sibling, attention deficit hyperactivity
disorder (ADHD). But the problem may
be as simple as lack of sleep. The American Sleep Apnea Foundation cites studies
suggesting that as many as 25 percent
of children diagnosed with ADHD may
actually have OSA, frequently due to enlarged tonsils.
“Having 5 or 7 or 10 apneas per hour,
or interruptions of sleep per hour, is considered well within the range of normal
[for adults]. For kids, that is clearly abnormal,” says Benton. What’s more, “they
don’t tolerate it as well,” particularly
because children require more sleep than
adults. Attention-deficit symptoms tend
to dramatically decrease after shaving
the tonsils, removing them altogether, or
removing adenoids, small glands in the
back of the throat that fight infection—all
procedures that also help relieve sleep
apnea in children.
Maria Dimi, the administrative direc-
tor of respiratory care and neurodiagnos-
tic services at Saint Barnabas Medical
Center in Livingston, attends local P TA
meetings and teacher conferences to raise
awareness about these issues. “We tell
these teachers, first of all, you don’t have a
degree to label [your students]. Teachers
are very quick to say, ‘the kid’s got ADD,’”
Dimi says. “Well, it may be because they
just aren’t sleeping at night and can’t stay
focused during the day.” Unfortunately,
ADD medications are also stimulants,
which can exacerbate sleep problems.
Dimi has personal knowledge of how
a misdiagnosis can affect a young person.
Her stepson was diagnosed with ADD at
a young age and subsequently was pre-
scribed Ritalin. But when he moved from
his mother’s house to Dimi’s home in his
sophomore year of high school, Dimi real-
ized the boy’s attention span wasn’t the
problem. “We found out that he really
had dyslexia and [periodic leg movement],
a very mild neurologically based sleep
disorder, that was easily treated with
medication,” she says. “We went from a
kid who was failing and could barely read
at a fifth-grade level” to a solid student
with an A- or B average.
NO MAT TER THE AGE, everyday behavior
plays a large role in getting restorative
sleep. Sleep specialists talk of “sleep hygiene”—habits that promote refreshing
sleep and prevent daytime fatigue.
We get sleepy at night because of our
circadian rhythm. Also known as the
internal clock, the circadian rhythm
reinforces and promotes physiological
sensations, like sleepiness, alertness and
hunger, to stay in sync with the 24-hour
day. This happens through internal and
external cues, including the presence of
light. (See circadian rhythm disorders,
below.) When the bedside lamp turns
off, optic nerves tell the brain it’s time
to wind down, triggering a release of
melatonin throughout the body, which
facilitates onset of the sleep cycle.
These days, our attachment to our
mobile devices with illuminated screens
has contributed to widespread poor sleep
hygiene. Using smart phones and tablets
in bed tricks the brain into delaying the
release of melatonin. Curling up with a
book or crossword puzzle doesn’t have
that effect, since they don’t cast harsh
light directly at the eyes. “We are now
wired for stimulation in the middle of the
night. You wake up and check your cell
phone,” says Kelley, who encounters ma-
ny patients who can’t resist using glowing
electronics in bed. “There’s always one
more website to go to or one more e-mail
you can send.”
Combine a stressful lifestyle with poor
sleep hygiene and you have a recipe for
UNDERSTANDING SLEEP PROBLEMS
The International Classification of Sleep Disorders lists roughly 80 different sleep disorders. Here’s a look at
several of those conditions:
Circadian Rhythm Disorders
● JE T LAG: Traveling through time
zones confuses the circadian system,
signaling the body to be tired in the
daytime and alert at night.
● SHIF T-WORK DISORDER: Unusual
shift hours force the body to stay
awake when it’s dark outside, creating a misalignment between the circadian rhythm and the outside world.
Sleep-hygiene techniques and medication help manage the symptoms.
● A rare sleep disorder characterized
by excessive daytime sleepiness
(EDS) that persists despite long periods of sleep. The cause is unknown.
● Difficulty falling asleep (onset) and/
or staying asleep (maintenance).
Transient insomnia is brief and often
happens because of stress or other
life circumstances; chronic insomnia
is disrupted sleep that occurs at least
three nights per week and lasts at
least three months.
● For narcoleptics, the sleep cycle
begins almost immediately with the
REM stage, and fragments of REM
can occur involuntarily throughout
waking hours. Manifestations include
sudden paralysis (known as cataplexy), waking hallucinations and
other debilitating symptoms.
Obstructive Sleep Apnea (OSA)
● Occurs when an airway blockage
causes an individual to repeatedly
stop breathing throughout the night.
OSA continually interrupts the sleep
cycle and deprives the brain of oxygen. Bedtime treatments include a
dental appliance that pushes the jaw
forward, or a mask that assists with
oxygen flow known as CPAP, or continuous positive airway pressure.
Parasomnias (abnormal sleep
movement and behavior disorders):
● REM SLEEP BEHAVIOR DISORDER:
A rare and dangerous condition in
which the body loses its ability to
paralyze during REM sleep, causing
the sufferer to act out dreams. Often
a precursor to a Parkinson’s disease
● NON-REM PARASOMNIAS: Behaviors
and movements unrelated to dreaming include sleepwalking, sleep eating, sleep paralysis, bed-wetting,
sleep talking, bruxism and RLS
● TEE TH GRINDING: Sleep bruxism, or
nocturnal tooth grinding and clenching, can cause facial pain, morning
headaches, earaches, jaw pain, temporomandibular joint (TMJ) disorders and damaged teeth. Treatment
includes physical therapy and an oral
appliance for night use.
● RESTLESS LEG SYNDROME: Also
known as Willis-Ekbom disease, RLS
is characterized by an overwhelming and unpleasant urge to move the
legs when resting.