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School kids with sleep trouble?

When Anthony Beckford had a bad night, nobody could sleep in the house.

"He snored strongly, would toss and turn in bed, take his clothes off and suddenly stop breathing for as long as 30 seconds," says his mother, Mellanie Barriffe. "But his mornings were worse: He could not get up. He would ask for five more minutes of sleep, cry and complain that he simply had no strength."

Anthony, 9, is one of thousands of children in the United States diagnosed with sleep-obstructive apnea, a medical condition known for interrupted breathing during sleep. Experts estimate that 30 percent of children between 2 and 18 will suffer from this or some other sleep disorder.

Sleep disorders have serious consequences, increasing the risk of obesity and diabetes and often leading to attention-deficit issues.


• Establish a routine and a specific time to go to bed. "Sleeping is like eating. You need to do both at regular hours or your biological clock gets confused," says Dr. Marcel Deray, director of the Sleep Disorder Center at Miami Children’s Hospital.

• Turn off all electronic devices at least 45 minutes before bedtime and devote that time to relaxing activities such as reading or putting together a puzzle.

• Get the TV, computer and other electronic appliances that generate blinking lights out of the room, as they disturb the pace of sleep.

• Don’t serve your child a heavy meal before bed. Serve dinner at least two or three hours before bedtime to give the digestive system time to process the food and prevent acids involved in the digestion to rise through the respiratory track, causing gastritis or reflux. If the child has extracurricular activities at night, they should eat dinner at about 5:45 p.m., go to the activity and, if they are hungry when they get back, give them something light, like a bowl of cereal.

"Sleeping is very important for concentration, attention, learning and memory," says Dr. Marcel Deray, director of the Sleep Disorder Center at Miami Children’s Hospital. "There are also other medical reasons that make sleeping important. For example, the growth hormone is secreted during the stage of deep sleep and there is evidence that both children and adults who don’t sleep well tend to be overweight and suffer from diabetes, probably for hormonal reasons."

Experts agree that children need nine to 12 hours of quality sleep daily. During the sleep cycles, the REM or dream stage (so called for its characteristic rapid eye movement), alternates with periods of deep sleep.

Interruptions in the deep sleep cycle mean the brain is not getting enough rest, which generates not only fatigue but can affect the child’s behavior.

"Early diagnosis of sleep disorders in children is important, not only for them to become healthy adults, but also because it has a direct impact on school performance, obesity and the child’s and family’s quality of life," says Dr. Kunjana Mavunda, a pediatrician at Baptist Children’s Hospital. She emphasizes that parents should monitor not only the number of hours their children sleep and whether they get up tired, but also their daily behavior, since in many cases the lack of rest presents itself as concentration and hyperactivity problems.

"This doesn’t mean that all children with ADHD [attention deficit hyperactivity disorder] have sleeping problems, but if your child has been recently diagnosed with attention or hyperactivity problems, it’s important to have a sleep study performed before giving him any medication," Mavunda says.

Sleep disorders go beyond occasional problems at bedtime. They are normally chronic and in many cases originate in physiological problems. One of the most common conditions among children ages 3 to 10 is sleep-obstructive apnea, which can cause breathing interruptions for as long as 30 seconds.

"Obstructive apnea affects 2 percent of children between 2 and 6 years old. It is more common at that age range because their tonsils and adenoids are large compared to the rest of the body and can block the respiratory tract," Deray says. "Beginning at age 6 they start to get smaller because they are no longer as necessary for the immunologic system. The problem tends to disappear, though it could return again in their adult life."

Specialists recommend that parents be alert to their children’s sleeping patterns, especially if they snore.

"Most children suffering from obstructive apnea snore, though not all children who snore suffer from apnea," Mavunda says. "It’s important for parents to listen to the rhythm of snoring, which is different in apnea patients, whose snoring is generally stronger and then nothing is heard for a while until it starts again.

"What happens in these cases is that the child’s respiratory tract is collapsing when the snoring is stronger and the brain enters an emergency mode and sends a wake-up signal. So children wake up, stop snoring for a while and later the process starts again."

It is precisely these frequent sleep interruptions that prevent rest and cause behavioral issues. Mavunda, however, says one can confuse the symptoms of obstructive apnea with other disorders.

"Apnea symptoms are very similar to those of allergies and inflammatory processes in nasal passages," she says. "In South Florida we have more allergens than in any other area of the country, and if the patient’s nasal passage gets inflamed by some allergy, it can get blocked and cause breathing problems while sleeping.

Therefore, parents must monitor their children’s environment and make sure that there are no causes for allergies."

If allergies are not the problem, there is a good chance that a child’s tonsils and adenoids are contributing to the condition.

"In 99 percent of the cases, apnea symptoms improve after the tonsils and adenoids are removed," Deray says.

Such was the case with Anthony, who stopped snoring after his adenoids were removed.

"He now sleeps a lot better and gets up rested," says his mother.