Sleep Issues in Children

If you go way back to the beginning of this blog, I brought over some links and articles regarding sleep issues in children. This is always a very big concern in our home, because of young's son inability to have good sleep experiences.

I realize I am jumping around a bit in this blog (yesterday, new apps, today sleep!), but I have yet to figure out how to put blogposts into groups and categories. Once I do that, this jumping from subject to subject will be better organized.

In my daily perusal of medical journals (yes, I have strange hobbies!), I came across these two article titles:

Cognitive Abilities May Be Affected By Childhood Sleep Problems Persisting Through Adolescence

and

Underlying Sleep Problem Linked To Attention-Deficit/Hyperactivity Disorder In Children

I know reading medical jargon and study results is not everyone's cup of tea, but when it affects your everyday life, you get smart and interested really fast. Basically, the sleep world finally woke up and realized that a lot of the issues with cognitive function and performance can be linked to faulty sleep habits, patterns and brain wiring/firing. In our case, my young son barely seems to have a circadian clock. He was diagnosed with Moderate Obstructive Sleep Apnea and Delayed Sleep Phase Syndrome. It looked like narcolepsy (before he got his CPAP machine) and insomnia, which is kind of impossible to have.

The big issue is that this has DEFINITELY affected his cognitive functions, executive functioning and memory. His short-term memory is shot and long-term is sketchy. He can not draw inferences and his brain stubbornly refuses to make leaps of connection from one subject (or even word!) to another related subject (or phrase!). Teaching him is very difficult (on bad days, I say it is non-existent) and I struggle to keep information flowing and relevant.

Okay, I am getting off subject. This is not about my son, per se, but is about awareness. Parents, please listen to me. My son went through the usual diagnosis of ADHD for years. However, though the behavior is similar, it is NOT the same disorder. My son remains unresponsive to ADHD meds. In fact, he is on Concerta (also took Ritalin for awhile, but made the sleep phase problem worse!), but it does not increase focus or attention. Makes him more hyper actually.

The point I want you to take away today is sleep disorders are very real. They have very real symptoms that mimic other disorders. And most doctors are not thinking "sleep disorder" immediately. This is changing.

I had the chance to attend a sleep conference last year in D.C. sponsored by the Sleep Foundation. There I heard the latest research into sleep disorders. Out of that meeting came the recommendations for doctors to begin asking questions regarding sleep for children as young as 2 years old, especially if there were hyperactivity symptoms.

Sleep issues are real. Here in the Unique Family, we live through it everyday. Three us (out of 5) wear CPAPs (hubby fights wearing his. Grrr!). All three have memory and cognitive issues.

Pass this along to anyone you think it might benefit. Also, let me know, anyone in your family/Friends that you are concerned about?

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Behavior Modification

This post was actually a reply to a discussion about ADHD and autism. They wanted to know what we had done that gave us success over the disorder.

Having a 16-year old who has overcome so many obstacles in this life, I gave some background on how I raised my son. It was not easy, by any means. And, I had very little help, except for the internet, which back in 1992-1996, was not the big, beautiful web we have today. Most of what I did is trial and error and whatever worked. Here is my response and take on behavior modification.

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Hello, All,I will try to remember what I did because he is now 16 and it is hard to think back so many years.

When he was a baby, we swaddled. Without it, he would hit the walls of the bassinet every other minute and no one got any sleep. Actually, the first six weeks, he slept in a stroller, swaddled in the basement. Now, before you call me cruel, it was the only place with no light and no noise. We used a baby monitor to know when he "really" woke up.

I learned very early on that he needed a routine or we would have a basketcase on our hands. I went back to work early and had a babysitter. Thing was, I walked in with a schedule of two pages! Everything was listed down there from when he would eat to when he probably made a bowel movement. She thought I was crazy, but after two days, she was amazed that everything I wrote down, complete with times, was accurate. If you followed the schedule, he would be fine. If not, screeching baby at ten o'clock.

His food has to be a certain temperature. The bottle nipples had to be a certain size. Too big and he would choke, too small and you got screeches. He couldn't figure out breast feeding, so I didn't. Of course, he had favorite foods and that was it.Life took on a very ordered tone. He has more autism/ADD than ADHD. Not very hyper, though he rocked and flapped regularly. He hated loud noises, crowds (no birthday parties or movie theaters to this day), bright lights and certain materials.

I am saying all of that to say this. The more I kept to a schedule, the calmer he was and then we could do some work together. Change had to be brought in very slowly. Everything had to be introduced. Foods, people, places, school, toys, holidays, etc. For example, a new person was never just brought into the room. He had to hear their voice somewhere in the house and we would wait to see if he would get curious. Most times, not. When he was around 5, it took him a year to speak directly to my best friend who was over almost every day.

As for language, he started talking around 12 months and then stopped. He didn't use regular language again until school. He made up his own language and used sounds. I didn't care what it was, it was communication and we responded. We called it Andrewisms. He still does it to this day, creating language. An old one was Fuf-fuf, it meant cartoons. We figured out later that I kept calling silly cartoons "fluff" and he made up the word to use when he wanted to watch them. Today, we have "linner." It means the meal between lunch and dinner, like brunch is the meal between breakfast and lunch. Whatever it is, we use it.

I am sorry this is long, but I feel very strongly about this. We hardly had any help. I once had a director of an autism center ask me how we taught my son humor. I told her, we laugh a lot and love comics, cartoons and jokes. If he didn't get it, we explained it. We even taught him what laughter sounded like. After many years (like around 10 years) he finally understood. The first time he laughed out loud, I cried. Most of his childhood, he hardly even smiled. Now, all his teachers remark about his cynical, sardonic wit. It is not a "monkey," but his own take on what we taught. EVERYTHING he does today, came that way. As he got better, I built in change and flexibility. Now, at 16, he can accept change on a dime; something almost miraculous in the world of autism.

I don't want anyone to get the idea it was easy. Many times homework was finally finished at 10pm. Or just not finished. He didn't get an aide in school until 5th grade and they promptly took it away in high school. He has the smallest amount of accomodations and hardly any speech and language help. He hardly ever get an A in a class, but his Cs are golden to me. We hardly ever went anywhere, including church. I didn't see the inside of a movie theater for nearly 12 years. And, he was not with me.

I am thoroughly with McDannells on this. We have to teach these kids to be confident in themselves and that they will find a place in this world. Excuses don't matter to the world at all.

Other than that, I give this piece of advice. Do what works. If you have to empty the cupboards and teach fractions using bells, whistles, every measuring cup and spoon, and food coloring (my personal favorite!), do it.

And don't make a monkey out of anyone. I would rather my son be eclectic and innovative than a drugged zombie working in a factory somewhere.

Children and OSA

In between my posts about my family and our lives with chronic illnesses and disability, I will also post about sleep disorders and how they have affected us.

I love to find articles about sleep disorders and will post them here with links to the original article as well as other sources. Please feel free to comment or leave more information. I so want people to understand how much this can affect their lives or the lives of a loved-one.

Here is the first of many posts. Enjoy.

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Though OSA has touched two members of my family, one older and one still a child, I think it is VERY important for parents to know what to look for in their children if/when they suspect sleep disorders.

Children can suffer from daytime sleepiness, but more likely, will have hyperactivity and restlessness. This could be misconstrued to be symptoms of ADHD. I do not have numbers, but my son was one of the many who was told he had and "tested positive" for ADHD, when he had sleep apnea. We even tried a trial of medication (only lasted two months) with no improvement. The side effects were many and more disruptive (insomnia, circadian clock rhythm dysfunction, loss of appetite and headaches) than the hyperactivity.

Below an article reprinted from The Herald News which goes into detail on this very subject. Again, a note of caution for parents. If your child suffers from hyperactivity, don't wait for the doctor to bring up whether your child sleeps well or not. If you have any questions regarding your child's sleep, bring them up to the doctor and don't shy away from this. Sleep apnea is nothing to play with when it comes to a child.


Sleep disorders linked to child hyperactivity

March 19, 2008
By Denise M. Baran-Unland
Special to the Herald news

Talk to a parent with a 2-year-old who is bouncing off the walls and she might apologetically tell you, "He's just overtired."

Flash forward to that same child five years later and that same parent might wonder if her child is hyperactive.

The fact is, he might still be overtired.

Between 1 and 3 percent of children ages 2 to 5 years old have obstructive sleep apnea, according to American Sleep Apnea Association. Left untreated, a child might experience failure to thrive, a number of cardiovascular disorders and symptoms commonly related to hyperactivity, including problems with learning, attention and behavior."

I have a number of patients with complaints of learning disorders," said Dr. Mohammed Saeed Homsi, pediatric sleep specialist at Provena Saint Joseph Medical Center in Joliet. "They think that their children have ADD until I dig deeper into their history."

If they tell me that their child snores, stops breathing or has mouth breathing, I do a sleep study. The parents are usually very surprised that sleep apnea is the cause of their child's hyperactivity and learning disability."

While being overweight may contribute to some cases of sleep apnea in children, as it very often does in adults, by far the most usual cause is enlarged tonsils and/or adenoids, Homsi said.

Yet, because sleep apnea is rarely diagnosed in children, the American Academy of Pediatrics now recommends that all children be regularly screened for snoring.

Sleep study

If the child has signs of obstructive sleep disorder, the pediatrician may order a sleep study or polysomnography. During the study at a hospital or sleep center, the child wears several recording devices --the same as an adult would -- none of which is painful; still parents are required to spend the night with the child, Homsi said.

The recording devices include an electroencephalogram (EEG), which measures brain waves; an electroculogram (EOG), which monitors the different stages of sleep; and electrocardiogram (EKG), which measure heart rate and rhythm. The child will also wear chest bands that sense breathing, monitors that record leg movements and monitors to sense oxygen and carbon dioxide levels in the blood.

If the sleep study reveals the child has obstructive sleep apnea, enlarged tonsils and adenoids -- if present -- will be removed. If obesity is the culprit, the child may need to lose weight.

In certain cases, the child may have to wear an electronic device when they sleep. This is called continuous positive airway pressure (CPAP).While all this may sound scary, the good news is that, with treatment, the symptoms and consequences of sleep apnea are reversible. But if symptoms persist, further exploration is needed.

Obstructive sleep disorder is not the only sleep disorder to plague children and teens, Homsi said.

For instance, the child may suffer from periodic limb movement. Similar to restless legs syndrome, the child periodically moves his legs while he sleeps. This causes him waken from sleep without being conscious of it, Homsi said. Unlike restless leg movement, which is diagnosed from the child's history, periodic limb movement is diagnosed by a sleep study."He will be very sleepy during the day and he will not be productive during school," Homsi said. "Sometimes iron deficiency causes it and sometimes we need to give medicine to control the leg movements. It depends on the result of the sleep study."

(Sorry, I do not have the exact citation link for this page. I will search and try to put these in as I go along.