Sleep apnea might be the cause of children's bedtime troubles

Searching for slumber

Bedtime at the Reain home used to be a battle. "We had to fight tooth and nail to get Quinn to bed," explains Quinn's mom, Kim Reain. "There were many years of sleeplessness for the whole family," adds Dan Reain, Quinn's dad. Waking him up in the morning was another struggle for the family.

Quinn's sleeping troubles began around age 4. Kim says that while her son slept well as an infant and toddler, he had croup four times a year and never outgrew it. Croup, an infection of the larynx, trachea and bronchial tubes associated with a barky cough, creates progressive breathing difficulty as the air passages narrow.

When Quinn was 6 and hospitalized with croup, one of his doctors suggested that he had pediatric obstructive sleep apnea, a sleep disorder that occurs when breathing becomes partially or completely blocked by the collapse of the upper airway during sleep. The result is a drop in oxygen and a rise in carbon dioxide in the body. The disruption of oxygen causes the brain to be disturbed and wakes the child several times throughout the night, preventing sound sleep. In the morning, because the child hasn't slept soundly, it may be difficult to wake him up.

"Young kids often don't complain of being sleepy," says Dr. Cami Matthews, a pediatrician in sleep medicine at Wisconsin Sleep (wisconsinsleep.org), located in Madison's UW Research Park. She also sees patients from infants to 18 years of age at the American Family Children's Hospital.

Matthews says that symptoms of pediatric sleep apnea include snoring or labored breathing during sleep, mouth breathing, crabbiness, inattentiveness, poor school performance, bed wetting after having been dry for a long time, morning headaches, restlessness and hyperactivity. Often the symptoms of pediatric sleep apnea look like attention deficit hyperactivity disorder.

"Apnea" is a medical term referring to a pause in breathing. Many children and adults who snore regularly will have a few apneas or breathing pauses or hypopneas, partial pauses throughout the night. Statistics from Wisconsin Sleep show that adults with sleep apnea stop breathing 10 to 60 times or more every hour. Children with sleep apnea have symptoms if breathing pauses occur as low as two times an hour. The breathing pauses or changes usually last 10 to 20 seconds.

Risk factors for pediatric sleep apnea include large tonsils, nasal allergies, obesity, Down syndrome, deformities resulting in a small face or air passage, and disorders causing muscular weakness.

"Parents should talk to their child's pediatrician if their child snores, has trouble waking up in the morning or if bedtime is a struggle," Matthews adds. Sleep apnea is more common in the last part of the night, during REM sleep. Matthews suggests that parents audio or video record their child sleeping and bring the recording to the pediatrician so that the doctor can determine if a sleep study or sleep consult is needed.

The sleep study, or polysomnography, is a comprehensive recording of physical changes and activities that occur during sleep. Usually performed at night, the study monitors body functions including brain, eye movements, muscle activity, heart rhythm and breathing through sensors placed on the face, chest and legs.

Sleep studies for children and adults are conducted at Wisconsin Sleep, which opened in 2007. The Wisconsin Sleep program serves over 6,000 patients each year between the sleep lab and the sleep clinic. Fourteen sleep techs conduct the sleep studies in the 16 private sleep study suites. For children, the sleep study suites have a second bed so that a parent can stay with the child.

The Wisconsin Sleep program is a collaborative effort of the University of Wisconsin Medical Foundation and Meriter Hospital. It's led by medical director Ruth Benca, M.D., who has worked in the field of sleep medicine for almost 30 years, 20 of them at the UW. "We treat the full range of sleep disorders, including sleep apnea, insomnia, sleep-related movement disorders, circadian rhythm disorders, parasomnias and disorders of excessive sleepiness," Benca says. "We treat all age ranges, from infants to the elderly."

Before his sleep apnea diagnosis, Quinn, now 11, suffered from night terrors and vivid dreams. He mumbled in his sleep and experienced weight gain for seven years. Because of the night terrors and vivid dreams he was afraid to go to sleep. Upon waking, he wasn't sure if his dreams were reality or part of his imagination. "I remember a vivid dream where I was watching a commercial and there was an alien crawling on a spaceship. The alien said, "I want air," Quinn recalls.

Quinn is one of Dr. Matthews' patients. Since his sleep study, he uses a CPAP (continuous positive airway pressure) machine at night. A gentle flow of air is sent from the machine through the nose to the back of the throat. The air acts like an "air stent" to hold the air passage open during sleep.

"This is going to be my year!" Quinn said after waking from the first night of using the CPAP machine. Kim and Dan Reain agree that since starting the CPAP, there's been a big change for the positive. "We all realized that Quinn's sleep problems weren't his fault. We spent three or four years trying to change his behavior," Kim says.

The sixth-grader is home-schooled and has played piano since age 6. Until his sleep apnea was diagnosed, he couldn't have sleepovers with his friends. A recent sleepover netted comments from his friends about how he slept like a baby. ?

Pediatric sleep apnea statistics

  • Pediatric sleep apnea occurs in about 2%-4% of children and teenagers.
  • Over 2 million children have some type of sleep disorder.
  • An estimated 30%-40% of children do not get enough sleep.
  • Pediatric sleep apnea has been linked to many other problems in children, such as SIDS, ADD, ADHD, autism, obesity, narcolepsy, insomnia and cardiovascular effects like high blood pressure.

Statistics from the Infant and Children Sleep Apnea Awareness Foundation website, www.kidssleepdisorders.org/awareness, and Wisconsin Sleep.

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