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Demystifying Pediatric Sleep Disorders

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A recent sleep study at Bryn Mawr Hospital Health Center.

Early to bed and early to rise is terrific in theory. But, as many overworked adults know, sticking to that plan is often difficult. The same goes for kids, who are experiencing an overall rise in sleep disorders due to a large number of factors—some common, others less so. Luckily for parents, the Main Line is home to a wealth of pediatric sleep expertise. 

Both Crozer-Keystone Health System and Main Line Health (through a partnership with Nemours) have recently opened pediatric sleep centers at Crozer-Chester Medical Center and Bryn Mawr Hospital’s Health Center. The center in Upland accepts children as young as 6 months and as old as 16 years. The facility in Newtown Square sees patients aged 6-17. Both specialize in the treatment of narcolepsy, insomnia, parasomnia, Circadian rhythm changes and other conditions.

While sleep medicine is a relatively new field, the conditions that are the subjects of so much research have always been around. “Pediatric sleep medicine has really emerged as its own discipline, and is being recognized more and more—especially by the American Academy of Pediatrics,” says Dr. Vatsala Ramprasad of Crozer-Chester’s sleep center. “They’re pushing to get more of their members to ask about sleep problems so they can do the studies necessary to diagnose their younger patients.” 

The major issue affecting children may sound surprising: According to the American Sleep Apnea Association, it’s estimated that one to four percent of children suffer from sleep apnea, many between the ages of 2 and 8. Although the condition is typically associated with heavier adults, sleep apnea in kids is often attributed to enlarged adenoids—a condition that manifests itself as snoring and restlessness during sleep. 

“The drop in oxygen interrupts a good quality sleep, and because of that, daytime cognition is affected,” says Ramprasad. “Children who have issues sleeping at night actually become hyperactive during the day, perhaps due to the fact that the interrupted cognition results in frustration and other side effects.” 

Dr. Siva Ramachandran from the Newtown Square center attributes the alarming upswing in childhood obesity to a correlating swell in apnea cases, along with an additional factor. “We have all these great antibiotics, which leads to fewer tonsillectomies,” he says. “But this also creates problems with enlarged tonsils and adenoids that haven’t been removed and that obstruct the airways,” he says. 

Aside from apnea, the sleep centers see a large number of patients coping with changes to their Circadian rhythm, or biological clock, which changes as we age. “Sleep evolves as we grow, beginning at 6 months,” Ramprasad says. “Newborns spend 25-50 percent of their day in [rapid eye movement] sleep. Then, at 6 months, we see a change in the pattern and stages of sleep, where they sleep through the night and take naps during the day.”

 By 5, most children get their rest in the form of consolidated, nighttime sleep. At 13, things really start to change.
Aside from the body’s biochemical influences, the presence of technological distractions like Facebook, videogames,
iPods and TVs in the bedroom have contributed to an increase in delayed-sleep-phase syndrome. 

“In general, teenagers get a poor quality of sleep, which can lead to delayed- sleep-phase syndrome,” Ramachandran says. “Their bodies get in the habit of staying up until 2 or 3 in the morning, and then struggle to wake up completely at 7:30 when they leave for school.” 

And there are also more dire implications than groggy eyes and a fuzzy brain. Sleep is the time for the body to release growth hormones, so the emphasis on getting a good night’s sleep can be crucial to development. 

An initial consultation is needed before participating in a sleep study. But the hard part for parents can be finding a reason to make the appointment in the first place. Adults aren’t always privy to their children’s sleeping habits, so the kids themselves are ultimately responsible for reporting anomalies. And once a body gets into a rhythm, as with delayed-sleep-phase syndrome, adolescents in particular are more likely to view the issue as more of a habit than a medical condition.

“There’s often an issue of too much environmental stimulation when children should be sleeping,” says Ramprasad. “As they become teenagers, they have their own rooms, and their parents won’t usually notice anything until they go on a family vacation.” 

But, as with any medical condition, awareness greatly increases the chances of a proper and successful treatment.

“Because sleep medicine continues to be more sophisticated, we’re more able to find the solutions to their problems now,” Ramachandran says.

To learn more, visit crozerkeystone.org and mainlinehealth.org.