clinical update publication
The New Face of Sleep Disorders

Twenty years ago, a headline such as “Sleep Disorders Present In Younger Victims” would have caused quite a stir within the medical community. Until that time, only adults had been routinely diagnosed as sufferers of maladies such as sleep apnea syndrome (SAS), insomnia and narcolepsy. It was not until the early 1980s that the sleep habits of children were thrust under the lens of a microscope. Since that time, however, boys and girls, from infancy to adolescence, have become an increasing focus of sleep diagnostics.

Just recently, in fact, the National Sleep Foundation (NSF) conducted its seventh annual Sleep in America poll, expanding on the focus groups of previous studies to include, for the first time, the sleep habits of children (infants to 10-year-olds). The poll found that: overall, children are not getting the recommended amount of sleep for their age group; parents/caregivers are not always aware of the best sleep practices for their children and many do not realize that their children are not getting the right amount of sleep; parents are unsatisfied with their child’s sleep habits; and many doctors (52 percent) do not regularly ask about a child’s sleep habits, although a large number (69 percent) of parents/caregivers report sleep-related problems in their children.

Those sleep disorders, comparable to the problems experienced by their older counterparts, include, but are not limited to, insomnia, narcolepsy and SAS. Children, however, also suffer from a number of parasomnias that are often reserved for only them, including bed-wetting, sleepwalking, sleep talking and night terrors.

Diagnosis
“Regardless of the present-day knowledge and insight that medical care professionals possess regarding sleep problems in children, too often these disorders are overlooked or go undetected,” revealed Alan Backman, CRT, RPFT, RPSGT, Co-Director, Respiratory Care Services, Deborah Heart and Lung Center. “Understanding what is normal and healthy sleep behavior is an important step towards ensuring a child’s overall health. Parents/ caregivers must be given information to help them recognize symptoms of sleep problems, and they need to discuss their concerns with their child’s doctor.”

This is especially important, considering the consequences of sleep deprivation; much the same as adults, children who suffer from a long-term disruption of their sleep architecture are predisposed to high blood pressure, type II diabetes and congestive heart failure.

“Plainly stated, if a child is sleep deprived for a sustained amount of time, his or her immune system is going to be impacted, his or her cardiac system is going to be impacted, and his or her vascular system is going to be impacted,” said Backman. “The message then is, when evaluating children, ask the mother and father how their child is sleeping. If the answer is less than 10 hours, then something is wrong.”

Sourcing a more extensive sleep log, as compiled by the NSF, it is recommended that newborns up to two months average 10.5 to 18 hours of sleep per day, and those between two and 12 months average 14 to 15 hours. Toddlers between one and three years old should average 12 to 14 hours of sleep per day, and those between three and five years old, 11 to 13 hours. Children five to 12 years old should average 10 to 11 hours of sleep. Adolescents 12 and up should average 9 to 10 hours of sleep.

Attaining such numbers, however, has grown increasingly difficult, especially considering the reality of living in a 24-hour society. While there exists no hard proof as to the cause of most sleep disorders, there are some extenuating factors that are viewed as plausible culprits, including the prevalence of artificial light, the electronic invasion (video games, television, the Internet), caffeine, consuming larger quantities of high-carbohydrate foods, exercising less, and, of course, family history. Unfortunately, many of these same identifiers are shared by other ailments, leading to the presence of a sleep disorder being overlooked, or worse yet, misdiagnosed.

“With 84 sleep disorders to consider, and each one having overlapping characteristics, there does exist the possibility that physicians and internists not versed in sleep medicine could very easily overlook one,” stated Backman. “This is especially true when considering that physical conditions, such as ADD and ADHD, can actually mimic sleep disorders in the way that they present themselves behaviorally.”

Correction
Fortunately, in the case of some children, there does exist an easily employed corrective therapy. As Backman recommends, creating an effective sleep profile in a child can, oftentimes, correct most sleep disorders. This entails having the parents expose the child to simulated sunlight for five to ten minutes, immediately following waking, and not letting the child go back to sleep until bedtime. Also, to institute a repetitive pattern in the brain, have the child go to bed within a half an hour of the same time every night and rise within a half an hour of the same time every morning. Once he or she grows attuned to that schedule, the sleep problem will likely disappear. If, however, that does not work, it could be a sign that the child suffers from a more severe condition, and a sleep diagnostics study should be considered.

Opened in 1986, Deborah’s Sleep Diagnostics Laboratory is a state-of-the-art, four-bedroom laboratory that operates five days a week. On staff are five full-time polysomnographers who are either certified or registered in respiratory therapy and who have been trained to the standards of the American Association of Sleep Medicine. This comprehensive training has equipped these professionals with the ability to accurately diagnose potential sleep disorders and tailor individualized treatment plans to correct them. In most cases, Deborah’s polysomnographers can correct a sleep disorder in as little as one or two nights

“Sleep is a vital asset for a child’s health and overall development, learning, and safety,” said Backman. “For no other reason than to ensure that every child is given the opportunity to grow up healthy and bright, we need to work together, as parents, primary care physicians and polysomnographers, to detect and eliminate the presence of sleep disorders in our younger generations.”™

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