Susan Boutilier, M.D.

East Carolina Neurology’s Pediatric Sleep Department provides a comprehensive evaluation and management of sleep disorders from infancy through adolescence. Sleep disorders in children often vary in symptoms, severity and frequency. Sleep disturbances in children also differ greatly, some experiencing frequent sleep problems, while others only have an occasional problem. Some disorders will be outgrown; others can be treated, simply by changing sleep habits and bedtime routines. Occasionally, surgery or medication will be necessary in order to treat a sleep disorder. Many times a sleep study will be required to assess and diagnose your child’s sleep disorder.

Children who don’t get enough restful sleep are more prone to behavioral problems than those who do. Children who get adequate amounts of sleep, often develop a better memory, concentration and longer attention span. Left untreated, sleep disorders in children may result in significant emotional, behavioral and/or cognitive dysfunction.

When we evaluate a child, obtaining a detailed and accurate sleep history is one of the most important elements of diagnosing a sleep disorder. A few things we look for in the sleep history include: when the problem began, bedtime rituals, sleep environment, arousals, sleep position, nightmares/terrors, seizure symptoms, total sleep time, family history, naps and previous efforts made to control symptoms.

Symptoms of sleep disorders include, but are not limited to:

Difficulty falling/staying asleep
Inability to get enough sleep affecting behavior/learning
Chronically sleepy
Trouble waking
Excessive sleep
Daytime sleepiness
Bedtime refusal
Difficult/heavy breathing
Sleeping with mouth open frequently
Frequent arm/leg jerks
Funny/unpleasant feeling in legs in the evening while at rest
Frequent nightmares, screaming, yelling, thrashing

Pediatric sleep disorders are classified into three different categories: dyssomnias, parasomnias and medical-psychiatric disorders.

Distinguished by abnormality in the amount, quality or timing of sleep.

Narcolepsy – child has normal sleep pattern, sleep efficiency and sleep/wake cycles, but possesses the need for longer amount of sleep. This may result in uncontrollable sleeping spells. There are no known causes for narcolepsy, and it may continue through adulthood.
Primary/Idiopathic Insomnia- inability to fall asleep or stay asleep. Usually chronic and may continue through adulthood.
Psycho-physiological Insomnia- unlike primary insomnia, psycho-physiological insomnia is not chronic and is defined by physiological stressors in the child’s life.
Pediatric Sleep Apnea - constant snoring and/or breathing difficulties caused mainly by enlarged adenoids or tonsils. However, other factors such as weight, weakness and head or neck abnormalities can also cause pediatric sleep apnea.
Periodic Limb Movement Disorder - often associated with Restless Leg Syndrome and ADHD, PLMD can disrupt sleep, and is the only movement disorder that only occurs during sleep.
Restless Leg Syndrome - leg discomfort and the urge to move legs.

Distinguished by abnormal behavioral or physiological events that occur in connection with sleep stages or sleep-wake transitions.

Sleepwalking - there are many different causes of sleepwalking, such as certain medications or other sleep disorders. Treatment options include lifestyle changes and a safer sleeping environment.
Nightmares – or a dream anxiety attack, occur during REM sleep. Generally, there is an increase in breathing and heart rate.
Sleep terrors – extreme panic with a sudden scream during sleep. Terrors can become physical, by way of hitting or throwing objects or getting out of bed and moving around.

Medical-Psychiatric associated sleep disorders:
There are many medical conditions and treatments that affect sleep.



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