Zafer Soultan MD explains why some kids have a difficult time getting a good night’s sleep.
What’s the most common cause of sleep trouble in children?
“After the first year of life, the most common is what we call obstructive sleep apnea, when children have difficulty breathing to the degree that they stop breathing while they are asleep. This problem occurs most commonly secondary to large tonsils and adenoids.
“The parents may observe that there is something wrong with the child breathing. They witness the child struggling to breathe, waking up frequently at night, snoring loudly with pauses and gasping for air.”
What else is to blame?
“Behavioral problems can cause insomnia and parasomnia, difficulty falling asleep and maintaining sleep.
“With these children, it’s hard for them to fall asleep because they haven’t learned how to sleep on their own. Since they were babies, they learned that in order to sleep they need to be in the hands of the mom or the dad, or rocked in a chair, and they fall asleep in the arms of a parent and they’re put in bed. These children do not know how to sleep on their own, and unless they are provided with the mom or the dad they will not be able to sleep.
“This is tied to another issue which we call a ‘limit setting problem.’ This is a child who keeps having what we call curtain calls. They keep coming out to the audience, the parents, with different requests. The reason they do that is, they’re having nighmares or night fears, or just because they never had limit setting in the family to say ‘you’ve got to go to bed to sleep.’ They haven’t learned that they can sleep on their own, that they don’t have to be in the arms of the mother or the father.”
How do you differentiate a disorder from normal developmental?
“When there are consequences, to the family or to the children, we call it a disorder.
“A lot of children snore, but not all these kids have obstructive sleep apnea. And even if they do have a few episodes of apnea, we ask whether they have developed consequences. They may have learning difficulties, cognitive deficits, hyperactivity, or they may wake up frequently and struggle to breathe.
“The same for insomnia. Most types we encounter are behavioral. If the parents are happy with this arrangement, there is no disorder. In fact, it sometimes varies by type of family, traditions, cultures. They may not mind that the child wakes up and they go to the child to hold them, to carry them. But sometimes it disturbs the life of the family and the child very much, and the children eventually do not get adequate sleep, and the next day they will manifest with cognitive problems and behavioral problems.”
“The children (age newborn to 18) who are referred to the sleep center will be evaluated by a sleep specialist to sort out the problem, and then the specialist will recommend proper treatment. If we feel it is a breathing problem, then the patient will undergo a sleep study to identify the exact problem and determine the treatment.
“For large tonsils and adenoids, the recommended treatment is surgical removal. For insomnia and other behavioral problems, the children and family are referred to a specialist in behavioral sleep medicine.”
Hear Dr. Soultan’s interview on this subject on Health Link on Air radio.