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A sleepy child is not always a lazy child

There are many reasons why children and young adults do not perform well in school. daytime One of the most common reasons is poor attention in the classroom, which may be related to an undiagnosed and untreated sleep disorder that shows up in the classroom as excessive sleepiness or excessive irritability, activity or distractibility.

Below are listed several sleep disorders that occur in school-age children and young adults. As with any medical disorder, a full evaluation by a sleep doctor specialist is required to administer the appropriate intervention.

Sleep insufficiency syndrome

Sleep insufficiency syndrome is a schedule disturbance that shows up as excessive daytime sleepiness, particularly in the mornings or mid-afternoons. This syndrome is a result of insufficient time being allowed for sleep. Since each individual’s need for sleep varies greatly, many children and young adults do not get enough sleep, even if they are sleeping for 7 or 8 hours per night. It is not unusual for some children to require 9 to 10 or more hours of sleep each night for optimal alertness during the day.

Delayed sleep phase syndrome

Delayed sleep phase syndrome is another schedule disturbance that shows up as excessive daytime sleepiness, particularly in the mornings. This occurs primarily in teenagers who have become delayed in their sleep patterns and are unable to fall asleep until well after 2 or 3 AM. Consequently, they have trouble getting up in the morning and staying awake during morning classes. This unworkable sleep schedule is related to physiological changes in the biological clock and can be very frustrating for the student, his parents and his teachers. It can be treated with bright light treatment and progressive schedule changes.

What is narcolepsy?

Narcolepsy is excessive sleepiness and spontaneous naps that occur far more frequently than in a normal child. It is the sudden, uncontrollable urge to sleep, even in inappropriate conditions and environments. The exact cause of narcolepsy is unknown, but a deficiency of orexin/hypocretin has been implicated. There is no cure, although symptoms can be controlled. Narcolepsy is a neurological disorder affecting the central nervous system, which controls sleep and wakefulness. It occasionally runs in families. 

Four main symptoms:

  • Excessive daytime sleepiness
  • Cataplexy (sudden, brief losses of muscle control, triggered by a strong emotion)
  • Sleep paralysis (the inability to move when waking up or falling asleep)
  • Hypnagogic hallucinations (vivid dreams that are difficult to distinguish from reality)

Additional symptoms:

  • Dreaming during naps
  • Automatic behavior (performing routine tasks while not consciously controlling the activity)
  • Poor memory
  • Frequent, irresistible urges to sleep
  • Inability to concentrate
  • Poor-quality sleep at night

Who gets narcolepsy? 

Narcolepsy occasionally runs in families. However, many people with narcolepsy do not have relatives with the disorder. Some researchers believe certain genes, when combined with lifestyle factors, cause the disorder. 

Diagnosis

Two tests are used to diagnose narcolepsy: a polysomnogram and a multiple sleep latency test (MSLT). During a polysomnogram, the patient spends the night in a sleep laboratory. Small electrodes are attached to the patient’s skin to record brain waves, muscle activity, respiration, heart rate and eye movements. The MSLT takes place the following day. With some electrodes still attached, the patient takes five 20-minute naps at two-hour intervals. The purpose of the polysomnogram and MSLT is to evaluate the patient’s sleep patterns, specifically REM (dreaming) sleep. In people with narcolepsy, REM sleep begins much sooner after falling asleep. With these tests, a sleep specialist can determine whether a patient’s symptoms are caused by narcolepsy or by another sleep disorder. 

Treatment  methods

  • Medical treatment withstimulant medications may be used to increase alertness. Antidepressants may be used to suppress REM and control frequent cataplexy.
  • Behavioral treatment requires following a regular sleep/wake schedule, taking naps and exercising caution when driving or undertaking other dangerous activities. 
  • Management of the environment includes educating friends and family members, joining a support group, discussing your disorder with your employer and educating your child's teacher about their narcolepsy.

Idiopathic hypersomnia

Idiopathic hypersomnia has symptoms of severe sleepiness similar to narcolepsy and often starts in the teens or 20s. No matter how much sleep the individual gets, they never “catch up.” Unlike narcolepsy, there are no symptoms of sleep paralysis, cataplexy or hypnogogic hallucinations. The disorder generally does not run in families. Many of the same treatments used for narcolepsy are used for idiopathic hypersomnia after proper diagnosis by a sleep specialist. 

Sleepwalking

Sleepwalking is a common cause of daytime sleepiness in children and young adults. It, along with bedwetting, creates frequent arousals from sleep. Sleepwalking can also create opportunities for physical injury, since children have a tendency to be clumsy when sleepwalking. They can injure themselves on stoves or by wandering into hazardous situations. Both sleepwalking and bedwetting occur most frequently in children between 4 and 8 years of age, and most children outgrow them. Parents should install safeguards such as locked doors and windows and gates across stairways. If the problem is severe or the child does not outgrow the symptoms, an evaluation should be considered and more involved treatment programs should be explored.

Obstructive sleep apnea

Obstructive sleep apnea is characterized by loud snoring with periods during which the snoring stops for 10 to 60 seconds, followed by a loud snore or snort. Sleep apnea is the quiet period during which the child stops breathing. Every time this occurs, the child arouses very briefly before returning to sleep. This sleep disorder can cause excessive daytime sleepiness, which may affect performance in the classroom. Obstructive sleep apnea is considered a serious medical problem, and parents should seek medical care as soon as possible.

Periodic leg movements disorder

Periodic leg movemen disorder is characterized by frequent jerking of the legs during sleep. This can occur more than 300 times per night and create very fragmented sleep. It also leads to excessive daytime sleepiness, which can affect the child’s attentiveness in the classroom and his learning retention. A variety of treatment programs are available, and parents should be encouraged to seek an evaluation by a sleep specialist.

Don’t let sleep disorders affect your child's life. Get back to your life with our help. Call Margaret Mike, MD Sleep & Wake Center at 972–981-7436 and learn how today’s advanced care options could potentially save your life. For your convenience, you can also use our online form to schedule your appointment with sleep doctor Margaret Mike today! We help children from DFW Metroplex, TX, including Plano (Collin County), Bedford, Colleyville, Grapeville (Tarrant County) and Frisco (Denton County) Physicians employed by Texas Health Physician Group practice independently, and are not employees or agents of Texas Health Resources hospitals.