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Ask the Expert

Is your child performing poorly at school? The problem could be sleep related.

Dr. Stuart Tomares

This month's feature is brought to you by Dr. Stuart Tomares, Associate Medical Director, Pediatrics, National Capital Sleep Center at Suburban Hospital. Dr. Tomares is a board-certified pediatric pulmonologist and an expert in pediatric sleep disorders. Dr. Tomares has had his work published in more than a dozen medical journals.

How do I know if my child has a sleeping problem?

There are many different types of sleep problems. Some such as insomnia, frequent awakenings, excessive daytime sleepiness, nightmares, and bedwetting are easily recognized and treated. Others may be less obvious, resulting in symptoms of emotional instability, peer problems, inattentiveness or hyperactivity, and changes in school performance. If your child is experiencing any of these symptoms, especially if accompanied by loud snoring and breathing pauses during sleep, you should consult with your pediatrician about the appropriateness of a sleep study. Most sleep disorders are easily diagnosed with an overnight sleep study.

Can sleep problems really affect my child's behavior at school?

Yes. Behavioral problems can arise in children due to the lack of, or poor nature of, sleep. In addition, disorders such as obstructive sleep apnea syndrome (OSAS) can result in poor brain oxygenation and can have a profound effect on behavior, often mimicking the symptoms of ADHD and learning disabilities. Children who sleep well are less prone to behavior problems and moodiness. They often develop better memory, concentration, and longer attention spans. With plenty of sleep, they may also recover from illness faster.

But what if my child isn't sleepy at bedtime?

Keeping a sleep log and carefully noting your child’s sleep and nap schedule, will help determine if a true sleep disorder is present, or if a behavioral or sleep hygiene issue is present. Most often a small change in habits or bedtime can change a sleepless child into a sleeper.

So how much is enough sleep?

Normal sleep requirements are affected by the age of the child and the child’s own specific rhythms. Sleep requirements change throughout life, with newborns sleeping between 16 to 20 hours a day, and older children sleeping only 8 to 9 hours. Sleep needs increase during adolescence and then taper off as we age; sleep needs in the elderly can be as low as 3-5 hours a day. Each child is unique. If you suspect that your child is not sleeping enough, consider keeping a careful sleep and nap log and providing it to your pediatrician for evaluation.

What can be done if I think my child is staying up too late?

Taking into account your child’s unique sleep requirements (an average of the total sleep time per day, over a two week period) you can pick an appropriate bedtime. Keeping a regular sleep schedule and using good sleep hygiene will help make any child into a good sleeper. Good sleep hygiene includes such things as a regular bedtime routine, avoiding late-night exercise or eating, avoiding stressful activities in bed (such as homework), keeping the room quiet, cool and dark, and avoiding excessive stimulation, such as rocking and patting.

Is there a definitive way to determine if my child has a sleep disorder?

Yes. If your pediatrician or ENT (ear, nose and throat doctor) suspects that your child has a sleep disorder, your child can undergo an overnight sleep study. Sleep studies, also called polysomnograms, are used to diagnose the majority of sleep-related disorders. At the Suburban Hospital National Capital Sleep Center, a pediatric sleep specialist will monitor your child’s sleep, measuring sleep stages and architecture, oxygen levels, dream time, breathing, and many other factors, to accurately determine if a sleep disorder is present. The sleep lab is a child-friendly environment. Tests are non-invasive and painless, and parents are welcome to stay with their children throughout the night.

Snoring isn't really a big deal, is it?

Not true. Snoring can be a sign of a very serious sleep disorder: OSAS. About 10% of normal children have some degree of snoring during the night, and most of them have a harmless condition called primary snoring. But one-fifth of these children will have a more serious problem. Unfortunately it is not possible to distinguish between these two groups without an overnight sleep study. Children with significant snoring, especially if associated with daytime sleepiness or behavioral problems, should undergo an overnight sleep test to rule out obstructive sleep apnea.

What exactly is OSAS?

OSAS, or obstructive sleep apnea syndrome, occurs when the airway is partially or completely blocked during sleep. This is usually due to one of three factors: a small airway, poor airway muscle tone during sleep, or enlarged tonsils and adenoids. When the airway becomes blocked during sleep, the body’s oxygen levels can fall, and carbon dioxide levels can rise, resulting in poor brain oxygenation, fragmented sleep, frequent arousals, and may, if left untreated, be harmful to the heart and lungs. Most cases of childhood OSAS are due to enlarged tonsils and adenoids, which clog the airway, but there are a number of other risk factors, including low muscle tone, genetic syndromes (especially Down syndrome), obesity, cerebral palsy, and others, that can predispose a child to OSAS. If OSAS is suspected, an overnight sleep study is necessary.

What can be done if my child is found to have a sleep disorder?

The good news is that almost all childhood sleep disorders are treatable. The most common disorder, OSAS, is most often cured by removing the tonsils and adenoids. Others respond well to behavioral or environmental changes. Some, such as narcolepsy, are treated with medications. Following your child’s sleep study, a pediatric sleep specialist will review the data and provide your pediatrician or ENT with a definitive diagnosis and will recommend the best way to help your child.

For more information about Suburban's sleep services, call Suburban On-Call at (301) 896-3939, or click here.

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