Side note: there was a story on 48 Hours in February 2002 that showed studies proving that a large number of children with apena, that caused excessive snoring at night, were misdiagnosed as being hyperactive or AD/HD. Once their apena was treated with minor surgery, their behavoir became normal. It was amazing!
It's the middle of the night and everyone in your house is fast asleep. Suddenly, you are jolted out of bed when you hear your child scream. It's probably another nightmare, you think, as you head into his room to console him.
A nightmare is one type of parasomnia. Parasomnia, which means "around sleep," also includes sleepwalking, night terrors, bedwetting, and narcolepsy. All can create havoc in your home, and some can be harmful to your child. Keep reading to learn about the three categories of parasomnia (rhythmic, paroxysmal, and static disorders) and to find out how you can help your child.
Rhythmic disorders, such as head-banging, head-rocking, and body-rocking, involve movements that range from mild to seizure-like thrashing. Other rhythmic disorders include shuttling (rocking back and forth on hands and knees) and folding (raising the torso and knees simultaneously).
During the rhythmic movements, the child may moan or hum. These movements seem to occur during the transition between wakefulness and sleep or from one stage of sleep to another.
There is no known cause for this type of disorder, but medical or psychological problems are rarely associated with it. Children who experience rhythmic disorders may have morning headaches, nasal problems, and ear infections.
Another rhythmic disorder is restless legs syndrome (RLS), a sensory and motor abnormality that seems to have a genetic basis. In RLS, the child's legs move repeatedly. Many people who have RLS also have periodic leg movement syndrome (PLMS) - this occurs during sleep when the legs move involuntarily.
Treatment for RLS can include:
- music therapy (rhythmic sounds, such as the ticking of a metronome, may help induce and regulate sleep)
- motion-sickness medications
Paroxysmal disorders are those that come on or recur suddenly. They include night terrors, nightmares, sleepwalking, and bedwetting.
Night terrors (also known as Pavor Nocturnus) are characterized by a sudden arousal from sleep with a piercing scream or cry. During the episode, heart and breathing rates may increase and the child's eyes may be open, but he probably won't remember what happened - other than waking up and feeling scared.
Night terrors occur in the first third of the sleep cycle, when the child is in deep sleep. Instead of waking or moving into another stage of sleep, the child gets "stuck" between stages. This can occur in as many as 15% of young children and can be caused by being overly tired or having an interrupted sleep cycle.
By themselves, night terrors are not dangerous, but what happens during one can be. A child may jump out of bed and do something that he might not otherwise do.
There is no known cause of night terrors, but some doctors believe that it has to do with physical causes. Apnea may be present.
Following evaluation to eliminate any possible physical causes (such as neurological conditions), medication may be used as treatment.
Nightmares differ from night terrors in that they are usually psychologically based, are more often remembered, and aren't usually dangerous.
Nightmares also occur only during REM (rapid eye movement) sleep. During REM sleep, the sleeping person's eyes move quickly, heart rate and breathing may be erratic, and dreams (or nightmares) may occur. Non-REM sleep (also called slow wave sleep) is deeper.
Sleepwalking, which is usually mild, can be hazardous when it's frequent or intense.
Because the child is not awake during an episode, dangerous objects should be removed from the room where he sleeps and the windows should be locked.
Following a medical evaluation, these treatments may help reduce or eliminate sleepwalking:
- consistent sleep-wake cycle
Bedwetting, also called enuresis, is a common problem that can affect a child's self-esteem as well as his sleep. Because it occurs at night and can affect sleep, bedwetting is classified as a parasomnia.
It typically occurs in children who are between the ages of 3 and 8. Bedwetting usually stops on its own, but it sometimes continues into adolescence. A child who regularly wets the bed should see a doctor to rule out any physical cause.
Static disorders, which are not disruptive, include sleeping with open eyes (this can be common in infants and young children) or in odd positions (such as upside down or arched).
Even though static disorders are not harmful, children who sleep in odd positions or with their eyes open should be examined by a doctor, especially if the behaviors persist or they are accompanied by other unusual symptoms.
Helping Your Child
If you're worried about your child's sleeping patterns, talk with your child's doctor. He or she may refer you to a sleep specialist or encourage you to establish good sleep hygiene for your child, which would include:
- following a fixed bedtime and wake-up time (and nap times)
- keeping consistent play and meal times
- avoiding stimulants, such as caffeine, near bedtime
- making the bedroom quiet, cozy, and conducive to sleeping
- using the bed only for sleeping - not for homework, playing, or watching TV
- limiting food and drink before bedtime if gastroesophageal reflux (GER) or bedwetting is a problem
It may also help to keep a pre-sleep diary for your child. In the diary, record what your child does before he goes to bed, when he goes to the bathroom, and what he eats and drinks. Other information you can include, such as the weather conditions, may help your child's doctor create a successful treatment program.
Updated and reviewed by: Kim Rutherford, MD
Date reviewed: September 2001
Originally reviewed by: Aaron Chidekel, MD
Apnea and Your Child
Everyone has brief pauses in their breathing pattern called apnea - even your child. Usually these brief stops in breathing are completely normal. Sometimes, though, apnea or other sleep-related problems can be a cause for concern. Read on to find out what it means when your child's doctor mentions apnea.
Types of ApneaThe word apnea comes from the Greek word meaning "without wind." Although it's perfectly normal for everyone to experience occasional pauses in their breathing, apnea can be a problem when breathing stops for 20 seconds or longer.
There are three types of apnea: obstructive, central, and mixed.
This type of apnea is caused by an obstruction of the airway (such as enlarged tonsils and adenoids), and it is a common type of apnea in children. As many as 1% to 3% of otherwise healthy preschool-age children have obstructive apnea.
The most common symptom is snoring; others include labored breathing while sleeping, gasping for air, sleeping in unusual positions, and changes in color. Because obstructive sleep apnea may disturb sleep patterns, these children may also show continued sleepiness after awakening in the morning, and tiredness and attention problems throughout the day. Sometimes this can affect school performance. One recent study suggests that some children diagnosed with AD/HD actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.
Treatment for obstructive apnea involves keeping the throat open to aid air flow, such as with adenotonsillectomy (surgical removal of the tonsils and adenoids) or continuous positive airway pressure (CPAP). CPAP involves having the child wear a nose mask while sleeping.
Central apnea results when the part of the brain that controls breathing doesn't start or maintain the breathing process properly. It's the least common form of apnea (except in very premature infants, in whom it is seen fairly commonly because the respiratory center in the brain is immature) and often has a neurological cause. A few short central apneas are normal, particularly following the deep breath that occurs with a sigh.
Mixed apnea is a combination of central and obstructive apnea and is seen particularly in infants or young children who have abnormal control of breathing. Mixed apnea may occur when a child is awake or asleep.
Conditions Associated With Apnea
Apnea can be seen in connection with:
Apparent Life-Threatening Events (ALTEs)
An ALTE itself is not a sleep disorder - it's an event that is a combination of apnea, change in color (bluish lips or face), change in muscle tone, choking, or gagging. Most ALTEs can be scary to observe, but they usually are uncomplicated and do not recur.
Some ALTEs, though, especially in young infants, are associated with medical conditions (such as gastroesophageal reflux (GERD), infections, neurological disorders) that can cause apnea. These medical conditions require treatment, so all children who experience an ALTE should receive emergency treatment. Call 911 immediately if your child shows the features of an ALTE listed above.
Apnea of Prematurity (AOP)
This condition can occur in infants who are born prematurely (before 34 weeks of pregnancy). Because the brain or respiratory system may be immature or underdeveloped, the baby may not be able to regulate his own breathing normally. AOP can be obstructive, central, or mixed.
Treatment for AOP can involve the following:
- keeping the infant's head and neck straight (premature babies should always be placed on their backs or sides to sleep to help keep the airway clear)
- drugs (such as aminophylline, caffeine, or doxapram) to stimulate the respiratory system
- continuous positive airway pressure (CPAP) - to keep the airway open with the help of forced air through a nose mask
Apnea of Infancy (AOI)
If the cause of apnea can't be found and it continues, this is called apnea of infancy. It occurs in children who are younger than 1 year old and who were born after a full-term pregnancy.
Infants can be observed at home with the help of a special monitor prescribed by a sleep specialist. This monitor records chest movements and heart rate and can relay the readings to a hospital apnea program or save them for future examination by a doctor.
The apnea usually goes away on its own, but if it doesn't cause any difficulties (such as low blood oxygen), it may be considered part of the child's normal breathing pattern.
What to Do if You Think Your Child Has Apnea
If you suspect that your child has apnea, call your child's doctor. If you suspect that your child is experiencing an ALTE, call 911 immediately.
Most cases of apnea can be treated or managed with surgery, medications, monitoring devices, or sleep centers. Many cases of apnea go away on their own.
Updated and reviewed by: Kim Rutherford, MD
Date reviewed: October 2001
Originally reviewed by: Aaron Chidekel, MD
Source: KidsHealth www.KidsHealth.com is a project of The Nemours Foundation which is dedicated to improving the health and spirit of children. Today, as part of its continuing mission, the Foundation supports the operation of a number of renowned children's health facilities throughout the nation, including the Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the Nemours Children's Clinics throughout Florida. Visit The Nemours Foundation to find out more about them and its health facilities for children http://www.nemours.org/no/
The National Alliance for the Mentally Ill (NAMI) is a nonprofit, grassroots, self-help, support and advocacy organization of consumers, families, and friends of people with severe mental illnesses, such as schizophrenia, major depression, bipolar disorder, obsessive-compulsive disorder, and anxiety disorders. URL: http://www.nami.org/illness/
Sleep disorders: There are several types of sleep disorders including insomnia, narcolepsy, and obstructive sleep apnea. Obstructive sleep apnea affects approximately 30 million Americans. It is characterized by recurrent episodes during sleep when the throat closes and prohibits air from entering the lungs (apnea), thus causing breathing to stop for a short time.
Sleep Disorders Fact Sheet - Reference guide to common sleep disorders, their causes, symptoms, and treatments.