The sleepy child: part 2 

Healthy sleep is essential for your child’s health

By Phil Noe, Pediatric Nurse Practitioner

Last month I discussed two potential causes of excessive daytime sleepiness in children: insomnia, which is difficulty falling asleep or staying asleep during the night, and narcolepsy, which occurs when children are very sleepy during the day sometimes resulting in sleep “attacks” that make them suddenly fall asleep or lose muscle control. This month I will discuss two more potential causes of excessive daytime sleepiness: Obstructive Sleep Apnia and Periodic Limb Movement Disorder and also Restless Leg Syndrome.

As I previously mentioned, for the majority of children, establishing a healthy sleeping environment and sleep schedule will result in a well-rested child. There are several keys that are critical to helping a child fall asleep, stay asleep, and achieve restful sleep. These keys include:

1. A quiet bedroom – no noisemakers in the room such as a television, computer, radio, I pod, video game or cell phone.
2. Falling asleep independently – A child should fall asleep on their own with no one else in the room or in the bed with them.
3. Nightlights are acceptable – otherwise, the room should be dark.
4. Keep the bedroom at a comfortable temperature (70-72 degrees) – avoid an overly hot room.

The next step is to make sure your child is getting enough sleep. Most 6-12 year old children need 10 – 11 hours of sleep each night. In addition, most children take around 15 minutes to fall asleep. When these two facts are combined, it is easy to see that 6-12 year olds need roughly 11 hours in bed each night. To determine an appropriate bedtime, simply subtract 11 hours from the time the child needs to get up in the morning for school. If morning wakeup time is 7 a.m., the appropriate bedtime is 8 p.m. Children who start their day at 6 a.m. should go to bed at 7 p.m. This practice will provide an opportunity for your child to obtain an adequate amount of sleep each night.

If your child continues to experience excessive daytime sleepiness despite an appropriate sleep environment and an adequate amount of sleep, the next step is to consider that your child might have a sleep problem. Here are two additional sleep problems that can exist during childhood:

Obstructive Sleep Apnea

This sleep disorder causes a person to stop breathing temporarily during sleep. One common cause of obstructive sleep apnea is enlarged tonsils or adenoids (tissues located in the passage that connects the nose and throat).  Children with obstructive sleep apnea might snore, have difficulty breathing, have pauses in their breathing, gasp and sweat heavily during sleep.  Because it disrupts sleep, someone with sleep apnea may feel extremely sleepy or irritable during the day.  Obstructive sleep apnea has also been linked with elevated blood pressure, concentration problems, learning difficulties and behavior problems mimicking ADHD.

“Most 6-12 year old children need 10 – 11 hours of sleep each night …[and] take around 15 minutes to fall asleep.”

If your child has symptoms of obstructive sleep apnea, he/she should be evaluated by a health care professional.  At the Pediatric Pulmonology & Sleep Medicine Center at East Tennessee Children’s Hospital, these children are then often tested with an overnight polysomnogram or sleep study. Treatment is available for children diagnosed with obstructive sleep apnea, and most problems can be eliminated or greatly reduced by the removal of the child’s tonsils and adenoids.

Periodic Limb Movement Disorder and Restless Legs Syndrome

This is an uncommon cause of daytime sleepiness in children.  Children with this condition find their sleep is disrupted by leg (or, less frequently, arm) movements, leaving them tired or irritable from lack of sleep.  In the case of periodic limb movement disorder (PLMD), these movements are involuntary rhythmic movements that occur frequently throughout the night while asleep.  They are called involuntary, because the person isn’t consciously controlling the movements and is often unaware of it.  These rapid leg movements may partially awaken the child repeatedly throughout the night, resulting in poor sleep and daytime sleepiness.  Children with restless legs syndrome (RLS) actually feel physical sensations in their limbs, such as tingling, itching, cramping or burning. The only way to relieve these feelings is by moving the legs or arms to get rid of the discomfort. This problem may result in major difficulty falling asleep, and doctors can treat PLMD and RLS with medications.

What to do if you suspect a sleep problem

If your child seems to be getting enough rest at night but is still feeling tired during the day, it’s a good idea to visit your health care provider. Excessive tiredness can be caused by a wide variety of health problems, not just difficulties with sleep. If a sleep problem is suspected, your health care provider will evaluate your child’s overall health and sleep habits. In addition to doing a physical examination, your provider will take a medical history by asking about any concerns and symptoms your child has and about his or her past health, your family’s health and any medications your child is taking. The provider also may do tests such as a sleep study to find out whether there is a medical condition affecting your child’s health. Your provider may even refer you to a specialist such as the Pediatric Pulmonology & Sleep Medicine Center at Children’s Hospital.

Healthy sleep is an essential part of your child’s overall health. Monitoring your child’s sleep and ensuring an adequate amount and quality of sleep is extremely important in keeping your child physically and emotionally healthy.

Phil Noe has been a Pediatric Nurse Practitioner with the Pediatric Pulmonology and Sleep Medicine Center at East Tennessee Children’s Hospital for the past 15 years. He works with a variety of sleep-related medical problems from newborns to young adults.