Sleep Disorders - Sleep Disorders

Screen / Test Your Child / Teen for Major Pediatric Sleep Disorders:

Bed-Wetting Excessive Daytime Sleepiness Insomnia Narcolepsy Periodic Limb Movement Disorder Restless Legs Syndrome	Sleep Talking Sleep Terrors / Night Terrors / Nightmares Sleep Walking Snoring Teeth Grinding Sleep Apnea
Sleep Disorders - Keyword Definitions
Naps
The experts unanimously agree on the average child's need to nap and on a napping schedule: Newborns sleep as much and as long as they need to. Between 4 and 12 months, babies usually move to two naps a day, one in the morning and one in the afternoon, each ranging from 20 minutes to three hours. In their second year, most toddlers take one two-hour nap in the middle of the day, and by their third birthdays, some may not nap at all. As with most sleep issues, being consistent with a child’s sleep schedule is essential. Most children take only one nap per day by age 2. The child should nap in the same place that s/he sleeps at night. A set naptime in a set place will ensure that your child gets the sleep s/he needs. The best time for naps is the early afternoon. Do not let your child nap past 4 p.m., or s/he will have difficulty going to sleep at bedtime. At least three hours should intervene between the end of a nap and bedtime. Make naptimes and bedtime consistent. Keep in mind that most American children need much more sleep than they are typically getting. If a child has poor sleep habits or refuses to go to bed before 10 or11 at night, the parents may think that their child doesn't need much sleep. That's probably not true — in fact, it is more likely that this child is actually sleep-deprived. To determine if your child is sleep deprived, ask yourself these questions: • Does your child fall asleep almost every time he or she is in a car? • Do you have to wake your child most mornings? • Does your child seem cranky, irritable, or overtired during the day? • On some nights, does your child seem to crash much earlier than his usual bedtime? If you answered "yes" to any of these, your child may be getting less sleep than s/he needs. To change this pattern, you'll need to help him/her develop good sleep hygiene and set an appropriate and consistent nap and bedtime. You can screen your child to see if s/he is getting enough sleep by going to www.Sleepdisorderhelp.com and clicking onto “Screening by Parents” and then completing the Sleep Disorders Inventory for Students.
Narcolepsy
The main characteristic of narcolepsy is overwhelming Excessive Daytime Sleepiness (EDS), even after sufficient nighttime sleep. A person with narcolepsy often becomes drowsy or falls asleep at inappropriate times and places. Daytime naps may occur with or without warning and may be unpreventable. These naps can occur many times a day. They are typically refreshing, but only for up to a couple hours. Drowsiness may persist for prolonged periods of time. Furthermore, night-time sleep may be fragmented with frequent wakenings. Normally, when an individual is awake, brain waves show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular. This sleep state is called Non-Rapid Eye Movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again. This sleep state, called REM (Rapid Eye Movement) sleep, is when most remembered dreaming occurs. In narcolepsy, the length and order of NREM and REM sleep periods are confused and REM sleep occurs at sleep onset instead of after a period of NREM sleep. Thus, narcolepsy is a disorder in which REM sleep appears at an abnormal time. Also, some of the aspects of REM sleep that normally occur only during sleep -- lack of muscular control, sleep paralysis, and vivid dreams -- occur at other times in people with narcolepsy. For example, this lack of muscular control can occur during wakefulness and is called a cataplexy episode. Sleep paralysis and vivid dreams can occur while falling asleep or waking up due to this REM stage. In summary, the brain does not progress through the normal stages of dozing and deep sleep but goes directly into (and out of) REM (Rapid Eye Movement) sleep. This has several consequences: · Nighttime sleep does not include much stage 3 and 4 deep sleep, so the brain tries to "catch up" during the day, resulting in Excessive Daytime Sleepiness (EDS). · People with narcolepsy fall quickly into a very deep sleep. · They wake up suddenly and can be disoriented when they awaken. · They have very vivid dreams, which they often remember. · People with narcolepsy may dream even when they only fall asleep for a few seconds. While the cause of narcolepsy has not yet been determined, scientists have discovered conditions that may increase an individual's risk of having the disorder. Specifically, there appears to be a strong link between narcoleptic individuals and certain genetic conditions. It is estimated that there are approximately 3 million people worldwide affected by narcolepsy. In the United States it is estimated that narcolepsy afflicts as many as 200,000 Americans, but fewer than 50,000 are diagnosed. It occurs as often as Parkinson's disease or multiple sclerosis and is more common than cystic fibrosis, although it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medications. Narcolepsy can occur in both sexes at any age, although its symptoms are usually first noticed in teenagers or young adults. There is strong evidence that narcolepsy may run in families; 8 to 12 percent of people with narcolepsy have a close relative with the disease. Narcolepsy has its typical onset after the age of nine years and more commonly in adolescence and young adulthood. There is an average 15-year delay between onset and correct diagnosis that may contribute to the disabling features of the disorder. It causes cognitive, educational, occupational, and psychosocial problems due to the Excessive Daytime Sleepiness (EDS) of narcolepsy. This occurrence at a crucial time when education, development of self-image, and development of occupational choice are taking place is especially damaging. The prevalence of narcolepsy in the United States has been estimated to be as high as one per 1,000. It is a major reason for patient visits to sleep disorder centers. With its onset in adolescence, it is also a major cause of learning difficulty and absenteeism from school. Normal teenagers may experience some Excessive Daytime Sleepiness (EDS) due to a maturational increase in a physiological need for sleep and increased educational and social pressures. Onset of narcoleptic symptoms in susceptible teenagers may result in a very disabling condition. Narcolepsy is much more frequently diagnosed in males than in females and is an underdiagnosed condition in the general population. This is partly because its severity varies from obvious down to barely noticeable. Some narcoleptics do not suffer from loss of muscle control. Others may only feel sleepy in the evenings. Diagnosis is relatively easy when all the symptoms of narcolepsy are present. But if the sleep attacks are isolated and cataplexy is mild or absent, diagnosis is more difficult. Two tests that are commonly used in diagnosing narcolepsy are Polysomnography (PSG) and the multiple sleep latency test (MSLT). These tests are usually performed by a sleep specialist. The PSG involves continuous recording of sleep brain waves and a number of nerve and muscle functions during nighttime sleep. When tested, people with narcolepsy fall asleep rapidly, enter REM (Rapid Eye Movement) sleep early, and may awaken often during the night. The PSG also helps detect other possible sleep disorders that could cause Excessive Daytime Sleepiness (EDS) (i.e. Obstructive Sleep Apnea Symdrome, Periodic Limb Movement Disorder, etc.). For the multiple sleep latency test (MSLT), a person is asked to try to sleep for 20 minutes every 2 hours during normal wake times. Measurements are made of the time taken to reach various stages of sleep. MSLT measures the degree of daytime sleepiness and also detects how soon REM sleep begins. Several treatments are available for narcolepsy that treat the symptoms, but not the underlying cause. The drowsiness is normally treated using Stimulant Medication such as Ritalin or Dexedrine, as well as other medications such as codeine. In some cases, regularly planned naps can reduce the need for pharmacological treatment of the Excessive Daytime Sleepiness (EDS). A new medication called Xyrem was recently approved in the USA. It increases the quality of nocturnal sleep and decreases the frequency of cataplexy. It may take weeks or months for optimal treatment to be found. Complete control of sleepiness and cataplexy is rare. Treatment is primarily accomplished with medications, but lifestyle changes are also important. For cataplexy and other REM-sleep symptoms, antidepressant medications and other drugs that suppress REM sleep are sometimes prescribed. Caffeine and over-the-counter drugs have not been shown to be effective and are not recommended. Learning as much about narcolepsy as possible and finding a support system can help patients and families deal with the practical and emotional effects of the disease, possible occupational limitations, and situations that might cause injury. A variety of educational and other materials are available from sleep medicine or narcolepsy organizations. Support groups exist to help persons with narcolepsy and their families. Individuals with narcolepsy, their families, friends, and potential employers should know that: · Narcolepsy is a life-long condition that requires continuous medication. · Although there is no cure for narcolepsy at present, several medications can help reduce its symptoms. · People with narcolepsy can lead productive lives if they are provided with proper medical care. · If possible, individuals with narcolepsy should avoid jobs that require driving long distances or handling hazardous equipment or that require alertness for lengthy periods. · Parents, teachers, spouses, and employers should be aware of the symptoms of narcolepsy. This will help them avoid the mistake of confusing the person's behavior with laziness, hostility, rejection, or lack of interest and motivation. It will also help them provide essential support and cooperation. · Employers can promote better working opportunities for individuals with narcolepsy by permitting special work schedules and nap breaks. If you or your child suffer from narcolepsy, you may want to consider · Joining a support group. · Taking short daily naps (10-15 minutes) to combat Excessive Daytime Sleepiness (EDS) and sleep attacks. · Alerting your employers, coworkers and friends in the hope that others will accommodate your condition and help when needed. · Not do drive or operate dangerous equipment if you are sleepy. Take a nap before driving if possible. · Breaking up larger tasks into small pieces and focus on small thing at a time. · Standing whenever possible. · Taking several short walks during the day. · Carrying a tape recorder, if possible, to record important conversations and meetings. If you have concerns that your child/adolescent may have Narcolepsy, go to www.Sleepdisorderhelp.com and click onto the “Screening by Parents” menu and then complete the Sleep Disorders Inventory for Students.
Neurontin (Gabapentin)
Neurontin was developed for the treatment of Epilepsy and pain reduction. It stops the tingling feeling of Restless Legs Syndrome (RLS) and the kicking that occurs to alleviate the leg pains in RLS or Periodic Limb Movement Disorder (PLMD). Neurontin produces relatively few or very mild side effects because it passes through the body unmetabolized. Its main side effect is drowsiness. However, the drowsiness subsides after a few days in most cases, but the therapeutic effects persist. A rare side effect that has been reported by parents of some children is a tendency for the child to be more emotional and cry easier. If this persists, the physician prescribing the Neurontin should be consulted. Gabapentin has also been used off-label in the treatment of bipolar disorder, anxiety disorder (such as social anxiety disorder and obsessive compulsive disorder), in treatment-resistant depression, and for insomnia. Gabapentin may also be effective in reducing pain and spasticity in multiple sclerosis.
Nighttime Disorders
(See Sleep Disorders)
Nighttime PSG Study
(See Overnight Sleep Study / Polysomnography)
Nocturnal Seizures
Nocturnal or sleep-related seizures can cause abnormal movement or behavior during sleep. These abnormal movements may range from awakening from sleep multiple times per night for no apparent reason, to violent movements of the arms and legs accompanied with biting of the tongue and bed-wetting. People having a nocturnal seizure may thrash around or act confused. Nocturnal seizures are a form of epilepsy caused by abnormal electrical activity within the brain. Nocturnal seizures frequently occur in people with epileptic seizures during the day, but may also occur only at night. It is sometimes difficult for people to distinguish a nocturnal seizure from a sleep or night terror. A sleep or night terror results in a child suddenly awakening from sleep screaming and crying as if having a bad nightmare, but the parent is unable to awaken the child. Actually, the child is still asleep with their eyes wide open in terror, but they cannot be consoled by the parent. The harder a parent tries to awaken the child, often the worse the sleep terror and crying and flailing of arms become because the child thinks s/he is being attacked! The best measure is for the parent to remain quiet by their child’s side to protect him/her from any harm and calmly wait for the night terror to subside, which usually takes 5-15 minutes. There are ways to distinguish a sleep or night terror from a nocturnal seizure: (1) the sleep or night terror usually occurs within the first 75-90 minutes after the child falls asleep (when the child is transitioning from Stage IV NONREM sleep to REM sleep and the child gets stuck in transition between the two stages). In contrast, a nocturnal seizure can occur at any time of night and often occurs right after the child falls asleep or in the early morning hours before awakening; (2) the parent usually cannot soothe or awaken the child from a night terror; however, a child can usually be soothed and awakened from a nocturnal seizure and talk to the parent; (3) a child who has had a night terror does not remember anything about it the next day, whereas the child who has a nocturnal seizure may remember it the next morning; and (4) the night terror does not cause daytime sleepiness the next day, whereas the nocturnal seizure may result in more daytime sleepiness or lethargy the next day. If there is suspicion of nocturnal seizures, the first step is to see a physician, neurologist, or sleep specialist. An overnight sleep study with video monitoring may be recommended. These nocturnal seizures often are controlled with medication.
Non-Rapid Eye Movement (NREM)
The sleep stages 1 through 4 are collectively referred to as NREM (non-rapid eye movement) sleep. REM (Rapid eye movement), or stage 5, is not included. Unlike REM sleep, there is usually little or no eye movement during this stage. Dreaming is rare during NREM sleep, and the muscles are not paralyzed as in REM sleep. NREM sleep is divided into four stages: · Stage 1 - occurs in the beginning when the person is just falling asleep, with slow eye movements. People in this stage often believe that they are fully awake because they are still aware of any movements or sounds in the room or outside. · Stage 2 - the person is unconscious, though awakened easily. No eye movements occur, and dreaming is very rare during this stage. · Stage 3 - transition between stage 2 and stage 4. Delta waves begin to occur and this is the beginning of much deeper, restful sleep. · Stage 4 - slow-wave sleep (SWS) referred to the "deepest" stage of sleep. Dreaming is more common in this stage than in other stages of NREM sleep though not as common as in REM sleep. The content of SWS dreams tends to be disconnected and not as vivid as dreams occurring during REM sleep. This is also the most common stage in which parasomnias occur. If a child or adult does not get enough of Stages 3 and 4 deep sleep, they are often irritable and more difficult to get along with the next day. Also growth hormones are released in these deep levels of sleep, so if a child is not getting enough deep sleep, they may be shorter than normal. If the sleep problem preventing enough deep sleep is corrected, the child may suddenly experience a greater than normal increase in growth and eventually catch up in height.


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