Sleep Medicine for Children
Children and adolescents need at least nine hours of sleep each night. Sleep problems and/or a lack of sleep can negatively affect children's health, performance in school, during extracurricular activities and even with social relationships.
Talk to your pediatrician if your child exhibits any of the following signs or symptoms of a sleep problem:
- Breathing pauses during sleep
- Difficulty falling asleep
- Problems with sleeping through the night
- Difficulty staying awake during the day
- Decreased attention span
- Low academic performance
- Unexplained decrease in daytime performance
- Unusual events during sleep such as sleepwalking or nightmares
If your child experiences any of these symptoms, your pediatrician may recommend that your child have a sleep study.
About the Sleep Center at Orange Regional Medical Center
The Center for Sleep Medicine at Orange Regional is dedicated to caring for children ages 2 and up, as well as teenagers. All studies are conducted in a warm and comfortable environment, specially designed to accommodate children. Additionally, accommodations will be made for one parent and/or guardian to stay overnight with the child.
Sleep Conditions We Treat
Specialists at The Center for Sleep Medicine can detect conditions that may be keeping your child from sleeping properly.
Obstructive sleep apnea
Obstructive sleep apnea occurs when a child's airway closes partway or all the way during sleep, blocking air from getting in. The drop in oxygen signals the brain to wake your child up, stopping him or her from getting the proper amount of sleep. In children without other medical conditions, enlarged tonsils or adenoids most often cause the blockage. This problem is most likely to happen during sleep when the throat muscles and tongue are most relaxed.
Central sleep apnea
Apnea refers to short pauses in breathing. Usually, these pauses are normal but when they occur often and last longer than about 20 seconds, they can cause problems. In children with central sleep apnea, the part of the brain that controls breathing doesn't start or maintain the breathing process as it should. This condition can affect babies, especially those who are born early (premature), because the breathing control center in the brain is not fully developed.
Excessive sommolence (drowsiness)
Young people with excessive somnolence are often very tired during the daytime or sleep for very long periods at night. These disorders, sometimes called hypersomnia, are different from sometimes feeling tired after not getting enough sleep at night. Signs of this condition often appear during the teen years or early adulthood. Your child may nap a lot during the day, fall asleep at odd times or find it very hard to wake up after a long sleep. Excessive somnolence may be caused by other sleep disorders such as narcolepsy or sleep apnea.
Insomnias are disorders that make it very hard to fall asleep or to stay asleep. Most people have trouble sleeping once in a while. Babies and young children often wake up naturally during the night. But when children have trouble falling asleep or staying asleep and the problem lasts a long time, a condition such as restless legs syndrome or obstructive sleep apnea may be the cause.
Narcolepsy causes tiredness that can't be controlled. People with narcolepsy, including children and teens, have "sleep attacks." Even if they have had a normal night's sleep, they may fall asleep without any warning during the day. These sleep attacks last from several seconds to a half hour or more. Signs of narcolepsy often appear during the teen years.
Parasomnias (Night Terrors/Sleep Walking)
Parasomnias are disruptions in your child's sleep. Night terrors may seem like nightmares but they are far more intense. During a night terror, you may not be able to comfort your child. Signs of a night terror are sitting up in bed, shouting or screaming. During sleep walking your child may seem confused or partly awake. They may either stay in bed or walk around without seeming to be aware of their surroundings.
The next morning, children often will not remember either night terrors or sleep walking. While scary for parents, night terrors usually do not harm children. In some cases, though, night terrors and sleep walking may be a sign of another sleep disorder that your child may have.
Sleep Phase Disorders
Circadian rhythm disorders are disruptions in your child's regular daily cycles, including sleeping and waking. Most circadian rhythms are controlled by the "clock" in the brain that runs the body. Circadian rhythm disorders may be caused by a mismatch between the internal body clock's setting and conditions in the outside world - a common example is jet leg. They may also be a sign of a problem within the clock itself. Teenagers often have this type of problem as their internal clock is naturally adjusted to a later schedule.
Sleep-related Movement Disorders
Sleep-related movement disorders include head banging, body rocking, periodic limb movements and growing pains (benign nocturnal limb pain of children). While the causes of these disorders are different, they all make it hard for your child to sleep, whether due to a strong urge to move (restless legs syndrome), muscle pain (growing pains) or involuntary movement (periodic limb movements and head banging).
Using state-of-the-art monitoring equipment and computer software to record data during sleep, experienced physicians can pin-point the disorder, allowing the referring physician to prescribe therapy for your child. In addition to doctors and nurses who specialize in caring for young people, our team includes registered Polysomnographic technologists who monitor and interpret children's sleep studies.
The Center for Sleep Medicine offers a full range of services to get to the bottom of your child's difficulty with sleep, including:
Polysomnography (Sleep Study)
Doctors use polysomnography (PSG or sleep study) to identify sleep problems. During sleep, the body acts differently than while awake.
A sleep study monitors your child's body functions during sleep including sleep stages, eye movements, brain waves, muscle activity, breathing, body positions and heart rhythm.
Multiple Sleep Latency Test (MSLT)
A Multiple Sleep Latency Test is a daytime nap study that gathers information about your child's sleepiness during the day.
The test is usually done right after a polysomnography (PSG or sleep study). During the MSLT, your child will take a series of naps every two hours throughout the day.
Sleep Study with CPAP, BiPAP or Oxygen
Children usually have sleep studies with CPAP or BiPAP after they have been diagnosed with obstructive sleep apnea or another breathing disorder during sleep. CPAP stands for Continuous Positive Airway Pressure and BiPAP for Bi-level Positive Airway Pressure.
Both studies use machines that get more of the air in the room to your child to help with breathing during sleep. During these tests, your child sleeps wearing a facemask hooked to a special air pressure device that delivers the right amount of air pressure to keep your child’s aiway open. The results determine the correct air pressure setting for you to set up a CPAP or BiPAP machine in your home. A sleep study may also be done with extra oxygen to help your child's breathing.
Scheduling An Appointment
If you choose the Center for Sleep Medicine at Orange Regional, your child would first be seen by an Ear, Nose and Throat (ENT) Specialist Board-certified in sleep medicine who will perform an evaluation. Based on the results of the evaluation, your child may need a sleep study.
Your Pediatrician can ask for a direct referral to The Center for Sleep Medicine for a sleep study, however, a consultation with a Board-certified sleep specialist may prove more beneficial in diagnosing a sleep disorder. If you believe your child has a sleep disorder and you contact The Center for Sleep Medicine directly, you will be referred to our Board-certified sleep physician for a consultation.
What to Expect During A Sleep Study Evaluation
When you arrive at The Center for Sleep Medicine for your sleep study, a sleep technician will meet you and bring you to your room. Your child’s vital signs (blood pressure, temperature, height and weight) will be taken and your child will be asked to get ready for bed. You will be given a sleep history form to fill out about your child’s sleep history and patterns.
During the night, the technician will monitor your child’s sleeping pattern by using a video monitor and perform a Polysomnogram test which will record your child’s:
- Brain waves
- Muscle activity
This is done with the help of sensors that are placed on your child’s head, chin, legs, chest and near the eyes. Gels secured with tape or special mesh netting help to secure the sensors. Your child’s head will be wrapped with gauze to hold the sensors in place. The placing of the sensors on your child is pain-free. Many of our patients are pretty amused by how they look with the sensors in place.
Special sensors that monitor oxygen levels are also placed on your child’s toes or fingers. Another sensor that measures airflow, carbon dioxide levels and a nasal cannula (a device used to deliver supplemental oxygen flow) will be placed at the child’s nose. If your child needs additional equipment during the night to assist with breathing, a CPAP or Bi-Pap may be used. Your sleep technician will speak with you about using this equipment before the study begins.
The hook-up process can take between 1-1 1/2 hours. During the process, you may read bedtimes stories or perhaps watch a video. "Lights Out" designates bedtime when all entertainment ends and the sleep recording begins.
Frequently Asked Questions
What should I do before the study?
- Try to withhold naps on the day of the study.
- Your child’s hair needs to be clean and dry upon arriving for your scheduled study.
- Please avoid using any conditioners, styling gels, or hair oils as they may prevent proper adherence of testing equipment to your child’s head.
- Do not let your child have any food or drinks with caffeine such as chocolate, coffee, soft drinks including Mountain Dew or energy drinks.
- To help your child remain comfortable you can bring pajamas, favorite pillows or blankets, bedtime story books and/or stuffed animals.
Can I Tour Sleep Center Beforehand?
Parents are welcome to bring their child into The Sleep Center prior to their study date for a tour and description of tests. Please contact The Sleep Center to schedule an appointment for a tour of the facility.
How do parents participate in the study?
One parent or legal guardian must be present for the entire study. You may step out of the testing area briefly for a walk or to get a snack, but please do not leave the building. Please make arrangements for additional adults and siblings to remain at home.
Where does the parent sleep?
The parent or guardian will sleep in the same room as their child. Each room has a recliner and space for the parent to spend the night. Be sure to bring comfortable clothes for yourself.
Will I be alone with my child during the study?
No. The sleep technician is in the control room all night, monitoring your child's sleep and the sleep of other children who are there for similar sleep studies. For that reason, parents are not permitted to stay with the therapists in order to maintain patient confidentiality of the other studies in process. During the night, the therapist may be in your child’s room as necessary to adjust sensors and evaluate the child’s breathing.
Will a Physician examine my child during?
No. The study will be conducted by a respiratory therapist, specially trained in pediatric sleep studies. If the therapist has concerns during the study, he/she may consult with a physician or nurse practitioner.
Will my child be in any pain?
The sleep study is almost always a non-invasive study. However, on rare occasions, it may be necessary to obtain a small blood sample, usually by pricking your child’s finger. If this is the case, the sleep technician will discuss the need for this sample with the parent and will ask permission to take the sample.
What if my child becomes upset?
Sometimes sleep studies are actually harder on the parents than on the kids. Parents should know that although their child may cry during the set-up, they are not being harmed and the procedure is painless. There will be plenty of cuddle time after the set-up for comforting nighttime rituals.
What do I need to bring?
- Please bring any medications, formulas or food items that your child may need before bedtime, throughout the night and in the morning. Please bring your child’s diapers and a change of clothing for the morning.
- Parents are responsible for administering medications, feeding and diaper changes.
- If your child has a CPAP/BiPAP mask, please make sure you bring this with you to the study.
- If your child uses a portable ventilator, please bring it on the night of the study.
What time do we leave in the morning?
Sleep studies conclude between 5:30 a.m. and 6:00 a.m. and it takes approximately 1/2 hour to disconnect the sensors. You and your child should be able to leave by 6:30 a.m. The physician ordering the study will receive the results approximately 2 weeks after the study date. Please follow up with the physician who referred your child for the sleep study.
MEET OUR TEAM
- Frank Salvatore,
As Administrator of Ancillary Services, Frank Salvatore Jr., RRT, MBA, FAARC oversees the departments of Respiratory Care, Sleep Medicine, Wound Care and Hyperbaric Medicine at Orange Regional Medical Center.
- Alan Schaffer,
Dr. Alan Schaffer is the Medical Director of The Center for Sleep Medicine at ORMC. He is Board-certified in Critical Care Medicine, Internal Medicine, Pulmonology, and Sleep Medicine.
- Samer El Zarif,
Dr. El Zarif holds Board certifications in internal, pulmonary, critical care and sleep medicine. He treats both adults and pediatric patients with complex sleep related medical disorders.
- Murali Krishna,
Dr. Krishna is member of the Division of Pulmonary, Critical Care and Sleep Medicine (PCCSM) team at Orange Regional Medical Group and is a Board-certified pulmonary-critical care physician.
- Aamir Gilani,
Dr. Gilani holds Board certifications in critical care, internal and pulmonary medicine and is board eligible in preventive medicine.