Sleep Disorders

What are childhood sleep disorders?

Childhood sleep disorders are conditions that make it difficult for children to get sufficient rest or cause excessive sleepiness. Childhood sleep disorders affect school performance by causing decreased attention, learning, memory and focus. Additionally, sleep disorders affect a child’s behavior, causing irritability and hyperactivity.

Sleep problems can be categorized as either behavioral or medical. Behavioral sleep conditions are frequently due to poor sleep hygiene caused by a lack of routine, poor sleep environment and insufficient sleep.

Medical sleep conditions include:

• Many forms of insomnia
• Obstructive sleep apnea
• Central sleep apnea
• Hypoventilation
• Circadian rhythm disorders
• Narcolepsy
• Parasomnias
• Restless legs syndrome
• Periodic limb movement disorder

What causes the medical sleep disorders?

Obstructive sleep apnea (OSA) is difficulty moving air during sleep. OSA can be caused by an obstruction of the airway (by enlarged tonsils and adenoids) and obesity. Conditions related to decreased muscle tone or craniofacial abnormalities seen in Down syndrome or in children with nasal obstruction can also cause the condition. OSA is diagnosed after an overnight sleep study.

Central apnea occurs when the part of the brain that controls breathing doesn't properly maintain the breathing process. It is fairly common in very premature infants because the respiratory center in the brain is immature.

Hypoventilation is inadequate breathing or ventilation at night. It can lead to abnormal blood gasses (the amount of oxygen and carbon dioxide in the bloodstream). Hypoventilation in pediatrics is typically associated with complex medical disorders.

Narcolepsy is a sleep disorder characterized by excessive sleepiness, dream-like activity while awake and a sudden loss of muscle tone. This is frightening for young children.

Parasomnias include sleepwalking, night terrors and confusional arousals.

Rhythmic movement disorder involves some type of rocking, rolling or head banging. For most children it is a soothing way to fall asleep and of no concern.

Circadian rhythm disorders describe a disruption in a person’s internal body clock causing children and teenagers to sleep at a time that is not normal for the rest of the family. Teenagers commonly have delayed sleep phase and are late to bed and late to rise.

Periodic limb movement disorder causes frequent twitching or movements of the legs or feet during sleep. This can lead to daytime sleepiness because of the interruption in sleep.

What causes the behavioral sleep conditions?

Insomnia is the inability to fall asleep or remain asleep. The causes can be chronic or acute and often involve poor sleep habits and routines. Sometimes insomnia is a medical problem caused by genes, different brain “wiring,” and involves a combination of medical and behavioral therapy.

Helpful resources

• The National Sleep Foundation provides information on healthy sleep as well as sleep disorders.
• American Academy of Sleep Medicine (AASM) is the only professional society dedicated exclusively to the medical subspecialty of sleep medicine.
• Healthy Children provides parents with health information on a variety of health issues and is from the American Academy of Pediatrics.

What are the signs and symptoms of sleep disorders?

Excessive daytime tiredness, inability to focus, hyperactivity and irritability can be a sign of poor sleep in children. Other symptoms of sleep disorders include:

• Snoring (the most common) followed by pauses or gasping
• Labored breathing while sleeping
• Very restless sleep and sleeping in unusual positions
• Daytime sleepiness or behavioral problems
• Bed wetting
• ADHD (attention deficit hyperactivity disorder)
• Parasomnias
• Failure to thrive

What tests are used to diagnose sleep disorders?

After a complete history and physical exam, your health care provider may ask you to keep a sleep diary or sleep log to help diagnose sleep phase problems and insomnia.

A sleep study may also be ordered. This is an overnight procedure in the Sleep Lab at Children's Hospital Colorado. This study is called a polysomnogram, and records different sleep stages to see if there are problems in a child’s sleep and breathing.

The polysomnogram will monitor a child’s brain waves, heart rate, breathing and muscle activity. This is done with the help of sensors that are placed on a child’s head, chin, legs, chest and near the eyes. The sensors are secured to the skin with gels, tape or special mesh netting. Placing the sensors on your child is pain-free.

The hook-up process can take between 1-1 1/2 hours. During the process, you may read bedtimes stories or perhaps watch a video. "Lights Out" designates bedtime when all entertainment ends and the sleep recording begins. When your child is scheduled for a sleep study, you will receive a packet of information detailing the study about 2 weeks prior.

How do providers at Children’s Hospital Colorado make a diagnosis?

There are dozens of causes for excessive sleepiness, sleep-disordered breathing, insomnia and movement problems during sleep. The experts at Children’s Colorado have been specially trained in childhood sleep disorders and provide advice and consultation to your pediatrician when sleep conditions are problematic.

When you see a provider at Children’s Colorado about a sleep disorder, he or she will give your child a physical exam and ask you about your child’s sleeping patterns, medical history, and symptoms. Based on this information, the provider may order further testing or consult with our team of multidisciplinary experts in sleep, breathing and behavior.

How do we treat sleep disorders?

The treatment of a child’s sleep disorder is dependent on the type of disorder and the cause. Breathing disorders may require medical therapy, oxygen, surgical management or machines to help with breathing during sleep. Other disorders require behavioral management or a combination of medical and behavioral therapy.

Occasionally, children seen at the Children’s Hospital Colorado Sleep Center require machines to help with breathing during sleep.

One machine commonly used is called CPAP, Continuous Positive Airway Pressure. CPAP is used to treat obstructive sleep apnea by providing a flow of positive-pressure air through a mask to open the upper airway while the child is asleep. The goal of CPAP is to enable the child to have regular or normal breathing, eliminate snoring and restore normal sleep patterns. Some children may need therapy to tolerate CPAP treatments. We have a desensitization program for these patients.

• Desensitization to PAP therapy (English) (.pdf)
• Desensitization to PAP therapy (Spanish) (.pdf)

Why choose Children’s Hospital Colorado for your child’s sleep disorder?

Children's Colorado’s Sleep Center provides comprehensive clinics to evaluate patients and to make appropriate treatment recommendations so that the entire family can return to a normal night of sleep. Our team assists primary care physicians and specialists with the diagnosis and treatment of infants, children and adolescents with sleep problems.

Many sleep problems can be coupled with other medical problems that your child is dealing with. That is why the multidisciplinary approach to care at Children's Colorado is so important when successfully solving sleep problems. The Sleep Center team works closely with other teams within the hospital, including Pulmonary Medicine, Otolaryngology or Ear, Nose, Throat (ENT) specialists, Neurology and Adolescent Medicine.