Julie Wiseman got used to hearing her son snore. But when he would suddenly stop snoring, she worried.
“There were times I’d go in to check to make sure he was still breathing,” says the mother of two from Middle River. “It was really scary.”
Testing at the Johns Hopkins Pediatric Sleep Center at Mt. Washington Pediatric Hospital revealed the problem. Her son, C.J., 16, has two types of sleep apnea, which doctors are optimistic will be corrected by weight loss and the recent removal of the teen’s tonsils and adenoids.
In hindsight, Wiseman suspects that apnea has interfered with her son’s sleep for many years, which may explain why he was always tired during soccer games.
“My husband has sleep issues, but I never put two and two together,” says Wiseman. “I felt like I failed him.”
Sleep disorders, which can range from difficulty falling asleep to trouble breathing, may be more common than many parents realize. They affect about 2 percent of all children, says Dr. Laura Sterni, associate director of the The Johns Hopkins Pediatric Sleep Center at Mt. Washington Pediatric Hospital. But the problems, which can affect growth and behavior, are often not recognized by parents who assume symptoms – especially snoring – are normal, Sterni says.
“They say, ‘Everyone in our family snores.’ It’s easy to overlook,” Sterni says.
To improve the recognition of sleep disorders, the American Academy of Pediatrics in 2002 issued a recommendation that all pediatricians routinely ask parents at well-checks if their children snore.
Snoring is the most obvious symptom of apnea, which is the most common sleep disorder. But other disorders include circadian rhythm disorders, which affect the internal clock that tells a child when it’s night and time to sleep, and periodic limb movement disorder, which is repetitive cramping or jerking of the legs.
A 9-month-old – and even sometimes a 3-year-old — may occasionally have trouble sleeping through the night. Especially with babies, a doctor might recommend first trying to “sleep train,” or teach a child how to soothe himself to sleep. But if the problem persists or the child is sleepy during the day or has a lot of trouble falling asleep, a sleep study may be recommended.
Several area hospitals, including Mt. Washington, have specialized sleep labs designed to diagnose children with sleep disorders.
In the lab, children spend the night while their brain waves and breathing — including oxygen and carbon dioxide levels — are measured. Wires are attached to their bodies and head but “nothing hurts,” says Sterni.
The most common worry is that the child won’t be able to fall asleep with the wires and belts attached to them, she says. “But they almost always do.”
A parent stays with the child through the night. And patients are encouraged to bring their own pillows and stuffed animals to make them feel more at home. But since C.J. was past the lovey stage, he brought the teen equivalent – his cell phone, Wiseman says, laughing.
It is important that the study be done in a sleep lab that specializes in children.
“The criteria of what is normal differs between adults and children,” says Dr. Anastassios C. Koumbourlis, medical director of the sleep disorders lab at Children’s National Medical Center in Washington, D.C.
And even in children, what is normal varies by age.
Sleep problems tend to peak around the age of 5, but they can start at any time. Children who are overweight or have conditions such as Downs Syndrome or multiple sclerosis are especially susceptible.
Breathing problems during sleep can cause strain on the heart and other physical problems.
“It could be dangerous,” says Koumbourlis. “Your body is working much harder than it should.”
Sleep disorders may lead to poor growth and may also be responsible for some behavioral problems, Sterni says.
“There are definitely behavioral side effects to poor sleep,” she says. “You’re more likely to see hyper- activity and aggressive behavior, for example.”
The good news is that sleep disorders — once identified — are fairly easy to fix.
Obstructive sleep apnea in children is almost always corrected by removing tonsils and adenoids. CPAP or BiPAP — types of breathing machines with masks that children wear every night — are also sometimes prescribed.
Light therapy, which exposes children to special lights, may be used to treat circadian rhythm disorders. (Sleep medication is rarely prescribed to children, experts say.)
Vickie Tinsman’s 9-year-old, Gabrielle, had many of the symptoms of a sleeping disorder. She was gaining weight. She was often cranky by evening. When she did go to sleep, she would wake in the night. And she was groggy and hard to wake up in the morning.
So her doctors at Mt. Washington ordered a sleep test this past spring.
“The setup is like an actual bedroom,” says Tinsman.
But the wires attached to her head were a big hit with the Carroll County girl. “The nurse joked that she looked like an alien,” Tinsman says, laughing. “So, she wanted her picture taken.”
It did take a while to get to sleep, but the doctors were able to collect the data they needed. Turns out, there was no problem. The family is relieved. And now, Tinsman will focus on environmental factors, such as mov- ing up her bedtime, so that she doesn’t become overtired.
Sometimes, the remedy is that simple.
Dr. Keith J. Slifer, director of the Pediatric Psychology Consultation Program at the Kennedy Krieger Institute, recommends parents first review what experts call “sleep hygiene” if their child isn’t sleeping well.
This covers the basics — a simple, relaxing bedtime routine (bath, brush teeth, and books, for example), a comfortable sleeping temperature (not too hot, not too cold), a diet free of caffeine and an established bedtime.
It is also important that children learn to self-soothe and are able to go to sleep without being rocked or held, doctors say. Because everyone wakes up multiple times during the night as a matter of course, it makes it easier for children who can soothe themselves to quickly go back to sleep.
There are a number of methods for sleep training, often identified by the sleep experts who have written about them. For example, Richard Ferber’s approach is widely endorsed by pediatricians. But there are others.
The most important thing, says Slifer, “is to pick something that you’ll use every night.”

Symptoms that may warrant a sleep study:
• snoring
• morning headaches
• crankiness
• decreased attention
• trouble falling asleep
• night terrors
• falling asleep during the day (in school-aged children)
• poor growth
• hyperactivity
• chronic congestion
• “mouth breathing”

Photo by istock.com/johncowie