Pediatric Sleep Medicine

Introduction

Sleep is essential for the child’s development, well-being, behavior, and health. The circulatory, respiratory, endocrine, gastrointestinal, and musculoskeletal systems undergo several physiological changes while a person is sleeping. Additionally, brain wave activities change with peculiar patterns and waves that differ in different sleep stages compared to the wakeful stage. The entire family gets affected if the child cannot sleep properly. Consultation with a sleep specialist experienced in treating children's sleep issues can be helpful if the child is having trouble sleeping.

How Much Sleep Do Children Need?

Children generally need more sleep than adults. Children between the ages of 1 to 2 years need 11 to 14 hours of sleep every night. However, teenagers need 8 to 10 hours of sleep.

Infants 0 to 1 Year

Sleep architecture varies in infants compared to other age groups. Infants have three sleep stages: wakeful, active (Rapid eye movement), and quiet stage (Nonrapid eye movement). The infant cries, eats, blinks, or examines the eyes while they are awake stage. Breathing is regular, and the child’s eyes are open. In the quiet period, breathing is regular, but occasionally startled or sucking may occur, movements decrease, and there is no ocular movement. The child in the active phase of sleep has eyes shut, and rapid eye movements occur, which can be absent sometimes, breathing becomes irregular, and movements are minimal.

Infants sleep for 60 percent of the day during the first few weeks. Most sleep occurs at night but is inconsistent and lasts for brief periods. Hunger and light play a role in a child’s sleep pattern. Most of the infant's sleep is in an active phase that reduces as the child grows. By two or three months, a child’s circadian rhythm matures.

Toddlers 1 to 5

The child sleeps through the night, but daytime napping decreases. Additionally, cultural habits, family routines, and school schedules can influence the toddler’s daytime nap.

Middle School 6 to 12 Years

Significant changes happen to the sleep architecture. The sleep-wake cycle and REM phase decrease, whereas the NREM phase increases.

Adolescents 12 to 18

Delaying bedtime and early wake-up time shortens overall sleep time.

What Is Pediatric Sleep Medicine?

It is a field of medicine that treats children with sleep issues. Pediatric sleep medicine includes a wide range of sleep problems in children, such as snoring, daytime sleepiness, or difficulty sleeping at night. Specialists, called pediatric sleep medicine experts, are trained to treat pulmonary and neurological causes of sleep disorders. These experts formulate a personalized care plan based on the child’s needs and the family’s lifestyle.

What Are the Sleep Disorders That Develop in Children?

• Sleep apnea.

• Periodic leg movement syndrome.

• Restless leg syndrome.

• Insomnia.

• Parasomnias include night terrors, sleeptalking, and sleepwalking.

• Delayed sleep phase syndrome.

• Narcolepsy and cataplexy.

• Behavioral insomnia in children.

• Disorders in control of breathing.

• Circadian rhythm disorder.

• Difficulty initiating or maintaining sleep.

• Excessive sleepiness.

What Are the Negative Consequences of Sleep Disorders?

Problems caused by sleep disorders in children are:

• Adverse effects on growth and development.

• Headaches.

• Difficulty learning as memories get stored during sleep.

• Reduced motivation for learning.

• Poor focus and attention.

• Reduced participation in activities.

• Fussiness and irritability.

• Snoring.

• Nightmares.

• Daytime sleepiness.

• Sleepwalking.

• Leg cramps.

• High blood pressure.

• Behavioral issues.

• Hyperactivity.

• Poor grades.

• Daytime sleepiness.

• Difficulty concentrating.

• Poor behavior.

• Urinating while sleeping.

What Are the Tests Performed to Analyze the Childs Sleep Patterns?

Children's sleep tests are carried out in a sleep facility with the direction of qualified experts. During assessment, electrodes are placed on the child’s head and arm to determine sleep stage, breathing pattern, oxygen and carbon dioxide level analysis, heart rhythm monitoring, and limb movement. The detectors can also be placed on the child’s skin surface or clothes. Some studies are:

• Nocturnal Polysomnography (Overnight Sleep Study): The child’s sleep patterns are observed overnight.

• Nocturnal Polysomnography With Positive Airway Pressure Therapy: The child's sleep habits are observed overnight, and positive airway pressure therapy is administered.

• Multiple Sleep Latency Test: The child's daytime sleep and activity will be observed following an overnight sleep study. The child is woken up several times during the test. The test is recommended for children with daytime sleepiness.

The child and the apparatus must be closely watched throughout the entire study. These tests are non-invasive and are not painful. After a complete assessment, the data is sent to the specialist.

How Are Sleep Disorders Treated in Children?

The following remedies are suggested:

• Home Interventions: Some sleeping problems in children can be treated by making minor but helpful changes during bedtime around the home. It includes sleep schedule changes, tips for a good sleep routine, and changes to the sleep environment.

• Behavioral Modification: The sleep specialist will work with the parent or child to address other issues causing sleep problems.

• Medications: Some children might need medicines to overcome sleep problems, but they must be administered when the benefits outweigh the risks.

• Removal of enlarged tonsils and adenoids can help children suffering from sleep apnea.

• Surgery is required in children with cleft palate.

• Continuous Positive Airway Pressure (CPAP): A nasal mask is worn during sleep to help keep nasal passage open and treat sleep apnea. Using the CPAP machine at home is possible if the reports are unusual. This treatment method is helpful in children with sleep apnea or snoring.

What Steps Can Parents Take to Improve Sleep Quality in Children?

Based on the American Academy of Pediatrics recommendations, parents must ensure their children are off their phones 30 minutes before bedtime. A consistent bedtime can help with better sleep. Setting parental control to the child’s phone or tablet can help.

When Should Parents Consult a Sleep Specialist?

Sleep disorders in children are hard to diagnose, and few doctors know how to recognize them. The parents can consult a sleep specialist when:

• When the parents have tried several methods, the child’s sleep quality is not improving.

• The child is struggling with sleepiness despite good sleep.

• Poor sleep has impacted the child’s daily life, causing mood swings, lack of attention, changes in eating patterns, and poor behavior.

Conclusion

As sleep disorders are increasing among children, sleep medicine can help treat them. This branch of medicine includes diagnosing and treating sleep problems in infants, toddlers, children, and teenagers. The treatment must be tailored to each child and family's needs with help from sleep specialists.