Pediatric Sleep

Healthy Sleep in Children – (Exploring the importance of sleep)

 

Sleep is a vital part of every child’s growth and development. It is time when their bodies recharge, grow, consolidate day’s experience & prepare for next day’s activities.

Does Your Child Get Enough Sleep

Unfortunately many children may not always get the quality sleep they

Many Have Obstructive Sleep Apnea But Most Don’t Know It Yet

30% Of children between 2 – 6 years and up to 50% of children who are actually diagnosed with ADHD actually have pediatric obstructive sleep apnea.

WHAT IS PEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA)?

Obstructive sleep apnea is a breathing disorder characterized by pauses in breathing or periods of shallow breathing during sleep. This may be due to Complete or Partial obstruction of respiratory tract. Each pause can last for few seconds to few minutes & may happen anytime at night. Sleep quality is affected during this attack which eventually affects various parts of the body.

 

WHAT ARE ITS LONG TERM EFFECTS?

If left untreated Pediatric OSA would result in poor quality of sleep which is important for a child’s growth & development. It can also result in poor oxygen delivery which can affect a child’s fragile body both mentally & physically.

How do I Identify it?

So here are 3 simple checks to perform while your child is asleep.

O.W.L

  1. Observe for restless sleep:

 

  • Your child may toss and turn in bed, and attempt to breathe very heavily.
  • This shows that your child is attempting to adjust his/her posture to open up airway

 

  1. Watch for Unusual Sleep Postures:

  • Your child may extend his/her head out and back, and be in a posture that looks unusual.
  • This includes lying on one’s stomach or sitting upright to sleep.
  • Your child has shifted into a position where their airway can be opened. When the airway collapses yet again, they will toss and turn until they find the next optimal position.
  • An open-mouth posture may mean that your child is mouth-breathing, which is a clear sign of obstruction in the nasal passages.

 

  1. Listen for Habitual Snoring

  • There would be snoring for 3 or more nights in a week.
  • This is a result of vibration when a child’s upper airway is being blocked.

What else can I look for?

Top 5 Daytime Symptoms:
  1. Headache
  2. Daytime sleepiness
  3. Irritability
  4. Poor concertation.
  5. Poor posture

 

Top 5 Night time symptoms:
  1. Snoring
  2. Teeth grinding
  3. Restless sleep position
  4. Bedwetting
  5. Frequent nightmares

Sleep Apnea Treatment for Child

 

The Link Between Sleep Apnea and your Dentist

Dentists Treat Sleep Apnea, Too

Did you know that many dentists are trained to help treat and manage your snoring and sleep apnea? Dental sleep medicine is an area of dental practice that focuses on the use of oral appliance therapy to treat sleep-disordered breathing, including snoring and obstructive sleep apnea (OSA). Dentists work together with sleep physicians to identify the best treatment for each patient.

Sleep-related breathing disorders (SRBD) can occur at any age. Obstructive sleep apnea, upper airway resistance syndrome and obstructive hypopnea syndrome all lie on the pathological continuum of SRBD. These disorders can have a great impact on a child’s quality of life and can progress to significant complications

Your Health and Quality of Life

The quality of your sleep has a dramatic impact on your health, well-being and overall quality of life. Snoring and obstructive sleep apnea disrupt your sleep and increase your risk of severe health problems. Remember that snoring is a warning sign that should never be ignored. Across the country, many dentists are prepared to provide oral appliance therapy to treat snoring and obstructive sleep apnea. Talk to your doctor and dentist about your treatment options.

What is a sleep disorder?

 

Simply put, a sleep disorder is a negative change or problem with the way you sleep. This can range from unwanted activities and occurrences during sleep, like snoring and sleep apnea, to disorders that affect your entire sleep experience, like insomnia.

Sleep disorders don’t just begin and end when your head hits the pillow. In fact, their presence often carries over into your waking life as well. Do you ask yourself “why am I so tired?” on a regular basis, or have you ever been told you gasp for breath while sleeping? Have you ever fallen asleep in the middle of the day when you didn’t mean to, such as at work or while driving? These are all potential symptoms of sleep disorders.

Sleep Apnea

 

Sleep apnea occurs when there are brief pauses in breathing during sleep, often associated with a partial or complete blockage within the throat. This happens when you lie down to sleep and the muscles in your throat relax. This may lead to a shift in the tongue or soft palate, causing your airway to narrow so much that it briefly closes off completely. This disrupts breathing and may reduce the level of oxygen in the blood.

Drops in oxygen levels alert the brain that something isn’t working as it should. As a result, the brain wakes up the sleeping person so the airway can be reopened. This becomes a problem when the sleeping person is woken up over and over again, sometimes dozens of times an hour.

Root causes

 

Traditionally, clinicians treating patients with psychiatric disorders have viewed insomnia and other sleep disorders as symptoms of the state of their patients’ psychiatric health and even directly contribute to, the development of some psychiatric disorders.

These connections are especially significant for the mental health field because of what those specific sections of the brain manage and regulate. One section of the brain is responsible for short-term memory, another governs reflections of the self, and the third section is responsible for negative emotion.

Signs and symptoms includes

– Frequent morning headaches

– Clenching both day and night

– Chronically sore jaw and neck muscles

– Joint clicking on the left side

– Bite relationship feels off

– Slight wear on the anterior teeth

– Chronic use of nasal decongestants

TMD-airway connection: The importance of dental and medical screenings There’s much discussion regarding the relationship between TMD and airway disorders. Many dentists look for TMJ issues or problems with a patient’s bite, but often the cause of a patient’s issues is related to airway and breathing complications.

Symptoms for TMD and Occlusal Issues:

 

– Joint discomfort

– Popping/clicking

– Chronically sore jaw and neck muscles

– Sore muscles

– Bruxism

– Poor bite

– Clenching

– Worn teeth

– Crooked teeth

Mouth breathing bypasses a person’s normal physiologic filtration system through the nose. Breathing dirty air through the mouth can be a source of inflammation and infection in the posterior throat and tonsil area. It can result in swollen tonsils and difficulty breathing through both the nose and mouth, and it can induce problematic ventilation during sleep. In turn, it can lead to both upper airway resistance syndrome (UARS) and, in more severe cases, obstructive sleep apnea (OSA).

Complications

The physiological and behavioral complications of sleep deprivation are enduring and have a significant impact on academic success and quality of life for the child and their family. Early treatment success will minimize these complications. Even with adequate treatment of sleep apnea, neurons may be permanently damaged and additional treatment of daytime sleepiness is needed. Treatment for these complications is needed as part of the overall management of sleep disorders.

 

Medical Care

Muscle weakness within the tongue, mouth, and upper throat may lead to snoring and obstructive sleep apnea. This may be improved with strengthening exercises called myofunctional therapy, especially when used in children.

What is myofunctional therapy?

Myofunctional therapy is a program of specific exercises that target the facial muscles used to chew and swallow. These exercises strengthen the tongue. The oropharynx is the part of the body that includes the mouth and throat. These muscles help us to eat, talk, and breathe. They also help to keep the airway open, especially during sleep. When the muscles of the oropharynx are weak, they may disrupt the flow of air and snoring may ensue.

Myofunctional therapy includes exercises that are meant to improve the strength of the muscles within the oropharynx, including the tongue. In addition, it helps to reinforce the proper position of the tongue within the mouth.

Myofunctional therapy may be an attractive alternative treatment for sleep apnea. There is some evidence that it can decrease sleep apnea severity.

Cognitive-Behavioral Therapy

Family dynamics should be explored and redressed. Sleep patterns of parents and their adolescent children reveal similarities; for example, strained and reciprocal parent-child interactions indicate that a mother’s poor sleep may directly affect parenting style.

CBT uses relatively straightforward and safe strategies for enhancing overall parenting effectiveness as well as ameliorating the aforementioned problems.

 

Cognitive-Behavioral Therapy

Family dynamics should be explored and redressed. Sleep patterns of parents and their adolescent children reveal similarities; for example, strained and reciprocal parent-child interactions indicate that a mother’s poor sleep may directly affect parenting style.

CBT uses relatively straightforward and safe strategies for enhancing overall parenting effectiveness as well as ameliorating the aforementioned problems.

 

Adenotonsillectomy and Ventilatory Support

Adenotonsillectomy is the primary treatment modality in children with OSAS, however recurrence is common post-surgery.[6]Myofunctional therapy in conjuction with orthodontia and craniofacial surgery may be more effective. Tongue and facial muscle exercises improve adult OSAS. Positive airway pressure is needed in cases of continued postoperative symptoms. Continuous positive airway pressure (CPAP), variable pressure devices (eg, bilevel positive airway pressure [BiPAP]), and on-demand pressure when airflow is impeded (D-PAP) may be needed. Weight loss can be helpful for obese patients.

 

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HOW TO GET HELP?

  1. Observe your child for symptoms
  2. Assessment for your child by a sleep dentist
  3. Records including- radiographs, sleep studies(if required) will be taken
  4. Understand the reason to sleep disordered breathing.
  5. Get a customized treatment plan which includes Orofacial Myofunctional therapy.
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