June 4, 2009
When sleep does not come easy
Kids with sleep problems may behave badly in the day and risk complications, including developmental delays. HUANG HUIFEN reports
Lullabies and bedtime stories may not always guarantee a good night's rest. These days, more children are being treated for sleep problems.
Specialists say obstructive sleep apnoea, sleepwalking, sleeptalking and night terrors are the most common disorders among children.
Obstructive sleep apnoea (OSA)
OSA occurs when a child's muscles relax during sleep, causing the airways in his nose, mouth and throat to be blocked.
When this happens, breathing stops, leading to loud snoring, poor sleep and, if severe, the child's skin colour may turn bluish, said Dr Jenny Tang, who is head and senior consultant of the respiratory medicine service at KK Women's and Children's Hospital.
The child does not sleep deeply. As a result, his sleep is often disrupted. This causes him to be lethargic when he wakes up and he can be aggressive, hyperactive and have poor concentration in the day.
This, in turn, may result in poor school performance andï¿½poorer brain development and may be associated with attention deficit hyperactivity disorder, said Dr Kenny Pang, an ear, nose and throat surgeon and director of Pacific Sleep Centre.
In serious cases, untreated OSA may lead to complications such as poor growth or short stature, developmental delay, neurocognitive impairment, behavioural disorders, bedwetting, hypertension, heart failure, increased post-operative breathing and chest complications or even death, said Dr Tang.
'The most common causes of childhood sleep apnoea are big tonsils, adenoids and nasal allergies,' said Dr Pang.
Dr Tang said several risk factors are associated with childhood OSA.
They include obesity, large tonsils and adenoids, smoking for some teenagers, allergies and asthma, various diseases including brain, nerve, muscle and airway diseases, and craniofacial anomalies.
In Singapore, there is a 1 to 3 per cent prevalence of OSA among children in the two to six years age group. This is higher in high risk groups. For example, more than 50 per cent of very obese children suffer from OSA, Dr Tang said.
Still, OSA is curable. Doctors would have to find the underlying contributory cause and treat it.
'If the tonsils or adenoids are enlarged, surgical removal would result in up to 95 per cent chance of a cure for these children,' said Dr Pang.
Other ways to treat OSA include positive airway pressure therapy for those who do not have enlarged tonsils or adenoids, reducing weight and optimising the care of asthma and other allergies.
Sleepwalking and sleeptalking are common children's sleep disorders. Though these are usually harmless, Dr Tang said parents should keep the child's room free of clutter and dangerous objects such as glassware as there is still a possibility the child could get injured while sleepwalking.
'Parents should avoid shaking, slapping and generally trying to wake the child. A better course of action is to soothe the child back to sleep,' said Dr Tang.
If your child sleepwalks or sleeptalks regularly, keep a sleep diary and take note of the time it occurs and wake the child 15 minutes before it happens.
'This has been shown to be a good way to reduce its occurrence,' said Dr Tang.
When a child wakes up and screams at the top of his lungs, he is most likely suffering from night terrors. Often, the child has no or little recollection of the event. Over-exhaustion can be a cause of night terrors.
Hence, Dr Tang advises parents to inculcate in their children good sleep routines and encourage them to nap to prevent night terrors. Most children tend to outgrow night terrors.
A good night's rest is essential for a child's healthy growth and development, said Dr Tang. Doctors advise that children get 10 hours of sleep every night to maximise their abilities.