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Sleep & Sleep Issues in the Pediatric Population.

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Presentation on theme: "Sleep & Sleep Issues in the Pediatric Population."— Presentation transcript:

1 Sleep & Sleep Issues in the Pediatric Population

2 Kids Sleep A lot Sleep is a common discussion point among parents and doctors

3 Many Issues from birth to adolescence…. SIDS Co-sleeping Night-wakenings Bed-wetting Nightmares Sleepwalking & Sleeptalking Timing of High School start times…

4 Sleep Physiology WakefulnessREM IndeterminateNREM

5 Wakefulness

6 Stage 1 NREM  Waves Stage 2 NREM Sleep Spindles K-Complexes

7 Stage 3 NREM %  Waves Stage 4 NREM > 50 %  Waves

8 Stage REM Alpha Waves Conjugate Eye Movements

9 Sleep Stages Overnight NREM is more common in the first part of sleep. REM is more common in the latter half of sleep

10 Children’s Sleep Architecture Differs from Adults More REM Earlier REM More frequent REM More Total Hours of Sleep



13 Sleep in Preemies “Indeterminate Sleep” –Neither REM nor NREM –Characterized by “Delta Brushes” and temporal spikes –Predominant pattern at 34 wks –Disappears by 3 months of age As gestational age increases… – maximum EEG sleep activity switches from temporal to frontal – Indeterminate Sleep decreases – Synchrony between the 2 hemispheres increases The preemie’s sleep legacy is easier arousal later on…

14 Normal Infant Sleep Patterns 18 hours a day, 50% REM, at birth Infants start sleep with REM Most sleep through night by 3 months –25 % still have not by 6 months of age Naps –Usually 2 / day until 1st Birthday –2nd nap usually given up by age 3

15 Night Wakenings Promotion of Good Sleep Habits starts early ** Beware of bastardizations of Ferberizing **

16 SIDS Death of an infant under the age of 1 during sleep –90% under the age of 6 months –Usually during winter months No known cause but many theories –Poor respiratory response to CO2 –Poor blood pressure control –Inability to remove obstructions to breathing Known associations –Sleeping on tummy –Smokers in the house –Not being breastfed

17 School-Age Sleep Issues Bedtime Struggles –Associated with TV viewing behaviors Parasomnias

18 Impressive Phenomena Positive Family History Usually Deep NREM Sleep (Stages 3/4) Common in childhood, decrease with age –Persistence into adulthood NOT a sign of psychopathology Can be induced or precipitated by fever, sleep deprivation, and certain medications

19 Prevalence of Parasomnias in Childhood Persists

20 Parasomnias Go Together Sleepwalking Sleeptalking Night Terrors Bruxism

21 Nightmares Extremely common –2/3 of all kids experience them Preschoolers ages 3-6 REM Child believes them to be real.

22 Night Terrors 5 % of pre-schoolers. Starts between ages 4-12 and resolves spontaneously Increased FHx of enuresis / sleepwalking in 1 st degree relatives During Stage 3-4 during 1 st third of night. Sits upright, stares, appears frightened, screams, cries, autonomic arousal, unresponsiveness –Lasts ~ 10 minutes then child returns to undisturbed sleep. No recall.

23 Night Terrors Not associated with psych problems in childhood; although in adults, associated with PTSD, panic disorders If disruptive or occur daily, can try Benzo qhs. Sometimes can be manifestation of seizures

24 NightmaresNight Terrors Age yrs4 - 8 yrs Sleep Stage REMNREM (3/4) Time of Night LateEarly State on waking Upset / ScaredDisoriented Response to parents Consolable Unaware of Parents Return to Sleep DifficultEasy / Rapid Memory of Event VividNone

25 Sleep Bruxism Up to 88% of children; 20 % of adults Any stage of sleep May result in damage to the Periodicity of 20 to 30 seconds. Malocclusion plays no role in bruxism

26 Sleeptalking Begins during school age NREM and REM sleep No treatment

27 Sleepwalking More than just walking around… –Simple Behaviors –Complex Behaviors Begins in ages 4-8 yrs and resolves spontaneously by adolescence. 10 % of children (2.5 % of adults) Positive Family History Stage 3-4 Sleep; 1 st third of night.

28 Nocturnal Enuresis NREM sleep May be restricted to Stage 3-4 Increased bladder pressures during deep sleep Males with Family History 15% of 5 year olds 10% cure per year, with 3-5% of adolescents

29 Treatment Of Nocturnal Enuresis Behavioral Modification Less drinks Double night Timed Nighttime voids Alarm Systems

30 Sleep Motor Phenomena Hypnic Jerks Body Rocking Restless Legs Syndrome –“Periodic Limb Movement Disorder” –Parathesias and desire to move the legs –Stage 1-2 NREM Sleep –More common in children than recognized 40% start in childhood

31 “Restless Legs Syndrome” –“Periodic Limb Movement Disorder” –Stage 1-2 NREM Sleep –More common in children than recognized 40% start in childhood –Secondary Causes Anemia, Pregnancy, Uremia, Neuropathy

32 Periodic Limb Movement Disorder

33 Persistence of Childhood Parasomnias into Adolescence

34 Adolescent Sleep Public Safety Extracurriculars School Start times

35 Nocturnal Emissions Nocturnal penile erections throughout all life stages –Occurs in utero 13 yrs, 2 months Sexual dream causes ejaculation –How common?

36 Delayed Sleep Phase Syndrome Excessive Daytime Sleepiness or typically as the sum of its complications Patients complain of inability to get to sleep until the early morning hours, but little difficulty sleeping once asleep Melatonin

37 Narcolepsy Begins in adolescence Triad of Symptoms Daytime Sleep Attacks Cataplexy Hypnagognic Hallucinations Sleep Study Findings –Normal total sleep time onset of sleep –Decreased latency Highest HLA-disease linkage in medicine

38 Narcolepsy Somnogram

39 Obstructive Sleep Apnea Periodic apneas due to sleep- related airway obstruction –Large adenoids –Obesity –Not all snorers have OSA Daytime Sleepiness in the short-term Pulmonary hypertension and right heart failure in the long term

40 All Sleep Phenomenon can be a Seizure… Anything that is recurrent, stereotyped, and inappropriate may be the manifestation of a seizure Most often confused with sleep terrors, More common in the first 2 hours of sleep, or around 4-6 am. More common in kids than adults.


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