Sleep Apnea in Children
Does your child snore on most nights? While snoring is normal from time to time, regular snoring is not normal in healthy children. In 2002, the American Academy of Pediatrics recommended that all children who snore regularly be screened to ensure they do not have Obstructive Sleep Apnea (OSA). Those with sleep apnea experience pauses in breathing lasting from ten seconds to more than a minute. These pauses (or apneas) can occur more than 30 times every hour. In many cases, enlarged tonsils and adenoids are found to be the cause, and once removed, the apneas subside. While the surgery can benefit many children with sleep apnea, children under the age of 3 or children with facial anomalies require additional care. These children could benefit from continuous positive airway pressure (CPAP). Sleepnet has a variety of pediatric sleep apnea masks that have the same comfort and benefits as our adult masks.
What kinds of sleep apnea exist?
Obstructive Sleep Apnea (OSA) occurs when the airway is partially blocked (hypopnea) or completely blocked (apnea) by tissue in the upper airway. OSA is the most common form of sleep apnea.
Central Sleep Apnea is much less common and involves the brain. Instead of a physical blockage, the muscles for breathing are sent incorrect messages.
Mixed or Complex Sleep Apnea describes a mixture of Obstructive Sleep Apnea and Central Sleep Apnea.
It is hard to tell the different kinds of sleep apnea apart as they have so much in common. Often a polysomnogram at a sleep center is the only way to confirm. Some of the most common sleep apnea symptoms are described below.
- Snoring followed by pauses, gasping or squeaking
- Difficulty breathing
- Restless sleep or sleeping in unusual positions
- Night Terrors, sleep walking, or bed wetting
- Mouth breathing
- Daytime hyperactivity or irritability, agitated, aggressive, and cranky
- Having problems in school
- Difficulty waking in the morning
- Appearing very sleepy or falling asleep during the day
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It is important to talk to a doctor or another medical professional immediately if you think your child might have sleep apnea. A doctor can give a physical exam, collect a personal and family history, or refer you to a sleep center.
At a sleep center, a sleep study is done. This is a painless test that can be done in a hospital as a polysomnogram, or in the child’s home with portable equipment. During the test, information is collected while the child sleeps. This includes blood oxygen levels, heart rate, blood pressure, breathing, brain activity, eye movement, chest and leg movement, and air moving in and out of the lungs. This test may be done over one or two nights.
The results of the sleep study are reviewed by the sleep technician. He or she sends a copy to the doctor, explains the results, and together they work to determine the best treatment.
If the results show a diagnosis of sleep apnea, another study called a titration study is done. This will help to find the air pressure needed to keep the airway open. Usually different sleep apnea masks will be presented and the technician will show the patient how to fit them correctly. There are many kinds of masks, and not all of them will be available. In the end some research into different mask options may need to be done until a good fit is found.
Positive Airway Pressure
Continuous Positive Airway Pressure (known as CPAP) is the most effective sleep apnea treatment. Pressurized air is used to keep the airway open during sleep. The machine itself is the size of a shoebox or smaller and connects by a hose to a mask worn on the face. There are different kinds of masks to choose from including nasal masks, full face masks, nasal pillows, and hybrids. Different options should be tried until a comfortable fit is found. Side effects can include a stuffy nose, dry nose or mouth, sore throat, headaches, skin irritation, and stomach bloating.
There are also other kinds of positive airway pressure devices. A Bi-level positive airway pressure machine provides two different air pressures: one for breathing in and a lower one for breathing out. This can be useful at high pressures when it may be hard to exhale. An automatic positive airway pressure (APAP) machine can automatically adjust the air pressure within a set range to exactly what is needed with each breath. This is an effective sleep apnea treatment for someone who experiences rare but severe apneas.
Positive airway pressure is not the best sleep apnea treatment for everyone and usually takes some getting used to. However, when used correctly, the results can be remarkable.
Oral appliances are an easy-to-use option in mild to moderate obstructive sleep apnea treatment. These mouthpieces are specially made by a dentist to open up the airway by moving the jaw, the tongue, etc. Oral appliance users should have regular check-ups to make sure that the device is fitted and working properly. Side effects may include pain and/or damage to the teeth, gums, or jaw. Their benefits include being easy to travel with, easy to wear, and easy to care for. However, they are not as effective as positive airway pressure therapies in sleep apnea treatment.
Some children may benefit from surgery for sleep apnea treatment. The surgery depends on the kind of sleep apnea.
In severe cases, a hole is cut in the windpipe and a tube is inserted. This allows the air to avoid the upper airway completely.
The operation removes the tonsils, the uvula, and part of the soft palate to create a larger airway. Snoring may decrease, but it is not always a successful sleep apnea treatment.
Laser Assisted Uvulopalatoplasty (LAUP)
A laser is used to remove the uvula and some of the soft tissue in the throat. It is intended to help treat snoring and may not be an effective sleep apnea treatment.
Your primary care physician, your sleep doctor, your Respiratory Therapist, specialists, and other healthcare professionals can provide a lot of helpful information on sleep apnea and its various forms of treatment. Family and friends can be wonderful sources of encouragement and care. Support groups and online communities are two great resources for asking questions, sharing experiences, and learning. The American Sleep Apnea Association (ASAA) has a network of A.W.A.K.E. (Alert, Well, And Keeping Energetic) groups across the country.
Helpful organizations and websites:
American Academy of Sleep Medicine
American Sleep Apnea Association
American Sleep Apnea Association Forum
National Heart Lung and Blood Institute
American Academy of Pediatrics
Sleep apnea is not curable, but it is manageable with the right therapy and especially the right outlook.