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The Sleepy Child Conundrum: What to consider when SDB is ruled out

by Mary Beth Nierengarten •

But first, Dr. Garetz said, parents need to be aware that their child is tired. “Surveys show that 90 percent of parents think their teens are getting enough sleep,” she said.

Parents also need to recognize that symptoms of sleepiness in the young child include irritability, hyperactivity and high energy, nearly opposite to the symptoms seen in adults. Data show that sleep needs vary throughout life (Table 1).

The following are simple things parents can do help their children achieve optimal sleep:

  • Establish a routine with no distractions from electronics.
  • Put younger children to bed when they are drowsy but not already asleep so they can learn to fall asleep on their own;
  • Ensure that the bedroom is comfortable: quiet, dark, and not too cold or hot;
  • Have the child do something calming during the hour before bedtime, while avoiding stimulating activities like watching TV or videos; and
  • Restrict or avoid caffeine.

Parents can also help their children develop good sleep hygiene by demonstrating it themselves. According to Dr. Garetz, surveys show a strong correlation between parental and child sleep deprivation.

Table 1: Key Clinical Manifestations of Sleep Disorders Other Than Sleep Disordered Breathing

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SOURCE: NATIONAL SLEEP FOUNDATION
Table 1
Table 2: Sleep Needs of Children

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SOURCE: NATIONAL SLEEP FOUNDATION
Table 2

Clinical Assessment

Taking a thorough history of the child or teen is the first critical step in diagnosis. Important questions to ask include how much sleep the child gets, what time the child goes to bed and wakes up, and what manifestations of sleepiness occur during the day.

According to Carole Marcus, MD, attending physician and director of the Sleep Center at Children’s Hospital of Philadelphia, it is important first to distinguish sleepiness from fatigue or tiredness. “Sleepiness really means the propensity to fall asleep, whereas tiredness may indicate a lack of energy which can be related to many things, such as anemia or depression,” she said.

To take a thorough history, Dr. Marcus and her colleagues send out a sleep diary to all patients prior to their clinical visits in order to obtain documentation of sleep patterns. These diaries, she said, provide clues about what may be causing the daytime sleepiness. Key clinical features described in a patient’s history and diaries may provide clues toward a differential diagnosis (Table 1). In some cases, these clinical symptoms are sufficient for a diagnosis. This is particularly true for sleepiness related to poor sleep hygiene and circadian rhythm disorders and, in many cases, for restless leg syndrome. Further evaluation is necessary, however, for suspected cases of narcolepsy and in some cases of restless leg syndrome.

Further Tests

“Any time you have a child with significant daytime sleepiness, I would do a sleep study and if the sleep study does not show apnea, I follow it with a daytime Multiple Sleep Latency Test (MSLT),” Dr. Marcus said. “That is the test for narcolepsy at the moment.”