Dr. Thomas Mellow (Guest): I think some of the things that I see very commonly are problems with breathing at night time. Patients and their families will say that kids have hard time breathing at night time or they have severe snoring. Other things that I see is that they actually stop breathing. So, that’s something that I am concerned about and I want to make sure that the patient gets seen. The other issue that I see quite commonly are kids that either have a hard time falling asleep or they tend to sleep more than would be expected. I also see patients who have an abnormal behavior or movements during their sleep.
Melanie: So, what are some things that we might notice if we knew, besides the child being sleepy, because kids wake up and they are still sleepy. But what could be some of the causes and what might we notice about sleep disorders?
Dr. Mellow: What I like to ask families is how was the quality of their sleep at night time and how was their breathing and how do they feel like they slept at night time? What we know now, in children, is that if they had a harder time sleeping at night time, they seem to have problems during the day. They can have problem with functioning, with their school work. They can have problems that almost look like depression or can even look like anxiety or hyperactivity.
Melanie: What do we do for our children if we are starting to recognize some of these symptoms? Do we take them to see somebody? We typically think of sleep studies, Dr. Mellow, for adults but what about kids? Can they do a sleep study? And if they do, will they even sleep in a brightly lit kind of scary sleep study spot?
Dr. Mellow: Well, I think in families who have concerns about sleep issues, I always recommend that they start with their primary care physician and if the primary care physician has concerns, then it's good for them to come and visit me for help. I do sleep studies quiet commonly in children. The Maine Sleep Institute does sleep studies on children every night. The sleep lab is more like a hotel than a true hospital. The technicians who work there work with children every night, so I feel as if I actually get very good quality studies on infants to all the way to 18 year olds.
Melanie: So, talking about some of the different types of sleep disorders out there. Anxiety--some children just don't want to go to bed or maybe they have night terrors or, as you say, maybe they have trouble breathing. What can you do about some these? Give parents some of your best advice for sleep hygiene for children or getting them to bed and helping with some of these things that every child goes through at some point.
Dr. Mellow: Well, the things that I feel that are most important is having a routine seven nights a week and having a relatively regular sleep schedule 7 days a week. I feel this is actually the most important thing for families and it really helps them a great deal. The other I think that is helpful is to have a good half hour to hour of quiet time before they go to bed. I think for kids to be very active and all of a sudden go to sleep is very difficult for them. For that reason, I like to have the kids have some quiet time before they go to bed. The other thing also is try and minimize electronics in the evening time: television watching, iPad, telephone. The other thing also is to make sure that the room is relatively clean and cool. There is a lot of evidence that suggests that having a very nice environment for sleep actually encourages sleep.
Melanie: So, what do we do with our stressed out kids? Some kids just are so busy--teenagers too, Dr. Mellow--and it's not even always sleep disorders but it’s just sleep issues. Maybe they are up too late. They are just not getting good quality sleep. So, what do we do with the stressful kids that sleep doesn't come as easily because they are worried and thinking all the time?
Dr. Mellow: So, a couple of things for me that I always want to question is whether or not that is related just with night time or are they having problems with anxiety during the day? If they are having a lot of problems with anxiety or stress during the day, it is important that those are addressed because what happens is that will play out in their sleep at night time making it difficult for them to fall asleep. The other thing that is important is also, especially with teenagers, try and work with them about what they would do. I find in teenagers telling them what to do never works. So, if you try and give them some choices and say, “Hey, you know, I think you are staying up too late on the weekends and trying to go to the bed on the weekends is really tough. How would you like to change that schedule?” I think that trying to involve the teenagers in any changes is really helpful and also you tend to be more successful.
Melanie: As we are seeing an increase in obesity and the epidemic that our children are going through in this country, Dr. Mellow, are you seeing an increase in sleep apnea and sleep issues in children because of obesity?
Dr. Mellow: I think what I am seeing right now is patients who are overweight. So, we know that in patients who are overweight, they are at an increased risk of having sleep apnea. What happens is that many of these patients need to have sleep studies to rule out sleep apnea. Some patients, because of sleep apnea, will need a tonsillectomy and adenoidectomy. Other patients may need to actually undergo what I call “CPAP therapy” which is a mask they wear at night time to help keep their airways open. Another thing that I also see a lot in the patients, I see in the clinic for overweight kids here, are problems with sleep hygiene and the fact that kids are just having hard time while sleeping. So, many times I work with the kids in that area as well.
Melanie: Is it normal for children to snore?
Dr. Mellow: Well, I think for snoring, the times I become concerned is the families are noticing snoring on a nightly basis that is loud, especially if the family of those thinks that kids are having pauses in their breathing at night time, and also if the family notices they’re having increased breathing. Those are all concerns that you bring to your primary care physician because in those patients, they might benefit from a sleep study to answer that question.
Melanie: Dr. Mellow, what about nightmares in children from two years up until into their teenage years? Kids can suffer from scary dreams that disrupt their good quality sleep. What's a parent to do about those and are they something that are a real problem or just something most kids go through?
Dr. Mellow: So, we see two different kinds of things, especially in younger children who are less than 4 or 5, I see, I think, a thing called “sleep terrors” or “night terrors.” It's something like sleepwalking and the children will wake up in the first half of the night and then they'll have crying and screaming but they seem awake during the episode. This is actually relatively common. The one thing that I do recommend families to do is to not try to interact with the kids too much because that tends to prolong the episodes but to keep the kids safe until the episode ends and they go back to sleep. The other thing I also see is nightmares. Nightmares tend to happen in the second half of the night. They are also very, very common. With nightmares some of the things that are helpful are to have the families talk about it the next day. Also, it’s important to see if there are any other triggers such as stresses during the day, scary movies, shows that may be scary for the children. Many times, these types of things can be big triggers for nightmares.
Melanie: What about medications? In this age, so many people are on things like Ambien to help them sleep at night. What do you do for kids? Is there a medication to help children sleep and do we even want them taking any of these things?
Dr. Mellow: My own recommendation is to avoid medication. There are a couple of problems with medication in children. One of them is that some of the medications that have been used in adults have not been shown to be very effective in children. The other problem is that there are not very many studies of using medication in children that are shown to be effective. In general, I try and stay away from these medications. I also think that for me I do--especially when kids are sleeping--I do a lot of work with the kids' sleep schedules in trying to work out what the best routine for them is.
Melanie: So, in just the last minute, Dr. Mellow, give parents listening your very best advice about sleep issues in children and why they should come to Maine Medical Center for their care.
Dr. Mellow: My concern is that, especially if the families are concerned about their children with snoring, difficulty in breathing at night or pausing in breathing, we have a really nice environment and take care of kids all the time to help do sleep studies in children. The other thing is, if you find they’re having significant sleep problems either a hard time sleeping or sleeping too much or problems with behavior while they are sleeping and you've kind of working with your primary care physician and are feeling stuck, I feel like we can be a very helpful resource for you.
Melanie: It's great information and something parents really need to hear. Thank you so much, Dr. Mellow. You are listening to MMC Radio and for more information you can go to MaineMedicalCenter.org. That's MaineMedicalCenter.org. MMC.org. This is Melanie Cole. Thanks so much for listening.