Pediatric Sleep Disorders

A little girl cuddling a teddy bear while sleeping in bed.

A good night’s sleep is essential for your child’s well-being. When sleep is disrupted, children may have health, behavior and development problems. At OHSU Doernbecher Children’s Hospital, doctors will give your child or teen the most effective treatment in a caring environment.

You’ll find:

  • Experienced sleep specialists who do more than 700 sleep tests a year.
  • A coordinated team of child specialists in:
    • Sleep medicine
    • Pulmonology (the respiratory system)
    • Otolaryngology (ear, nose and throat)
    • Neurology (the brain and nerves)
    • Craniofacial surgery
  • Sleep tests in a homelike setting where you can stay with your child.
  • Sleep tests at Doernbecher for children on ventilators or who can’t be in a regular bed.

Understanding sleep disorders

What are sleep disorders?

Sleep disorders happen when your child has trouble falling asleep or staying asleep at night. Sleep can be disrupted because of blocked airways, low iron levels, neurological disorders or other causes. Left untreated, your child may have problems functioning or may develop health problems.

Why is sleep so important?

Children who don’t get enough sleep at night become fatigued and irritable. They may have problems with attention, learning, and behavior at home and at school. Poor sleep can also affect a child’s growth, blood sugar levels and immune system.

Types of sleep disorders

The most common are:

Sleep apnea: Up to 4% of children, typically ages 2 to 8, have sleep apnea. The two types are:

  • Obstructive sleep apnea: The most common type occurs when soft tissue at the back of the throat blocks the upper airway. This cuts off oxygen for a few seconds until the child wakes up and breathes normally.
  • Central sleep apnea: This happens when the brain stops signaling a child to breathe, sometimes for a minute or longer. It’s usually linked to other conditions that involve the central nervous system (brain and spinal cord).

Insomnia: Your child has trouble falling asleep or staying asleep, or wakes too early. Causes can be poor sleeping habits, stress or anxiety. In the U.S., 45% of adolescents don’t get enough sleep, and some may suffer from insomnia, according to National Sleep Foundation.

Delayed phase sleep syndrome: This chronic disorder, common among teens, occurs when they go to bed two or more hours later than normal. This makes it hard to wake up the next morning.

Excessive sleepiness: This is unexplained sleepiness, with no other sleep disorder or related medical issue.

Periodic limb movement disorder: An urge to move or kick the legs repeatedly wakes the child. Scientists have linked this disorder to iron deficiency.

Parasomnia: This set of conditions is marked by abnormal movements during sleep. Doctors sometimes call it “things that go bump in the night.” Common types include:

  • Nightmares: A child wakes from a frightening dream.
  • Sleep terrors: A sleeping child sits up screaming, shouting or kicking. The child typically doesn’t respond to voices and has no memory of the event the next morning. These are also called night terrors.
  • Sleep talking: A child talks during sleep.
  • Sleepwalking: A child walks or makes other movements while partly awake.

Narcolepsy: This is a central nervous disorder in which the brain can’t properly regulate sleep and awake cycles. It’s uncommon in children. Children with narcolepsy have poor sleep, excessive sleepiness, sleep attacks and sudden loss of muscle control. They may also have cataplexy sudden and uncontrollable muscle weakness that causes them to collapse.

Signs and symptoms of sleep disorders

If your child has any of these symptoms, see your child’s doctor. Your child may need to see a sleep specialist.

  • Difficulty falling asleep
  • Waking frequently
  • Noisy, choppy breathing
  • Tossing and turning all night
  • Pauses in breathing while sleeping
  • Gasping or snorting during sleep
  • Nightmares
  • Waking up screaming
  • Sleep walking
  • Restless legs
  • Bedwetting
  • Irritability
  • Falling asleep in class
  • Overweight
  • Attention deficit hyperactivity disorder (ADHD)

Tests for sleep disorders

Your child’s doctor will gather his or her medical and sleep history to determine the best test. Tests include:

A photo of Dr. Derek Lam.
OHSU’s Dr. Derek Lam is an ear, nose and throat surgeon who specializes in sleep and aerodigestive disorders. He is the surgical director of our aerodigestive clinic.
  • Sleep study: A polysomnogram or PSG is an overnight study in our sleep lab to measure and record how your child is sleeping. The test is used to diagnose sleep apnea and other disorders. You can stay with your child through the night.
  • Electroencephalogram (EEG): This test detects the brain’s electrical activity during sleep. It measures your child’s sleep stages and brief episodes of wakefulness.
  • Multiple sleep latency test: This test is used for unexplained sleepiness and to diagnose narcolepsy. It measures brain activity and eye movement to see how quickly your child falls asleep during a series of naps.
  • Actigraphy: The test is used to diagnose obstructive sleep apnea and insomnia. Your child wears a watch-like device with a sensor that measures sleep and awake patterns.
  • Blood test: This can find iron deficiencies. Low iron levels have been linked to periodic limb movement disorder and restless legs syndrome.

Preparing for a sleep study

“Preparing for your sleep study” and “OHSU Doernbecher Children’s Hospital,” with a photo of a young boy smiling in bed holding a teddy bear.

We’ve created a fun, interactive booklet for you to read with your child. It details:

  • What you need to bring
  • What to expect
  • What happens the next morning

Sleep lab location:

The Residence Inn by Marriott at RiverPlace
2115 S.W. River Parkway, fifth floor
Portland, OR 97201

Treatments for sleep disorders

A range of specialists will confer about your child’s specific sleep disorder. Treatment will vary by diagnosis.

Surgery: Surgery to remove enlarged tonsils and adenoids is the first-line recommended treatment for children with obstructive sleep apnea. If a child has unusual facial anatomy, we may consider other options, such as craniofacial surgery.

Nonsurgical treatments: We’ll consider nonsurgical options if a child:

  • Is not a good candidate for surgery
  • Has central sleep apnea
  • Has some remaining obstructive sleep apnea after surgery to remove the tonsils and adenoids

Nonsurgical options include:

  • CPAP (continuous positive airway pressure): A CPAP machine improves breathing at night. The child wears a mask over the nose that’s connected by a hose to a machine that gently blows air. Your child’s doctor determines the correct air pressure to keep the airway open.
  • BPAP (bilevel positive airway pressure): This machine, similar to a CPAP, helps some children exhale. It uses higher air pressure for inhaling and lower pressure for exhaling.  
    Medication: Nasal steroids and other medications may be prescribed to help open airways and ease your child’s breathing.

Medications: There are no FDA-approved medications specifically for children’s insomnia. Our doctors generally discourage using over-the-counter medicines for children with insomnia, but they can review all options with you.

Behavior therapy: Your child’s doctor will work with you to develop strategies and routines to help your child fall asleep and stay asleep. They include:

  • Setting regular times for your child to go to bed and wake up every day.
  • Limiting the amount of time in bed without sleeping.
  • Restricting sugar.
  • Avoiding caffeine.
  • Reducing television time.
  • Minimizing use of smartphones or video games before bed.
  • Relaxation therapy, including deep breathing.
  • Exercising regularly.

Environmental changes: Create signals, such as blackout curtains, to help a child fall asleep.

Medications/supplements: Melatonin supplements or medications may be prescribed for a short time and with behavior strategies.

Behavior therapy: Your child’s doctor will work with you to develop strategies including:

  • Setting regular times for your child to go to bed and wake up every day.
  • Restricting sugar and caffeine before bed.
  • Setting a quiet time before bed with no smartphones, television or video games.

Bright light therapy: Exposure to a special light box early in the morning can readjust your child’s body clock.

Supplements: Iron supplements may be prescribed if your child has low iron levels.

Behavior therapy: Your doctor will work with you to develop strategies including:

  • Setting regular times for your child to go to bed and wake up every day.
  • Restricting sugar and caffeine before bed.
  • Setting a quiet time before bed with no smartphones, television or video games.
  • Increasing physical activity.
  • Avoiding food or medication that may worsen the condition.

Supplements: Iron supplements may be prescribed if your child has low iron levels.

Behavior therapy: Your child’s doctor will work with you to develop strategies including:

  • Setting regular times for your child to go to bed and wake up every day.
  • Restricting sugar and caffeine before bed.
  • Setting a quiet time before bed with no smartphones, television or video games.
  • Increasing physical activity.
  • Avoiding food or medication that may worsen the condition.

Behavior therapy: Your child’s doctor will work with you to develop strategies including:

  • Setting regular times for your child to go to bed and wake up every day.
  • Restricting sugar and caffeine before bed.
  • Setting a quiet time before bed with no smartphones, television or video games.
  • Increasing physical activity.
  • Avoiding food or medication that may worsen condition.

Parent counseling: Parents are guided on what they can do when their child has a parasomnia. For example, with night terrors, parents are advised to stay calm, to not try to wake the child, and to make sure the child can’t hurt him or herself.

Medications: Alert medication such as modafinil in the morning can increase wakefulness. Antidepressants before bed can help a child sleep.

Behavior therapy: Your child’s doctor will work with you to develop strategies including:

  • Scheduling nap times.
  • Avoiding activities when not alert, such as swimming or driving.
  • Exercising.
  • Lifestyle counseling.

Learn more

Other information

For families

Call 503-346-0640 to:

  • Request an appointment.
  • Seek a second opinion.
  • Ask questions.

Location

Parking is free for patients and their visitors.

Doernbecher Children’s Hospital
700 S.W. Campus Drive
Portland, OR 97239
Map and directions

Refer a patient

  • Call 503-346-0644 to seek provider-to-provider advice.

Story for children

A cartoon image of three puppies, one standing looking down, one waving, and one sleeping. The cartoon has text that reads "No more snoring for snoring puppy!"