Feeling sentimental one Saturday night, I said yes to my four year old when he asked if he could sleep in Mama and Dada’s bed. After the hubby and I hung out solo (ahhhh), we went upstairs to find our li’l dude spread across the bed and snoring. It was quite the cute sight. However, there was one major, major concern I learned after that night: snoring can be a sign of sleep apnea, a condition where a person stops breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. In the event you just simply have a snorer, it can mean disrupted sleep patterns for your child AND even be misdiagnosed as ADD or other behavior problems because the over tired child is so exhausted after continuous nights of interrupted sleep. Breezy Mama spoke Dr. Danna Tauber — the Medical Director of the Sleep Center at St. Christopher’s Hospital for Children in Philadelphia– for signs to keep an eye out for, what can be done if your child has sleep apnea, other concerns and more.
Why do some children stop breathing in their sleep?
Children who stop breathing in their sleep may have obstructive sleep apnea, which can be caused by either big tonsils or big adenoids, or a combination of both. Other causes of obstructive sleep apnea include obesity, certain genetic syndromes, abnormalities of the face or throat or low muscle tone in children.
Is not breathing common for children who snore or an extreme case?
Many children snore but do not have trouble with their breathing. Some reports say that 12 percent of pre-school children snore but only 2 percent have obstructive sleep apnea.
When is snoring okay/ not a concern and when is it time to call the doctor?
In most cases, snoring is okay. But, if your child snores and you witness him stop breathing, gasp for breath, choke or have labored breathing, then your child should see his doctor. Also, if your child snores coupled with daytime symptoms of excessive sleepiness such as falling asleep in school, difficulty paying attention and/or learning problems, then your child should be evaluated for a sleep disorder.
How would a parent know their child stops breathing in their sleep?
It is not easy to tell if your child stops breathing while sleeping. That is why doctors have to order a polysomnogram, a sleep study, to see if a child stops breathing. An overnight sleep study involves monitoring brain waves, heart rate, eye movement, muscle tension, airflow through the nose and mouth, blood oxygen levels, audio monitoring to detect snoring or gasping and video monitoring to detect movements.
Can a child die from this?
If left untreated, a child with severe obstructive sleep apnea is at risk of dying.
What can be done?
Once a diagnosis of obstructive sleep apnea is confirmed by an overnight sleep study, most children can be cured by having their tonsils and adenoids removed. In the cases where this does not work, children may need to be treated overnight with continuous positive airway pressure (C-PAP), a machine that delivers constant air pressure to the back of the throat via a mask over the nose (and sometimes the mouth) and prevents the airway from closing. This is done at home on a nightly basis.
How does sleep apnea contribute to behavior problems?
Children with sleep apnea have fragmented sleep, which means that they are not getting enough, high-quality, continuous sleep. Because of this, they are frequently tired and groggy during the day. In some children this manifests itself in changes in their behavior including aggression, impulsivity and inattentiveness.
What sorts of behavior problems could be signs of sleep apnea?
Some children have increased anger and aggression. Others have inattentiveness and poor impulse control. Others can be excessively tired, which can look like depression.
Is sleep apnea just as common in boys and girls?
My son snores on occasion, but seems to sleep through it. Is it possible for some children to get a good night’s sleep even though they snore?
Yes. This is called primary snoring when a child snores but does not have disruptions in breathing or in sleeping pattern. Also, many children snore when they have a cold or when their allergies act up.
How can parents rule out altogether that their child may have sleep apnea?
An overnight sleep study is the only definitive test to determine if a child has obstructive sleep apnea. Observation by a parent or audio or video taping can help, but the sleep study is the only way to know for sure.
Can sleep apnea occur in babies? What are the most common ages?
Obstructive sleep apnea is rare in healthy babies without other medical conditions such as Down syndrome or other genetic disorders that lead to deformities of the face and throat. The highest rates of obstructive sleep apnea occur in pre-school aged children, usually between the ages of 2 to 5 years.
If snoring occurs when the child is stuffed up, is there anything parents can do to clear the passage so the child can sleep peacefully through the night?
If the snoring is disrupting the child’s sleep, trying to clear out the nasal passages can help. If the child has allergies, then antihistamines and topical nasal sprays can help reduce the swelling in the nasal passages and allow the child to breathe easier. In the case of colds, using nasal saline drops followed by removing the mucous with a bulb syringe can be helpful. Also topical nasal decongestants can be used for a few days to try and clear the nasal passages. Topical nasal decongestants should not be used in infants nor should they be used for more than 2-3 days. It is always best to ask your pediatrician first.
Obese children are at a higher risk of developing severe obstructive sleep apnea and its complications. In addition to behavioral issues, children with severe obstructive sleep apnea are at higher risk of hypertension and heart disease. Therefore it is very important to screen obese children for obstructive sleep apnea. For parents, this means letting your child’s pediatrician know if your child snores, has difficulty breathing during sleep, is difficult to wake up in the morning or complains of being tired during the day.
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Pediatric pulmonologist, Dr. Danna Tauber, is the Medical Director of the Sleep Center at St. Christopher’s Hospital for Children in Philadelphia. She is also an Assistant Professor of Pediatrics at Drexel University College of Medicine. Her clinical interest is in pediatric sleep disorders with a focus on sleep disordered breathing.
Dr. Tauber is board-certified in sleep medicine. She completed her pediatric training at Albert Einstein College of Medicine-Montefiore Medical Center, Bronx. N.Y. and a pediatric pulmonary fellowship at Children’s Hospital of Philadelphia.