Pediatric Sleep Disorders and Treatment

Wishing Sweet Dreams For Both You And Your Child

Comprehensive Sleep Care Center offers expert diagnosis, treatment, and care for pediatric sleep disorders for children from the ages of 3 months and up with the goal of providing a better night’s sleep and a better day ahead for the entire family.

Led by Shahriar Shahzeidi, MD, FAAP, FCCP, FAASM, our pediatric sleep team is skilled in the evaluation and management of children with behavioral and physiological sleep disorders in conditions such as Autism, ADD and ADHD . Dr. Shahzeidi is a former Assistant Clinical Professor of Clinical Pediatrics at the University of Miami, Miller School of Medicine, and a former Director of the Pediatric Sleep Center at the University of Miami. He is a graduate of Howard Medical Center and completed his fellowship in Pediatric Pulmonary and Sleep Medicine at the Children’s National Medical Center and George Washington University in Washington, D.C.

Recent studies show that inadequate sleep leads to symptoms very similar to ADHD including:

  • Tiredness
  • Difficulty focusing attention
  • Learning problems
  • Impulse modulation problems

If you suspect your child has ADHD or ADD, a consultation with Dr. Shahzeidi may be the next best step, as studies have shown if a child has a sleep issue and it is resolved, ultimately the child’s behavior improves as does academic performance.

Kids Sleep Health Needs Are Unique And Require Special Care

Inadequate, disrupted, poor-quality, non-restful and at times elusive sleep constitutes one of the most common complaints raised by parents to their pediatricians. The consequences can be serious, and range from behavioral concerns and academic failure to delayed growth, failure to thrive and cardiovascular problems. For this reason, it is important for both parents and educators to understand how sleep works and how disruptions in normal sleep patterns can affect children and teenagers.

If you suspect that your child or teen has a sleep problem that goes beyond a few nightmares or restless nights, do not delay seeking help. Start with your child’s pediatrician or call and schedule a consult with our board-certified pediatric sleep medicine physician. The earlier a sleep problem is identified and treated, the more quickly a normal sleep routine can be restored—for everyone.

How To Recognize If Your Child May Have A Sleep Disorder

Some sleep disturbances are mild, fairly common, and fairly easy to treat. Others may be more stubborn, or they may be signs of potential physical problems that could have long-term consequences if left untreated.

When Do You Consider A Sleep Evaluation For Your Child

If your child:

  • Snores or breathes through their mouth at night
  • Makes other noises during sleep
  • Is sleepier than expected during the daytime, may be irritable and struggling with school
  • Has trouble falling asleep
  • Has trouble staying asleep
  • Wets the bed (past the age of 5 years)
  • Has trouble falling asleep due to leg discomfort
  • Sleepwalks excessively
  • Has frequent sleep terrors
  • Exhibits sudden behavioral problems at school or at home
  • Shows signs of memory dysfunction or a lack of concentration
  • Grinds teeth during sleep
  • Moves excessively during sleep
  • Has a craniofacial abnormality that may contribute to difficulty breathing during sleep

If your child is suffering from a sleep disorder, he or she may exhibit one or more of these symptoms. Talk with your child’s pediatrician or healthcare provider. Please keep in mind, not all pediatricians recognize the variety of sleep problems children and teenagers experience, and if parents are not satisfied after meeting with their child’s physician, then you may want to request a referral to our board-certified pediatric sleep specialist at Comprehensive Sleep Care Center.

At school, parents might find some assistance from the school psychologist or social worker, who may use a diagnostic interview as part of an evaluation. This interview should include questions about the child’s normal sleep patterns, including bedtime routines, typical bedtime and wake time on school days and weekends, whether the child has trouble falling asleep or staying asleep, and the frequency of nightmares. When parents or teachers have concerns about attention and behavior problems, sleep problems may be an issue. This is because side effects associated with sleep disturbance or deprivation includes inattention, irritability, hyperactivity, and impulse control problems.

How Is A Sleep Disorder Diagnosed?

It begins with using our ears, our board-certified pediatric sleep specialist starts with listening to your child’s problem, not our solution. After hearing from you about your child’s medical history, current health issues, and your child’s individual sleep or lack of sleep experience, our sleep doctor will do a brief exam of he or she’s nose throat and neck, which may reveal any issues such as a nasal obstruction or enlarged tonsils. Our doctor will then know how to start customizing a treatment plan and determine if the next step may be a sleep you or your child discuss your medical history, sleep history and symptoms.

We are unique in the DC metro area in that we offer a multidisciplinary approach; and have a board-certified pediatric sleep medicine physician as part of our team who will work collaboratively with your child’s pediatrician, ENT specialist, or psychologist/psychiatrist to ensure we address the full range of your child’s sleep disorder and potential treatment options. Kids are unique from adults, so a pediatric sleep specialist is critical to ensuring the best in care for your child’s sleep health needs.

Our Arlington and Lansdowne centers offer a kid themed room, but we can accommodate children at all our centers. Mom, Dad or a guardian are included as well with a special recliner to sleep in next to their child with many of the comforts of home available. Children are encouraged to bring their own toys, favorite blanket or any items from home that will make their stay more comfortable. We offer our kid patients a treat bag as a special thanks and congratulate them on a night well spent at the completion of their study.

We diagnose and treat children from the ages of 3 months and up with the goal of providing a better night’s sleep and a better day ahead for the entire family.

What Happens During A Pediatric Sleep Study?

To measure breathing and sleep, sensors and belts will be attached to your child’s head, near the nose, mouth, chest, abdomen, finger and legs. These sensors will allow us to record his or her breathing and sleeping patterns. Attaching the sensors is completely painless and involves a lot of stickers and tape. Paste is used to attach the sensors to your child’s scalp. Please wash your child’s hair before the study and do not use any gels, mousse, sprays or lotions as these may interfere with the testing and disrupt your child’s study. When the study is finished the paste attaching the sensors will easily wash off.

Children who are prepared for the study often have a better experience than those who are unprepared. That’s why it’s a good idea to talk with your child about the study a few days beforehand and let him or her know what to expect. Give you child time to ask questions and offer plenty of reassurance. Your attitude can greatly affect how your child feels about the study, so be positive and confident. You are welcome to call and schedule an appointment to tour the sleep center before the night of the sleep study. If you have any questions the night of the study, our registered sleep study technicians can assist you during your stay.

How Do You Treat My Child’s Sleep Disorder?

We do not offer a one size fits all approach, as different types of sleep disorders may call for different treatment options depending on the needs of your individual child.

Night terrors Night terrors are sudden, partial arousal associated with emotional outbursts, fear, and motor activity. Occurring most often among children ages 4–8 during NREM sleep, the child has no memory of night terrors once fully awake. If your child experiences night terrors, make sure he or she is comfortable but do not wake the child. In extreme cases, night terrors may require medical intervention.

Sleepwalking is most common among 8–12 year-olds. Typically, the child sits up in bed with eyes open but unseeing or may walk through the house. Their speech is mumbled and unintelligible. Usually, children will outgrow sleepwalking by adolescence. In the meantime, take safety precautions (e.g., using a first-floor bedroom), but keep efforts to intervene to a minimum. Awakening the child on a regular schedule can reduce or eliminate episodes.

Nighttime bedwetting Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child’s breathing is interrupted during sleep — often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat, and daytime drowsiness.

Obstructive sleep apnea (OSA) Although more common in adults, 1–3% of children experience difficulty breathing because of obstructed air passages. Studies have suggested that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder may actually have symptoms of OSA 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 sleep apnea. Some researchers have charted a specific impact of sleep disordered breathing on “executive functions” of the brain: cognitive flexibility, self-monitoring, planning, organization, and self-regulation of affect and arousal. Additionally, several recent studies show a strong association between pediatric sleep disorders and childhood obesity.

Treatment of OSA Surgical removal of the adenoids and tonsils is the most common treatment for pediatric OSA. In uncomplicated cases, the operation results in complete elimination of OSA symptoms in 70 to 90 percent of the time. Although generally an outpatient procedure, some children with chronic medical conditions like obesity or severe OSA or complications of OSA should be carefully monitored overnight following the surgery as breathing abnormalities may not appear until REM sleep begins several hours in the next extended sleep cycle after the operation. Owing to post-operative swelling, full resolution of the OSA symptoms may not occur for six to eight weeks. If adenotonsillectomy is not indicated or if the surgery does not fully resolve the symptoms, CPAP (Continuous Positive Airway Pressure) will be helpful in getting restful sleep for your child. (CPAP therapy may also be prescribed before surgery in severe pediatric OSA cases.) PAP should be regarded as palliative rather than curative.

Other Treatment Options for OSA Oral appliances for treatment of pediatric OSA are helpful in some cases, especially in adolescents whose facial bone growth is largely complete. One device that rapidly expands the transversal diameter of the hard palate over a six-month to one-year period has been used successfully in children as young as 6.
Weight management, including nutritional, exercise, and behavioral elements, should be strongly encouraged for all children with OSA who are overweight or obese. An adequate nightly duration of sleep is an important component of weight management.

Other treatments are directed towards additional risk factors in individual cases; i.e., allergy medications for children with seasonal/environmental allergies, asthma medications/inhalers, and treatment for gastroesophageal reflux.

Narcolepsy is often not recognized and thus often underdiagnosed. It is a rare but potentially dangerous, neurologically based genetic condition that may include sleep attacks (irresistible urges to sleep), sleep-onset paralysis, or sleep-onset hallucinations. It affects 1 of every 2,000 adults and may first appear in adolescence. Treatment may include ensuring a full 12 hours of sleep per night or more, scheduled naps, or medication.

Delayed sleep-phase syndrome This is a disorder of sleep (circadian) rhythm that results in an inability to fall asleep at a normal hour (e.g., sleep onset may be delayed until 2–4 a.m.) and results in difficulty waking up in the morning. Symptoms among children include excessive daytime sleepiness, sleeping until early afternoon on weekends, truancy and tardiness, and poor school performance. Treatment might include light therapy (exposure to very bright light in the morning), chronotherapy (gradually advancing the child’s sleep schedule 1 hour per night until a normal routine is achieved), maintaining a consistent sleep schedule, or a short course of sedative medication to help achieve a new schedule. It may be necessary and beneficial to (temporarily) adjust the child’s school day to allow for a later start.

A sleep disorder not only results in a sleepy, cranky, and often poor-performing student at school, but also an irritable, unhappy child or teenager at home. A youngster with a disrupted sleep pattern more than likely is wreaking havoc on the sleep and patience of other family members.

If you suspect that your child or teen has a sleep problem that goes beyond a few nightmares or restless nights, do not delay seeking help. Start with your family physician. The earlier a sleep problem is identified and treated, the more quickly a normal sleep routine can be restored—for everyone.

Sleep Developmental Characteristics

Infants and Children Both these sleep states develop before birth. Infants cycle through many sleep periods throughout the day. As they develop, they sleep longer at night and have fewer sleep periods during the day. Newborns sleep almost all the time. By 6 months they sleep about 13 hours a day with the longest sustained period being about 7 hours. By 24 months children sleep for 12 hours, including naps, and by 4 years children sleep 10–12 hours with one daytime nap at most.

Throughout childhood children typically get about 10 hours of sleep a night. This drops significantly at adolescence, but less for biological reasons than for socio-cultural reasons. Sleep researchers studying the optimal sleep periods of teenagers have found that when the sleep-wake cycle is studied in the laboratory under controlled conditions (e.g., removing clocks and lighting cues), teenagers typically sleep 9 hours a night. In the real world—especially during the school year—very few teenagers get this much sleep and thus are constantly coping with sleep debt to a greater or lesser degree.

Whereas infants enter into REM sleep immediately, young children move quickly from drowsiness and the lighter sleep stages to Stage IV, then experience cycles of light to deep sleep, arousal, etc., eventually cycling between REM and Stage II sleep, much like the sleep patterns of adults.

Adolescents Adolescent sleep patterns deserve particular attention because of the potential impact on school performance. It has only been in the last 20 years or so that sleep researchers have recognized that there are distinctive changes in sleep patterns in adolescence. There are changes in the biological clock (also called circadian rhythms) of teenagers. With the onset of puberty, teenagers begin to experience a sleep phase delay such that they develop a natural tendency both to fall asleep later in the evening and to wake up later in the morning. Even youngsters who have experienced sleep deprivation (and therefore accumulated some sleep debt) tend to feel more alert in the evening, thus making it more difficult to go to bed at what parents might consider a reasonable hour.

The onset of sleep is triggered by the release of melatonin, a natural body hormone. Toward dawn, melatonin shuts off as another hormone, cortisol, increases, signaling the youngster to wake up. Research shows that the pattern of melatonin secretion makes it hard for teenagers to fall asleep early in the evening and to wake up early in the morning. Schools with early start times place students at a disadvantage in terms of arousal and alertness—not only for early morning classes but throughout the day because the adolescent’s biological rhythms are out of sync with typical school routines.


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