Pediatrics in Minnesota

Treatment of Sleep Disorders in Children

Symptoms

Falling asleep in the classroom, during conversations, while being driven in an automobile, or while watching television or reading a book, as well as inattentiveness and mood swings are common symptoms. Daytime sleepiness is fairly common, affecting about 10 percent of all school children.

Effective and specific treatments are available, and can help improve the child's life. The most common causes of daytime sleepiness in childhood are insufficient sleep at night, abnormal sleep hygiene, use of over-the-counter or prescription medications, narcolepsy, obstructive sleep apnea and abnormalities of the biological clock, like the delayed sleep phase syndrome.

Frequently Asked Questions

What is narcolepsy?
Narcolepsy is a life-long sleep disorder that frequently has its onset during childhood. It leads to an uncontrollable urge to fall asleep in the daytime at inappropriate times (in the classroom, during conversations, etc.), seeing vivid and sometimes terrifying dreams during daytime naps, having episodes of muscle weakness in association with laughing, crying, fright or rage, or episodes of momentary inability to move at the onset of sleep.

What is sleep apnea and how does it manifest itself?
Sleep apnea refers to a cessation of breathing during sleep. It may be due to many different causes. Night-time snoring, restless sleep, frequent awakenings at night, sleeping with the mouth open, a feeling of daytime fatigue or sleepiness, mood swings, inattentiveness and hyperactivity commonly occur with sleep apnea. It may be due to enlarged tonsils or adenoid glands, an enlarged tongue, obesity, abnormalities of the jaw, or a malfunction at the level of the brain in the control of breathing.

What does the sleep evaluation consist of?
A sleep history and physical examination conducted by a board certified sleep specialist from the Center for Sleep Medicine are the initial steps. This may be followed by obtaining a 2- to 3-week log of sleeping and waking function at home, and if necessary by a sleep laboratory evaluation.

What is a sleep laboratory evaluation?
Depending upon the nature of the suspected problem, it consists of either an overnight study (nocturnal polysomnogram) alone, or an overnight study followed the next day by multiple planned naps in the sleep laboratory (multiple sleep latency test). The nocturnal polysomnogram is a painless test in which a number of sensors are applied to the skin surface to record the brain wave activity, eye movements, breathing function, oxygen and carbon dioxide levels, heart rate and muscle activity during sleep.

The information is processed by a computer, scored by a technician, and then reviewed by a sleep specialist. The test helps determine the nature of the night-time sleep disturbance and plan appropriate treatment. The multiple sleep latency test is similar to the nocturnal polysomnogram, except for the fact that your child will be expected to take four naps at two-hour intervals with all the leads and sensors hooked up.

Will any other tests be needed?
Based on the nature of the problem, the sleep specialist may also advise other tests such as an electrocardiogram (ECG), X-rays of the chest and upper airway, and magnetic resonance imaging (MRI) of the head.

Clinical Trials

The sleep specialists at Mayo have developed a registry of patients with narcolepsy (Dr. Lois Krahn and group). Long-term follow-up of these patients will shed light on the how sleepiness affects the quality of life in narcolepsy. Studies are also planned on correlating the degree of daytime sleepiness with measures of attention and concentration. The sleep program at Mayo is also attempting to characterize and quantify normal values for a variety of events seen in the normal sleep of infants and children.

1. Evaluating the effect of vagal nerve stimulation on the sleep architecture of patients with intractable epilepsy.
2. Assessing the impact of daytime sleepiness in children on neuropsychological function.
3. Determining normal values for nocturnal awakenings and miniature arousals in preschool age children.