Episode 5: Sleep disorders in children

This episode explores and breaks down some of the common sleep disorders in children 

Transcript

SPEAKER_00 0:07

Hello everyone, welcome to another episode of the Sleep Lab Stories. My name is Miriam, I'm your host. If you're new here, thank you for choosing to spend this time with me again, or rather, for uh deciding to spend this time here. And if you've been here before, welcome back and thanks for the consistent support and coming over again. Remember to subscribe, like, and share this and any of the episodes if uh it is um concurring with what you're going through, or if you know anyone who it can be of benefit to. I also offer one-on-one session, so if you're interested, you can book a slot via my calendar. It's on the website, which uh you will find. I will link it up in the comments below. So today we'll be talking about sleep across the lifespan, with the main focus being on children. That's where we all begin, and we will explore how sleep evolves from infancy to older adulthood and why it matters for health, learning, and um overall well-being. So we will dissect the common pediatric sleep disorders, how they are diagnosed, and what trick treatment options are available. Yeah, that's all I'll have in this episode. I will have a series of this sleep through the lifespan, which will also look into their different stages of life on the coming episodes. Sleep supports brain development, emotional regulation, learning, memory, memory consolidation, immune health, and growth, and these are all core areas of development throughout infancy. Making sleep actually is essential. Studies suggest that 20 to 30 percent of children experience sleep difficulties at some point, which is actually quite a significant number, if you can if you look at it from like every 20 out of 100 children, or rather 20 to 30, that's a lot, and that's also a huge number of families which are affected. Today we'll explore normal sleep patterns in children, the most common childhood sleep disorders, and the diagnostic methods applied, as well as the treatment options available for these disorders in children. To begin with, what actually does normal sleep look like in children? And what does it even mean to say normal, you know? Newborns typically sleep around 14 to 17 hours per day, and uh, if you've had any experience with newborns, these are spread out across the day, like they'll be sleeping and waking, and between between short periods where they feed, and uh this also even happens at night, like they don't have that sleeping throughout pattern yet when they are newborns, and by the time they are in the preschool age, the sleeping time goes down because yeah, they need to sleep longer, the development they're catching up also goes like is less because they're catching up, they can sit, they can walk, muscles are building up, which is what takes most of their energy, and they need to have more sleep. So, in preschool age, the number of times that kids need, I mean hours is approximately 10 to 13 hours per night, often with naps. Although the naps um disappear gradually, by the time they join school, they need around 9 to 12 hours of sleep, and teenagers require 8 to 10 hours of sleep, though these look different in reality, especially in the phone and social media era, which I feel like this pressure to sleep is I mean to miss sleep is higher than the pressure to sleep, although biologically the more teenagers do need more sleep. Children cycle through two main stages: the REM sleep, which is uh the dreaming and brain development, and the non-REM, which supports the physical restoration and growth. Disrupted sleep affect mood, attention, behavior, and academic performance. My mentor was actually telling a story how he would wonder why kids who are performing well also seemed to have like good features and like were appeared more stable, which is also one thing, like the facial structure and at times the bone structure of the face can already sometimes tell if there is um disruption or rather the developmental uh physiology of the kids, which includes the airways, the mouth, nose, they affect the breathing and yeah, and uh sleep in general. So there is a way, especially in kids, where their facial structure already more or less can tell the quality of the sleep that the children have. And now moving on to the next point, which is um common sleep problems in children. The first common sleep problem is the behavioral insomnia. This is usually noticeable during sleep onset or before bedtime. Children associate sleep with certain rituals like being rocked to sleep or having a parent present. When they wake up at night and not find these same conditions or rituals, they struggle to fall back to sleep. And also common at the delayed bedtime when kids repeatedly ask for staff or resist to go to bed due to inconsistent routine or rules. But this could sound it it's not supposed to be like a critic, but um it's a learned behavior. The children learn that okay, if I ask for more, I get more time, I get more attention, and with time they they do it repeatedly, which is a cycle that yeah can be broken. And um how are these sleep, how is this like the insomnia diagnosed in children? Mainly this uh behavioral insomnia is diagnosed mainly based on sleep history, which is mostly gotten from the parents, the bedtime routine, the uh parent interviews, and the sleep diaries which are recorded again by parents mostly, and this can show a pattern in in how the kids go to bed or how they stay awake. And here I would like to encourage um the parents to use all available tools like phones to document if you notice that your child is delaying their sleep time or they're getting late and late, you can just document the patterns and you can notice whether it's about um the something they need or it's the routine that they get, and that can also be helpful to see where to break the cycle from. What treatment options are available for this behavioral insomnia? The focus is mainly on behavioral strategies, like I've already mentioned. So, a consistent bedtime routine would be very useful. Gradual withdrawal or parental presence, because if you're already training, for example, the child to sleep on their own or to sleep in their room, it's helpful to maybe make the times where you take them to bed shorter and shorter and shorter, and eventually just make them go alone and just maybe way from the door with like do it gradually, don't just do it once, because that will also make them not get like the pattern not like last longer, and also controlled comforting, which is yeah, you can go with them when they need something, but not overstay or not sleep along with them because again, if they see you sleeping with them, they'll fall asleep quick. But if they wake up at night and not find you, they will struggle to go back to sleep. Medication is rarely recommended for these, so yeah, those uh the behavioral strategies are the main ones. OSA is the next uh common uh sleep disorder in children, which is obstructive sleep apnea. This is when the airway is partially or completely blocked during sleep. The symptoms are loud snoring or loud breathing, poses in breathing, mouth breathing, restless sleeping, daytime sleepiness, hyperactivity, mood swings, learning difficulties. And also, if you notice that your child sleeps with their head stretched backwards, that could also be a sign that um they are trying to elongate their airways to get more air. And at times, also with the breathing, I would like to emphasize that with kids the sound of their breathing should be really hard to know. Like if you enter a room where a child is sleeping, you should and the lights are out, you should actually struggle to find where the child is. But if you enter a room and can hear the child's breathing sound, that should already call for um watchful a watchful observation. So you need to just watch how this progresses or develops with time that you sneak into the room and they are sleeping to hear how their breathing progresses, and that can be very helpful. And uh, the breathing in children I wanted to demonstrate is usually could be even something like that's already enough to give a hint that they could be struggling with their breathing. So I watch full observation is um the tip I would give on on that. The most common cause of um obstructive sleep apnea in children are enlarged tonsils and adenoids. The diagnosis for this is usually a polysomnography study, so a sleep study, which currently can be done both in a lab and at home. There are currently really good tools that can be used at home to do this. Treatment option the first line of treatment option to OECA for kids is adenotonsilectomy, which is the shaving or complete removal of the adenoids and tonsils. Weight management can also be um factored in in case obesity is a factor, because yeah, OEC the weight as the way in adults it's mostly also perpetrated with um obesity, can also be a problem to children. And in persistent cases, the kids can also be introduced to CPAP, or rather, the cases where kids end up using CPAP can be varied, maybe there could be still no um if they're not uh stable enough to go through surgery, or if there may be other underlying conditions that uh could still not give them the benefit when they go through a surgery, so this uh using a CPAP can also be an option. Another common sleep problem in children are parasomnias, and these are unusual behaviors that occur during sleep, they are common and harm harmless, and the common examples are night terrors, which is sudden screaming or fear. Children wake up, sometimes they are not conscious, or rather, most of the times they never have the memory of the event. And sleepwalking is another one where yeah, walking in sleep occurs in non-REM sleep, and yeah, that's why because in REM sleep the muscles should be lamed. So sleepwalking mostly happens when the muscles are still active, confusion or arousal when the kids wake up disoriented and not looking like they are aware of their environment, their diagnosis for parasomnias, clinical history, and parent interview, treatment options, adequate sleep, safe sleep environment, scheduled awakening for frequent episodes. Because some I had a case where someone had noticed their child always having these two hours into their sleep. So the best tactic was to wake them up shortly before that so that you can break the cycle before that, like not really completely wake them up, like be around them, make them aware, like two hours into their sleep. Mostly, if kids sleep earlier than the parents, you can be in a position to do that, and then the kids continue with their sleep. The other common sleep disorder in children is restless leg syndrome and periodically movement. This involves uncomfortable sensations in the leg, creating an urge to move, and this worsens at midnight. Yeah, because at night that's when you're supposed to be like resting, the legs are not moving, so this urge worsens when that kind of calmness sets in. Symptoms, difficulty falling asleep, not nighttime restlessness, daytime fatigue, which leads which is actually a cause of poor sleep at night and behavioral concerns, diagnosis for restless leg syndrome or periodic leg movements, clinical history, family history, ion level testing, and sleep studies where the muscles muscle activities of the leg are on main focus. And treatment options are ion supplements if iron deficiency is detected, sleep hygiene improvement, and also rarely there could be other medications administered, although this is very rare. Children may develop delayed sleep, wake phase disorder in their adolescence due to many factors. Like I mentioned before, in this current social media and screen time era, they could have more urge to stay on the screens at times, even with restriction. Maybe they find how to hide or do something, or just generally hanging longer on the screen than they should. This ends up with time shifting their uh circadian rhythm, and also generally, maybe just uh habits of hanging out longer, doing things out longer with friends can lead to this shift. Diagnosis is done mostly through a sleep log or a diary and artigraphy. Treatment, gradual sleep, schedule adjustment, morning bright light therapy, which means the first thing in the morning expose yourself to the natural light instead of the artificial light on the screen, and then you limit evening scream time exposure, and also in some cases there could be admission of melatonin under supervision. So, when do caregivers and parents need to seek help when they suspect that their children have sleep disorders? When there is observed persistent snoring, loud breathing or breathing pose, severe bedtime resistance, frequent night awakenings, excessive daytime sleepiness, development or behavioral changes, safety concerns related to night terrors or sleepwalking. So, I mean any observation you could be making on your child that could make you feel that something is wrong, mostly your instincts could be right, and it's best to have it checked by a specialist because most of the uh disorders in children are actually can be treated. How to promote healthy sleep in children, keep consistent routine at bedtime, cal bell time routines, screen-free window period, comfortable bedroom and environment of sleep, age appropriate sleep duration. Like, don't make these kids maybe who don't need to sleep long, don't take them to the bedroom too early because eventually they will develop what looks like insomnia, but not, and also encouraging uh daytime physical activity and not just um inactive or or you know, like activities that make them not feel tired because their body needs that, the body needs more um movement. I I mean this is not only for children, but even another but today the focus is on children, encourage them to do uh physical activities because this also activates their body to activate the other processes, which includes initiating sleep on its own. Understanding these disorders helps family seek timely support and improve not only the child's well-being but that of the family as well. I hope this episode has um you've taken something along with you, some learned something new, and I'm grateful for joining me on this episode once again. And for uh don't forget to share if you know anybody who could be needing to hear this or who the information can be useful too. Leave a comment also if you have your experience with kids or your own or kids you've taken care of, how you went about it, and which tips helped to go through that um stage, whether with sleep disorders or in um when the observation what you did, which steps you took, and how it ended up. I would really like to hear different experiences. And till next time, I hope you take care and I decourage encourage you to watch out for um a couple of events I'll be posting upcoming, and uh I will either post the direct links the live uh upcoming end of this month. That would be very interesting if you can join them on live or if you can also you can also have the recorded um events later on. So watch that out and stay on this space. I'll be excited to have an interaction with you all, and yeah. Till next time, have a good day or good night, depending on where you are.