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Is it ADHD or Sleep Apnea? How to know the difference in kids (Part II)

In Part II of "Is it ADHD or Sleep Apnea" Lisa Mercurio speaks with Dr. Daniel Barone of New York's Weill/Cornell Sleep Center and explores the warning signs of sleep apnea.  Crankiness?  Poor academic performance?  Are you sure it's ADHD?  Dr. Barone sheds light on this often misdiagnosed childhood malady.

LM: What is it like for a child coming to a sleep center?

DB: They get hooked up the way an adult would. Our nighttime techs are fantastic with children.  So the kid gets hooked up, and then typically what happens is that the parent would sleep in a pull-out chair.  They are there and not in the bed itself.

LM: It’s not like a hospital, it’s a sleep center, and here at New York Cornell it’s almost like a spa. 

DB: Ah!  We also have Pediatric Sleep Center – all in private rooms…

LM: What’s the youngest you have seen?

DB: Personally – I’ve seen 4 or 5 year olds come in here…sleep problems can start at 2 years old and even earlier.  When I was in training I saw two or three-year-old kids with tonsils like golf balls.

LM: One doesn’t necessarily think of little children as being apnea suspects.

DB: Fortunately, ENTs (ear, nose and throat doctors) are sending kids for sleep studies for this reason with the plan to remove the tonsils and adenoids if a problem is found.

LM: Right…we’re about to remove some of your lymph nodes (aka tonsils), but we think this might be the problem.

DB:  As far as physiology is concerned, children have a much higher percentage of Delta Wave sleep than adults do.  A much older person might be down to 15% a night whereas a child may be getting 25-30%.  You need both REM and Delta sleep.  In a typical middle aged adult – you get about 20-25 percent of each.

LM:  Kids and teens are paying off the sleep debt.  The college scene is riddled with a song that says, “Hey – last night I was out partying, I’m hoping I’m going to make up my sleep in the next few days over the weekend.”  Can that happen???

DB:  Here’s the thing. There is a myth that we have to make up our sleep minute-to- minute.  Here’s what happens.  If you are sleep deprived for even one night, what the brain will do is it will go into Delta Wave (also known as N3) and REM sleep earlier and more frequently to make up what had been lost.  The other stages of sleep are not as important necessarily.  The brain will forgo going into those in order to make up what it needs.

LM: The brain is protecting us and saying, “I’ve been getting ripped off” and I’m going to get what I need.”  Seems to me that it’s a compensatory situation, because the body makes sure that it takes what it needs.  It reminds me of the pregnant body taking the calcium from the bones in order to give it to the unborn child, if there’s not enough.

DB: Homeostasis.

LM: It’s a beautiful thing.

What is the trend toward kids and teens not getting enough sleep and what are the physiological and biological factors that parents need to be on the lookout for….

DB:  Chronic sleep loss, crankiness, difficulty in waking up in the morning, poor performance in school, snoring, behavioral issues.

LM: And you’re saying, “don’t rush to make an ADHD diagnosis.”

DB:  Yes.  Also, nighttime urination in kids can be a sign of some things, but if a kid is bed-wetting repeatedly, it can also potentially be a sign of sleep apnea.

LM: What are the remedies?? You obviously cannot be giving Ambien to a 7 or 8 year old.

DB: In most cases, it can be solved.  For example, if tonsils are the culprit, take them out.  If it’s not because of tonsils but because of weight: reduce the high calorie foods.  Weight loss is key.  In terms of sleep habits, keep a good schedule.  Keep the TV and electronics off at least a half hour before bedtime.

LM: What kid do you know that isn’t sleeping with an iPhone?  I saw my daughter sleeping next to her computer as if it were a bed companion.

DB: It’s become the way of the world, but because of this, our kids are not getting the rest they need.  Technology, unfortunately, is destroying some of the basic fundamentals of sleep.

LM:  There is a limit to how we should be plugged in.

(to be continued)