Does Your iPad Lead to Insomnia?

 

Our old, well-worn first-gen iPad has gotten a LOT of use over the years, and admittedly much of the use has been in bed at night.  I read quite a bit, and though I still prefer good old-fashioned paper print books (I’m always in the middle of 2 or 3), our iPad has also become a regular staple in my routine prior to turning off the lights for the night, primarily for e-mails and this blogsite adventure I started several months ago.  My wife and I have never had problems falling asleep as a result of iPad use, but many of my patients have found their insomnia improves with modifications in their habit of using electronic devices involving bright backlit screens in bed.

We’ve all experienced activities that cause us to end up going to sleep later than what we intended.  However, backlit electronic pads can contribute to difficulties falling asleep if used shortly prior to bedtime, and there are a couple reasons why.  First, the content of what you’re doing or reading can obviously play a role.  Whether it’s an exciting video or the discovery of the latest shoe sale on Zappos, anything that you’re exposed to that is visually or emotionally stimulating or is of emotional importance to you can create an alerting effect that delays the onset of drowsiness.  Second, and importantly, the light exposure from the backlit screen (particularly when full-color) can also have a stimulating effect.

 

Light tends to inhibit the release of melatonin in your brain.  There is a thin band of neurologic tissue–called the retinohypothalamic tract–that connects your eyeballs to the hypothalamus, the seat of your body block.  This tract is stimulated when the back of your eye–the retina (the cells of which are illustrated above)–are exposed to bright light, and the resulting signal to the brain leads to a sensation of wakefulness and alertness, the exact opposite of what you want when your goal is to fall asleep for the night.  This is why it’s important to avoid bright light late at night and to expose yourself to bright light early in the morning if you have insomnia.

The problem is that modern backlit e-readers are not only capable of emitting very bright multi-colored light, but also held very close to your eyes:  unlike your television set, which is across the room, your iPad is on your lap or held right in front of your face, bathing your retinas with light.

So here are some suggestions for you if you’re having difficulties falling asleep following backlit e-reader use at bedtime:

1.  Turn down the intensity or brightness of the screen.
2.  Try an e-reader without a backlit display, such as a basic Kindle.
3.  Call me old-fashioned, but you could always go back to paper books, and save your e-mail for tomorrow morning.
4.  Read in relatively dim light.
5.  In general, avoid intense light for about 1-2 hours prior to your projected bedtime.

Happy reading, everyone!

“What’s With This Big Body Jerk Out of My Sleep?”

Tell me if this has ever happened to you.

 

You’re lying on your couch one night, watching a movie. An hour into the show, you gradually start to drowse. Your eyes are getting heavy; it’s increasingly hard for you to concentrate. You want to keep watching, but finally you start to give in: your eyes are closing.  A familiar, dark, fuzzy, comfortable sensation enshrouds you, mixed with a vague feeling like you’re falling into some kind of void. There is a brief reverie; you are asleep. Then, shortly thereafter and out of nowhere, BOOM! There’s a sudden shock-like sensation and an abrupt awakening. Your entire body jerks violently, like someone sucker-punched you, but there is no pain. That singular jerk almost sends you off the couch. The person you’ve been watching the movie with looks over, wondering what the hell is wrong with you.

Sound familiar? Most (up to 70%) of us have had that experience at one time or another in our lives. This phenomenon is called a hypnic jerk, or sleep start. Much is not understood about why or how it occurs, but a hypnic jerk consists of a single, sudden simultaneous contraction of multiple body muscles, basically the manifestation of a full-body reflex occurring shortly upon entering light stages of non-REM sleep and resulting in a sudden arousal from sleep.

Hypnic jerks tend to happen more in the setting of sleep deprivation or irregular sleep schedules. I vividly recall that during my residency training days, I abruptly awakened with these jerks all the time, probably because of the frequent sleep deprivation to which I was subjected at the time. It drove me nuts. Now that I’m allowed to get my 8 hours per night most of the time, only rarely now do they occur.

There are several reasons why it’s worth writing about hypnic jerks. First, some people freak out about them. The jerks in and of themselves generally are benign and aren’t harmful per se. Secondly, some may wonder if the jerks indicate an underlying medical problem, such as epilepsy. A generalized convulsion that involves jerking movements of the entire body are usually associated with repetitive jerking instead of a solitary body jerk, and you would be unconscious during the seizure. Finally, if the hypnic jerks are frequent or bothersome, there is often something that can be done about them. If you’re chronically sleep deprived, do what you can to gradually increase your total sleep time per night; most adults require about 7.5 – 8 hours of sleep per night. Regulate your sleep schedules by awakening around the same time every morning, including between workdays and non-workdays. Consider tapering down things that can disrupt sleep, like caffeine or alcohol. Sometimes stress or particularly strenuous activities late at night may also increase the likelihood of having hypnic jerks, so relaxing prior to your bedtime may be helpful as well.

Have a great weekend, everyone!

Post-Traumatic Stress Disorder and Sleep: My Interview With Captain Ken LeBlanc

I want to tell you about my old and dear friend, Ken LeBlanc, a Captain in the United States Army. Ken and I went to high school together and have watched our lives and careers evolve in recent years.  He lives in and is stationed in Wiesbaden, Germany, near Frankfurt, and he works at US Army Headquarters for the G-34 Force Protection Directorate at Wiesbaden Army Airfield.  He is an Operations Officer.  His responsibilities include the entire Black Sea region of eastern Europe. He assesses and mitigates risk by developing site-specific guidelines for force protection and personnel safety, including counter-surveillance, stand-offs, and personnel access.  He develops travel guidelines, working with the DIA and Department of State for any individual and group travel to foreign lands. He has been deployed several times.  I consider Captain LeBlanc a hero, not only because of what he’s done for the benefit of our country, but also how he has handled the many intense experiences he has had as part of his military duties over the years.

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Ken tells me that he has had some genuine difficulties with his sleep since relocating to Germany.  Troubled by vivid dreams, he suffers from disrupted sleep, frequently awakening with a sensation of anxiety and in a cold sweat.

Ken has been diagnosed with post-traumatic stress disorder (PTSD).  He tells me that he’s not alone:  many of his colleagues have had similar symptoms upon returning from their deployment and have been diagnosed with PTSD, reflecting recent Veterans Administration reports that indicate that nearly 30% of VA patients who served in the Iraq and Afghanistan wars have been diagnosed with this disorder.  He also believes that PTSD is still under-recognized and under-treated in the military.

PTSD is commonly associated with sleep problems, often stemming from a combination of factors:  the self-protective mode of constantly being “on alert,” worry, physical symptoms (such as chronic pain) associated with previous trauma, and frequent nightmares which may or may not be directly related to previous traumatic experiences.  Chronic sleep-onset and sleep-maintenance insomnia and daytime fatigue are commonly observed in those suffering from PTSD.

Captain LeBlanc was kind enough to agree to describe some of his experiences with Sleep Help Desk from his home in Wiesbaden.

MC:  You’ve been in the military for many years, Ken; you’ve visited many countries and you’ve seen many things most Americans never will see. How does a soldier process all of the intense experiences such as the ones you’ve had?

KL:  If possible, by processing the good and bad with groups of others. The Army has many specific programs to help deal with and process activities and experiences. As an Officer I have a duty to help younger Soldiers with any issues that might arise from their combat- and noncombat-related experiences. Sometimes being far away from your family causes things to happen such as divorce and bankruptcy, and this can be as difficult to process as combat. As Soldiers one hopes that the foundation they have morally and psychologically helps them to diffuse critical events but being with like-minded others brings a support system unlike any other I have been involved with.

MC:  How do you perceive your experiences have affected your sleep?

KL:  Sleep is a critical and performance-altering behavior. I am an older Soldier who has witnessed many things younger Soldiers have not experienced and I’ve thought from the very beginning that this would be my personal asset. They aren’t, however, like good experiences (like the birth of a child or success at work), which do not replay in your head during times of attempted sleep. It might be thunder or loud noises or strange noises, but they all bring me back to unfavorable experiences. Dreams become more vivid and after awakening one goes through a litany of questions concerning that event. After a few months it gets a little better but when one least expects it one might dream of something as innocuous as a large crowd and begin to feel the anxiety that accompanies it. My military experiences cause many sleepless nights because after waking up (usually in a sweat) it becomes hard, if not impossible, to regain drowsiness and fall back to sleep.

MC:  So let’s talk more about your dreams, Ken.  How often and how intensely do your dreams relate to your current work or previous military experiences?

KL:  After returning stateside I had incredibly vivid dreams every night. I would wake up and go through them repeatedly. I would feel foolish for having them. Most of the time they relate directly to military experiences but after a while they lose that flavor and start to relate to difficult periods in my life. It feels as if it becomes a habit:  waking up to dredge over bad experiences no matter what the setting. I would normally not associate one with the other except that in prior times this never happened. The causality of combat and dream behavior is in my opinion directly linked.

MC:  What helps?

KL:  The honest truth is that alcohol and I have self-medicated many a night in order to fall asleep. This is not a good sleep, but it is the ability to get to sleep that one desires more than any other thing. Once in the habit it is very hard to break (thankfully I have recognized this as a direction I did not want to go and have stopped drinking as a habit). It affects performance at work and weight and psychological issues so this is not something I would recommend to anyone. I have also tried prescription medications. This is not a good alternative for me either as I still wake up, unknowingly, and re-medicate. I remember one night in particular, in which I woke up the next day to find that out of 30 prescription pills, some time during the night I had ingested 20 (and lived). This was my wake-up call and I stopped all medication thereafter. Now I read as long as I can before trying to sleep. It gets me to sleep but not for very long. I awaken again, usually in a sweat, and either get up for the day or lie in bed all night until a reasonable hour and then get up. I have tried many nights to stay awake for several days and then “reset” my body clock only to find I experience the same outcome as if I had gone to bed every night. It truly makes me wonder why I can function on such little sleep.

MC:  Is there anything that happens in your current work life that triggers a worsening of your sleep, other than jet lag from travel?

KL:  As a Soldier I always have different report times as the events I manage don’t stop to allow me to get some rest. At the risk of sounding cavalier, they are life-and-death situations and as a result I never really know when I will be able to shut work out completely and rest. This is true for all Soldiers, not just me. In what other career can something happening 10,000 miles away affect your daily life? Sometimes it’s just the Army philosophy of early to rise. My days have started as early as 0345 to 0900 and there usually isn’t a cut-and-dry schedule as to when that will be.

MC:  Ken, tell me about how your colleagues handle their own problems with sleep.

KL:  Honestly, alcohol is pretty prevalent. Some medicate with sleep aids; some try relaxation techniques. Most Soldiers diagnosed with any form of PTSD is prescribed some form of selective serotonin reuptake inhibitors (SSRIs). This helps many deal with what I would refer to as “sleep anxiety.” I can only speak for myself when I say going to bed is one of the hardest events of my day. I know I’m not going to sleep, or the sleep will be lousy, but I also know if I don’t try I’ll be worthless the next day.

My deepest thanks go to Captain LeBlanc for bringing attention to this important problem, and for his honorable and courageous work in securing and protecting our country.

To Dream of Drowning

 

It’s a sleep experience shared by many:  awakening abruptly from a dream, wet with sweat, grateful that you’re not actually drowning.

Our recalled dreams often consist of imagery that is unpleasant.  Visual images can range from monsters to some amorphous figure coming after you.  Just as frightening, however, are the formless, soundless sensations you may feel given the place and circumstance you’re in during the dream.

One dream element that I often hear about in clinic is the feeling of drowning or suffocating.  This sensation is described by my patients in many various ways:  the imagery can be very specific, such as swimming in the middle of the ocean, sharks and fish surrounding the dreamer as he or she is slowly but surely pulled under the surface, or vague and nonspecific, such as the general feeling of air escaping the lungs and throat.  The feeling of asphyxiation may be associated with imagery of water submersion, a premature burial, perhaps, or hands or rope constricting one’s throat.  Common to these different scenarios, however, are the terror felt upon abruptly arousing from the dream and substantial relief upon realization that it was a dream.  Sometimes patients suddenly sit bolt upright out of breath, or even jump out of bed and run to an open window to get some air, because the sensation of breathlessness is so intense and uncomfortable.

Such dreams may occur out of nowhere and for no discernible reason.  However, there is a sleep disorder that can often cause people to awaken abruptly from a dream with the sensation of air hunger.  Obstructive sleep apnea is a breathing disorder in which one’s upper airway collapses or closes down episodically during sleep.  One thing that is important to know is that sleep apnea is often made worse in the setting of rapid eye movement (REM, or dream) sleep.

There are a couple reasons why this is the case.  We humans naturally breathe more erratically during REM sleep.  In addition, during REM sleep most of your body muscles are temporarily paralyzed (otherwise we’d all be in bed physically enacting our dreams); under normal circumstances, there is minimal sustained muscular tone while you’re dreaming.  Your airway therefore may be more prone to collapse, and for longer periods of time.  As such, people with untreated sleep apnea often demonstrate a substantially worsening of the sleep apnea during dream sleep:  in analysis of overnight sleep studies, for example, it’s common to see longer pauses in breathing and dramatically more severe blood oxygen abnormalities during REM sleep as compared to during other sleep stages.

So here is my suggestion.  If you awaken abruptly from dream imagery of drowning or suffocating, such that you feel like you had not been breathing or like you were not getting in enough air, ask your bed partner if you’re snoring loudly, gasping, or sounding like you’re stopping your breathing during sleep.  If there are no bed partners or roommates, ask yourself if you’ve awakened hearing a brief snort or with a brief gasping sensation out of sleep, including without preceding recollection of dream imagery.  Also determine in your mind if you have daytime sleepiness:  a tendency to fall asleep by accident while sedentary during the day or to become drowsy when you shouldn’t, such as while driving.  If you’re experiencing such things, you probably would benefit from seeing a doc like me.  Sleep apnea is an imminently treatable problem, and this frightening sensation of dreaming of being underwater usually evaporates with treatment.

Have a good day and stay dry, everyone!

 

Insomnia: It’s Okay to Hope

Last night Wichita State University fell to top-seeded Louisville in a valiantly fought Final Four semi-final NCAA men’s basketball tournament game in Atlanta.  As my blog followers know, I’m a Kansas Jayhawk first and foremost, but I grew up in Wichita and have strong ties to WSU.  My heart aches for the Wichita State Shockers, as it did last week when Kansas lost to Michigan.

Intermediate- to low-seeded teams are a rarity in the Final Four, and ninth-seeded WSU truly exceeded the expectations of many.  Few anticipated the Shockers to make it much past the second or third round of the tournament.  But as Wichita State continued to shock the nation with win after high-profile win, something beautiful started to germinate and grow in my native Wheat Country:  hope, hope that those wins will continue, all the way up to the end.  Could it be that this young mid-major squad, whose name sportscasters and game announcers can’t even pronounce properly (“Wishlata?”  “Stalkers?”  Seriously???), might possibly wrestle the national title from the vaunted blue bloods of college basketball?

 

The Merriam-Webster definition of hope:  “desire accompanied by expectation of or belief in fulfillment.”

Though the championship is now not to be this year for Wichita State, Shocker fans did not lose much by daring to hope.  Hope implies a transition from non-expectation to expectation.  Hope is also rooted in reality, arising from a personal interpretation of what is experienced, such as upsetting the top-seeded team in your tournament region.  Despite the inevitably profound disappointment when your team loses after having battled to within an arm’s length of the national title, there still lingers the warm feeling of what has been achieved, against all odds, and what therefore can be further achieved in the future.  The new expectation then morphs into a different belief system, and it is this new set of beliefs that generates optimism, a hopeful confidence that continues to build and grow as the years go by.

Nowhere in the realm of sleep medicine is one’s individual system of belief more important–and more responsible for great success or abject failure–than in the management of insomnia.  If you’ve had difficulties falling and staying asleep in your bed for years, you can gradually become conditioned to not sleep well there.  There is no longer the expectation that you will sleep well there due to years of experience to the contrary, so you begin to feeling you’re losing hope that you’ll sleep well again.

Therein lies the cognitive paradox pertaining to insomnia.  We all know that sleep is a necessary and required biological function, and that sleep must be achieved eventually and inevitably, because we must sleep no matter how bad our insomnia; as such, logically there is every reason to expect to sleep, every reason to hope.  However, previous experience sleeping badly enforces the idea that we won’t be able to sleep reliably well again, and this misconception is reinforced every time we try unsucessfully to achieve asleep–such as by counting sheep, listening to relaxation tapes, or what have you–and the resulting fear and frustration keep the hope from surfacing.

In a clinical scenario, a longstanding insomnia patient may respond to the physician’s suggestion, for example, with the knee-jerk exclamation, “But I’ve already tried that!”  I’ve heard that response once or twice in my career, sometimes loudly, even angrily.  But the thought process that generates that frustrated claim can be self-defeating.  First of all, by the time insomniacs feel compelled to visit me in my clinic, they’ve usually already been through a variety of physician-recommended or self-employed treatments or management programs.  Second, by the time they make it through my doors they usually have developed multiple specific reasons to have the insomnia.  Third, whatever was tried earlier probably wasn’t tried in the same context of what is being suggested now.  Finally, often what is “tried” in the first place is tried with the additional burden of performance anxiety:  that feeling of “this had better work,” which only compounds the frustration when what is tried doesn’t result in the achievement of sleep.  Despite all of this, however, hope exists:  were it not for hope, these folks would never have bothered to make an appointment.

My job in this situation is that of both doctor and coach.  Hope is based on reality and fueled by knowledge.  Therefore, for my chronic insomnia patients, the first thing I do after collecting a history and performing a physical examination is sit and discuss at length why I think the insomnia is happening.  I make a list and outline all the probable reasons why the problem has started and continued.  I’ve found this helps them understand the reasons why subsequent recommendations are made, and why I believe that real improvements can actually be achieved, no matter how stubborn or prolonged the insomnia has been.

I believe that even the most hardcore insomniacs can use hope to their advantage.  I suggest that insomniacs choosing to visit a sleep specialist go in with an open mind, a willingness to absorb thoughtfully made recommendations and employ them with an expectation that they may well be helpful, though not necessarily immediately.  It’s hope that brings them to the clinic in the first place, so I recommend making the most of what they already have in them and allow themselves the willingness to believe that the sleep can get better.  If doctor and patient listen to each other openly, it just might.

Snoring in a Song: My Interview With Eduardo Mendonça

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I play alto saxophone and percussion for Show Brazil! here in Seattle.  Originally from Salvador in the northeastern Brazilian state of Bahia, the band’s leader, Eduardo Mendonça, is an internationally renowned and award-winning recording and touring artist, accomplished songwriter, teacher, community leader and benefactor to the Puget Sound area Brazilian community.  His music is played and appreciated worldwide.  He has played for the Dalai Lama, Pope John Paul II, and Nelson Mandela, as well as audiences all around the world.  I’m honored that Eduardo christened me with my Brazilian name, Maracujá, about which I will write in an upcoming entry.

One of Eduardo’s many great songs is “Vingança,” a live version of which is shown here (from a Carnaval gig we played in 2011).

“Vingança” features both Portuguese and English lyrics.  Here are the English lyrics, which served the basis for a casual over-coffee discussion I recently had with Eduardo pertaining to sleep and snoring.

She left me just because I snore
It is so bad, I sing when I dream
To me it is nothing, it is nothing to me
Boy, I am crazy, please come back to me
Always back, come back to me
Baby, it is hard, come back to me
Yeah, I made my revenge
I scratched up all her pans
She got that stuff from my mother-in-law
Yeah, it was really nice
I broke her porcelain
It is my revenge because she’s gone away
I am so bad

So, here is my interview with my friend Eduardo, who I asked to provide the song’s backstory.

EM: The wife’s left this guy and he’s really mad. He reacts with non-violence. He wouldn’t hit this woman or anything, but he’s mad, and he starts to destroy the things that she likes, like the porcelain given by her mother-in-law, and he feels really compelled to do this. It’s funny; it’s humor. It’s nothing like asking anyone to be violent to solve the problem. I didn’t compose the Portuguese and English together.

MC: So you wrote the Portuguese portion first and later you added the English?

EM: Right, many years later. After I moved to the United States, I was willing to have Americans understand a little bit more about what I was saying.  I was reflecting about how snoring and sleeping problems really can damage any marriage, right? Any relationship. Snoring is in my family. My mother always complained a lot about how much my father was snoring and sometimes talking in the night, and they stayed married for many years until she passed away. She was a hero to keep living with this problem. They slept in the same room and everything, but she complained, I remember she complained. Later I found out I snore as well, though not all the time.

MC: Your wife complains about your snoring?

EM: When I’m really tired, she starts to complain about the snoring, and she reports it to me, like my mother complained, and I saw that it can cause a problem in the relationship. You sleep when you sleep. You don’t have a clue that you’re interfering with somebody else’s sleep!

MC: It’s no fault of your own, but it’s causing distress to your spouse.

EM: That’s where “Vingança” came from.  From my family’s experience, from my experience, and just to alert people: who has the problem? When I wrote this song, “to me it’s nothing, it’s nothing to me.” Of course not, right? Because you don’t know that you’re causing somebody else’s problem. And that’s the humorous part: when you say it’s not a problem, but it is a problem for somebody else. That’s what’s the music is about: just to make people aware that it’s something that needs to be reviewed, something that needs to be treated and talked about, because it does interfere in any kind of relationship.

MC: So he acknowledges that he is doing something that his wife is not liking, and that is a component in what eventually ends up being a dysfunctional relationship that gets worse and worse.

EM: Yes. She left because of that, right?

MC: But did she really leave only because of the snoring?

EM: Only because of the snoring! [we both laugh]

MC: Now, I will tell you that I have had patients that have gotten divorced in large part because of the snoring.

EM: I can believe that.

MC: And it’s not really because of the loudness and the obnoxiousness of the snoring, but because the person doing the snoring didn’t believe it, or didn’t do anything about it. It’s like, “I don’t care that you’re bothered by it; I don’t care.” So I’ve actually had patients that have been in that situation, when they refuse to do anything about it, knowing that it’s bothering the spouse, and then they get divorced. That’s happened!

EM: Yep, that’s my song.

MC: So what that song is then is basically a communication to people that you shouldn’t be ignoring those things, problems that you may not necessarily help, but don’t ignore it, or else your spouse isn’t going to be happy. And it’s humorous on one hand, but on the other hand, it’s deadly serious.

EM: Yes, it’s serious. The song treats a serious problem in a light way, because sometimes we can address some problem–and can make people reflect–not in a drastic way, but with humor. It’s a way to reflect on some cause, that the action that makes that cause can be changed, can be treated, and can be rethought.

MC: You can do something about it.

EM: Right. And this guy didn’t do anything about it.

MC: And he paid a price, because she left.

Obrigado to my old friend Eduardo for bringing some awareness to sleep problems such as snoring!  His music may be found on Amazon, iTunes, and Spotify; Show Brazil! is constantly touring, throughout the Pacific Northwest and beyond.  I highly encourage you to explore Eduardo Mendonça’s wonderful songs.

Could Your Child’s ADHD Be a Sleep Disorder?

Attention deficit hyperactivity disorder (ADHD) has again made top news in the past couple days.  The federal Centers for Disease Control and Prevention recently released data demonstrating that 11% of U.S. school-age children have received a diagnosis of ADHD, and that almost 1 out of 5 boys in the U.S. have been diagnosed with ADHD.  6.4 million children 4-17 years of age have been diagnosed in this country, making for a 53% increase over the past decade.  Millions of prescriptions have been written for these children, often, paradoxically, stimulants such as methylphenidate and amphetamine derivatives.

 

These are stunning figures, no doubt, sparking a renewal of debate regarding potential causes and solutions.  Fingers have been pointed at the pharmaceutical industry, doctors, parents, schools, and our burgeoning quick-fix technology, with iPhones and video games cluttering the landscape of our–and our children’s–lives.  However, there is a medical disorder–a sleep disorder–whose symptoms can be very similar to those of ADHD.  This sleep problem is very real, and one that is very often overlooked.

Obstructive sleep apnea (OSA) is much more common in children than many may realize.  The stereotypical sleep apnea patient is older, male, and overweight, and a misconception that may result from this stereotype is that young children, particularly skinny ones, are not prone to developing OSA.  Not only is OSA quite prevalent in children, it is also easy to miss, in part because the daytime symptoms from OSA can be different in children as compared to adults.

For adults, the most common daytime symptom is excessive daytime sleepiness:  drowsiness, a tendency to struggle to stay awake or to fall asleep at inopportune times, no matter how much sleep is obtained at night.  Children are different.  For many kids, the primary daytime manifestations of OSA are distractibility and irritability, potentially leading to poor school performance, problems concentrating, an inability to stay on task for long periods of time, and chronic conflicts at home or at school.  Sound familiar?  Patients diagnosed with ADHD also have such symptoms.  Additional symptoms attributable to pediatric sleep apnea would include bedwetting, sleep-talking, sleep-walking, frequent sleep disruption, headaches, profuse night sweats, learning problems, depression, and retarded growth.

A big clue to possible OSA is snoring.  The snoring of a young child, particularly 8 years of age and younger, really should be brought to the attention of the child’s pediatrician.  A child’s or teenager’s loud snoring should most definitely be discussed with the doctor.  And certainly if there are witnessed breathing pauses or gasping noises, the child’s doctor needs to be alerted as soon as possible.

Tonsillectomy and adenoidectomy represent the most common form of treatment for pediatric sleep apnea.  For many children, the removal of tonsils completely solves the problem, and it’s amazing how much the child’s (and family’s) life can change for the better as a result.

So today’s pearl, reflecting these recent news from the CDC:  sleep apnea is one of the most under-recognized and under-diagnosed medical disorders for children, and can present clinically in a way that is very similar to ADHD.  If your child is snoring at night and distractible or irritable during the day, I would recommend a sleep evaluation.

Have a great day, everyone!