Sat, Sep 20, 2008
Mind Your Body, The Straits Times
Sleepless tots
In a stressful world, being able to sleep like a baby is something to be envied as it connotes deep, restful slumber.
However, it may come as a surprise that not all babies sleep well and that young children can suffer from sleep disorders.
Babies who wail into the night, toddlers who snore loudly, perennially sleepy kids - these behaviours may indicate sleep disorders. Frazzled parents console themselves that their child will outgrow it.
Surgical solutions
A year ago, nine-year-old Qwek Jin Kee's laboured breathing and loud snores would frequently wake his father. Initially, Mr Qwek Teck Leong did not think much of it, brushing it aside as a possible side effect of his son being overweight.
However, Mr Qwek grew alarmed when Jin Kee began to put himself in a sitting position periodically during the night to sleep.
'I would lay him down to sleep only to find that he would be sitting upright while sleeping later in the night. It seemed like it was easier for him to breathe while he was in a sitting position, but I thought that couldn't be normal," said Mr Qwek.
It wasn't.
After several visits to the polyclinic, Jin Kee was referred to the University Children's Medical Institute at National University Hospital to undergo an overnight sleep study.
The study found that Jin Kee was suffering from severe obstructive sleep apnoea (OSA). He had 39 episodes per hour of very shallow breaths or no breath at all.
He underwent surgery two months ago to have his tonsils and adenoids removed. Jin Kee now sleeps with nary a snore and does not sit up to sleep anymore.
Seven-year-old Muhammad Dzulqarnain, who was diagnosed with OSA earlier this year, also underwent a similar surgery last month.
His father, Mr Mustafa Ali, said that Muhammad's post-operation sleep study has shown that his son's oxygen level during sleep has improved remarkably from as low as
60 per cent before the surgery to around 90 per cent.
Mr Mustafa has noticed that his son has become a much more alert and active child since the operation.
He said that as the boy no longer has OSA, he sleeps soundly every night and is no longer always tired during the day. 'Now I sleep better too, knowing that my son will not gasp for air or stop breathing in his sleep.'
However, in recent years, more Singaporean parents have become aware of paediatric sleep disorders, said Dr Chng Seo Yi, a consultant paediatrician at the National University Hospital's (NUH) University Children's Medical Institute. NUH provides comprehensive screening and diagnostic services, including sleep clinics, for children with sleep disorders.
Dr Chng said anxious parents invariably have this question: What is the best way for my child to learn to fall asleep on his own?
Parents of a newborn, especially, can expect sleepless nights. In the first year of caring for a newborn, each parent may lose on average around 400 hours of shuteye, wrote British consultant child psychologist, DrDiane Gumley.
However, some parents may unwittingly play a role in their child developing unhealthy sleep habits, DrChng said.
Sleep-onset association disorder, for example, occurs when a child closely associates going to sleep with bedtime rituals such as bottle feeding or rocking. A child with sleep-onset association disorder, who wakes up in the middle of the night, will have difficulty falling asleep again if that learnt association is absent.
A more unusual sleep disorder affecting infants is manifested in rhythmic head-banging, head-rolling or body rocking.
This need not be a cause for alarm with infants aged nine to 18 months - often, they just find these repetitive, rhythmic actions soothing.
However, for those older than 18 months, it could be a sign of anxiety or stress. In mentally impaired children, such behaviour may be much more frequent.
Head-banging can also become a reinforced behavioural pattern if an infant learns that he can get the caregiver's immediate attention. Dr Chng's advice is to ignore him, unless the infant is inflicting serious bodily harm on himself.
There is also obstructive sleep apnoea, which may develop from infancy.
In this common sleep disorder, the airway collapses or is partially blocked during sleep. The blockage causes shallow breathing or breathing pauses during sleep. 'Corrective surgery, usually the removal of the child's tonsils and adenoids, can treat obstructive sleep apnoea," she said.
The tonsils and adenoids are part of a ring of glandular tissue that encircles the back of the throat.
Narcolepsy, a neurological disorder caused by the brain's inability to regulate sleep-wake cycles, can also affect children. Narcoleptics can suddenly fall asleep for a few seconds to several minutes.
A child who is overwhelmingly sleepy during the day - called Excessive Daytime Sleepiness - may have narcolepsy.
'Many cases go undiagnosed, especially if they are relatively mild. Parents may just blame the child for being lazy and for falling asleep all the time,' Dr Chng said.
Some paediatric sleep disorders can be life-threatening. In one rare disorder - congenital central hypoventilation syndrome (CCHS), also chillingly known as Ondine's Curse - the autonomic (involuntary) control of breathing is impaired from birth.
Most patients afflicted with CCHS breathe normally when awake but breathe poorly or fail to breathe at all when asleep. Untreated or misdiagnosed, children with CCHS can die or develop serious complications caused by periods of low or no oxygen.
CCHS is a lifelong condition but with the help of a portable respirator, such kids can lead normal active lives.
However, even children without sleep disorders may not be getting the quantity and quality of sleep that they need.
Dr Chng suspects that many children in Singapore are sleep-deprived.
'Pre-school children should get about
12 hours of sleep a day, and school-age children, around 10 hours. However, due to the busy schedules of working parents, many children probably stay up late to spend time with their parents when they return home. These kids then wake up early to go to school the next day," she said.
For a growing child, being asleep is just as important as being awake.
This article was first published in Mind Your Body, The Straits Times on Sep 18, 2008.
