WHEN IT COMES TO GETTING SLEEP, IT'S MORE THAN JUST COUNTING SHEEP

Do you have trouble sleeping?

Snoring? Sleepwalking? Staying awake during the day?

Most kids don't realize that sleep can be a problem. Usually it's someone else in the house who's not sleeping because of your problem.

Dr. Deborah Givan knows all about this. She's the director of the Children's Sleep Disorders Center at Riley Hospital for Children. It is the only sleep clinic for children in the state.

About 100 new patients a year are referred to the sleep clinic. Givan, who has run the facility for seven years, says disorders such as sleepwalking and sleep talking typically aren't serious, but others - such as obstructive sleep apnea (blocked breathing passages) and narcolepsy (frequent, uncontrollable desires for sleep) - can be.

Because most of us sleep during one-third of our lifetime, Givan believes a lot of problems could occur during that time.

"We're just beginning to find out what some of those are," she said. "It's a relatively new area of research, and many of the things we know are things we extrapolate from things we know in adults, and they don't necessarily apply to children. We found that out pretty quickly."

Common sleep problems

At her clinic, Givan said the three most common medical problems that disrupt sleep are: behavioral sleep disorders, obstructive sleep apnea and narcolepsy. The causes of these conditions vary.

"Some of them may be genetic," she explained. "For example, you may inherit a small airway from your parent. Or narcolepsy is believed to be inherited in some instances, although rarely.

"Other things might be environmental. For example, you may develop large tonsils and adenoids because you've been exposed to a lot of infections, or (you live) in a family where people smoke and so make you more susceptible to infection.

"So oftentimes it's a combination of factors that result in a problem."

Behavioral sleep problems arise from children who refuse to sleep or won't sleep when they should. These are treated with different discipline techniques, such as getting the child used to sleeping in his or her own bed. "Those are the easy ones," Givan said.

Sleepwalking, sleep talking and night terrors are disorders of arousal, Givan explained. That means the body wakes up but the mind does not. These are most common in children 4 years and older and usually disappear by ages 10 to 12.

These kids usually are unaware of their disorders, Givan said.

"If somebody wakes you from a dream, you remember the dream. But if somebody wakes you from sleepwalking or sleep talking, you have no recollection of it. The next morning you would only know it because somebody told you that you were walking around or talking to them at night."

Sleepwalkers may not remember, but Givan says about 75 percent of them will injure themselves in some way - running into a door or even walking out a window.

There are drugs that can temporarily, but not permanently, stop sleepwalking. As with most sleep disorders, it cannot be "cured."

"It gets better with age and it gets better if you develop good sleep habits," such as sleeping in a restful environment and relaxing before bedtime, Givan said.

Snoring children

A more serious problem is an obstruction of the airway, which can cause several disorders including snoring and sleep apnea.

"Snoring is probably the most common complaint of people who have airway obstruction," Givan observed.

Although no large-scale studies have been done with children, it is estimated that 9 percent to 15 percent of all kids snore. Givan said snoring in any child is always cause for concern.

"It's not well-known in children. . . . Before, (these problems) weren't caught until they were so serious they caused pretty significant symptoms," the pediatric pulmonolgist said.

"If somebody just snores, it doesn't necessarily mean they need their tonsils out. Your tonsils sit right on the carotid artery, which is the main artery to the brain. So you don't want to be messing around back there if you don't need to be."

Doctors may recommend the patient sleep on his or her side to keep the breathing passages open or lose weight to relieve pressure on the airways.

Sleep apnea dangerous

Sleep apnea is more serious. People with this disorder don't breathe properly during sleep and may not get enough oxygen. If you don't get enough oxygen, the heart can enlarge.

Sleep apnea sufferers also may have restless movements in their sleep and loud snoring followed by a breathless pause then a snort or gasp. Children with this condition sometimes squeak when they speak.

Givan said sleep apnea can lead to heart failure, learning problems in school, liver and kidney problems, and even sudden death, although that is rare. Treatment is similar to that for snoring. In addition, medication may be prescribed or the patient may be asked to wear a dental appliance to keep the tongue from blocking airway or special masks that pump air continuously into the nose. Surgery to widen airways also is an option.

Sudden sleep at anytime

Narcolepsy is also a serious sleep disorder. Although relatively uncommon, it involves a malfunction of the central nervous system.

People with narcolepsy fall asleep suddenly many times during the day. This can be embarrassing and dangerous, especially if the victim is driving or cooking.

Narcoleptics also may have a hallucination just before or after sleep or sudden loss of muscle control when emotions are strong. They may experience fatigue, irritability, depression and reduced concentration.

A child with narcolepsy "sometimes develops problems with self-esteem because everybody around them thinks they're lazy when they really have a medical problem," Givan said.

There is no real cure for narcolepsy. Treatment includes scheduled naps, medications and good sleep habits. "If you have narcolepsy you have to get a lot of sleep," Givan said.

She also emphasized that patients are counseled to be very conscientious of their condition. "If you have narcolepsy and you're going to fall asleep behind the wheel, that's not very good. So you have to be educated about that and you have to stay on your medicine or you're not going to be able to drive," she said.

Some people are more at risk than others. For example, kids born with nose, face and mouth deformities or who have a lung disease, such a cystic fibrosis or severe asthma, are at risk because their airways might be blocked.

Kids who have had infections of the tonsils and adenoids also are more vulnerable to airways obstructions. So are kids who are overweight.

What are the signs to look for?

Givan says children with sleep problems may be sleepy during the day. For example, hypersomulance, like narcolepsy, causes more than normal sleep during the day. This disorder many times follows a head injury or encephalitis - an inflammation of the brain.

Other symptoms are harder to read.

For instance, young children with sleep problems may not be sleepy at all. Instead, they may be hyperactive and have trouble concentrating in school.

Teachers, too, may tell parents if a child is sleeping in class or if his or her grades are dropping.

Parents often know when something is wrong, Givan said.

"Sometimes the parent may come and say, `My child snores and they don't breath right when they sleep,' " Givan said. "Parents watch those things on their kids. requently you can figure out what the problem is just by listening well."

When just paying attention doesn't give a parent enough information, Riley Hospital does sleep studies in addition to doing a physical exam of a child.

There is good news for many children with sleep problems.

"In adults, most sleep problems, except for narcolepsy, tend to get worse with age. In kids, they tend to get better with age."

EDITED BY: Elizabeth Schnippel, 15.