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Health Plus Medical Correspondent

You have noticed that your seven-year-old recently started bedwetting, when previously she did not have this problem. You have also noticed; her level of anxiety is fluctuating, and you heard her snoring. But how is it possible for a seven-year-old to be snoring? Your child may be presenting with the tell-tale signs of Obstructive Sleep Apnea (OSA). As we all navigate this COVID-19 Pandemic, let’s ensure we are informed and not missing these signs or detrimental consequences of OSA.

The introduction of virtual school contributes to daily fatigue. Some children are no longer on a good sleep schedule. They go to bed and wake up at various times, creating difficulties falling to sleep, waking in the morning and sometimes difficulty sleeping during the night. These children feel sluggish during the day and may take a nap, making it hard to fall asleep the next night.

Studies have suggested that as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder may have symptoms of OSA and that much of their learning difficulty and behaviour problems can be the consequence of chronic fragmented sleep.

Difficulty going to sleep, frequent night awakenings, nightmares and sleep terrors are some of the symptoms of trouble sleeping at night. When a child does not sleep enough or if their schedule is not predictable, they are more likely to feel fatigued and listless during the day. They are more likely to have difficulty focusing on their schoolwork. Just like adults, they are more likely to be irritable or emotional. Anxiety and depression are more common in children who have chronic sleep problems.

How is anxiety related to sleep?

Anxiety problems and sleep problems feed each other and create a cycle. If a child is anxious, he or she may not be able to fall asleep. If the child does not sleep well, he or she is more likely to be anxious.

How is bedwetting related to sleep?

Children often wet the bed at night, but it is a problem if it occurs twice a week after the age of five. Sleep Enuresis as it is called, affects between 3% and 30% of children between the ages of four and 12. Although sleep enuresis may be due to infection, stress, or other medical conditions, bedwetting can also be a sign of sleep apnea. Sleep apnea is believed to cause chemical imbalances in the brain that can induce bedwetting not only in children but adults as well. It occurs during the slow wave sleep when a child is less able to be aroused if they have a full bladder.

Adult OSA vs Paediatric OSA

There are differences between adult sleep apnea and paediatric sleep apnea. Adults usually have daytime sleepiness, children are more likely to have behavioural problems. The underlying cause in adults is often obesity, while in children the most common underlying condition is enlargement of the adenoids and tonsils. However, obesity also plays a role in children. Other underlying factors can be craniofacial anomalies and neuromuscular disorders.

Early diagnosis is KEY and so too is treatment to prevent complications that can impact children’s growth, cognitive development and behaviour.

Paediatric sleep disorders require careful sleep specific evaluation (Sleep Study) that includes interviewing the parents, child, teachers, as well as assigning and reviewing sleep diaries. Parents should be encouraged to record children’s sleep-wake habits using sleep diaries over a 24-hour period for at least two continuous weeks prior to initial visit.

What is the recommended amount of quality sleep a child should get?

It varies based on age. The American Academy of Paediatrics recommends:

– Infants under 1 year: 12-16 hours

– Children 1-2 years old: 11-14 hours

– Children 3-5 years old: 10-13 hours

– Children 6-12 years old: 9-12 hours

– Teenagers 13-18 years old: 8-10 hours

What can a family do to reduce anxiety-related sleep problems?

– Ensure a set bedtime and set wake time, allowing the child to have an age-appropriate amount of time to sleep.

– Monitor exposure to electronics. TV programmes, video games and social media can result in anxiety by raising concerns regarding life and death in family members, concerns about their parents’ jobs, or may contain fanciful scary content. In general, we recommend elimination of electronics at least one hour before bed.

– Eliminate caffeine. Caffeine can interfere in a child’s ability to go to sleep. Caffeine is found in teas, coffee and soda.

– Children with anxiety often have difficulty turning off their thoughts. A child should be given an opportunity to express their concerns earlier during the day or before bed by talking to their parent and/or writing their concerns down.

– When it is time to go to bed, children with anxiety need a way to occupy their thoughts in a way that helps them go to sleep. Deep breathing, meditation and progressive muscle relaxation exercises can be helpful. For families who are not familiar with these exercises, the Calm or Headspace apps may be used to help the children learn meditation and relax their brains prior to sleep.

Untreated Sleep Problems

The consequences of untreated sleep problems may include significant emotional, behavioural, and cognitive dysfunction. The magnitude of these events is inversely proportional to the child’s overall ability to adapt and develop despite the sleep disturbance. Sleep regulation remains a critical part of health for youths.

Therefore, it is important to get it evaluated early. In all cases, the specific treatment for OSA depends on many factors and is tailored for each child. Sometimes surgical solutions are necessary if there is tonsillar or adenoidal hypertrophy. Please discuss your child’s condition, treatment options and your preference with your child’s physician or healthcare provider.

Rachel Dawkins, MD, with Johns Hopkins Children’s Hospital states, “Sleep is an essential part of everyone’s routine and an indispensable part of a healthy lifestyle. Studies have shown that kids who regularly get an adequate amount of sleep have improved attention, behaviour, learning, memory, and overall mental and physical health.”

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