Sleep is recognized as our body's way to rejuvenate. Adults need an average of 7.5 hours, adolescents 9 hours, children 10 hours and young children need 12 hours of sleep. It is important that these hours are uninterrupted. Short or interrupted sleep interferes with the ability to achieve and maintain the various stages of restorative sleep which in turn interferes with:

• converting daytime learning to long-term memory
• release of human growth hormone
• maintaining long-term memories
• motor skill development
• handling depression
• dealing with anxiety
• dealing with pain

Behavior and growth and development of children can be related to sleep. Sleep deprived children do not exhibit daytime sleepiness the same as an adult. Daytime sleepiness in children manifests itself as neurocognitive issues: hyperactivity (mimicking Attention Deficit-Hyperactivity Disorder), behavioral problems, irritability, diminished memory, learning difficulties, acting out and/or inability to concentrate; and as growth and development issues: failure to thrive (loss of weight or failure to gain weight and height). These can lead to short and long-term issues at school, in socialization and with executive functions (decision making).

How can you determine if your child is sleeping well through the night? Observation is an important clue as to whether your child is sleeping well. If your child regularly experiences one or more of these disturbances during sleep it may be a sign of obstructive sleep apnea (OSA).

• snoring (any snoring in children is not normal)
• mouth breathing
• restless sleep
• sleep walking/talking
• night terrors
• bedwetting

What is OSA? Obstructive sleep apnea is the complete or partial blockage of the airway repeatedly through the night. Oxygen levels in the body drop causing awakenings from a few to hundreds of times during the night. Each awakening interferes with restorative sleep. OSA is common in the pediatric age group occurring in about 3% of children and as high as 60% of obese children.

What are some of the causes of OSA in children? Enlarged tonsils and adenoids, small lower jaw, small and/or high narrow upper jaw, deviated nasal septum, and obesity are some of the most common causes. Down's syndrome children and pre-term babies often have OSA.

How is OSA diagnosed and treated in children? First, a good evaluation with a physician or dentist trained to recognize the symptoms of OSA, followed by referral to a pediatric sleep center for a physical exam and sleep study by a pediatric sleep physician. If OSA is diagnosed from the sleep study, recommendations will be made for treatment. Often the most problematic issues are enlarged tonsil/adenoid tissue, reduced nasal airflow and small jaws. Treatment may involve consultation with an otolaryngologist (ENT) to decide if the tonsil/adenoid tissue should be removed and evaluation for any nasal obstructions. Also, consultation with an orthodontist who treats OSA children for expansion of the jaws may be needed. This expansion will also expand the base of the nose making nasal breathing easier. Recent studies have shown that removal of tonsil/adenoid tissue alone and orthodontic expansion alone is helpful but the combination of these treatments achieved the best results for children with OSA.

Why not just wait to see if they grow out of it? Childhood overgrowth of the tonsil and adenoid tissues will shrink as children reach adolescence and the airway will improve allowing for better sleep and fewer disturbances. The problem with waiting is that the damage done earlier is not able to be regained leaving the adolescent and adult with permanent neurocognitive deficits and growth loss and many of these non-treated children will develop adult OSA.

Dr. Robert A. Gallegos is a Fellow in the Academy of General Dentistry, he is on the faculty of Spear Education, a member the American Academy of Cosmetic Dentistry, the American Academy of Dental Sleep Medicine and the American Dental Association. Dr. Gallegos practices dentistry in Middleburg, VA. www.MiddleburgSmiles.com.