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
Parasomnia
A parasomnia is any sleep disorder such as sleepwalking, teeth grinding (bruxism), night terrors, REM (Rapid Eye Movement) -Behavior Disorder, Restless Leg Syndrome (RLS), Periodic Limb Movement Disorder (PLMD), and somniloquy (or sleep talking), which are characterized by unusual body movements resulting in partial arousals during sleep that occur during transitions between wakefulness and sleep. Parasomnias are sometimes associated with stress, over-tiredness, and biological factors may also be involved. It is more common for children to have parasomnias than adults. Most children outgrow their parasomnias by later childhood or adolescense.

Some parasomnias, such as sleepwalking, are used as themes in comedy, but can actually have serious consequences. For example, a person with REM Behavior Disorder, while thinking that s/he is fighting an intruder breaking into the home, can actually injure their bedmate. People with night terrors can scare their parents and prevent them from sleeping well. For these reasons, some parasomniacs need medical treatment.
Pediatric Sleep Disorders
(See Sleep Disorders)
Pediatric Sleep Medicine
Most parents and professionals do not realize that sleep disorders are common in children. Some studies suggest that as high as 20-to-25% of the population will develop a sleep disorder sometime between birth and 18 years of age. Some of these disorders are unique to pediatrics, such as apparent life-threatening events or SIDS. Other sleep disorders exist in all age groups, but differ significantly in their presentation in children compared with adults, such as obstructive sleep apnea (OSA) syndrome, in which Excessive Daytime Sleepiness (EDS), which is the primary symptom in adults, is rare in young children. Some sleep disorders such as narcolepsy are usually diagnosed during late adolescence or adulthood, although its symptoms most commonly begin during childhood. Pediatric sleep disorders range from the common conditions encountered by every pediatrician (such as toddlers who keep their parents awake at night [sleep-onset association disorder] and teenagers who won’t go to bed at night [Delayed Sleep Phase Syndrome (DSPS)]) to those that are rare and life threatening (such as congenital central hypoventilation syndrome). Despite the frequency and severity of pediatric sleep disorders, this field of medicine has not received much attention from either the pediatric or sleep medicine community.

The National Institute of Health (NIH) has issued a revised 2003 National Sleep Disorders Research Plan with a strong emphasis on pediatric issues. In recent years, the NIH has paid increasing attention to the importance of sleep disorders in children, which includes issuing two requests for applications in recent years: one on childhood obstructive sleep apnea and one on sleep and sleep disorders in children. The success of these initiatives has no doubt influenced the new NIH research plan. In this plan, the need for developmental studies of sleep processes is highlighted, and equal credence is given to the study of pediatric and adult sleep disorders.

In summary, the importance of childhood sleep disorders is becoming increasingly recognized in recent years by pediatricians, and now professional associations and scientific bodies. Depending on age, children sleep as much as 50% to 65% of the time. Increasing attention to this "other half of life" can only improve the health and development of our children.
Pediatric Sleep Specialist
(See Pediatric Sleep Medicine)
Periodic Limb Movement Disorder (PLMD)
Periodic Limb Movement Disorder is a sleep disorder where the patient moves involuntarily during sleep. It can range from a small amount of movement in the ankles and toes to wild kicking and flailing of all four limbs. These movements, which are more common in the legs than arms, occur for between 0.5 and 10 seconds, recurring at intervals of 5 to 90 seconds. A formal diagnosis of PLMD for adults requires three periods during the night, lasting from a few minutes to an hour or more, each containing at least 30 movements followed by partial arousal or awakening. For a diagnosis in children and adolescents, there must be an average of at least five periodic limb movements per hour.

PLMD is a cause of insomnia and Excessive Daytime Sleepiness (EDS). The incidence of this disorder increases with age. It is estimated to occur in 5% of people age 30 to 50 and in 44% of people over the age of 65. As many as 12.2% of patients suffering from insomnia and 3.5% of patients suffering from Excessive Daytime Sleepiness (EDS) may experience PLMD. There is a big need for more studies looking at the prevalence rate in children, but limited information suggests that the incidence rate of PLMD and Restless Legs Syndrome in children may also be as high as 5 or 6 percent.

Approximately 80% of the patients with Restless Leg Syndrome (RLS) also have PLMD and move their legs frequently in sleep to relieve themselves of the painful RLS feelings. However, most people with PLMD do not experience RLS. PLMD has the following impact on sleep:

· fragmented or restless sleep;
· complaints of insomnia or excessive daytime sleepiness;
· can occur immediately with the onset of stage 1 (the lightest stage of sleep);
· most frequently occur during stage 2 sleep;
· decrease in frequency during stages 3 & 4, the deepest stages of sleep;
· usually absent during REM because our bodies are paralysed during this stage so that we will not act out our dreams;
· can be associated with an arousal (brief awakening) or a complete awakening;
· usually causes hyperactivity and ADHD symptoms in children and adolescents;
· frequently results in touchy, oppositional daytime behaviors in children and adolescents.

Previous treatment for PLMD has been the use of Levadopa or Neurontin to stop the nighttime limb movements. However, new research suggests that 25-to-80 percent of children with PLMD have a low serum ferritin level (a chemical contained in the iron) that causes the nighttime periodic limb movements. Three months treatment of iron therapy has raised the serum ferritin level and significantly reduced the nighttime PLMD. Once the PLMD has been corrected, studies show that the daytime ADHD characteristics and oppositional behaviors improve significantly. If your child is hyperactive and kicks around frequently in sleep, ask the pediatrician to do a blood test to measure your child’s serum ferritin level (not iron level, which is different). A child can be low in serum ferritin, but have a normal iron level; therefore, it is important to stress that the serum ferritin level is checked, not the iron level.
Polysomnography (PSG)
(See Overnight Sleep Study / Polysomnography)
 
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