How Do You Know If Your Child Is Getting Good Sleep?

When sleep disorders come up in conversation, most people immediately think of older patients. One patient population that is regularly forgotten about is children.

Sleep Apnea In Children

Most parents are aware of the short term effects that happen when children don’t sleep well, but many are unaware of the long term cognitive effects.The signs of a sleeping disorder present differently in adults versus children and the treatment is different.

Sleep Disordered Breathing (SBD)

SDB describes a wide range of sleep related breathing abnormalities. The main one people think about is obstructive sleep apnea (OSA). A person has sleep apnea if they stop breathing for a certain period of time and their blood oxygen levels fall down to a certain level. Sleep apnea is mainly seen in adults but can also be seen in children as well.

Another type of SDB that is more commonly seen in children is called Upper Airway Resistance Syndrome (UARS). Simply put, it’s when there is a narrowing in ones airway.

Understanding Your Needed Sleep Cycle

To understand why this is such as issue in children, the different stages of sleep need to be discussed.

Stage 1

This stage is our transition from awake to asleep.

Stage 2

This is a lighter sleep when we process motor skills learned that day. We are in these first two stages for about 60% of the night.

Stage 3

Stage 3 is also known as non-REM deep sleep. During this time, the brain processes the facts learned that day and short term memories.

Stage 4

This next and final stage is REM sleep. REM sleep is important because it is when we manage pain, anxiety, depression, and long term memories.

We go through these 4 sleep stages 3-4 times a night, and each time REM sleep gets longer.

Why Be Worried?

When a child has OSA or UARS, the narrowing of the airway can be caused by many things. Usually it is caused by enlarged tonsils and adenoids or a constricted dental arch that doesn’t allow for proper location of the tongue.

Patients with OSA and UARS respond differently when their airway starts to constrict. With OSA, the airway muscles relax during REM sleep, which can cause significant narrowing of the airway. This constriction prevents oxygen from entering the bloodstream and the patient will wake up suddenly to catch their breath.

Children with UARS, on the other hand, do a better job fighting this airway closure by letting off bursts of adrenaline throughout the night when they sleep. This allows the muscles of the airway to tighten, which keeps the airway open. The problem is that the adrenaline keeps children out of Stage 3 and REM sleep and they only experience Stages 1 & 2. Whether it’s a child with OSA or UARS, both are not getting the benefits of REM sleep.

How Do I Know If My Child Is Getting Enough Deep Sleep?

There are pediatric sleep questionnaires that can screen you children for sleep issues.  Some sample questions are:

1. Does your child snore? Is it habitual?  Is it loud?
2. Have you ever seen your child stop breathing during the night?
3. Does your child tend to breathe through the mouth during the day?
4. Does your child have behavior issues?
5. Does your child suck his/her thumb?
6. Does your child grind his/her teeth at night?
7. Is your child overweight?
8. Your child is easily distracted by extraneous stimuli?
9. Your child is “on the go” or often acts as if “driven by a motor?”

If the answer is yes to many of the above questions, the best thing to do it to talk to your pediatrician so your child can be diagnosed.

What Tests Are Used For Diagnosing Sleep Apnea?

The best diagnostic tool is a sleep study, which is referred to you by your child’s doctor.  However, sleep studies are best for patients with sleep apnea (not UARS) and many sleep centers are not setup to test children.  If this is the case with your child, you could also use cardiopulmonary coupling (CPC). It is a screening tool to determine the quality of sleep a child is having. They take the device home and sleep with it for two nights and it can be used on children as young as 6 months old.

Many times, you will be referred to an ear, nose and throat doctor (ENT) to evaluate your child’s tonsils, adenoids, and nose. The ENT uses a scope, which is needed to see the adenoids and the full extent of the tonsils. Secondly, if your child has a small dental arch (determined by your dentist), he/she may need to see an orthodontist to help expand their arches. Sometimes a speech therapist is needed to train the muscles of the oral cavity to position themselves in the proper position.

There Are Many Ways to Treat Sleep Issues In Children

It is so important to involve both your dentist and physician if you feel your child is showing signs of sleep issues. Don’t go by the belief that because your son or daughter sleeps for eight hours straight that it’s ‘good sleep’. It’s not how much sleep they’re getting, but the quality.