Pediatric Sleep Medicine Services at Norton Children’s
Norton Children’s provides care for a variety of sleep disorders in infants, children and teens. Norton Children’s Pediatric Sleep Centers offer sleep studies for children of all ages. Our fellowship-trained pediatric sleep physician and staff have the training and experience to provide care that’s “Just for Kids.”
Conditions we treat
- Non-REM parasomnia (sleepwalking, night terrors)
- Obstructive sleep apnea (disordered breathing)
- Restless legs syndrome
- Other sleep disorders
Insomnia is a persistent difficulty with falling asleep, staying sleep or quality of sleep that occurs despite adequate opportunity and circumstances for sleep. It causes daytime impairment due to sleepiness.
Insomnia symptoms in children
Symptoms of insomnia in children include bedtime resistance, frequent nighttime awakenings and/or an inability to sleep by themselves. It can lead to poor school performance, impaired attention and behavioral issues.
Insomnia diagnosis and treatment
There are several possible causes for insomnia in children, including stress, caffeine use, medication side effects, underlying medical and psychiatric conditions, and poor sleep environment. There is no specific test for diagnosing insomnia — it is based on symptoms and medical history.
Insomnia usually is treated with several approaches, such as creating a good sleep environment (removing electronics from the bedroom, etc.), keeping a consistent bedtime routine, teaching calming methods and behavioral therapy.
At this time, there are no Food and Drug Administration-approved medications to help children sleep. Medications may be considered in very special circumstances.
Narcolepsy is a relatively uncommon sleep disorder in children. Children with narcolepsy usually experience constant excessive daytime sleepiness, fall asleep at unusual times and fall asleep in awkward or inappropriate places. The exact cause of this condition is unknown. In some cases, it is associated with lack of a particular chemical in the brain called hypocretin.
Narcolepsy symptoms in children
The five most common signs of narcolepsy are:
- Excessive daytime sleepiness marked by lack of energy, even after going to bed and being asleep for an adequate or prolonged amount of time.
- Cataplexy, a sudden and uncontrollable muscle weakness or paralysis that comes on during the day. Cataplexy often is triggered by strong emotions, such as excitement or laughter. With little warning, the child can lose muscle tone, have a slack jaw, broken speech, buckled knees, or total weakness in their face, arms, legs and trunk. These episodes can last a minute or two, and some children may fall asleep afterward.
- Hypnagogic hallucinations, which are vivid, dreamlike sensations in which a child may hear, see, feel or smell an illusion. Hallucinations usually happen near the onset of sleep.
- Sleep fragmentation, which causes many brief arousals throughout the night that the child remembers. The child may have difficulty going back to sleep.
- Sleep paralysis, the feeling of being awake and conscious but unable to move. It can happen during the transition from awake to asleep, and vice versa. Children can experience hallucinations and a feeling of fear during sleep paralysis.
Narcolepsy diagnosis and treatment
Narcolepsy usually is diagnosed through the following tests and observations:
- A thorough sleep history
- Assessing the sleep schedule at home with an actigraphy watch, a wrist watch-type sensor worn for a week or more to capture sleep and waking habits
- Sleep diary
- Multiple sleep latency test, an overnight sleep study followed by daytime nap test to assess daytime sleepiness
In some special cases, spinal fluid or genetic testing may be performed but are not routine.
There is no permanent cure for narcolepsy. However, treatments can help manage a child’s educational and social life. Medications can help with excessive daytime sleepiness, cataplexy, sleep paralysis and sleep hallucinations. Behavioral modification and education among family members, friends and teachers also can help the child’s symptoms improve.
Sleepwalking (somnambulism) is an abnormal behavior in which the child appears to be awake during the middle of sleep and walks or does other activities without any memory of having engaged in the activities. Sleepwalking most often occurs in first one-third of the night, usually during slow wave sleep (stage 3), and can last for 5 to 20 minutes. Most of the time, the child gets out of bed and wanders around. During an episode, the child also may:
- Sit up in bed and repeat clumsy movements
- Not respond to verbal comments
- Sleep talk
- Look dazed
- Urinate in undesirable places
Sleepwalking usually is caused by a lack of adequate sleep, interrupted sleep, sleep apnea, acute illness/fever, anxiety, stress, going to bed with a full bladder or certain medications. Most children grow out of sleepwalking by their teen years.
Having good sleep habits and a consistent sleep schedule can help stop sleepwalking. Treating the primary sleep disorder, if present, such as sleep apnea or periodic limb movement disorder, can also help. On rare occasions, sleep physicians may prescribe a medication to help with sleepwalking. Safety measures, such as door and stair gates, should be used to keep the child safe during an episode.
Sleep terrors, also called night terrors, are caused by overarousal of the central nervous system during sleep. Sleep happens in five stages — stages 1 to 4, and stage 5, which is known as REM sleep. REM sleep is when dreaming takes place, including nightmares. However, night terrors are a complex behavior usually caused by partial awakenings from slow-wave sleep (stage 3).
Night terror episodes can last from a few minutes to 30 minutes. The child’s eyes are open with a confused glassy stare. During the night terror, a child also may cry, scream, thrash, kick or sleepwalk if they get out of bed.
What causes night terrors?
There is no clear cause for night terrors. They usually occur in children ages 3 to 12, and resolve with age. Some factors that could trigger a sleep terror include:
- Acute illness (fever, cold)
- Full bladder
- Insufficient sleep
- Noisy sleeping environment
- Some sedative medications
A child’s safety is extremely important during night terror episodes. Children may get out bed and hurt themselves. To protect them, secure windows and use stair and door gates. Help your child get back to bed with as little interference as possible and do not wake up your child during these episodes.
When to see a sleep specialist for night terrors
Maintaining a regular sleep schedule and cutting down on screen time can help stop night terrors. In most cases, sleep terrors do not require treatment. However, talk to your child’s primary care provider about whether a referral to a sleep specialist is needed if the night terrors:
- Happen frequently
- Are associated with dangerous activities
- Last longer than 30 minutes
- Cause concern for seizures
Obstructive sleep apnea in children
Obstructive sleep apnea (OSA) is a condition in which there are brief pauses in a child’s breathing during sleep. Breathing usually stops when there is blockage or obstruction in the airway. OSA may cause brief awakenings from sleep when the brain senses oxygen and carbon dioxide changes in circulation and sends signals to the lungs to try to breathe.
Although OSA occurs in children of all ages, it is more common in children ages 2 to 6. The most common cause of OSA in children is enlarged tonsils and adenoids. Other causes can include:
- Acid reflux
- Low muscle tone
- Narrow facial bone structures (commonly associated with a craniofacial syndrome)
- Small jaw, cleft palate or palatal surgery
Obstructive sleep apnea symptoms in children
The most common symptoms of OSA include:
- Loud or heavy breathing
- Mouth breathing
- Pauses in breathing
- Sweating more in sleep
- Bed wetting
- Restless sleep
- Abnormal sleeping positions (commonly seen in children with Down syndrome)
- Morning headache
- Lack of concentration at school
- Poor school performance
- Behavioral issues
Obstructive sleep apnea treatment
OSA usually is diagnosed by taking a sleep history, examining the upper airway and performing a sleep study. Treatments in children may include:
- Surgically removing enlarged tonsils and adenoids
- Surgical correction of upper airway abnormalities
- Weight loss if the child is overweight
- Nasal steroid spray and allergy medication
- Continuous positive airway pressure (CPAP): A mask worn over the nose, mouth or both during sleep. The mask is attached to a portable machine that blows air to keep the airway open, allowing the child to breathe normally during sleep.
Restless legs syndrome
Restless legs syndrome (RLS) is a type of movement disorder in which the child experiences an uncomfortable urge sensation in the legs. The sensation is described as creeping, pulling, crawling, itching, cramping, pain, burning, soda bubbling, tingling or gnawing — causing the urge to move the legs. It usually happens at bedtime or when sitting for long time. The urge usually gets better by stretching, tossing and turning, walking, rubbing or massaging the leg.
Restless legs syndrome diagnosis and treatment
RLS can keep a child from falling asleep and sometimes can wake the child. The exact cause of RLS is unclear. However, it may be related to low iron levels and other medical conditions or medication side effects. RLS sometimes runs in families and has a genetic link.
There is no specific diagnostic test for RLS, as it usually can be diagnosed through a medical history. The child may be tested for iron deficiency. A sleep study may be useful in some cases to see if it is periodic limb movement disorder (PLMD). PLMD is repetitive cramping or jerking of the legs while asleep. PLMD is the only movement disorder that occurs only during sleep.
RLS treatment consists of adopting appropriate bedtime habits, cutting down on caffeine consumption, applying a heating pad or cold compress, and massage. The child may need to stop taking medications that can cause RLS. The child may be prescribed an iron supplement if needed.