It’s shocking how little sleep most people get. It’s the trend in today’s busy, electronic, always-on culture. It’s almost a badge of honor. But it’s not healthy for anyone.

For many parents, especially new parents the night-after-night routine of 2 a.m. (and 4 a.m. and 6 a.m.) wakings goes from “missing a little sleep” to sleep deprivation. In my practice and here at DrGreene.com, I hear from parents that it’s one of the things they are most concerned about — and for good reason. When we sleep our bodies heal from the days’ workouts and injuries and our minds have time to carefully log all that’s taken place since the last time we slept.

The good news is, there are natural ways to encourage a good night’s sleep. They include the right light and temperature at the right time.

In this video, I discuss how you can work with your own (or your child’s) body rhythm to help your body and mind fall asleep and stay asleep.

These tips are not the cure for every sleep issue. Newborns will still wake up to be fed. There will still be trips to the bathroom in the middle of the night. But working with nature makes it easier to fall back asleep when night time sleep disturbances do happen.

When was the last time you felt truly rested? How would having natural energy that comes from a good night’s sleep change your life?

For more information on sleep:

When Baby Won’t Go to Sleep on Her Own
When Children Can’t Sleep
Adolescents and Sleep
Sleep Deprivation and ADHD
Sleep Well. Do Well.

Aren’t they angels when they sleep? But sometimes troublesome behavior during the day is caused by what happens each night during sleep. If your child seems to have ADHD and also snores, the two may be related.

A study published online in the March 2003 issue of Pediatrics looked at thousands of 5 to 7 year olds and found that snoring is significantly more common among children with mild ADHD than it is in the general population.

Snoring can be a symptom of poor breathing during sleep (obstructive sleep apnea), which can lead to chronic poor quality sleep, which can lead to behavior and attention problems during the day. Treating the snoring may be a much better option than treating the child with ADHD medicines.

For some children, this will get to the cause of the problem, rather than just treating the symptoms.

If you think your child may have ADHD, make sure you know whether he or she snores.

Related concepts:

Snoring, Obstructive sleep apnea, OSAS, Adenotonsillar hypertrophy

Introduction to sleep apnea:

Parents are quick to mention some things to their pediatrician: fevers, seizures, and bleeding. Snoring is another important symptom that your child’s doctor needs to know about, though it often goes unreported.
Any child who snores may have obstructive sleep apnea, and may not be getting adequate sleep.
Not all kids with sleep apnea snore. Even when they do, sleep apnea is often overlooked. Instead, the child may be diagnosed with a behavioral disorder — most commonly ADHD.

What is sleep apnea?

Most people make some quiet snoring noises when they have (or are recovering from) a cold but this quickly resolves after the cold. Some people snore even when not ill, and some snore loud enough that others can easily hear them. In these cases, snoring may be the sign of obstructive sleep apnea syndrome (OSAS), where there is prolonged partial blocking, or intermittent blocking, of breathing during sleep. The obstruction is usually caused by large tonsils or adenoids, which may be temporarily enlarged by infection or allergies.
Children with sleep apnea do not get sound sleep. They may also get suboptimal oxygen to the brain at night. Obstructive sleep apnea can have a serious negative impact on a child’s intellect and behavior.
OSAS can cause growth problems. It has also been linked to ADHD, poor school performance, learning difficulties, bedwetting, high blood pressures, lung disease, heart disease, and rarely even death.
OSAS is different from primary snoring (PS), the name given to snoring that doesn’t cause sleep disruption or breathing problems. Primary snoring is more common than OSAS.

Who gets sleep apnea?

OSAS occurs in about 2 percent of children. The peak age is 2 to 5 years old, but it can occur at any age.
In older children and adults, it is more common among the obese. It is also common in those with sickle cell disease, Down syndrome, birth injuries, or any other condition that might narrow the upper airway.

What are the symptoms of sleep apnea?

Classically, those with sleep apnea snore quite loudly for a bit, then are silent (sometimes not appearing to breathe), then snort briefly, move about, and resume snoring. If snoring is accompanied by nighttime breathing difficulty and pauses in breathing, then it may well be sleep apnea.
However, many children with OSAS do not follow this classic pattern. OSAS and PS cannot be reliably distinguished from each other based on the symptoms alone.
Other common symptoms of sleep apnea include mouth breathing, restless sleep, difficulty paying attention during the day, decreased academic performance, oppositional behavior, and restlessness.

Is sleep apnea contagious?

No

How long does sleep apnea last?

Children often outgrow OSAS within several years.

How is sleep apnea diagnosed?

Snoring should be brought to the attention of your pediatrician. You might want to make a cassette tape of your child’s sleep noises to bring with you.
OSAS and PS cannot be reliably distinguished from each other based on the physical examination and history alone. Other tests must be used. A sleep study is the gold standard test for telling the difference. Thus, snoring needs to be reported to the doctor, and when snoring lasts longer than a brief respiratory infection, or fails to respond to allergy treatment, it deserves thorough evaluation. Often pediatricians enlist the help of ear-nose-and-throat, neurology, or pulmonary specialists to help distinguish between the two.

How is it treated?

Because enlarged tonsils and adenoids usually cause the obstruction, removing them can usually solve the problem.
Sometimes the obstruction is treated with gentle positive air pressure in the airway at night – nasal CPAP (continuous positive airway pressure).
Supplemental oxygen, and correction of anemia may provide additional help.
Decongestants, steroids, antibiotics, or other medicines might reduce snoring caused by enlarged tonsils or adenoids in PS but are unlikely to be of much help with true obstructive sleep apnea.

How can it be prevented?

Early treatment of primary snoring might prevent the cycle that leads to obstructive sleep apnea. Preventing or treating obesity and nasal congestion can also help protect children from OSAS.

Related A-to-Z Information:

Adenovirus, Allergies (Allergic Rhinitis), Anemia (Low hemoglobin), Asthma, Attention Deficit Hyperactivity Disorder (ADHD),Bronchiolitis,Cerebral Palsy, Cleft Lip and Palate, Common Cold, Congenital Heart Disease, Cough, Croup, Depression, Down Syndrome, Enuresis (Bedwetting), Epilepsy, Gastroesophageal Reflux, Head Banging,Obesity, Pertussis (Whooping cough), Sudden Infant Death Syndrome (SIDS), Tonsillitis

Related concepts:

Confusional arousal; Partial arousal state; Sleep terrors

Introduction to night terrors:

Your little angel wakes up screaming in the middle of the night, calling for his mommy – but his mommy is right there, unrecognized. You try to comfort him, but he shrieks even louder, eyes bulging. He might be having a night terror.

What are night terrors?

Within fifteen minutes of your child’s falling asleep, he will probably enter his deepest sleep of the night. This period of slow wave sleep, or deep non-REM sleep, will typically last from forty-five to seventy-five minutes. At this time, most children will transition to a lighter sleep stage or will wake briefly before returning to sleep. Some children, however, become stuck and are unable to completely emerge from slow wave sleep. Caught between stages, these children experience a period of partial arousal.
Partial arousal states are classified in three categories: 1) sleep walking, 2) confusional arousal, and 3) true sleep terrors. These closely related phenomena are all part of the same spectrum of behavior.
When most people (including the popular press and popular parenting literature) speak of night terrors, they are generally referring to what are called confusional arousals by most pediatric sleep experts.
During these frightening episodes, the child is not dreaming and typically will have no memory of the event afterwards (unlike a nightmare). If any memory persists, it will be a vague feeling of being chased or of being trapped. The event itself seems to be a storm of neural emissions in which the child experiences an intense fight or flight sensation. Once it is finally over, the child usually settles back to quiet sleep without difficulty.
These are very different from nightmares.
True sleep terrors are a more intense form of partial arousal. They are considerably less common than confusional arousals and are seldom described in popular parenting literature. True sleep terrors are primarily a phenomenon of adolescence.

Who gets night terrors?

The tendency toward sleepwalking, confusional arousals, and true sleep terrors often runs in families. They tend to be more common in boys, and are much less common after age 7.
The events are often triggered by sleep deprivation or by the sleep schedule’s shifting irregularly over the preceding few days. A coincidentally timed external stimulus, such as moving a blanket or making a loud noise, can also trigger a partial arousal (which again shows that the event is a sudden neural storm rather than a result of a complicated dream).

What are the symptoms of night terrors?

Typically, a confusional arousal begins with the child moaning and moving about. It progresses quickly to the child crying out and thrashing wildly. The eyes may be open or closed, and perspiration is common. The child will look confused, upset, or even “possessed” (a description volunteered by many parents). Even if the child does call out his parents’ names, he will not recognize them. He will appear to look right through them, unable to see them. Parental attempts to comfort the child by holding or cuddling often prolong the situation.

Are night terrors contagious?

No.

How long do night terrors last?

Most often, a confusional arousal will last for about ten minutes, although it may be as short as one minute, and it is not unusual for the episode to last for a seemingly eternal forty minutes.

How are night terrors diagnosed?

The diagnosis is based on the history. When a question remains, a physical exam or tests may be run to rule out other possibilities.

How are night terrors treated?

When an event does occur, do not try to wake the child — not because it is dangerous, but because it will tend to prolong the event. It is generally best not to hold or restrain the child, since his subjective experience is one of being held or restrained; he would likely arch his back and struggle all the more.
Instead, try to relax and to verbally comfort the child if possible. Speak slowly, soothingly, and repetitively. Turning on the lights may also be calming. Protect your child from injury by moving furniture and standing between him or her and windows. In most cases, the event will be over in a matter of minutes.
Night terrors can also be treated with medications, hypnotherapy, or with other types of relaxation training if they become a significant problem.
A Novel Approach – The Greene Technique
When my youngest child was going though night terrors, I observed that he was also “working on” achieving nighttime dryness. In fact, night terrors are most common at the same ages that children are becoming aware of the bladder feeling full during sleep. It dawned on me that perhaps some of these kids just need to go to the bathroom, but are not yet able to wake up fully when their bladders are full. I’ve now treated many kids by having the parents take them to toilet while they’re still asleep. For many of these children, even though they do not recognize their parents, they will often recognize the toilet and urinate. For these children, the episodes stop abruptly and they return to sleep. The calm is dramatic.

How can night terrors be prevented?

Prevention usually involves trying to avoid letting the child get over-tired, and trying to keep the wake/sleep schedule as regular as possible. Taking the child to the bathroom before the parents go to bed can also prevent some night terrors.

Related A-to-Z Information:

Enuresis (Bedwetting), Epilepsy, Nightmares, Sleep Apnea

Introduction to colic:

It usually strikes toward the end of a long day, when your baby is just about at the age when your sleep deprivation has really begun to set in. Your baby stops being the quiet, peaceful, miracle baby and begins screaming every evening. It is no wonder that parents become frustrated, discouraged, and depressed.

What is colic?

Almost all babies go through a fussy period. When crying lasts for longer than three hours a day, and is not caused by a medical problem (such as a hernia or an infection), it is called colic. This phenomenon is present in almost all babies, the only thing that differs is the degree.
The child with colic tends to be unusually sensitive to stimulation. Some babies experience greater discomfort from intestinal gas (and they tend to swallow even more air when they cry!). Some cry from hunger, others from overfeeding. Some breastfed babies are intolerant of foods in their mother’s diets. A few bottle-fed babies are intolerant of the proteins in formula. Fear, frustration, or even excitement can lead to abdominal discomfort and colic.
Whatever the mechanism, I believe that the fussy period exists in order to change deeply ingrained relationship habits. Even after the miracle of a new birth, many parents and families would revert to their previous schedules and activities within a few weeks – if the new baby would only remain quiet and peaceful. It would be easy to continue reading what you want to read, going where you like to go, doing what you like to do as before, if only the baby would happily comply. Instead, the baby’s exasperating fussy period forces families to leave their previous ruts and develop new dynamics that include this new individual. Colic demands attention. As parents grope for solutions to their child’s crying, they notice a new individual with new needs. They instinctively pay more attention, talk more to the child, and hold the child more – all because of the colic. Colic is a powerful rite of passage, a postnatal labor pain where new patterns of family life are born.

Who gets colic?

Almost all babies will develop a fussy period. About 20 percent of babies will cry enough to meet the definition of colic. The timing varies, but colic usually affects babies beginning at about three weeks of age and peaking somewhere between four and six weeks of age.

What are the symptoms of colic?

For most infants the most intense fussiness is in the evening. The attack often begins suddenly. The legs may be drawn up and the belly distended. The hands may be clenched. The attack often winds down when the baby is exhausted, or when gas or stool is passed.

Is colic contagious?

Colic is not contagious, but babies do respond to the emotions of those around them. When others are worried, anxious, or depressed, babies may cry more, which can make those around them more worried, anxious, or depressed.

How long does colic last?

Colic will not last forever! After about six weeks of age, it begins improving, slowly but surely, and is generally gone by twelve weeks of age. When colic is still going strong at 12 weeks, it’s important to consider another diagnosis (such as reflux).

How is colic diagnosed?

Colic is usually diagnosed by the history. A careful physical exam is wise to be sure the baby does not have a hernia, intussusception, a hair tourniquet, a hair in the eye, or another medical problem that needs attention.

How is colic treated?

Helping a child with colic is primarily a matter of experimentation and observation. Different children are comforted by different measures. Some prefer to be swaddled in a warm blanket; others prefer to be free. The process of treating colic involves trying many different things, and paying attention to what seems to help, even just a little bit.
Holding your child is one of the most effective measures. The more hours they are held, even early in the day when they are not fussy, the less time they will be fussy in the evening. This will not spoil your child. Body carriers can be a great way to do this.
Some babies are only happy when they are sucking on something. A pacifier can be like a miracle for some.
Singing lullabies to your baby can be powerfully soothing. It is no accident that lullabies have developed in almost every culture. The noise of a vacuum or of a clothes dryer is also soothing to many babies.
As babies cry, they swallow more air, creating more gas and more abdominal pain, which causes more crying. This vicious cycle can be difficult to break. Gentle rocking can be very calming (this is directly comforting and seems to help them pass gas). When you get tired, an infant swing is a good alternative for babies at least 3 weeks old with good head control.
Holding your child in an upright position may help (this aids the movement of gas and decreases heartburn). A warm towel or a hot water bottle on the abdomen can help. Some babies prefer to lie on their tummies, while someone gives them a backrub. The gentle pressure on the abdomen may help.
Some children seem to do best when they are going for a ride in the car. If your child is one of these, you might try a device developed by a pediatrician to imitate car motion and sound.
Some parents report an improvement by giving simethicone drops, a defoaming agent which reduces intestinal gas. It is not absorbed into the body and is therefore quite safe. Sometimes doctors will prescribe stronger medicines for severe colic (but this should only be done after a physical exam). If nothing else seems to work, you might try pretending your baby is sick, and taking a rectal temperature (do not use a mercury thermometer). This will often cause babies to pass gas and obtain relief.
There are many stories about foods that breastfeeding moms should avoid. Most often, I hear about abstaining from broccoli, cabbage, beans, and other gas-producing foods. The scientific evidence is strongest for avoiding stimulants such as caffeine and caffeine-related compounds (those found in chocolate). The other foods in mom’s diet that are most likely to cause a problem are dairy products and nuts. I would try eliminating these for a few weeks. Other foods may also irritate the baby. Experimentation and observation will guide you.
Switching formulas is not helpful for most babies, but is very important for some.
Taking a break is a good idea. Each of you can take charge and spell the other. Time for oneself is an important part of the new family dynamic. You will be able to pay more loving attention to your baby when you’ve had a chance to get refreshed.

How can colic be prevented?

A fussy period is likely no matter what prevention techniques are undertaken. Good feeding techniques (as advised by a lactation consultant, if appropriate), good burping, and early identification of possible allergies in the baby’s or mother’s diet may help prevent colic. Experimenting with the comfort techniques outlined above before colic develops can help you identify your baby’s needs and desires, and can help stop the fussy period from becoming so intense.

Related A-to-Z Information:

Diaper Rash, Food Allergies, Gastroesophageal Reflux, Hernia (Inguinal hernia), Intussusception, Nightmares

Related concepts:

Attention Deficit Disorder, ADD, Hyperactivity

Introduction to ADHD:

Over-diagnosed? Under-diagnosed? Probably both – and certainly real. ADHD affects children’s school performance and their relationships with others. Parents who are wondering if their children have ADHD are often exhausted and frustrated.

What is ADHD?

ADHD is a problem with inattentiveness, over-activity, impulsivity, or some combination of these. Scientific studies, using advanced neuroimaging techniques of brain structure and function, show that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters (including dopamine, serotonin, and/or adrenalin) differently from their peers.

While we still don’t know exactly what causes ADHD, it appears that it is often genetic. Whatever the specific cause may be, it seems to be set in motion very early in life as the brain is developing. Other problems, such as depression, sleep deprivation, specific learning disabilities, tic disorders, and oppositional/aggressive behavior problems, may be confused with or appear along with ADHD. Every child suspected of having ADHD deserves a careful evaluation to sort out exactly what is contributing to his concerning behaviors.

Who gets ADHD?

There is a lot of controversy surrounding the actual number of children with ADHD. The Diagnostic and Statistical Manual (DSM-IV) suggests that it occurs in 3 to 5 percent of all children. Other estimates are far higher or lower. It is diagnosed much more often in boys than in girls.

Most children with ADHD also have at least one other developmental or behavioral problem.

What are the symptoms of ADHD?

The Diagnostic and Statistical Manual (DSM-IV) divides the symptoms of ADHD into those of inattentiveness and those of hyperactivity/impulsivity.

Inattention

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
2. Often has difficulty sustaining attention in tasks or play activities
3. Often does not seem to listen when spoken to directly
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
7. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
8. Is often easily distracted by extraneous stimuli
9. Is often forgetful in daily activities

Hyperactivity

1. Often fidgets with hands or feet or squirms in seat
2. Often leaves seat in classroom or in other situations in which remaining seated is expected
3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
4. Often has difficulty playing or engaging in leisure activities quietly
5. Is often “on the go” or often acts as if “driven by a motor”.
6. Often talks excessively.

Impulsivity

1. Often blurts out answers before questions have been completed
2. Often has difficulty awaiting turn
3. Often interrupts or intrudes on others (e.g., butts into conversations or games)

Is ADHD contagious?

No

How long does ADHD last?

ADHD is a long-term, chronic condition. About half of the children with ADHD will continue to have troublesome symptoms of inattention or impulsivity as adults. However, for many children, the symptoms of ADHD may improve with time.

How is ADHD diagnosed?

Too often, difficult children are incorrectly labeled with ADHD. Some of these children may actually have other mental illnesses or learning difficulties that are not being appropriately managed.

Others may be unfairly judged based on their age.  Recent studies show that children who are young relative to the other children in their class are much more likely to be labeled as having ADHD than children who are older than their classmates. (Journal of Health Economics 29 (2010) 657–673)

On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue.

The diagnosis is based on very specific symptoms, which must be present in more than one setting (including at school). Every evaluation should include a search for possible additional conditions including conduct disorder, oppositional defiant disorder, mood disorders/depression, anxiety, and learning disabilities.

To be diagnosed with ADHD, children should have at least 6 of the attention symptoms or 6 of the activity/impulsivity symptoms listed in the DSM-IV. They must display these to a degree beyond what would be expected for children their age.

The symptoms must be present for at least 6 months, observable in 2 or more settings, and not caused by another problem. The symptoms must be severe enough to cause significant difficulties. Some defining symptoms must be present before age 7.

Older children who still have symptoms but no longer meet the full definition have ADHD in partial remission.

Some children with ADHD primarily have the Inattentive Type, some the Hyperactive-Impulsive Type, and some the Combined Type. Those with the Inattentive type are less disruptive and are easier to miss being diagnosed with ADHD.

How is ADHD treated?

The American Academy of Pediatrics (AAP) has developed evidence-based guidelines for the treatment of ADHD:

• ADHD is a chronic condition and must be treated as such.
• It is important to set specific, appropriate target goals to guide therapy.
• Medication and/or behavior therapy should be started.
• When treatment has not met the target goals, it is important to evaluate the original diagnosis, the possible presence of other conditions, how well the treatment plan has been implemented, and the use of all appropriate treatments.
• Systematic follow-up for the child with ADHD is important to regularly reassess target goals, results, and any adverse effects of medications. Information should be gathered from parents, teachers, and the child.

ADHD is a frustrating problem. A number of alternative remedies have become quite popular, including herbs and supplements, chiropractic manipulation, and dietary changes. While there is evidence suggesting the value of a healthy, varied diet, with plenty of fiber and other basic nutrients (the diet that would be best for most children), there is little or no solid evidence for many remedies that are marketed to parents. The most promising specific nutritional actions include getting adequate iron and omega 3 fats in the diet, and possibly avoiding certain artificial dyes and chemical preservatives. Adequate sleep has been proven to help ADHD symptoms.

Children who receive both behavioral treatment and medication often do the best. Medications should not be used just to make life easier for the parents or the school. There are now several different classes of ADHD medications that may be used alone or in combination.

How can ADHD be prevented?

New links are being discovered between ADHD and environmental triggers. Avoiding prenatal tobacco, lead, or organophosphate pesticide exposure, for instance, has been linked with lower rates of ADHD. Minimizing unnecessary exposure to known neurotoxins and maximizing healthy food and sleep may prevent ADHD, but this has yet to be proven.

Early identification and treatment can prevent many of the problems associated with ADHD.

Related A-to-Z Information:

Depression, Enuresis (Bed-wetting), Sleep Apnea, Tourette’s Syndrome, Tonsillitis

In anger I threw my pager across the on-call room, slamming it against the wall. I don’t anger easily or often, but I was a pediatric resident who had been awake for 36 hours. The pager had gone off one time too many. Sleep deprivation had changed me from a calm, caring person into an irritable, impulsive mess.

As if it shouldn’t have been obvious, research has shown that the sleep deprivation associated with residents’ on-call schedules brings about significant “impairment of physician mood” as the sleep deprivation increases (Journal of Occupational Medicine, Dec 1992).

The surprising news is that partial, or low-level, sleep deprivation has a bigger effect on behavior than either the short or long-term complete sleep deprivation experienced by residents (Sleep, May 1996). Until recently, the effects of partial sleep deprivation have been seriously underestimated.

We know, based on common sense, that inadequate sleep makes kids more moody, more impulsive, and less able to concentrate. We’ve known for more than 20 years that sleep deprivation makes it difficult to learn (Journal of Experimental Psychology, Mar 1975).

Recent research has verified that chronic poor sleep results in daytime tiredness, difficulties with focused attention, low threshold to express negative emotion (irritability and easy frustration), and difficulty modulating impulses and emotions (Seminars in Pediatric Neurology, Mar 1996). These are the same symptoms that can earn kids the diagnosis of attention deficit hyperactivity disorder (ADHD, popularly known as ADD).

ADD is an important problem in its own right, but research in sleep laboratories has shown that some (and perhaps a great many) kids are mislabeled with ADD when the real problem is chronic, partial sleep deprivation.

When children are identified with symptoms of ADD, often no one thinks to explore the child’s sleeping habits, and whether they might be responsible for the symptoms. (People also forget to consider childhood depression as a possible cause for these symptoms — but that is another story.)

Sometimes it is obvious to parents that their children are not sleeping well — but not always!

Any child who snores may not be getting adequate sleep. Obstructive sleep apnea is a common medical condition that is now being identified in more and more children. The peak age for this is 2 to 5 years old, but it can occur at any age. Not all kids who snore have sleep apnea. Classically, those with sleep apnea snore quite loudly for a bit, then are silent, then snort briefly, move about, and resume snoring. If snoring is accompanied by nighttime breathing difficulty and pauses in breathing, then it may well be sleep apnea. This should be brought to the attention of your pediatrician. You might want to make a cassette tape of your child’s sleep noises to bring with you.

Children with sleep apnea do not get sound sleep. They may also get suboptimal oxygen to the brain at night. Obstructive sleep apnea can have a serious negative impact on a child’s intellect and behavior. The common symptoms of sleep apnea are difficulty paying attention during the day, decreased academic performance, oppositional behavior, and restlessness. Not all kids with sleep apnea snore. Even when they do, sleep apnea is often overlooked. Instead, the child is diagnosed with a behavioral disorder — most commonly ADD (Journal of Clinical Child Psychology, Sep 1997).

Children with sleepwalking, restless leg syndrome, narcolepsy, insomnia, or other sleep problems may also be misdiagnosed with ADD (Neurology, Jan 1996).

When parents of children with ADD are interviewed, they usually identify their kids as poor or restless sleepers (Journal of Pediatric Psychology, Jun 1997). Kids who have been diagnosed with ADD do wake up more often at night than their peers (Pediatrics, Dec 1987). Poor sleep is a common feature of ADD — a problem that can be made worse by the use of stimulant medications such as Ritalin or Dexedrine. In fact, recent studies have reported sleep problems in 25% to 50% of children and adolescents with ADHD, two to three times the rate of sleep problems in children without ADHD! (Sleep. Aug 1, 2007)

In an individual child, it can be very difficult to tease apart whether interrupted sleep is the cause or the result of ADD. The good news is that even when ADD is the correct diagnosis, addressing the sleep issues can dramatically improve the behavior of the child (Journal of Pediatric Psychology, Apr 1991).

A 10-year-old girl in Pittsburgh, Pennsylvania who had true ADD also had significant sleep difficulties. She had long delays before falling asleep. She would often wake up at night and have difficulty falling back asleep. She received professional help for her sleep problem (chronotherapy combined with a behavior modification program), which resulted in an increase of sleep from 7.2 to 9.2 hours per night. There was significant, measurable improvement in her schoolwork, teacher evaluations, and behavior. These changes were observed by teachers and peers who were not aware of her treatment.

If your child has ADD symptoms or other behavior problems, he or she should be carefully assessed for sleep problems. If sleep disturbances are present, they need to be addressed, regardless of whether or not they are the root cause. If your child is not getting sound, uninterrupted sleep, discuss this with your pediatrician. You may also want to contact the National Sleep Foundation (202 785-2300) or the American Sleep Disorders Association (507 287-6006) for information or referrals. There are now more than 3,000 Sleep Disorders Centers that can provide the kind of help the little girl from Pittsburgh received. Another great resource is Helping Your Child Sleep Through the Night, by Joanne Cuthbertson and Susie Schevill.

How do we know how much sleep our children need? First and foremost, every child is different. In general, toddlers and preschoolers sleep approximately 12 hours per day with one nap. School-age children need less, about 10 hours per day. Most preteens and teens need around 9 hours of sleep per day – though we all know that many teens get much less!

These are just averages! Some children need much more sleep than these numbers, other much less. Many sleep experts recommend asking yourself some questions to determine if your child is getting too little sleep.

These include:

• Does your child seem sleepy or irritable during the day?
• Does your child have difficulty staying awake when sitting still?
• Does your child have trouble paying attention at school or at home?
• Does your child seem to perform below his or her potential?
• Does your child have emotional outbursts?

As parents, we all know what it feels like to be grumpy, contrary, and “not at our best” from lack of sleep. If our kids often feel this way, we owe it to them to find solutions to this problem.

Dr. Greene`s Answer:

Any child who snores may not be getting adequate sleep. Obstructive sleep apnea is a common medical condition that is now being identified in more and more children. The peak age for this is 2 to 5 years old, but it can occur at any age. Not all kids who snore have sleep apnea. Classically, those with sleep apnea snore quite loudly for a bit, then are silent, then snort briefly, move about, and resume snoring. Children with sleep apnea may adopt unusual sleeping positions, like bending their necks back so their chin is lifted upwards, in order to keep their airway open. If snoring is accompanied by nighttime breathing difficulty and pauses in breathing, then it may well be sleep apnea. This should be brought to the attention of your pediatrician. You might want to make a cassette tape of your child’s sleep noises to bring with you.

Children with sleep apnea do not get sound sleep. They may also get suboptimal oxygen to the brain at night. Obstructive sleep apnea can have a serious negative impact on a child’s intellect and behavior. The common daytime symptoms of sleep apnea are difficulty paying attention during the day, decreased academic performance, oppositional behavior, restlessness, morning headache, and dry mouth. Not all kids with sleep apnea snore. Even when they do, sleep apnea is often overlooked. Instead, the child is diagnosed with a behavioral disorder — most commonly ADD (Journal of Clinical Child Psychology, Sep 1997).