Lack of sleep may cause behavioral, learning and attention problems

Nine-year-old Fernando Perry-Mendoza may no longer need medication for attention-deficit/hyperactivity disorder thanks to the results of a sleep study at Doernbecher Children’s Hospital’s new Pediatric Sleep Program.

The study showed Fernando’s behavioral problems were due to a lack of sleep, and that he snored because his tonsils and adenoids were blocking his breathing while he slept. After surgeons on Doernbecher’s sleep team removed his tonsils and adenoids he was a whole different boy.

“We took him off medication and, so far, he hasn’t needed to get back on them,” said his mother, Alice Perry of Portland. “Now he’s getting a good night’s sleep, has more energy and isn’t grouchy.” The full impact of improved sleep for Fernando won’t be known until he’s back in school.

Alice said behavioral problems frequently landed Fernando in his school’s administration office. A community child psychiatrist suggested the boy may not be getting enough sleep and referred him to Doernbecher’s new program. “I really want parents to be aware that snoring/sleep apnea maybe part or all of their child's problem,” Alice said.

"Studies have demonstrated that sleep deprivation can cause problems with concentration, mood regulation and school performance,” said Kyle Johnson, M.D., child and adolescent psychiatrist and assistant professor of psychiatry, Oregon Health & Science University School of Medicine. Johnson said adults who don’t get enough sleep feel tired and sleepy, while children may fight sleepiness and act the opposite – hyperactive.

Fernando isn’t alone. A recent survey by the National Sleep Foundation found most children are not getting enough sleep, which could lead to functional difficulties during the day.

Doernbecher’s Pediatric Sleep Program, the only pediatric sleep program in Oregon, features a unique combination of pediatric specialists in psychiatry, pulmonology and otolaryngology. Together, they provide care to children and adolescents suffering from sleep disturbances and daytime sleepiness.

"This is a true multidisciplinary center," said Holger Link, M.D., pediatric pulmonologist and assistant professor of pediatrics, OHSU School of Medicine, who, with Johnson, leads the sleep laboratory and diagnostics team. "There are a wide range of specialties working together. That's one of the biggest advantages of this program."

Other physicians on the team are: Carol MacArthur, M.D., and Henry Milczuk, M.D., both pediatric otolaryngologists and assistant professors of otolaryngology; and Mark Richardson, M.D., pediatric otolaryngologist, and chairman and professor of otolaryngology. All are faculty members in the OHSU School of Medicine.

Richardson said parents seeking resolutions to their children's problems often see several physicians, only to receive conflicting results. "If we do this in a coordinated fashion," he said, "then they get a consistent message and, hopefully, an overall plan which will enable resolution of the problem."

Sleep disorders seen and treated at the program include obstructive sleep apnea, restless leg syndrome, narcolepsy, insomnia, behavioral sleep disorders, parasomnias (sleep terrors and sleep walking), and delayed sleep phase syndrome.

According to the National Sleep Foundation survey, about 69 percent of children experience sleep problems a few nights a week. When it comes to the amount of sleep time, the survey went on to state that toddlers ages 12 months to 35 months sleep an average of 11.7 hours rather than the recommended 12 to 14 hours. First- through fifth-graders average 9.5 hours of sleep instead of the recommended 10 to 11 hours, the survey said.

"For a lot of adolescents, there are so many expectations on their daytime activities these days," Richardson said. "They bounce from school, to sports, to homework, to bed, then they wake up to crank it all up again."

In Fernando’s case, problems are hidden below the surface. "Sometimes the specific nature of sleep issues are hard to determine without a very sophisticated exam in a sleep lab," Richardson said.

Sleep studies, such as polysomnograms and multiple sleep latency tests, are performed at the program. Treatments include education, behavioral interventions, pharmacotherapy, and surgery or continuous positive airway pressure (CPAP) for sleep-disordered breathing.

The program has plans to study the connection between sleep-disordered breathing and attention-deficit/hyperactivity disorder.