What is Asthma?
Asthma is a chronic lung condition marked by inflammation, constriction of the airways, and difficulty breathing. Asthma attacks, or worsening of asthma symptoms, can occur after exposure to factors known as triggers.
Asthma symptoms can vary from one patient to the next, but generally include wheezing, noisy breathing, coughing (often at night and/or with exercise), chest tightness, and/or trouble breathing. Symptoms can happen daily, weekly, monthly, or even less often. Symptoms can range from mild to severe. Although rare, an episode of asthma can lead to death.
The optimal treatment of asthma depends upon a number of factors, including the person’s age, the severity and frequency of asthma attacks, and proper use of prescribed medications. For most children, asthma treatment can control symptoms, allowing the child to participate fully in all activities, including sports.
Successful treatment of asthma involves three components:
- controlling and avoiding asthma triggers
- regularly monitoring asthma symptoms and lung function
- understanding how and when to use medications to treat asthma
Common asthma triggers fall into several categories: respiratory infections, allergens (including dust, pollens, and furred animals), irritants (such as tobacco smoke, aerosol sprays, some cleaning products), exercise, and cold air among others. Your doctor might have your child do a breathing test to see how his or her lungs are working. Most children five to six years of age and older can do this test. This test is useful, but it is often normal in children with asthma if they have no symptoms at the time of the test. Your doctor will also do an exam and ask questions about symptoms, especially nighttime symptoms and symptoms that occur during/after colds and with exercise.
Asthma is treated with different types of medicines. These can include inhalers, liquids, and/or pills. Asthma medicines work in one or two basic ways:
- Long-term control (prevention) medications help control asthma, decrease the risk of having an asthma flare up, help prevent future symptoms, and need to be taken consistently each and every day.
- Quick-relief (rescue) medications help decrease symptoms quickly. Doctors prescribe these when children do not have symptoms often. Some children get very active after taking these medications.
Almost all children with asthma use an inhaler with a device called a “spacer“. Some children also need a machine called a “nebulizer” to breathe in their medicine. Your doctor will show you the right way to use these.
It is very important that you give your child all the medicines prescribed. You might worry about giving a child a lot of medicine, but leaving your child’s asthma untreated has much bigger risks than any risks the medicine might have. Asthma that is not treated with the right medicines can prevent children from doing normal activities, cause children to miss school, and possibly damage the lungs.
An asthma action plan is a list of instructions that tell you what medicines your child should use at home each day, what warning syptoms to watch for, what other medicines to give your child if the syymptoms get worse, and when to get help or call for an ambulance (ex. dial 9-1-1).
Sometimes, asthma gets better as children get older. They might not have asthma symptoms when they become adults. But other children can still have asthma when they grow up.
Talk with your child’s doctor about any questions you have about asthma.
What is a Sleep Specialist?
A Sleep Specialist is physician with advanced training and expertise in the management of disorders of sleep and wakefulness. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, excessive sleepiness, fatigue, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.
Our sleep physicians are dually trained and Board Certified in the subspecialties of sleep medicine AND another medical specialty.
We specialize in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep, and circadian rhythm disorders. Sleep specialists use multidisciplinary approaches, incorporating treatments from medicine, psychology, and even dentistry when needed.
Sleep apnea is airway restriction
During normal sleep, our airway muscles remain open permitting air to flow properly. However with sleep apnea, the airway muscles can relax and become partially or totally blocked resulting in diminished air flow or complete obstruction. This repetitive process over time can be harmful to an individual’s vascular, neurological, and mental health.
While many people have signs of snoring, not all snoring is related to sleep apnea. On the other hand, if snoring is associated with certain symptoms, such as sleepiness or insomnia this may be an indication of sleep apnea which requires further evaluation. Recall that while sleep partners are often the ones to complain about snoring, treating one’s snoring can improve the sleep quality of the affected bed partner as well.
Common symptoms associated with sleep apnea include restless sleep, awaking with a choking, gasping, smothering, snorting sensation, morning headaches, dry mouth, frequent need to urinate during the night, sweating during sleep, waking up unrefreshed, daytime sleepiness, and memory impairment.
Who gets sleep apnea?
Risk factors for sleep apnea include increasing age, male sex, obesity, sedating medications, alcohol, abnormal upper airway or jaw anatomy. Women’s risk factors also increase during menopausal years.
Men with neck sizes of 17 in. or greater have a higher risk of sleep apnea. Women with neck sizes of 16 in. or greater have a higher risk of sleep apnea.
Patients with poorly treated high blood pressure requiring at least two or three medications are at higher risk for sleep apnea. Patients with cardiac rhythm problems, such as atrial fibrillation in particular, are at increased risk of having sleep apnea.
If a bed partner specifically identifies pauses in breathing, this is a very sensitive indicator for this disease.
Treating Sleep Apnea Can Add Years to Your Life
Accidents – The complications of sleep apnea include increased risk of accidents because of daytime sleepiness and inattentiveness. The effects of sleep disorders can be significantly more than driving while under the influence of alcohol. There have been studies showing that people with severe sleep apnea are two times as likely to be involved in a motor vehicle accident as opposed to people without this condition.
Stroke, heart attack, diabetes – In addition, there is now ample medical evidence showing that untreated sleep apnea can increase the risk of cardiovascular problems such as high blood pressure, heart attacks, abnormal heart rhythms, or stroke. It has also been associated with poorly controlled diabetes mellitus.
Effects on pregnancy? In pregnant women, there is increasing evidence that untreated sleep apnea can be associated with complications toward the end of pregnancy and smaller weight babies.
How Do I Know if I have Sleep apnea?
The best way to identify this particular disease is by performing an overnight sleep test called a polysomnogram. The test is performed in a comfortable hotel-like atmosphere with highly trained technicians that monitor breathing, brain, leg movements, and heart parameters throughout the night. It is a painless test and can provide invaluable information on how to proceed with further treatment. In some cases, a home sleep study is utilized in place of an in-lab study. This is increasingly required by some insurance companies as a screening tool. This can also be obtained either through our office or through the sleep lab. It is advisable to have a board certified sleep physician review the data results for the most accurate interpretation. Reviewing the results of these studies help patients understand the meaning of these test results.
Treatment – CPAP and More
If one is diagnosed with obstructive sleep apnea, the severity of the disease can dictate the potential treatment options.
CPAP, BPAP, SVPAP – Most people are familiar with CPAP, a device that produces air pressure using a soft and pliable mask placed over the nose or mouth which provides mild pressure support to prevent the throat from collapsing throughout the night. While it may take several weeks or months to get used to this particular treatment, it can be particularly rewarding as it can improve sleep and reduce multiple risk factors discussed above.
Alternatives to CPAP? Your sleep physician may also discuss alternative treatments.
- Dental Treatments – With mild or moderate sleep apnea, an oral appliance which is a modified dental guard may be suggested. This is usually a custom designed device that helps maintain an open airway throughout the night and is generally well accepted. It typically requires at least 10 native healthy teeth and no evidence of significant TMJ.
- Nasal Valves – Newer alternative treatments for sleep apnea continue to develop including a novel nasal device called “Provent.” Board certified sleep physicians are well versed on this newer form of therapy.
- Surgery – On occasion, surgical treatment may be an alternative form of therapy or as additional therapy to help remove excess tissue in either the nasal area or the throat area which may improve airway movement. Newer tongue surgery or jaw surgery can also be considered. The success rate with surgery is roughly about 50-75% and sometimes is used in combination with other forms of treatment. Surgical options should be considered by a surgeon well versed and experienced in their particular area. A sleep physician can help guide possible surgical options. One of the most important issues regarding the pursuit of surgical options is that the patient must get a post-surgical sleep study to be certain all the disease is eliminated successfully.
- Weight loss – Other forms of treatment for sleep apnea include weight loss. Weight loss can reduce the severity of sleep apnea and in some cases of mild sleep apnea can actually eliminate the disease. But one cannot assume that weight loss alone will cure the problem without retesting after weight loss has been achieved.
- Avoidance of alcohol and sedating medication can also decrease the severity of sleep apnea. Sometimes avoidance of sleeping on your back can reduce the severity of sleep apnea. Unfortunately this is difficult to achieve throughout the entire night on a consistent basis, though some commercial products are currently on the market.
A board certified sleep physician is the best resource to determine which optimal treatment you should pursue. It is important to find an acceptable form of therapy as each individual therapy needs to be optimized for one’s individual needs.
Insomnia:
Most individuals experience insomnia at some point in their lives. Most often it is a temporary situation that resolves on its own. However if initiating or maintaining sleep persists more than 3 continuous months, then this may be an indicator that professional help is needed. If someone becomes reliant on taking some form of medication, whether over the counter or prescription medication, then a formal evaluation by a sleep specialist may be helpful.
Commonly people will try to take melatonin at increasing doses if lower doses do not help. What is often misunderstood however is this medication is not totally benign, especially at higher doses. Indeed, this medication can alter one’s circadian rhythm and actually can exacerbate sleep schedules. It is best to have a sleep specialist review potential reasons an individual develops insomnia or to help guide therapy on how best to treat insomnia without the need for medication. If one is on chronic medication for insomnia, discontinuing that medication suddenly is not advisable and should be done on a gradual and graded fashion.
Tools used by a sleep physician include the use of Actigraphy, a special watch worn by the patient for several days to monitor sleep/wake and light exposure. Use of sleep diaries over 1-2 weeks can also be helpful. Increasingly, smartphone apps are used to monitor sleep. At this point in time, they are not approved by the FDA and their accuracy is in question. However they can be useful to determine general sleep schedules and may assist therapy to a limited extent.
OTHER SLEEP DISORDERS:
Sleep physicians are also well versed in treating night time awakenings caused by “parasomnias”, dream enactment, and limb movement disorders. In addition, excessive sleepiness as noted by conditions such as narcolepsy is commonly treated by sleep specialists.
What is a Pediatric Pulmonologist?
A pediatric pulmonologist is a medical doctor who specializes in the treatment of lung and breathing disorders in children. The diagnosis and treatment requires expert knowledge that is obtained through extensive educational training and followed by board certification through the American Academy of Pediatrics. If your child has trouble breathing, asthma, problems with his or her lungs or signs of sleep apnea, a pediatric pulmonologist has the experience and qualifications to treat your child.
What type of problems does a pediatric pulmonologist treat?
Pediatric pulmonologists often treat children with the following conditions:
- Asthma
- Recurrent cough and wheezing
- Snoring and sleep apnea
- Chronic cough
- Difficulty breathing
- Exercise induced shortness of breath
- Recurring pneumonia
- Cystic Fibrosis
- Neuromuscular diseases
- Infant Apnea
- Chronic lung disease in premature infants
- Noisy breathing
- Chronic ventilation
- And many others…
Our goal is to improve the quality of life for all of our patients so they may lead healthy active lives.
We offer a comprehensive approach in the diagnosis and management of breathing and lung diseases. We perform lung function tests, provide thorough asthma education and monitor symptoms closely.
Children that are born prematurely may have a unique set of pulmonary and medical problems. More specifically, these children are at risk for developing a pulmonary condition, known as bronchopulmonary dysplasia or chronic lung disease. All children with this disorder should be under the care of a pediatric pulmonologist. These children are more susceptible to viral infections and require a comprehensive approach in management. As part of these children’s care, we administer Synagis to increase protection against the potential life threatening complications from a virus known as RSV. It is given monthly during RSV season for babies (less than 2 years of age) that were born premature or have congenital heart disease.
Remember:
Children and teens are not just small adults. Their bodies are growing and have unique medical needs. They usually express their concerns differently than adults and cannot always answer medical questions appropriately.
Pulmonary Procedures performed:
- Asthma Education
- Pulmonary function testing (PFT)
- Exercise testing
- Bronchoscopy
- Rhinoendoscopy
- Nebulizer Treatments
- Impulse Oscillometry (IOS)
Asthma Diagnosis
The diagnosis of asthma in children requires a careful review of a child’s current and past medical history, family history, and a physical examination. Specialized testing is sometimes needed to diagnose asthma and to rule out to assess other possible causes of symptoms. Many children with asthma appear and sound completely normal.
Spirometry testing
The most accurate test for diagnosing asthma is spirometry or pulmonary function testing. Spirometry measures the flow and volume of air generated after a child takes a very deep breath and then forcefully tries to blow the air out of his/her lungs. If airflow obstruction is present, the test is repeated after the child uses an asthma inhaler (bronchodilator) to confirm that the obstruction is reversible (a feature of asthma).
Children younger than six years sometimes have a hard time following the instructions to perform spirometry. Airway resistance testing can also be performed in specialized centers such as our center. Alternatively, a healthcare provider may recommend a trial of medication to confirm the diagnosis.
Does My Child Have Asthma?
This is a frequent question parents ask their healthcare provider. Many times the answer may not be straightforward and requires a detailed history, exam and additional testing such as pulmonary function tests to make the diagnosis. In our office, we have the expertise to assess your child and provide the proper therapy if indicated.
Why is it important to have a proper diagnosis for asthma?
The symptoms of asthma can be tricky and it is not just about wheezing. For this reason, children are often misdiagnosed with allergies, chronic cough, and sinus problems when in fact it is unrecognized asthma. Some patients and parents are scared when a diagnosis of asthma is made, for fear that their child will be labeled as weak or will always have breathing difficulties. This is definitely not true, and it is important to receive proper education and information regarding asthma, so that your child can receive appropriate care. We expect all of our patients with asthma to live full and normal lives without any impairment.
What is a Pediatric Sleep Specialist?
A Pediatric Sleep Specialist has special advanced training in disorders of sleep and wakefulness in youngsters through the age of adolescence.
Sleep problems in children has been linked to inattentiveness, hyperactivity, poor school performance, bed-wetting, ADHD, weight problems, headaches, asthma and many other problems. Sleep disorders frequently complicate other common pediatric problems such as Downs syndrome, cerebral palsy, developmental delay, epilepsy, spina bifida, lung and airway disorders and many others.
Our medical staff is certified by the American Board of Pediatrics after passing a comprehensive examination covering all areas of health related to infants, children, and young adults.
If your physician suggests that your child see a sleep specialist, you can be assured that your child will receive the best possible care.
What is Obstructive Sleep Apnea?
The most common kind of sleep apnea is called Obstructive Sleep Apnea Syndrome. It is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation.
What symptoms may or may not be present?
- inattentiveness
- hyperactivity
- excessive daytime sleepiness
- suboptimal school performance compared to the child’s ability
- frequent episodes of obstructed breathing during sleep
- unrefreshing sleep
- falling asleep in inappropriate situations
Associated features may include:
- snoring
- nocturnal snorting, gasping, choking (may wake self up)
- restless sleep
- heavy irregular breathing
- excessive perspiring/sweating during sleep
- bedwetting
- bad dreams (nightmares)
- night terrors
- sleeps with mouth open, causing a dry mouth upon awakening
- chest retraction during sleep in young children (chest pulls in)
- sleeps in strange positions
- confusion upon awakening
- morning headaches
- unrefreshing sleep
- excessive daytime sleepiness
- may develop high blood pressure
- may be overweight or underweight
- learning problems
- excessive irritability
- change in personality
- depression
- difficulty concentrating
- Developmental problems
- failure to thrive or grow
- frequent upper respiratory infections
- hyperactive behavior
How serious is sleep apnea?
It is a potentially life-threatening condition that requires immediate medical attention.
The risks of undiagnosed obstructive in children with sleep apnea include learning problems, developmental problems, behavior problems and in some cases, failure to grow, heart problems and high blood pressure. In addition, obstructive sleep apnea causes daytime sleepiness that can result in personality changes, lost productivity in school and interpersonal relationship problems. A child with sleep apnea may lag behind in one or many areas of development. The child may become easily frustrated and depressed. The severity of the symptoms may be mild, moderate or severe.
How does the doctor determine if my child has Obstructive Sleep Apnea?
A sleep test, called polysomnography is usually done to diagnose sleep apnea. An overnight polysomnography test involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level in the blood and audio monitoring. (for snoring, gasping, etc.). The test is painless.
How is Sleep Apnea treated?
In children, simply removing the tonsils or adenoids may take care of the problem. Sleep Apnea in children where removing the tonsils or adenoids does not take care of the problem is usually treated with a C-PAP (continous positive airway pressure) or Bi-Level positive airway pressure. C-PAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. Bi-Level has an inspiratory pressure that is higher than the expiratory pressure. The sleep doctor will “prescribe” the pressure and a home healthcare company will set it up and provide training in its use and maintenance.
When your child needs a machine, it can be quite intimidating. A C-PAP machine requires some care and a period of adjustment, but the benefits of C-PAP therapy are worth the inconvenience. C-PAP is NOT a ventilator; it merely keeps the airway open so your child can breathe easily. It is not a complicated machine. A one night stay in a sleep clinic to monitor the child’s breathing is generally all that is required. A C-PAP machine may be “prescribed” for your child. A home healthcare company that contracts with your insurance will provide the machine and show you how it works and how to clean and maintain it.
Some children have facial deformities that may cause or contribute to the sleep apnea. It simply may be that their jaw is smaller than it should be or they could have a smaller opening at the back of the throat. Some children have enlarged tonsils, a large tongue or some other tissues partially blocking the airway. Fixing a deviated septum may sometimes help to open the nasal passages. Removing the tonsils and adenoids or polyps may help also. Compared to adults, children are much more likely to have their tonsils and adenoids removed to solve the problem. There are other treatments that your doctor may consider including orthodontics and surgery.
Although sleep is a basic part of life, it is a complicated process and frequently can cause problems. Problems stemming from not getting enough sleep and not the right kind of sleep can cause mental, physical and psychological problems, which may not be asked about by your doctor.
Healthy Sleep
It is important to instill healthy sleeping habits in your child. Some studies suggest sleep plays a role in brain development. A tired child may have developmental or behavioral problems. Your child’s sleep problem not only affects him/her, but can also be a source of stress and concern for the entire family. For this reason, it is important to make sure that your child gets enough sleep and sleeps well.
The recommended sleep requirements for age:
How much sleep should my child get?
- Infants (3 to 11 months): 14 to 15 hours
- Toddlers: 12 to 14 hours
- Preschoolers: 11 to 13 hours
- School-age children: 10 to 11 hours
These are some signs that your child has a problem with sleep:
- Is too much time spent “helping” your child fall asleep?
- Does your child wake up repeatedly during the night?
- Does your child snore or has pauses in breathing during sleep?
- Does your child have behavioral, mood or school performance problems?
- Does your child wet the bed?
- Are your child’s sleep problems affecting your own sleep?
- Does your child have trouble falling or staying asleep? Many children have behavioral insomnia of childhood.
These are some tips to help your child sleep better:
- Follow a consistent bedtime routine.
- Set aside 10 to 30 minutes to get your child ready to go to sleep each night.
- Establish a relaxing setting at bedtime.
- Interact with your child at bedtime.
- Don’t let the TV, computer or video games take your place.
- Keep your children from TV programs, movies, and video games that are not right for their age.
- Do not let your child fall asleep while being held, rocked, fed a bottle, or while nursing.
- Near bedtime, do not allow your child to have foods or drinks that contain caffeine. This includes chocolate and sodas.
- Try not to give him or her any medicine that has a stimulant at bedtime.
- A child who gets enough sleep and sleeps well is more likely to be cheerful during the day. The better the child sleeps, the happier the entire family will be.
- If your child has an ongoing sleep problem, then you should talk to your child’s doctor or to a sleep specialist.
Frequently Asked Questions for Sleep Disorders
How serious is sleep apnea?
It is a potentially life-threatening condition that requires immediate medical attention. The risks of undiagnosed obstructive sleep apnea include heart attacks, strokes, high blood pressure, irregular heartbeat, and impotence. In addition, obstructive sleep apnea causes daytime sleepiness that can result in accidents and lost productivity.
Is sleep apnea common?
Doctors estimate that about 20 million Americans have sleep apnea. Men who are over age 40 are more likely to have sleep apnea, but it can affect anyone at any age. The prevalence in children is around 1-3%.
What are some symptoms of pediatric sleep apnea?
Although snoring is a common symptom in children with obstructive sleep apnea, it is important to remember that between 10-20 percent of normal children snore (primary snoring) on a regular or intermittent basis. In addition to continuous loud snoring, other symptoms of obstructive sleep apnea in children include:
- mouth breathing
- enlarged tonsils and adenoids
- problems sleeping and restless sleep
- excessive daytime sleepiness
- daytime cognitive and behavioral problems, such as paying attention, aggressive behavior and hyperactivity
How do you know if you or your child may have sleep apnea?
Common night symptoms include:
- snoring or snorting during sleep
- choking or gasping
- apneas (stopping breathing)
- restless sleep
- diaphoresis (sweating)
- enuresis (bed wetting)
- sleeping in abnormal positions such as with neck hyperextended
Common daytime symptoms include:
- inattention or daydreaming
- hyperactive behavior
- learning difficulties
- depression
- aggressive/oppositional defiant behavior
- morning headaches
- tiredness
- difficulty with morning awakening
- mood changes and irritability
- cor pulmonale (right heart overload/failure)
- high blood pressure
- failure to thrive (in infants)
Risk factors for sleep-disordered breathing include the following:
- enlarged tonsils and adenoids
- being overweight (although not all with sleep apnea are overweight)
- craniofacial characteristics, including mid-facial hypoplasia, retrognathia, micrognathia, high arched palate, choanal atresia
- cleft palate
- Down syndrome
- sickle cell disease
- spina bifida
- cerebal palsy
- neuromuscular conditions associated with hypotonia
- allergic rhinitis
- gastroesophageal reflux
- congenital heart disease
- asthma
- family history of sleep-disordered breathing
What happens if my sleep apnea is untreated?
In adults, untreated sleep apnea can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotence and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. In children, untreated sleep apnea can cause failure to thrive, loss of memory and IQ, inattention, hyperactivity, aggressive behavior, and high blood pressure.
When does my child need a sleep study?
When sleep-disordered breathing is suspected, pediatricians should refer the child for a sleep study. The combination of historical information and physical findings has been shown to be poor predictors of obstructive sleep apnea in children. The gold standard for diagnosis remains overnight polysomnography. A sleep study provides additional information for your physician to risk stratifies each child prior to surgery.The more severe and high risk cases require closer monitoring and possible overnight hospitalization. There have been many reported cases of post-operative deaths in children undergoing surgery (adenotonsillectomy) who were not properly assessed prior to surgery.
What should you do if you suspect that you or your child may have a sleep disorder?
You should first discuss it with your physician, and if sleep disordered breathing is suspected or a problem beyond implementing healthy sleep habits, you might need to see a sleep specialist. In order to diagnose certain conditions, you or your child might require an overnight polysomnography or sleep study.
What is a sleep study or polysomnography?
Polysomnography is a series of comprehensive tests that are performed on patients while they sleep in order to look for sleep disorders. It usually involves monitoring of the patients airflow through both the nose and mouth, blood pressure, heart rate, blood oxygen level, brain wave patterns, eye movements and the movements of respiratory and limb muscles movements.
Sleep studies are pain free and are able to diagnose sleep apnea, narcolepsy, cataplexy, hallucinations, sleep paralysis, and even what is called parasomnias. Parasomnias are abnormal behaviors or movements during sleep (i.e. sleepwalking, nightmares, bed-wetting). Sleep studies can be used to detect and evaluate seizure disorders, sleep related depression, and panic disorders.
What is the treatment for sleep apnea and other sleep related problems? Although tonsillectomy and adenoidectomy (T&A) is a common procedure that is done frequently, it is not without risk for complication. Certain high risk children, such as those less than three years and those who already have serious medical complications of OSAS such as failure to thrive, pulmonary hypertension, cor pulmonale and who have underlying congenital or medical conditions such as genetic diseases and facial deformities may require close inpatient observation.
Patients with sleep apnea are at an increased risk for anesthesia complications. For this reason, appropriate post-operative monitoring is crucial post-surgery. There is little data on other surgical options (e.g., uvulopalatopharyngoplasty) for OSAS in children. Age-appropriate weight management strategies are necessary for overweight and obese children with OSAS.
Treatment of contributing risk factors such as asthma and allergies is also important. While there is little in the literature about CPAP for children, Continuous (or bi-level) Positive Airway Pressure (CPAP) therapy has been shown to be an effective treatment in children and adolescents for whom other treatment options have failed or are inappropriate. To our knowledge, there are no published studies on the use of oral appliances for pediatric patients.
In adults, the mainstay of treatment remains CPAP, which is nasal continous positive airway pressure therapy. This involves the use of a high-pressure blower that delivers constant air flow through a mask that is worn by the patient during sleep. This continous air-flow helps to keep the airway open and prevents from collapsing and causing apnea. Although some patients may find CPAP inconvenient and noisy, patients that are compliant with therapy, often report feeling better rested less headaches and improved energy throughout the day. Other treatment options include certain types of surgeries which are usually effective for mild sleep apnea.
What is Insomnia?
It is a sleep disorder that results in a difficulty to fall and/or stay asleep. People with insomnia have one or more of the following symptoms:
- Difficulty falling asleep
- Waking up often during the night and having trouble going back to sleep
- Waking up too early in the morning
- Tired upon waking
Some causes of insomnia include:
- Significant life stressors such as a death in the family, moving or job loss
- Emotional or physical (pain) discomfort
- Environmental factors such as light, noise and extreme temperatures (hot or cold) that interfere with sleep
- Some medications (for example those used to treat colds, allergies, depression, high blood pressure and asthma) may interfere with sleep
- Changes in normal sleep schedule such as jet lag or shift work (switching from a day to night shift)
- Depression and/or anxiety
- Chronic stress
How Is Insomnia Treated?
Mild Insomnia can be cured by following good sleep habits (See healthy sleep section). Acute insomnia may not require treatment. Moderate to severe Insomnia requires following good sleep habits and treatment of any underlying medical conditions. Additional treatment may include the use of sleep aids and behavioral modification techniques. Sleep aids should only be prescribed by your doctor. Over the counter sleep aids may have undesirable side effects. Behavioral techniques include relaxation exercise, sleep restriction therapy, and reconditioning. Many children have behavioral insomnia of childhood. Here are two common causes in children.
Sleep-onset association
All of us wake up briefly a number of times during the night. This occurs most often during the stage of sleep when we have most of our dreams. This sleep stage is known as rapid eye movement (REM) sleep. Usually, we are unaware of these awakenings and return to sleep quickly. Young children may cry when they wake up. Parents naturally may feel that they need to help their child return to sleep. Parents do this by feeding, rocking, holding or lying down with their child. As a result, many young children become unable to fall asleep on their own. They depend on their parents help instead of learning to comfort themselves. The child learns to connect or associate going to sleep with a person or activity. If this describes your child, then he or she may have a problem with sleep-onset association. A parent may recognize this problem by saying something like this: I am exhausted. I have to rock my child to sleep every night and for every nap. If she wakes up during the night, she is unable to fall asleep until I rock her again. This child appears to be connecting the action of falling asleep with being rocked. She is unable to fall asleep when that action is missing.
Limit-setting problems
Limit-setting problems usually begin after the age of two. It occurs when your child refuses to go to bed, stalls, or makes it hard for you to leave the bedside. Limit-setting problems can occur at bedtime, nap time, or when your child wakes up during the night. Parents need to assert that they are the ones who decide when it is time for bed. They should enforce this time even if the child disagrees or seems active and alert. Children can get very creative when they want to stay up later. They may ask for one more hug, a tissue, a drink of water, another story, to have the light turned off or on, or to tell you something important. It can be hard to know what is real and what is simply a delay tactic. You need to be firm and consistent when you respond to the delays. Giving in to them will only encourage the behavior. Parents need to give their children well-defined limits. If your child or you have an ongoing sleep problem, then you should talk to your pediatrician or to a sleep specialist.
I would like to find out more information about my child.
Many parents have very important and difficult to answer questions about their or their child’s neurological disease. Where is a reliable and informative place to obtain these answers?
First, the MOST INFORMED OPINION can only be obtained in person, and NOT over the Internet. Your physician can best correlate history, examination and tests and give advice. If you feel that have more questions, please ask & ask again. Write down your questions and ask in a follow-up appointment.
Second, beware of where you are getting information over the Internet. There is a concern that much information provided over the Internet is incorrect, unfounded in fact, or at times untrue. Be sure to use RELIABLE sources, typically from Medical Societies, or from Parent/Patient Organizations. In general, most of the listed sites have valid information, although it is impossible to account for every Web Page link.
Third, YOU have access to the medical literature. Although difficult to read, you can browse the medical literature through PubMed or GratefulMed. The abstracts (short form) of most articles are available on the Internet, and longer forms of the articles can be ordered.
