With the arrival of the new semester of primary and secondary schools, work and study have entered a busy stage, and the sleep clinic has also received a large number of children with various sleep problems, and a large number of children often come to the hospital because they are sleepy and dozing off during class.
I slept in class during the day, and my academic performance could not keep up... Why are some children prone to excessive daytime sleep? What are the causes of daytime sleepiness? What should I do if this happens? Issues such as these are common concerns of many parents.
March 21 is World Sleep Day,
This year's theme is:
"Good sleep, the source of health",
On the occasion of World Sleep Day,
Let's pay attention together
Several questions about daytime sleepiness in children ↓↓↓
01 What are the normal sleep needs of children?
The healthy growth of children, growth and development is inseparable from good sleep, and the sleep needs of children and adolescents vary according to age. Regular recommendations for sleep duration are as follows:
14-17 hours for infants aged 0-3 months;
12-16 hours for infants aged 4-12 months;
11-14 hours for children aged 1-2;
10-13 hours for children aged 3-5 years;
9-12 hours for children aged 6-12 years;
8-10 hours for adolescents aged 13-18.
The above time frames are the recommended sleep times for most children and adolescents, but there are still individual differences. If it does not affect normal growth and development and daytime activities, it is acceptable for some children to have a slight difference in sleep duration, and parents do not need to worry about it. However, if it affects daily activities and work and study, parents should pay attention to it, intervene and adjust in time, and seek professional help from a professional doctor in the hospital if necessary.
02 What are the causes of excessive daytime sleep?
Children and adolescents tend to get drowsy and doze off during the day, and the following reasons should be considered.
The number one reason is lack of sleep. With the increasing busyness of schoolwork, and some children and adolescents have poor personal sleep hygiene habits, like to indulge in electronic products for a long time, watch TV and play games before going to bed, do homework to delay time stay up late to do homework, etc., often make many children unable to fall asleep at the appropriate time at night, and the next day to get up early to go to school, the length of sleep all night does not meet the sleep needs of the above age, insufficient sleep duration at night causes daytime sleepiness the next day, affecting daytime learning life.
This is followed by delayed sleep wake phase disorder. It is characterized by a habitual delay in sleep time relative to the regular schedule. When children need to get enough sleep on a busy school day night, it is often difficult to fall asleep within the allotted time, and when they need to get ready for school the next day, it is difficult to be fully awake in the time they need to wake up. The disturbance of the biological clock also causes poor energy and drowsiness during the next day, which may be manifested as frequent lateness, absenteeism, declining grades and even depression and truancy in older children and adolescents, rather than as symptoms of sleep itself, and some even cause safety problems.
The third is sleep-related breathing disorders such as obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. Among them, obstructive sleep apnea is a more common disease in children, which refers to a series of pathophysiological changes caused by frequent partial or complete upper airway obstruction during sleep, disrupting children's normal sleep ventilation and sleep structure, and children often appear at night snoring, apnea attacks, sleep disturbance, enuresis, night terrors, sleepwalking, teeth grinding, etc. During the day, these patients often have difficulty awakening, mood changes, lack of concentration, learning disabilities, daytime sleepiness, etc. Sleep monitoring can be performed to confirm the diagnosis.
The fourth is narcolepsy. Narcolepsy is a relatively serious and rare disease. Children often experience severe drowsiness, including falling asleep during meals, conversations, sports, or social activities. Typical symptoms include excessive daytime sleepiness, cataplexy, hallucinations before falling asleep, and sleep paralysis. The diagnosis of narcolepsy requires targeted history and physical examination, complete sleep monitoring, and multiple nap latency tests.
The fifth is periodic limb movement disorder. It is characterized by periodic repetitive limb movements during sleep, with clinical sleep disturbances or daytime sleepiness, and cannot be explained by other sleep disorders or causes. Diagnosis is based on polysomnography findings.
The sixth is combined with primary diseases, such as anemia, heart disease, malignant tumors, encephalitis, craniocerebral tumors, etc. Appropriate history questions, physical examination, laboratory tests, etc. can be performed.
The seventh is narcolepsy associated with mental disorders. Patients with mental disorders such as depression and bipolar disorder also often have complaints of daytime sleepiness. Some are combined with changes in appetite or weight, fatigue, and difficulty concentrating. When the cause of the sleep disorder is unknown, a psychiatrist-assisted evaluation may be required.
03 How to assess excessive daytime sleep?
If parents find that their children are easily tired and sleepy during the day, which affects normal study and life, it is recommended to seek a professional doctor for a clear diagnosis in a specialist hospital. Children with hypersomnia require a detailed history and physical examination. It is necessary to know the duration and frequency of your child's sleep problems, the timing of the onset, and whether there are accompanying symptoms, including hyperactivity, inattention, or irritability. At the same time, some sleep questionnaires can be collected for screening and evaluation, and for children with previous abnormal movements or behavior during sleep, parents can record videos at home to facilitate the doctor's initial diagnosis and determine whether further testing may be needed. Depending on the situation, it can be selected including polysomnography monitoring, multiple nap latency tests, and motion recorder examination.
Polysomnography is usually performed in a sleep laboratory and records sleep throughout the night to reflect the structure of sleep and the characteristics of sleep pathology. A variety of physiological parameters were measured, including: sleep staging, mouth and nose airflow, thoracic and abdominal breathing exercise, oximetry, electrocardiogram, limb movement, snoring, video recording, etc. It can be used for the diagnosis and differentiation of sleep breathing disorders, narcolepsy, and periodic limb movement disorders.
The Multiple Nap Latency Test is an objective assessment of daytime hypersomnia, mainly used to evaluate clinically suspected narcolepsy and quantify the degree of daytime sleepiness. Schedule 5 naps during the day after the end of nighttime sleep monitoring, each 2 hours apart, while recording EEG and other parameters. According to the 3rd edition of the International Classification of Sleep Disorders, the mean sleep latency of less than 8 minutes and the occurrence of ≥ 2 sleep initiation rapid eye movements are among the diagnostic criteria for narcolepsy.
A mography is a watch-like device used to monitor sleep at night. Sleep and wakefulness patterns in children can be estimated. It has the advantage of being portable, collecting data at home for multiple days and using it to monitor the effects of interventions.
04 How to deal with excessive daytime sleep?
Developing good sleep habits is one of the important ways to treat excessive daytime sleep in children. For children with sleep deprivation and sleep wake lag disorder, a reasonable and regular schedule (at least 10 hours for school-age children and at least 8 hours for adolescents) is the first task to improve sleep disorders. Active participation in physical exercise, balanced diet, daily moderate vitamin and mineral supplementation, avoiding caffeine and tea intake, can also help improve night sleep, improve sleep efficiency, increase children's deep sleep, improve related symptoms and reduce daytime sleepiness.
In children associated with sleep-disordered breathing, further polysomnography can be performed to determine the severity of the disease and appropriate medical or surgical treatment options. Children with narcolepsy, when they still have daytime sleepiness after sleep habit adjustment and affect normal study and life, can be treated with central nervous system stimulants under the guidance of professional physicians. Children with PLM can focus on nonpharmacological interventions and maintenance of optimal iron levels. Most children with daytime sleepiness can get certain benefits after relevant behavioral strategies and lifestyle modifications, and if the expected results are not achieved, it is recommended to seek professional treatment and help from a professional doctor in the hospital.
In summary, due to a variety of reasons will cause excessive daytime sleep in children and adolescents, if drowsiness affects children's daily activities and work and study, parents should pay attention to and timely seek medical attention, intervene and adjust, and take corresponding measures to solve children's sleep problems as soon as possible.
Science popularization officer: Ding Ying, attending physician of the Department of Respiratory Medicine, Shanghai Children's Hospital
Reporter: Luo Xinyue
Source: Shanghai Children's Hospital
Editor: Lu Jinghui
Image: Figureworm Creative