What to Do if Your Child Can’t Concentrate, Lacks Energy, or Snores

If your child has trouble concentrating in school, lacks energy or is snoring while asleep, he or she may be suffering from sleep apnea. It’s estimated that one to four percent of children suffer from sleep apnea and many of them are between the ages of two and eight.1 An ear, nose, throat specialist can diagnose sleep apnea and prescribe effective treatments.

What to know about sleep apnea in children
There are many signs and symptoms of sleep apnea and some appear to be unrelated to a lack of sleep. For example, you may think your child is having difficulty in school due to concentration problems. Your child may be hyperactive and exhibit the classic symptoms of ADHD, or, on the other hand, he or she may be lethargic. All of these may be related to repeatedly interrupted sleep.

 
Common signs and symptoms of sleep apnea in your child

• Snoring: Either classic loud snoring or loud, noisy breathing while sleeping.
• Breathing stops: You notice that your child’s chest is moving up and down as though breathing, but no air is moving in or out of the nose or mouth.
• Breathing through the mouth: Your child is breathing through his or her mouth while sleeping instead of through the nose.
• Restless sleep: Your child tosses and turns frequently throughout the night.
• Odd sleeping positions: You find that your child sleeps sitting up in bed, or sleeps with the neck arched backwards.
• Sleepiness: Your child is sleepy during the day.
• Behavior problems: Your child is hyperactive, lethargic, irritable, frustrated and/or angry.
• Problems in school: The teachers may report that your child has problems engaging in school or seems slow to learn. They may even say your child is lazy.
• Frequent ear infections: Sleep apnea may cause frequent ear infections as well as infections of the tonsils and adenoids.
• Headaches: Your child may complain about having headaches during the day.

There are two types of sleep apnea: obstructive (OSA) and central sleep apnea

1. Obstructive (OSA) sleep apnea: This type of sleep apnea occurs when the airway is blocked during sleeping. When the tonsils become swollen they can block the airway.
2. Central sleep apnea: This type of apnea occurs when the brain forgets to tell the muscles to expand and contract for breathing during sleep.

Confusing diagnoses
As you can see from the long list of symptoms, it can be confusing to determine the causes of some types of childhood behavior and physical problems. For example, the American Sleep Apnea Association (ASAA) states that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder (ADHD) may, in fact, have symptoms of obstructive sleep apnea (OSA) and that “much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep1.”

Suspected sleep disorders should be addressed and properly diagnosed. Believing that a child will grow out of his or her sleep disorders can be detrimental to long-term health. It may create a wide range of problems that can range from hormonal problems to the ability of the brain to organize thoughts and actions. Sleep is so important that the ASAA quotes one of its board members, Judith Owens, M.D., director of sleep medicine at the National Children’s Medical Center in Washington, DC as saying that “adequate healthy sleep is as important as proper diet and sufficient exercise in preventing childhood obesity.”

 
How is sleep apnea diagnosed?
As with adults, one of the ways to diagnose sleep apnea in children is in a sleep lab. The child sleeps in a comfortable bed in a bedroom setting while hooked up to sleep monitors2 called “electrodes.” They are not electrified; rather, they are diagnostic leads that detect many different things while the child sleeps including brain function, breathing and eye movement. A sleep technologist is present during the sleep lab overnight to supervise your child and to gather data. When the sleep study is complete, the data is interpreted by a doctor who is a board-certified sleep specialist (see Dr. Don Sesso, D.O.).

In addition to requesting a sleep study, your child’s physician will conduct a physical examination and collect a medical history, including information about the child’s sleep patterns and behavior while sleeping.

How is sleep apnea treated?
There are several different types of treatment depending upon the diagnosed cause of the sleep apnea. They can include:

• Removal of the adenoids and tonsils: These are removed surgically. If it is determined that they are blocking the child’s airway during sleep, removing them may successfully address the sleep apnea. According to the ASAA1, this can eliminate symptoms 70 to 90 percent of the time.
• C-PAP machine: Short for “positive airway pressure therapy,” these assistive devices increase airflow while sleeping. The child wears a mask much like an oxygen mask or a nasal canula, a small plastic piece that is inserted into the nasal openings and worn while sleeping, that increases airflow to counteract any obstacles to breathing. Children who use these should be checked every year to determine the effectiveness of the machine and adjustments, if any, to air pressure.
• Oral devices: Sometimes a small mouthpiece can help to keep the airways open, thereby avoiding sleep apnea.
• Losing weight: Obese children with heavy necks may experience sleep apnea because the weight of their neck flattens their airways when they lie down. Losing weight can significantly reduce, and may eliminate, sleep apnea.

Support for sleep apnea
Parents who suspect their children suffer from sleep apnea should consult their child’s physician and an ear, nose, throat specialist. Once diagnosed, treatments for sleep apnea can improve sleep and daily functioning for the child. Parents of children with sleep apnea can find support through the ASAA and their A.W.A.K.E. group network3.

References
1: https://www.sleepapnea.org/treat/childrens-sleep-apnea/
2: http://www.chop.edu/conditions-diseases/obstructive-sleep-apnea
3: https://www.sleepapnea.org/community/all-about-awake/a-w-a-k-e-network-map/