How are snoring and sleep apnoea related?
A child with sleep apnoea almost always snores. They may struggle to breathe and have restless sleep. There are often breathing pauses which may end with a gasping or choking noise. As the child struggles to breathe, they may wake up briefly. In young children the chest may be sucked in at this time. This may lead to the child sleeping in strange positions. They may sweat a lot when they sleep. In some cases they will wet the bed. In the morning they may wake up with a dry mouth, a headache or confusion.
What is sleep apnoea?
Sleep apnoea is where the child stops breathing for a short time when they sleep. It tends to happen repeatedly during the night. Each time lasts from ten seconds to a minute or so. Usually such apnoeas occur due to the airway being blocked. In children, the cause is most often big tonsils and adenoids. This is called Obstructive Sleep Apnoea. A less common form of apnoea is called Central Sleep Apnoea. Central Sleep Apnoea results from a problem with the way that the brain controls breathing.
What are the symptoms of sleep apnoea during the day?
Because of the events during sleep, the child with sleep apnoea may have a number of problems during the day. Infants may feed poorly, fail to gain weight and be delayed developmentally. Older children may have problems with their behaviour, e.g. being hyperactive, aggressive, having trouble learning and/or not being able to focus well. Being sleepy during the day may lead to personality changes, not doing well at school and problems with how they get on with others. A child with sleep apnoea may lag behind in many areas of development. They may get frustrated and depressed. In the long term, if sleep apnoea is not treated it may cause heart problems and high blood pressure.
How does this affect the child’s family?
Sleep apnoea in a child may be very worrying for the family. Possible behavioural problems, combined with potential problems at school, can be stressful for the whole family.
What is the cause of sleep apnoea?
In a child, the most common cause of snoring and sleep apnoea is larger than normal tonsils and adenoids. Obesity can play a part as well. Other risk factors are the shape of the skull and the size of the tongue e.g. a child with Down syndrome has a larger tongue that may block the airway. In children with a small or receding jaw, sleep apnoea is more common. Children who have had surgery on a cleft palate may also be at a higher risk for sleep apnoea.
How is sleep apnoea diagnosed?
A doctor might suspect this if they see large tonsils and adenoids and certain symptoms are reported. This could include the child snoring, feeling sleepy and possibly having episodes of breathing obstruction. However the best way to be really sure about the problem and its severity is with a Sleep Study. The study is conducted in a special area of the hospital. The child has some fine wires attached to the skin, which are connected to a computer which measures sleep, breathing and oxygen levels. Studies may be done at night in older children or in the daytime in babies. None of the measurements are uncomfortable or painful and children usually manage to sleep. Parents generally stay with the child.
How is sleep apnoea treated?
If a child’s sleep apnoea is thought to be due to the size of their tonsils or adenoids, the first thing that is normally done is to take them out. In many cases this will cure the sleep apnoea. If the reason is an abnormality of the facial bones, surgery may sometimes be done to fix this. If surgery is not an option, then the best treatment is CPAP – Continuous Positive Airway Pressure. This involves a small a pump that provides air under gentle pressure through a mask worn over the nose. It only needs to be used at night and the treatment starts working straight away. With the right support, most children do well with CPAP. If the sleep apnoea is due to the child’s weight, losing weight may help or even cure the apnoea.
Can it be treated with drugs?
To date there is no effective drug for treating sleep apnoea although a number have been tried. Other remedies havebeen marketed, but none has been shown to be effective.
What about sleep habits?
Although sleep apnoea usually requires a treatment such as already outlined, it is also very important that the child has good sleep habits. A regular time to go to bed and to wake up should be set. Before bed, the child should be away from anything that stimulates them (e.g. games, television). The bedroom should be quiet and dark. In the afternoon and evening you should avoid giving caffeine drinks (including cola and hot chocolate) to your child. See Good Sleep Habits or more on this.
What other sleep problems can a child suffer from?
Although snoring and sleep apnoea are common conditions, children may also suffer from other sleep disorders. Parasomnias such as Sleep Walking and Sleep Terrors are common in childhood and can be distressing to the child and parent. Underlying medical conditions such as epilepsy, asthma or cystic fibrosis may also cause sleeping problems. See these pages for more; Sleep Problems and Sleep Disorders in School Aged Children and Behavioural Sleep Problems in School Aged Children
Should I seek help?
If you are worried about snoring or sleep apnoea in your child, you should speak with your GP. A referral will be needed to see a sleep physician.