Summer Sleep Solutions: A Q&A with Pediatric Sleep Specialist Dr. Vikas Jain
June 26, 2024

Summer Sleep Solutions: A Q&A with Pediatric Sleep Specialist Dr. Vikas Jain

Texas Health Center for Diagnostics and Surgery

As summer begins, Dr. Vikas Jain, Director of the Pediatric Sleep Institute, discusses why it's the perfect time to address children's sleep issues. Learn about common sleep disorders, misconceptions, and treatment options for better sleep and improved well-being.

Categories:   Children's Health Pediatric Sleep Disorders Pediatric Sleep Institute

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School’s out, and kids’ schedules are filling up with day camps, swimming lessons, play dates and summer activities.

Early summer is also a good time to schedule a sleep evaluation, if you’re concerned about your child’s sleep, according to Vikas Jain, M.D., a pediatric sleep specialist and director of the Pediatric Sleep Institute, a department of Texas Health Center for Diagnostics and Surgery. It’s much easier to address childhood sleep disorders over the summer, when kids’ schedules are less full and families are less stressed, and there’s more time to try treatments and begin to achieve improvements.

In this FAQ, Dr. Jain discusses common pediatric sleep conditions and treatments, and why early summer is a good time to get sleep problems evaluated.

Why is early summer a good time to begin a sleep evaluation for a child?

Improving anyone’s sleep habits takes some time. For children and teens, the beginning of summer is a good time to start an evaluation and treatment, because then we have the whole summer to work on improving sleep habits.

Sometimes parents bring their kids to see us a week or two before school starts. That doesn't provide much time to put the interventions in place that will help the child sleep better by the time the new school year starts. It’s best to plan ahead and use the summer break, when we have time to our advantage, to start a sleep evaluation and treatment.

What are some of the most common concerns that bring patients to a pediatric sleep clinic?

Behavioral issues and problems with school performance are some of the big things that typically lead parents to have their kids evaluated. We also see patients who have health issues that can cause certain types of sleep disorders as well, such as childhood epilepsy, Down’s syndrome, or Chiari malformation, a congenital condition in which brain tissue extends into the spinal canal.

What kinds of behavior issues might suggest a sleep problem?

Children with disrupted sleep tend to present a little differently than adults. When adults don’t sleep well, they tend to be a bit more sleepy, tired, or fatigued. Whereas kids with pediatric insomnia or disrupted sleep tend to be more inattentive or even hyperactive.

The hard part is figuring out which came first. Sometimes parents will notice their child’s irritability, hyperactivity, or difficulty concentrating, and decide that their child needs to be evaluated for ADHD, and they sort of go down that path. However, there could be an underlying pediatric sleep disorder contributing to those symptoms. When we treat those sleep problems, often the child’s behavior really improves, and their grades may improve too. This shows the importance of making sure that children are sleeping well at night.

It's also important to know that the sleep requirements of kids are much higher than those of adults. A 10-year-old needs 10 hours of sleep. Kids younger than 10 probably need to sleep even more than that, maybe even 11 or 12 hours.

Are there any other key symptoms of sleep problems in children that you'd want people to be aware of?

Some signs of conditions that disrupt sleep, like childhood sleep apnea, can be if they're snoring, if they're waking up to urinate a lot at night, or if they're wetting the bed at night, especially if the child starts bedwetting after they have been toilet trained at nighttime for some time. Childhood night terrors, or sleep talking or sleepwalking, are also possible concerns.

Other factors to consider: Is the child getting enough sleep consistently? Are they able to fall asleep and stay asleep throughout the night? Are they waking up feeling tired and unrefreshed? Are they having a hard time getting up in the morning, even on weekends?

As kids reach middle school or high school, they may start going to bed really late, and then waking up really late on the weekends. That can create circadian rhythm issues that can then pose a problem. It's really hard for them to readjust to the regular school schedule on the weekdays.

Where should a parent start if they are worried their child may have a sleep problem?

Generally, you can start with your pediatrician or a sleep specialist, like myself. We gather information on your child’s sleep history. We try to get some sense of the child’s sleep patterns, bedtime routine, and sleep environment. Are they snoring? Are they having any issues with their breathing? Or any unusual behaviors during their sleep at night?

We also try to get a sense of the child’s day. We ask about mood changes, behavioral issues, and academic performance. Is there any family history of sleep disorders? Some of these conditions can run in the family, so that's helpful to know.

We also try to get a sense of the child’s airway. We'll take a look in the nose and throat for conditions like enlarged tonsils or adenoids.

Many kids will end up getting a pediatric sleep study. We'll order a sleep test, where the child spends the night sleeping in a comfortable room in the sleep lab. That allows us to look at the child’s brain activity, heart rate, and oxygen levels. That can help us differentiate between sleep-related breathing disorders, periodic limb movement disorders, and some other sleep conditions there as well.

Then usually we use both that sleep history and the results of that pediatric sleep study to help formulate a plan in terms of what might be going on and how we might want to manage it.

What age range do you see in the sleep range?

The Pediatric Sleep Institute can see children as young as 6 months old.

What are some of the most common diagnoses, and how would you typically treat them?

Probably the most common diagnosis is pediatric sleep apnea, which is actually handled quite differently in kids than it is in adults. Also, the criteria to diagnose sleep apnea are very different in kids than in adults. That’s why it’s important if you're having your child evaluated, to make sure they're going to a pediatric sleep center that has experience in the evaluation of children. If the clinic is using adult metrics in a child, then you're going to miss things.

When we do diagnose a child with childhood sleep apnea, usually the first line of treatment is to have an ear, nose and throat (ENT) specialist evaluate the child. Often, a procedure such as getting their tonsil and adenoids removed can be very helpful.

There are also things we try to do to help influence the growth of the airway. In children, the jaw is still growing, so there's still an opportunity to help the child grow out of having sleep apnea. We may have patients work with airway dentists, who are focused on how to help widen the airway over time.

Are there any common misconceptions that you encounter that parents have about pediatric sleep issues that you'd like to address?

One misconception is that, if a patient is diagnosed with sleep apnea, the only option is sleeping in a CPAP with a big, Darth Vader-like mask. Most pediatric patients don’t need a CPAP, because we usually try other options first. Also, we do have smaller, child-appropriate masks. Patients and their families can work with their medical equipment companies to find masks that are right for them.

Another misconception is that childhood snoring is normal. People assume that everybody snores so it must not be a big deal. In fact, childhood snoring can indicate a sign of childhood sleep apnea and that can cause significant issues with a child's sleep and behavior. It’s always important to get that snoring evaluated.

Sometimes parents notice a child’s daytime sleepiness and dismiss it as laziness when there could be an underlying health issue. Daytime sleepiness is one of the signs of childhood sleep apnea.

Another common misconception is that, if a child undergoes a sleep evaluation, they’re going to be diagnosed with sleep apnea and put on a continuous positive airway pressure device, or CPAP. That is the standard for sleep apnea in adults. With pediatric sleep apnea, however, CPAP is considered more of a third-line treatment. It’s not what we would typically consider first for a child. However, it is an option for kids to use, and we do have many children who use CPAP effectively as well. Usually, CPAP can help more immediately while we work through some of those other treatment modalities as well.

Another common concern I hear is, “If my child has a sleep disorder, are they just going to medicate my child?” For most cases of pediatric sleep disorders, our treatments don't involve using prescription medications.

I would also say, don’t assume your child will outgrow a sleep disorder. It is true that kids can grow out of pediatric sleep disorders. But just assuming that your child will outgrow their sleep problems may mean we miss an opportunity to really help the child today. That’s better than waiting several years to see if they grow out of it.

What kind of training does a pediatric sleep specialist have?

Some sleep fellowships are particularly geared towards pediatric sleep. I did my training at Stanford, which has a pretty good mix of both adult and pediatric sleep. There's definitely a need for more sleep specialists who take care of children and help manage those pediatric conditions. There’s a lot of opportunity to really help these kids and families who are suffering from sleep disorders.