved sleep apnea, which in turn dramatically improved their overall health and sleep
  • Eliminating sleep apnea can decrease your chances for more severe health problems including stroke, cardiovascular failure, diabetes and high blood pressure

Obstructive Sleep Apnea

Obstructive sleep apnea is characterized by a collapse of the upper airway during sleep.  Excess weight and fatty tissues block air passage and weaken muscles in the throat and pharynx resulting in snoring, labored breathing, and excessive daytime sleepiness. By reducing the amount of fat in these critical areas, airways are clearer which allows for deeper more restful sleep.

Dr. Charu Sabharwal, the Medical Director of Comprehensive Sleep Care Center, states ‘Sleep apnea is a vicious cycle. Many patients I see don’t have the energy to exercise and lose weight, as they are exhausted due to a poor night’s sleep. They often gain more weight which leads to more severe sleep apnea which compounds their problems.’

If you are overweight and have signs or symptoms of sleep apnea, take the first step.  Call and schedule a consultation with one of our sleep medicine physicians, or ask your doctor about a sleep referral to the Comprehensive Sleep Care Center.

If you are struggling with any of the issues discussed in this article, contact Comprehensive Sleep Care Center for a consultation and Say Hello to Sleep Again…

5 Sleep Apnea Side Effects Your Wife Wants You to Know



When you wake up in the morning, you probably don’t give much thought to what went on while you were sleeping. But your partner may be giving it a lot of thought. Sleep apnea issues don’t just affect you. They can affect everyone around you. Here are 5 sleep apnea side effects  your wife wants you to know.


Exhaustion is one of the biggest symptoms of sleep apnea. When you stop breathing, your brain sends out a distress call. This causes you to start to wake up, even if you don’t realize it. But waking up, even if it’s just for a few seconds, can disrupt your sleep cycle, leaving you exhausted the next morning. And no one likes a partner who is exhausted all the time.


Past studies in men have shown a spike in erectile dysfunction (ED) among men who suffer from sleep apnea. Sleep experts believe that the link may be due to the body’s levels of the sex hormone testosterone, which naturally rise while we sleep.  Because sleep apnea causes repeated nighttime waking, this chronic sleep deprivation may inhibit the body’s ability to produce and process testosterone, which is partially responsible for libido. Treatment for sleep disorders can usually get you back into the game.


Arguing because of snoring is something that affects more than half of the couples around the world. Loud snoring is the second major sleep apnea side effect. Not everyone who has sleep apnea snores (and not everyone who snores has sleep apnea).   Along with severe snoring, your bed partner may notice a “gasping, snorting, or struggling” as you return to breathing. This can be dramatic and alarming for the person you sleep next to.


If you consistently pass out on the couch watching TV or can’t help but doze off in a dark movie theater, this could point to some extreme apnea-related exhaustion. It can cause some deadly consequences, too. This instant ability to fall asleep is one of the major risks with driving. In 2014, there were 846 fatalities recorded that were drowsy-driving-related. These reported fatalities (and drowsy-driving crashes overall) have remained largely consistent across the past decade.


Mood changes and difficulty with memory and concentration stem from the sleep deprivation that comes along with sleep apnea side effects. Poor sleep can leave you feeling crabby, making you no fun to be around.

If you are struggling with any of the issues discussed in this article, contact Comprehensive Sleep Care Center for a consultation and say hello to sleep again.

10 Tips to Help Holiday Insomnia


Say Hello to Sleep Again

Follow these 10 simple tips to help holiday insomnia. To help reduce the stress, worry and overindulgence that can rob you of sleep and dampen your holiday spirit.

Watch our video Help Holiday Insomnia.

From Thanksgiving to New Year’s Day, it’s game on. You run yourself ragged, trying to cram as much holiday cheer, shopping, and cooking as you can in a short time. Combined with your daily responsibilities, it’s enough to make you lose sleep — and it usually does — turning you from a Happy Elf into more of a Grinch. So I put together these 10 tips to help holiday insomnia.

As a medical director of a large sleep health practice and a mother of two boys, the things dancing in my head while I’m trying to go to sleep are not visions of sugar plums; it’s more likely worry over how to get everything done.

Let’s just say when it comes to sleep issues, ‘tis the season. Read more