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.
• Developing a regular bedtime or wind down routine.
• Limiting the amount of time in bed without sleeping.
• Avoiding caffeine and too much sugar.
• Minimizing use of electronics (smartphones, television, or video games) before bed or while falling asleep.
• Relaxation strategies, including deep breathing.
• For families that want their child to sleep on their own, helping their child learn to fall asleep without a parent or another caregiver present
• Environmental changes, such as blackout curtains to help signal bedtime and a “good morning” light to signal when it’s time to get out of bed.
• Positive feedback and reward charts for good bedtime behaviors and/or for learning to fall asleep independently.

Medications/supplements: Melatonin supplements or medications may be prescribed for a short time along with behavior therapy and/or bright light therapy.

Behavior therapy: Your child’s doctor will work with you to develop strategies that help get your child’s body clock back “on time,” including:

• Setting regular times for your child to go to bed and wake up every day, or helping your child gradually wake up earlier to shift their sleep schedule.
• Avoiding caffeine and too much sugar.
• Minimizing use of electronics (smartphones, television, or video games) before bed or while falling asleep.
• Developing a regular bedtime or wind down routine.
• Reducing or eliminating daytime naps.

Bright light therapy: Exposure to a special light box or to natural sunlight early in the morning can help reset 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.
• Avoiding caffeine and too much sugar.
• Minimizing use of electronics (smartphones, television, or video games) before bed or while falling asleep.
• Developing a regular bedtime or wind down routine.
• 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.
• Avoiding caffeine and too much sugar.
• Minimizing use of electronics (smartphones, television, or video games) before bed or while falling asleep.
• Developing a regular bedtime or wind down routine.
• 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.
• Making sure your child is getting enough nighttime sleep, because insufficient sleep can worsen parasomnias.
  
• Avoiding caffeine and too much sugar.
• Minimizing use of electronics (smartphones, television, or video games) before bed or while falling asleep.
• Developing a regular bedtime or wind down routine.
• Increasing physical activity.
• Avoiding food or medication that may worsen parasomnias.
• Working with your family to:
  • Stay calm when your child has a sleep terror or is sleepwalking.
  • Avoid waking your child during an episode.
  • Keep the environment safe so your child can’t hurt him or herself.

Medications: Your sleep provider may prescribe medications that can help manage symptoms of narcolepsy.

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

• Scheduling nap times.
• Setting regular bed and wake times.
• Avoiding activities when not alert, such as swimming or driving.
• Exercising.
• Coping with narcolepsy symptoms.
• Learning how to communicate with family, friends, and teachers about narcolepsy.
• Working with your child’s school to make sure there is a clear school plan for narcolepsy management.