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
Serum Ferritin
Ferritin is a globular protein found mainly in the liver. Serum ferritin levels are measured in patients as part of the iron studies workup for anemia. The ferritin levels measured have a direct correlation with the total amount of iron stored in the body. If ferritin is high, there may be iron in excess, which would be excreted in the stool. If ferritin is low, there is a risk for lack of in iron, which could lead to anemia. However, there are people who have a normal iron level and low serum ferritin. Recent research suggests that a low serum ferritin level can cause problems with Restless Legs Syndrome (RLS) and/or Periodic Limb Movement Disorder (PLMD). As a result, children with RLS and/or PLMD often appear to have Attention Deficit/Hyperactivity Disorder (ADHD). However, correction of the RLS and/or PLMD by raising the serum ferritin to normal levels may result in a significant decrease in ADHD. Research suggests that the serum ferritin level can be increased by giving the child iron therapy supplements for approximately 12 weeks. This can be done by the pediatrician or the parents giving the child multiple vitamins with extra iron added in a tablet or liquid form. If given in a liquid form, make sure the child or adolescent rinses and brushes his teeth after each intake of liquid iron or else it can permanently stain the teeth a reddish-brown color. Also increase the child’s intake of fruit, vegetables, and whole wheat breads to prevent constipation that can occur with extra iron intake. Another option is to try to increase the iron and serum ferritin levels by giving the child more foods high in serum ferritin such as raisons, egg yokes, liver, and leeks (to make leeks more palatable, try creaming them or cooking and grinding them up, and putting them in your child’s favorite soup or stew where the leeks are not noticeable).
SIDS
Sudden Infant Death Syndrome (SIDS) is any sudden death of a seemingly healthy infant between the ages of one month and one year that cannot be explained by illness, suffocation, or other reasons. Another term used for SIDS in North America is “crib death”. SIDS is a definition of exclusion that is used only after the performance of an adequate postmortem investigation and the death still remains unexplained. Typically, the infant is found dead after being asleep and does not display any signs of having suffered. The unexplainable event of SIDS sometimes leaves the parents with a deep sense of guilt in addition to their great loss and grief. SIDS occurs in approximately 50 deaths per 100,000 births in the U.S. It is responsible for far less deaths than disorders related to premature births or congenital disorders, although it is the leading cause of death in healthy babies older than one month of age. There are several preventative measures that parents of infants can do to lessen the likelihood of SIDS: a) Sleep position Less SIDS occur when the infant is placed on its back to sleep. There is less chance that a small infant who has poor head control may inhale its exhaled breath or smother in its bedding when face down. Another theory suggests that infants sleep more soundly on their stomachs and are unable to awaken when they have an sleep apnea events (e.g., pauses in breathing, which may be fairly common in infants). Only use a firm, well-fitted mattress that does not leave cracks between the bed wall and the mattress. Also use well-fitted, tight sheets in a crib or bassinet. Do not place pillows, stuffed animals, loose blankets or fluffy bedding in the crib. In cold weather, dress the infant warmly in well-fitted, warm pajamas with feet, especially when it is really cold. b) Sleeping-Sacks or Sleeping Bags for Infants When bedding is necessary to maintain a baby's body temperature, the use of an infant sleeping-sack or sleeping bag that can be tied in place with long straps to the mattress to prevent the infant from rolling over on its stomach is becoming more popular. This sleeping-sack zips up and snaps at the chin with head and arm openings. One study published in the European Journal of Pediatrics in August 1998 reported that sleeping-sacks significantly reduce the risks of turning from back to stomach during sleep, keep the infant warm in cold climates, and prevent bedding from covering the infant’s face, which leads to increased temperature and breathing in harmful carbon dioxide. They concluded that "The use of a sleeping-sack should be particularly promoted for infants with a low birth weight." c) Breastfeeding Breastfed infants have 1/5th the rate of SIDS as formula-fed infants according to a study published in the May, 2003 issue of Pediatrics. d) Sleeping near the baby Parents who sleep near their babies are more likely to be awakened by the infant in distress even if s/he is unable to cry out for help. However, 'Near' is referring to sleeping in the same or an adjoining room, but not in the same bed. There is much greater risk of suffocation when the infant sleeps with the parents who use fluffy pillows and blankets or may roll on top of the infant when extremely tired and cause suffocation. e) Baby Monitor When the parents cannot sleep within hearing range of the infant, then a good-quality baby monitor that can be attached to the bed to allow the parents to hear any crying or problems can be very effective (provided that the parents remember to turn it on every night and keep good batteries in it if it does not plug in to electricity). f) Pacifiers The use of a pacifier resulted in a 90% reduction in the risk of SIDS according to a 2005 study. The researchers reported that the raised plastic on the front of the pacifier held the infant's face away from the mattress, preventing suffocation. f) Secondhand Smoke Infants exposed to secondhand smoke after birth are at greater risk of SIDS. Research studies indicate that infants who die from SIDS tend to have higher concentrations of nicotine and cotinine in their lungs than infants who die from other causes. Parents who smoke should quit smoking or smoke only outdoors, leaving their house completely smoke-free to reduce their infant's risk of SIDS, as well as other serious side effects of second-hand smoke.
Sleep Attacks(s)
Sleep Attacks are short, uncontrollable sleep events that occur throughout the day. They are a form of Excessive Daytime Sleepiness and sometimes a symptom of Narcolepsy or Obstructive Sleep Apnea Syndrome (OSAS). In any event, a person having sleep attacks throughout the daytime in spite of getting adequate nighttime sleep, should consult with their physician and rule out Narcolepsy, OSAS, and other serious medical problems.
Sleep Disordered Breathing (SDB)
Sleep-Disordered Breathing (SDB) involves repeated events where the person’s airways are either partially or totally obstructed for short or longer periods of time during sleep, resulting in snoring, sleep apnea events, and sometimes arousals from sleep. In the most severe form, Obstructive Sleep Apnea Syndrome (OSAS), apnea events are occurring because the upper breathing airways have momentarily been obstructed (possibly by enlarged tonsils or adenoids, an elongated uvula, fatty tissue in the throat, craniofacial abnormalities, narrow structure of the jaw or airways, tumors growing in the airways, or other reasons.). Loud snoring, choking, gasping, or snorting in sleep should not be ignored by parents because OSAS can have serious medical, learning, and/or behavioral consequences. It is a medical condition that can, in approximately 90% of the cases, be easily corrected with the help of a sleep specialist, Ears, Nose, and Throat (ENT) specialist, or orthodontist. Correction usually results in more alertness and concentration, improved work or school performance, and less irritability, improved attitude, and behaviors.
Sleep Disorders
A sleep disorder is an irregularity or disorder in the sleep patterns. It is estimated that at least forty million Americans may suffer from chronic, long-term sleep disorders, and an additional twenty-to-forty million Americans experience occasional sleeping problems. These disorders and the resulting sleep deprivation and excessive daytime sleepiness interfere with school and work performance, driving a vehicle, emotional/ behavioral regulation, and social interactions. They also account for an estimated $16 billion in medical costs each year, while the indirect costs due to lost productivity, vehicular accidents, and other factors are probably much greater. Sleep specialists have identified more than eighty sleep disorders, most of which can be corrected or managed effectively once they are correctly diagnosed. The most common sleep disorders include: · Insomnia, including Delayed Sleep Phase Syndrome (DSPS) or Behavioral Insomnia of Childhood (BIC) · Sleep Apnea (See Central Apnea / Mixed Apnea / Obstructive Sleep Apnea) · Restless Legs Syndrome (RLS) · Periodic Limb Movement Disorder (PLMD) · Narcolepsy
Sleep Disorders Inventory for Students (SDIS)
The Sleep Disorders Inventory for Students (SDIS) was designed for use by professionals working with children and adolescents (from 2 years-through-18 years of age) to identify sleep disorders at an early age before too much harm is done to cognition, achievement, behaviors, self-esteem, emotional regulation, and health or safety. The SDIS is simple and quick for a parent or guardian to complete and a professional to computer score. However, it is a very accurate and reliable screening instrument for evaluating children and adolescents’ sleep problems. The SDIS screens and helps identify approximately 90% of the sleep disorders occurring in children and adolescents. The sleep disorders that are excluded from this inventory rarely occur, or do not appear to impair students’ functioning, or they usually disappear in early-to-middle childhood with little or no consequences. If parents want to screen their children for the major pediatric sleep disorders, they can go to the internet website (www.Sleepdisorderhelp.com), and for a small fee, parents can complete a SDIS screening inventory that helps identify the major sleep disorders in children and adolescents. After completing the SDIS inventory, the parent/guardian immediately receives a report with graph discussing their child’s sleep problems. This report describes any of the sleep disorders the child may have, how this sleep disorder can negatively effect the child’s functioning, possible treatment modes used for the sleep disorder, and a website that lists sleep clinics in the parents’ living area that are accredited that can help the child/teen correct his/her sleep problems or disorder. The SDIS has numerous features that make it a unique and reliable sleep screening inventory: * The SDIS is the only sleep inventory designed to screen a broad age range of children from 2-through-18 years for the most harmful sleep disorders impairing children’s functioning. * It is inexpensive and quick, but an accurate sleep disorder screening inventory. * It provides two screening inventories depending on the student’s age: (1) The SDIS – Children’s Form (SDIS-C) for ages 2-through-10 years, and (2) The SDIS – Adolescent Form (SDIS-A) for ages 11-through-18 years. * These two inventories are available in English or Spanish, which is a very important feature given the quickly growing Hispanic population in the USA. * The SDIS – Children’s Form screens for four of the most common and harmful sleep problems/disorders in children (Obstructive Sleep Apnea Syndrome, Periodic Limb Movement Disorder, Behavioral Insomnia of Childhood or Delayed Sleep Phase Syndrome, and Excessive Daytime Sleepiness). It also provides an overall Sleep Disturbance Index and helpful information and intervention tips on five parasomnias that are common in childhood (Teeth Grinding, Sleep-Talking, Sleep-Walking, Sleep or Night Terrors, and Bed-Wetting). * The SDIS – Adolescent Form screens for all of the above-mentioned sleep disorders just like the SDIS-C, but it also screens for Narcolepsy and Restless Legs Syndrome. * These sleep factors on the SDIS are easily interpretable because they are constructed from clearly defined sleep disorders. * The SDIS is written on a simple 4th-to-5th grade reading level. * It only takes parents about 6-to-10 minutes to complete the SDIS. * Professionals can quickly computer score the SDIS in approximately 3-5 minutes. * The SDIS computer scoring minimizes scoring and interpretation errors. * The SDIS sleep scales and Total Sleep Disturbance Index have high internal consistency and test-retest reliability. * The SDIS test designers used many forms of validity testing and the SDIS scales obtained high validity scores (validity coefficients), indicating that the SDIS accurately measures the sleep problems/disorders it claims to measure. * The SDIS was developed using a fairly large and diversified sample of children and teens for a sleep inventory. This sample contained children with and without sleep problems/disorders, students in general education, special education, gifted and talented programs, and children/adolescents with and without mental health disorders (DSM-IV diagnoses like ADHD, depression, conduct disorder, etc.). * The sample of children with sleep disorder diagnoses came from seven sleep centers around the country specializing in sleep disorder diagnosis and treatment of children and adolescents. These sleep centers were All Children’s Hospital in St. Petersburg, FL; Johns Hopkins Pediatric Sleep Centers, MD; Miami Children’s Hospital, FL; Stanford Sleep Disorders Clinic, Stanford, CA; Carle Regional Sleep Disorders Center, Urbana, IL; Tampa General Hospital’s Sleep Center, FL; and University Community Hospital, Tampa, FL. * The sample of children without a diagnosis of a sleep disorder came from 45 schools in the Tampa Bay, FL region (although these children did not have a sleep disorder diagnosis, approximately 15 percent of them had undiagnosed sleep problems or possible sleep disorders). In the special education sample, approximately 33 percent of these children were rated by their parents as having significant sleep problems and possible sleep disorders.
SDIS Start-Up Kit and Its Components
All professionals using the Sleep Disorders Inventory for Students must first purchase the SDIS Start-Up Kit that contains the CD ROM computer scoring program and Technical Manual, as well as one packet of 25 SDIS-Children’s Inventories and one packet of 25 SDIS-Adolescent Inventories. If a professional only works with one of these age groups, then s/he can choose two packets of SDIS – Children’s Inventories or two packets of SDIS - Adolescent Forms. This Start-Up Kit is mandatory in order to accurately score the SDIS with the computer. In case of a computer crash, hand scoring is explained in the Technical Manual, but it is discouraged using the hand scoring except in the case of a computer going down due to a greater risk of human errors when hand-scored. Furthermore, the hand scoring lacks the computer-produced interpretive report and graph that parents and MD’s like to read to better understand the possible sleep disorder/s. After this SDIS Start-Up Kit is purchased, the professional can use the computer scoring unlimited times and only has to purchase the SDIS inventories occasionally for a small fee.
Sleep Disorders Inventory for Students – Adolescent Form
See Sleep Disorders Inventory for Students (SDIS)
Sleep Hygiene
Sleep hygiene is the practice of following or developing healthy guidelines to ensure restful, effective sleep. Good sleep hygiene also means that a person gets enough sleep to promote daytime alertness and help avoid the onset of sleep disorders. Difficulty sleeping and Excessive Daytime Sleepiness (EDS) can be indicators of poor sleep hygiene. Good sleep hygiene includes the following guidelines: · Going to sleep and getting up at the same time each day. · Establishing and keeping a regular bedtime routine. · Using relaxation techniques (e.g., meditation) shortly before sleep and allowing at least one hour to unwind before bedtime. · Do not eat large meals within an hour of going to bed. · Do not play video or computer games, or watch wild or scary television programs within an hour before going to bed because they often stimulate the brain and make it difficult to fall asleep. · Read calm, relaxing books using a small night light or listen to peaceful music in bed before going to sleep. Make sure the room is dark except for a small night light. · Exercise vigorously on a daily basis, preferably in the morning, but not immediately before bedtime. · Get adequate exposure to natural daylight every day. · Avoid naps in the daytime. · Keep the bedroom at a cool, comfortable temperature. Losing body heat helps the onset of deep (slow wave) sleep. · Keeping the bedroom dark leads to the production of melatonin, which helps people to fall asleep and stay asleep for lengthy periods of time. · Avoid stimulant medication within one hour of retiring, except at the direction of a physician, as well as caffeine drinks, drugs, or alcohol (which in smaller doses can act as a stimulant.
Sleep Level
See: Levels of Sleep
Sleep Medicine
See Pediatric Sleep Medicine
Sleep Onset
Sleep onset is the transition from wakefulness to sleep.
Sleep Specialist
See: Pediatric Sleep Specialist
Sleep Stage
See: Levels of Sleep
Sleep Study
See Overnight Sleep Study / Polysomnography
Snoring
Snoring is the act of breathing through the open mouth while asleep in a manner that causes a vibration of the uvula and soft palate, thus producing a sound ranging from a soft raspy noise to a loud, unpleasant sound. This snoring is often caused by some obstruction partially or totally blocking the airways. It could be enlarged tonsils or adenoids, a long uvula, cranial-malformations, fatty tissue in the throat due to obesity, tumors growing in the airways, a cleft palette, etc. There is a wide range of statistics on snoring, but at least 30% of the adult population and possibly as high as 50% of people in some demographic groups snore. In some mild situations, snoring is not a health risk to the snorer, but snoring resulting from a significant obstruction of the breathing passage can be an indication of the potentially life-threatening disorder Obstructive Sleep Apnea Syndrome (OSAS). The immediate effects of sleep apnea are that the snorer sleeps lightly and does not get enough deep sleep, is sometimes aroused from sleep, and exerts more energy during the night to keep muscles tense in order to keep airflow going to the lungs. Because the snorer does not get a good night’s rest, s/he may be sleepy during the day, which impairs job and school performance and makes vehicular driving hazardous. After many years with this disorder, elevated blood pressure and heart enlargement may occur, possibly even resulting in right ventricle heart attacks. Surgery is one treatment option to stop snoring (for example, an adenotonsillectory or a uvulopalatopharyngoplasty). If surgery is too risky or unwanted, the patient may sleep every night with a nasal mask that delivers air pressure into the throat to keep the airways open; this is called continuous positive airway pressure or “CPAP”. In combination with the above-mentioned treatments, weight-loss may also be undertaken to reduce fatty tissue in the airways. Children should not snore at night during sleep. A chronically snoring child should be examined for problems with his or her tonsils and adenoids. A tonsillectomy and adenoidectomy correct approximately 80% of the cases of childhood snoring and bring the child to full health, improve his/her concentration, and school performance.
Sodium Oxybate
Sodium Oxybate is a drug most commonly used in the form of a salt like sodium gamma-hydroxybutyrate (GHB). It has been used as a general anesthetic and a hypnotic to reduce insomnia. In the United States, GHB is used under the trade name Xyrem to reduce the number of cataplexy attacks in persons with narcolepsy.
Somniloquy
Somniloquy is commonly referred to as sleep-talking in sleep. It is a parasomnia, which means “strange or unusual movements in sleep”. Somniloquy can be quite loud, ranging from simple sounds to long discourses, and can occur numerous times during sleep. Listeners may or may not be able to understand the sleep-talking. Sleep-talking usually occurs during transitions from Non-Rapid Eye Movement (NREM) sleep to REM (Rapid Eye Movement) sleep. It can also occur during REM sleep. Full consciousness does not occur, and the sleep talker is unaware of this talking. Sleep-talking can occur in isolation or as a characteristic of another sleep disorder such as: · REM sleep behavior disorder (RBD) - loud, emotional or profane sleep-talking · Sleepwalking · Night terrors - intense fear, screaming, shouting · Sleep-related eating disorder (SRED) Sleep-talking is common and occurs in 50% of young children; however, most children outgrow sleep-talking by puberty, although it may continue into adulthood (about 5% of adults are reported to talk in their sleep). It runs in families. Sleep-talking by itself is harmless and the sleep-talker’s comments should not be taken seriously; however, loud sleep-talking can wake up others and cause them concern—especially when misinterpreted as conscious, purposeful speech by an observer. If the sleep-talking is dramatic, emotional or profane it may be a sign of another sleep disorder (see above).
Sonambulism
Sonambulism is a sleep disorder commonly referred to as sleep-walking and is a parasomnia. The sleep-walker takes part in activities that are normally undertaken while awake, but s/he is asleep or in a sleep-like state. Sleepwalking can affect people of any age. It generally occurs when an individual awakes suddenly from Slow Wave Sleep (SWS or sometimes referred to as "deep sleep"), causing the sleepwalking. In children and young adults, up to 25% of the night is spent in SWS. However SWS decreases as the person ages. Therefore, children and young adults (or anyone else with high amount of SWS), are more likely to sleepwalk than older individuals. Somewhere between 1% and 16.7% of U.S. children sleepwalk, and young adolescents are more likely to sleepwalk. One study showed that the highest incidence rate of sleepwalking was 16.7% for children around 11-to-12 years of age. Males tend to sleepwalk more than females. Sleepwalkers have been observed to eat, get dressed, go for walks outside, or even try to drive cars while technically asleep. Most sleepwalking occurs when the person is awakened (something or someone disturbs their SWS), and the person may sit up, look around, and then typically goes right back to sleep. But these more common events of going right back to sleep are rarely noticed or reported unless they are recorded in an overnight sleep study at a sleep clinic. Sleepwalkers have their eyes open so they can navigate their surroundings, resulting in some parents or a spouse thinking the sleepwalker is awake. However, when spoken to, the sleepwalker usually does not respond appropriately or intelligently. Many cartoons or children’s TV programs portray sleepwalkers moving around with their eyes closed and arms outstretched. However, their eyes are wide open and their arms are usually hanging naturally at their sides. If family members look closely, they may notice that the sleepwalker’s eyes may have a glazed, blank appearance. While sleepwalking is not a serious health concern, accidents sometimes occur as the sleepwalker is moving around without the awareness of dangers because s/he is unable to use his/her conscious decision-making abilities. A common myth of this disorder is that one should never awaken sleepwalkers while they are engaged in their movements. However, awakening the sleepwalker may prevent them from accidentally walking into something that could harm them. The biggest problems with awakening sleepwalkers are that they may be disoriented, embarrassed when awakened, or they may do something harmful to the individual doing the waking. In a few cases, sleepwalkers may become aggressive when awakened because they are in a confused state and may think that someone is trying to harm them. However, this is rare and sleepwalkers are much more likely to endanger themselves than anyone else while walking around in their sleep state. When sleepwalkers are a danger to themselves or others (i.e., when climbing up or down steps, walking outside on a freezing, snowy night, or trying to use a dangerous tool such as a knife or drive a car), waking them is the safest action to take. Because some severe sleepwalkers have fallen out of windows or gone outside at night while sleepwalking and died, it is important to put bars or tight screens on windows and keep them locked at night. The same goes for safety-proofing locks or putting alarms on doors to awaken the sleepwalker or other family members when the sleepwalker tries to leave the home.
Spinal Tap
A lumbar puncture (LP), sometimes called a spinal tap, is a procedure in which a small amount of the fluid is removed that surrounds the brain and spinal cord in order to examine it to gain specific information about a particular illness or disorder. This fluid is called the cerebrospinal fluid (CSF). In infants and children, a spinal tap is undertaken to determine if the child has meningitis, an infection of the meninges, which is the membrane covering the brain and spinal cord. There are other reasons to do spinal taps: They may be performed to remove fluid and relieve cranial pressure when certain types of severe headaches exist, to check for other diseases in the central nervous system, to check a person’s hypocretin level to determine narcolepsy, or to insert chemotherapy medications into the spinal fluid. Some measures can be taken to lessen the pain during a spinal tap. For a non-emergency spinal tap, a nurse can rub a topical anesthesia cream on the skin of the back where the tap will be done about 30 minutes to 1 hour before inserting the needle. When the needle is inserted into the skin, the person won't feel sharp pain, only lesser pressure. After the skin is numbed, a doctor can also inject liquid anesthesia such as lidocaine into the tissues under the skin to prevent further pain, which can be very important, especially when doing spinal taps with infants and children. This spinal fluid is sent to the laboratory and analyzed for evidence of an infection or the hypocretin level. Some of the results are available within 30 to 60 minutes. However, in the case of a bacterial culture, it is necessary to watch for organisms growing in the sample. Culture results are usually ready in two days or 48 hours. If the doctor strongly suspicions that the child has an infection, s/he will often start antibiotic treatment while waiting for the results of the culture and then make necessary adjustments once the results come back. There are usually no complications with spinal taps.
Stages 1 and 2 of NREM Sleep
See: Levels of Sleep and Non-Rapid Eye Movement (NREM).
Stimulant Medication
The most common stimulants are Ritalin, amphetamines, such as Dexedrine, and methamphetamines, such as Desoxyn. Stimulants are most commonly used in treating Attention Deficit/Hyperactivity Disorder or ADHD. However, they have been used for other conditions, such as Excessive Daytime Sleepiness (EDS) associated with Obstructive Sleep Apnea Syndrome or Narcolepsy. It is important for physicians to do a comprehensive medical history and mental status examination before starting an adult or child on stimulant medication because a variety of other medical conditions or situations can cause symptoms of inattention and distractibility that may look similar to ADHD. There are several sleep disorders (Periodic Limb Movement Disorder, Obstructive Sleep Apnea Syndrome, and sometimes even Narcolepsy), Anxiety Disorders, Depression, and possibly even family stressors such as divorce of parents or a death in the family that may result in temporary symptoms of inattention and ADHD. The physician also needs to gather outside data such as relatives’ reports or teacher-rated behavior rating scales and classroom observations made by a school psychologist or school nurse to help verify the diagnosis of ADHD once sleep disorders and familial stressors are ruled out. Some people may have another psychiatric condition together with their ADHD.


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