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My Child Snores
Adults are not the only ones who snore. Researchers have found that 20% of normal children snore from time to time. Seven percent to 10% of children snore every night. Snoring is not always a sign of a problem in a child. In most cases, children who snore are perfectly healthy. They will sleep just as well and develop the same as children who do not snore.
Severe snoring is found, however, in about 2% of children. Their snoring is a sign of a sleep or breathing problem. In these cases, snoring can be a danger to the child. As a parent, you need to be aware of your child's sleep and snoring patterns. If you suspect a problem or notice something unusual, then you should seek the advice of a sleep specialist.
I. How do I know if my child's snoring is serious?
Obstructive sleep apnea (OSA) is a common sleep disorder. A child who struggles to breathe while snoring may be suffering from OSA. A child who has sleep apnea may snort or gasp while snoring. He may also appear to "suck in" his chest. OSA is described as breathing that starts and stops during sleep. These pauses in breathing are usually caused when the throat narrows or even closes during sleep.
There is a range of snoring from simple to severe. Simple, primary snoring is "normal" and is, for the most part, harmless for your child. The severe snoring related to sleep apnea, however, can have serious side effects. Children with OSA may have a hard time sleeping at night. This can lead to problems in how the child acts during the day. If sleep apnea is not detected and treated, it can lead to:
- Problems at school
- Delayed growth
- Heart failure
Both boys and girls can suffer from sleep apnea. Some of the signs you can look for in your child are when he or she:
- Sleeps in an unusual position, with head off the bed or propped up with many pillows
- Snores loudly and often
- Stops breathing for very short periods during the night
- Snorts, gasps or completely wakes up after a pause in breathing
- Sweats heavily during sleep
- Has behavior problems at school, day care or at home
- Sleeps restlessly
- Is difficult to wake up even after a long night of sleep
- Has headaches during the day, especially in the morning
- Is often grumpy, aggressive or simply "cranky"
- Falls asleep or daydreams in school or at home
- Has attention-deficit/hyperactivity disorder (ADHD)
- Has not outgrown bedwetting (enuresis) at the typical age (especially if snoring is present)
Some of these signs are very much like those that are found in children with ADHD. The most common signs of sleep apnea that are shared by ADHD are:
- Trouble concentrating
In fact, some children are thought to have ADHD when in reality they are suffering from OSA. These two problems can also occur together in the same child. Sleep apnea can even make the ADHD symptoms worse. Talk to your pediatrician if your child shows some of the signs listed above. Your doctor may refer you to a sleep specialist.
II. What really happens when my child stops breathing?
Sleep is a time when your child's body can relax. This includes the muscles used in breathing. They don't have to work as hard when your child is resting. The throat muscles in children who have sleep apnea can relax too much. They can block the throat and make it hard to breathe. In other cases, the air passage is to blame instead of the muscles. The muscles may relax normally. But if the child's air passage is too narrow, the muscles will still block the throat and stop the flow of air.
In either case, the child's breathing is stopped. It is like trying to slurp a drink through a clogged straw. You may hear deep gasps as your child's breathing starts again. Each gasp for air may wake up your child for a few seconds. This process can occur many times during the night.
Anything that makes the throat more narrow or flabby can increase the risk for sleep apnea. This includes enlarged tonsils and adenoids. OSA can also be due to an abnormal bone structure of your child's face or jaw area. Sleep apnea is common in children with Down syndrome. It is also found in kids who have other congenital problems that may affect the nervous system or structure of the face.
Other factors known to increase the risk of OSA in children include:
- African-American ethnicity
- Being overweight
- Premature birth
- Having another family member with OSA
Allergies and a "stuffy nose" may cause snoring. But these conditions rarely lead to sleep apnea. Some sedative medications can increase snoring or slow breathing in children with OSA.
III. How do I find out for sure if my child has sleep apnea?
You should visit a sleep specialist who works with children. He will be able to detect if your child has sleep apnea. Your child will need to do a sleep study for at least one night at a sleep center. This study is called a polysomnogram (PSG).
Sensors are put on your child's head, face, chest and legs. The sensors are gently placed on the skin and do not cause any pain. They send tiny electrical signals to a computer. The cables are long enough for your child to move around and turn over in bed. There is no risk or danger related to the sleep study.
The PSG charts your child's brain waves, heart beat, and breathing during sleep. It also records eye and leg movements as well as muscle tension. This is the only sure way to find out if your child has sleep apnea. It will also show how severe the problem is. This will help determine the level of treatment that will be needed to help your child.
Parents should normally stay with their children during the overnight study. This may not be needed for teenagers. In the morning, you should let the staff at the sleep center know if your child's sleep and breathing were similar to how they usually are at home.
IV. What are the treatment options for sleep apnea?
In many children, large tonsils and adenoids are the cause of sleep apnea. Removing them will help solve the problem with OSA. This surgery to remove the tonsils and adenoids is called adenotonsillectomy. A different surgery may be needed if your child's sleep apnea is caused by a structural problem with the throat, face or jaw.
Sometimes surgery will not cure sleep apnea even though it stops the snoring. A second sleep study may be needed a few months after surgery. This will show for certain if the OSA has been cured.
Positive airway pressure (PAP)
Positive airway pressure (PAP) is the most common treatment for sleep apnea in adults. It may also help children when surgery is not possible or does not work. PAP provides a gentle and steady flow of air through a mask that is worn over the nose. This keeps the airway open and prevents pauses in breathing as your child sleeps.
Obesity may be a cause of your child's sleep apnea. In this case, a plan to help your child lose weight needs to be put in place. This will involve changes in diet, exercise, and other behaviors. Even if other treatments are used, weight loss should always be a goal for an overweight child with OSA.