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Tuesday, September 19, 2006
Sleep problems in kids
Nightmares
ARE frightening dreams that awaken the child, most often crying. The crying is usually consolable and returns to sleep without difficulty. The contents of the frightful dream can be easily recalled. Nightmares are considered normal occurrences in the life of the child.
Night Terrors
Are seen in children 3-8 years of age. They are episodes of night awakenings 90-100 minutes after going to sleep. The child suddenly sits up in bed screaming, agitated, sweating profusely, and breathing rapidly with glassy eyes. Crying is often unconsolable. The episode last 15-30 minutes then the child relax and return to sleep with no recall of the event.
Night terror is one of the most frightening events for the parents and other members of the family. They have to be reassured that these episodes are not serious and nothing to worry. As the child grows, night terrors will eventually resolve. However in some cases the attacks are severe that may need a referral to a physician for treatment. Some attacks will continue to adulthood.
Sleepwalking and Sleep talking
Commonly seen in children ages 5-12 years with an estimated incidence of 1-6%. More common in males than in females. The episode begins with clumsy body movements during sleep and then the child suddenly sits up in bed occasionally arising and walking without purpose, or may go the bathroom or downstairs to the kitchen. Efforts to communicate, the sleepwalker often answers in monosyllables, mumbled and slurred speech. Sleep talking may occur in association with sleepwalking or may occur alone.
The episode often last 10-15 minutes, the child returns to sleep and no recall of the event upon waking up in the morning. The episodes are often harmless and resolves by adolescence. Purposeful walking and meaningful speech during sleep should be referred to a psychologist for a possible psychological disorder.
Narcolepsy
Narcolepsy is a rare sleep disorder commonly seen during adolescence. It consists of excessive daytime sleepiness, momentary inability to move (sleep paralysis), visual hallucinations (false perception of something that is not really there) during sleep, and cataplexy (the child suddenly collapses without loss of consciousness provoked by laughter or any strong emotions).
It is a lifetime sleep disorder that needs referral for proper evaluation and management.
Snoring
Snoring is a loud breathing noise from vibrations of the soft palate (soft part of the roof of the mouth) or from obstruction of the upper airway.
Snoring is frequently seen in children living in crowded places and are more common in boys than in girls.
Snoring is present in 18-20% of infants, 7-13% of children 2-8 years old and 3-5% of older children.
Conditions such as asthma, allergies and cigarette smoke are reported to increase the risk of snoring in children as they induce irritation of the upper respiratory tract and enhance the enlargement of the tonsils and adenoids (tonsils at the rear of the nose).
It used to be that snoring was a subject of fun between friends or shared secrets during family gatherings. Not anymore as we now know that snoring can have problematic medical consequences.
Snoring in children may be the first steps towards the more serious form of sleep disordered breathing like sleep apnea. Since the consequences of sleep apnea can be severe, one must consider the possibility of sleep apnea in any child who snores.
However, H. Topol in a follow-up study of primary snoring in children published in the Journal of Pediatrics, Feb., 2001 noted that 50% of children who were suspected of having sleep apnea because of snoring did not have the disease. Children who snore but do not have sleep apnea are considered to have primary snoring. Most of these children after a 3 year follow-up did not progress to sleep apnea.
Apparently there are children who snore who would go on to be just snorers.
Children who snore and who go on to develop sleep apnea will eventually develop behavior disturbances such as restlessness, aggressive behavior, excessive daytime sleepiness and school problems.
This complication which is probably linked to intermittent hypoxia (an abnormally low concentration of oxygen in the blood and tissues) the hallmarks of sleep disordered breathing have been recognized for sometime and are repeatedly reported in the literatures.
However, a study by M. Urschitz and associates published in the American Journal of Respiratory and Critical Care Medicine Dec. 2002 have noted poor academic performance in school children who are only habitual snorers, without the effects of intermittent hypoxia.
Habitual snoring is defined as snoring frequently or always.
Snoring "always" is significantly associated with poor academic performance in mathematics, science, and spelling.
Snoring "frequently" is also significantly associated with poor academic performance in mathematics and spelling.
Also noted in the study are more than 30% of parents reported snoring just like their children. Thirty eight (38) percent of fathers reported loud and frequent snoring compared with 22% of mothers.
It seems that there are a lot of snoring in some families. It may be possible as one author have suggested that "families that snore together will stay awake together" and "families that snore together probably also will have difficulty graduating from grade school together".
Not a pretty picture for one out of 20 children who snores.
For Bisaya stories from Davao. Click here. (September 19, 2006 issue)
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