A good night’s sleep is important to growing children. However, a recent study showed an increasing trend of young children suffering from sleeping problems. MH finds out more.
WORDS CINDY LIM
Jasmine Tan, four, snores in her sleep every night. She often talks or shouts in her sleep, and sometimes would sit or try to climb off her bed. “It is worrying – she will snore loudly with her mouth open and sometimes choke on her saliva and start coughing. With the constant fidgeting in bed and talking at night, I am worried that she is not getting enough quality sleep,” shares Emily Lim, 33, a homemaker and mother to Jasmine.
Like Jasmine, there are many other young children suffering from sleep problems and this number is increasing. “In general, childhood sleep problems are quite common. Many times these are not brought up in medical consultations and sometimes not adequately addressed. We know that in Singapore, almost 44 per cent of parents of children under three years of age reported sleep problems in their infants,” explains Dr Mahesh Babu Ramamurthy, head and senior consultant, Division of Paediatric Pulmonary and Sleep, National University Hospital.
Childhood Sleep Disorders
There are several types of sleeping problems that children may face.
Snoring, or noisy breathing, occurs when there is obstruction of the flow of air through the mouth and nose. Air flow can be obstructed by a combination of factors such as obstructed nasal airways, poor muscle tone in the throat and tongue, bulky throat tissue, large tonsils and adenoids or long soft palate and/or uvula. Snoring can be harmless but it may also result in poor quality of sleep.
Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) happens when the tongue, tonsils, or other tissues in the back of the throat block the airway. When you try to breathe in, the air cannot flow through. Children with OSA snore loud enough to be heard in the neighbouring room. It will be punctuated with gaps and the child might have a gasp to restart breathing.
Children who suffer from OSA face two problems. Firstly, their sleep pattern is very disrupted and this results in these children not having a deep and consolidated sleep. Inadequate sleep has its effect on child’s daytime activities – including memory, learning behaviours in school and daytime interaction.
Secondly, there are intermittent drops in oxygen concentration during sleep in these children, and though these are very minor drops and do not put our children at risk on an everyday basis, it does have long-term consequences. This can also affect daytime behaviour as well as blood pressure and the heart in the long-term. Children with obstructive sleep apnea also have stunted growth.
“Almost 25 per cent of children will snore at some time or the other. Not all children who snore have sleep problems. Only about 6 to 8 per cent amongst them actually snore regularly and 3 to 4 per cent have more severe snoring associated with obstructive sleep apnea. These two groups of children are at high risk for medical problems and need to be monitored and addressed,” cautions Dr Mahesh.
Sleep talking and sleep walking
Fairly common in children, these occur in the transition to deep sleep and hence happen a while after going to sleep. Sleep walking or talking does not indicate any underlying abnormality. It can be a transient process with the child growing out of it. Sleep walking has the potential for physical harm. The child may fall off the steps or any elevation, trip on any wires running on the floor of the house or even walk out of the house. Parents are advised to keep the house risk-free for these incidences. These sleep behaviours are usually outgrown by adolescence.
These occur typically in children between five to twelve years of age. These tend to occur in the first half of the night, wherein the child wakes up abruptly from sleep with a loud scream and is agitated and sweating. The child might jump out of bed as if running away from a threat and cannot be calmed by parents during the episode. The child will then spontaneously go back to sleep and will not remember the incident in the morning. These are different from nightmares, which tend to occur in the latter half of the night. During these episodes, the child awakens from a bad dream, usually involving fear and anxiety and can vividly remember their dreams.
Insomnia is a disruption of the sleep cycle that includes difficulty falling asleep and difficulty staying asleep. In children, insomnia can last a few nights or can be long term, lasting weeks. Short-term insomnia is usually caused by factors such as sickness or short-term medication. Long-term insomnia which occurs for a month or longer, may be caused by factors such as depression, anxiety, pain and medical problems for which medical advice should be sought. For kids, feeling scared or worried at bedtime is one of the main reasons for having trouble falling asleep. Children might be afraid of the dark, of being alone and if your child has a vivid imagination, he might hear noises at night and fear the worst.
Causes of Sleep Problems
Sleep walking/talking and sleep terrors may be familial and some studies have shown the incidence to be more in families whose parents exhibited these behaviour themselves. Some medical conditions like obstructive sleep apnea and other causes for arousal from sleep may be triggers for these events. Nightmares are more likely in generally anxious children and have been associated with separation anxiety as well.
Obstructive sleep apnea happens more in children who are obese and those with medical conditions which affect their nervous system and muscle. Children who are born with either a small jaw or other facial features which affect the breathing tubes (like cleft palate, large tongue etc) are also more prone to have obstructive sleep apnea.