Eleanor Worrell knew something was wrong. Her daughter, April, would get up at night and wander around the house in a twilight state of sleep. It was getting harder to wake her in the morning.
"It was taking me a good 20 minutes to get her out of bed,'' says the Tampa woman. "She would come home from school and say, 'I'm so tired, Mom.' ''
All that ended about three years ago, when April, now 13, started using a CPAP (continuous positive airway pressure) machine. It pushes air into her nose when she sleeps at night, allowing her to breathe freely.
She was diagnosed with obstructive sleep apnea, a condition in which the throat closes during sleep and obstructs the air passageway. Sufferers wake frequently to catch a breath, spending the night in a restless sleep that leaves them exhausted. For adults, apnea is defined as 10 seconds without breathing; for children, it's an interruption of two cycles of inhaling and exhaling, says sleep specialist Dr. William Kohler, April's physician.
Sleep apnea seems to be on the rise in children. For those with the usual causes, such as large tonsils and adenoids or, as in April's case, simply the way their airways are configured, doctors aren't sure if more kids have it these days or it's being diagnosed more often.
A weighty issue
In other children, apnea clearly is getting more common "because of the epidemic of obesity we have in our children,'' says Kohler, director of pediatric sleep services at University Community Hospital in Tampa.
Obese children may breathe normally while awake, but when they sleep, the muscles relax and the fat deposits in the throat constrict the airway.
Sleep apnea can lead to elevated blood pressure and heart problems in adults. In children, it often results in behavioral problems and the inability to think clearly or pay attention in school.
Paradoxically, the condition also may put normal-weight children at risk of becoming obese, just as lack of sleep in adults is associated with weight gain.
Obstructive sleep apnea and obesity in kids is a "vicious cycle,'' says Dr. Bruce Schnapf, director of pediatric pulmonology at the University of South Florida College of Medicine. Some kids who lose weight and return to the normal range still have sleep apnea.
And apnea can inhibit growth, he says.
"Once you fix kids' apnea, growth picks up like crazy,'' Schnapf says.
Sleep and performance
For some kids diagnosed with attention-deficit (hyperactivity) disorder, the underlying problem may be lack of restful sleep. Kohler says studies have shown that 50 percent of children diagnosed with ADHD have a sleep disorder, whether it's apnea, insomnia or something else.
April takes medicine for ADHD, but she was diagnosed with the problem before symptoms of sleep apnea appeared, Worrell says. "Being hyperactive, she was wearing out faster.''
Now, April sleeps through the night, is a lot calmer, and her schoolwork has improved, says her mom. "She used to struggle a lot, getting passing grades but very low grades. Now she's maintaining A's and B's.
April says she no longer feels like her nose is stuffy when she sleeps, and she's more refreshed when she gets up in the morning.
Doctors say parents may want to have their children checked for sleep apnea if they see they aren't performing in school and seem to be more irritable, hostile or depressed.
For many, sleep apnea is worse when they sleep on their backs, "but it really is variable,'' Schnapf says. Some have more problems sleeping on their stomachs. And, for some, it's the level of sleep; many experience apnea during deep dream sleep.
Snoring, which isn't normal in children, may be a real clue. Unchecked, it can lead to additional trouble.
"If you follow them for four or five years,'' Kohler says, referring to studies on the subject, "they are more likely to be at the bottom of the class and have behavior problems compared to children who don't snore.''
Diagnosis starts with a detailed examination of the upper airway, Schnapf says. Often, removing the tonsils and adenoids solves the problem. Beyond that, he says, the most successful treatment for kids is the CPAP machine.
Controlling the problem of sleep apnea often improves the child's behavior and school work, Schnapf says.
"The outcomes are very good, very positive.''
Philip Morgan is a St. Petersburg writer. He can be reached at firstname.lastname@example.org.