Hypersomnia in children – Authored by Dr.Jayanthi Viswanathan, Consultant Pediatrician,Gleneagles Global Health City, Chennai
Hypersomnia also called as excessive day time sleepinessis known to be rare in children. Early recognition, prompt diagnosis and appropriate treatment are considered vital, as this condition is noted to cause significant issues in the social, academic, mental and familial front. These symptoms are often under-recognized by parents, school authorities and health care professionals alike. The consequences of day time sleepiness are significant, especially from the point of view of its impact on mood, learning, behavior and dexterity.
Children with hypersomnia will often sleep more than 10 hours at night and take nap for another 4 to 8 hours during the day, only ifit’s possible. They may also be extremely difficult to wake them up. The child may nap in inconvenient or unacceptable places (such as school). Other symptoms of hypersomnia may include anxiety, irritation, loss of appetite and slow thinking or speech. If these symptoms persist beyond three months, it is ideal to get the child evaluated.
Types of Hypersomnia: It can be primary or secondary.
In the primary group there are no identifiable causes, except excessive fatigue.
Secondary hypersomnia may be due to lack of sleep or medical problems due to obstructive sleep apnoea such as adenoidal hypertrophy or obesity. Some of the neurological disorders related to the muscles, epilepsy or medications may also contribute to hypersomnia.
Lifestyle changes like excessive use of electronic gadgets, faulty sleep hygiene, early school timings have all been implicated in causing hypersomnia.
Symptoms and pattern recognition:
- Parents may find it difficult to wake their child in the morning for school even after appropriate goodnight sleep.
- They will show constant dullness and lethargy
- Most of the children will be in confused state, and will also have poor attention span in the class rooms. Hence, it leads to poor performance at school.
- Due to lack of sleep at night children show irritability and anxiety
- Children with this condition sleep at school, they will be slow at speech and may experience trouble in thinking
- Such children find it hard to concentrate in their studies.
- They also experience loss of appetite
Obstructive sleep apnoea:
It is potentially a serious disorder. The most prominent sign of this disorder is snoring. Usually,these children have disturbed sleep at night, snoring, frequent awakening, drooling of saliva and excessive day time sleepiness. Long term consequences would include failure to thrive, attention deficit disorder, behavioural problems, poor academic performance and cardio-pulmonary disease.
A most common cause of obstructive sleep apnoea is adeno-tonsilar hypertrophy in children younger than 5 years. These children may benefit from adeno-tonsillectomy after appropriate evaluation. Even though many children have no clear symptoms of obstructive sleep apoea (OSA), it has been found that OSA occurs in children as a result of loss of neuro-muscular tone.
Diagnosis of OSA is usually performed with the help of a team comprising of paediatrician, ENT surgeon and polysomnography to study the sleep cycle in more detail. If there is significant evidence of OSA then a joint decision is taken about the plan of treatment including adeno-tonsillectomy or CPAP (continuous positive airway pressure).
Sleep disordered breathing is a public health concern given the increasing incidence of obesity and hyperactivity in children. Studies say that these children can be cured more effectively with appropriate recognition and treatment of sleep disordered breathing than with the use of stimulant medication.
One of the under recognized causes of hypersomnia is depression,particularly in adolescence. This needs to be identified early and appropriate intervention given as it may result in a significant lack of motivation and behavioural adjustment issues in future and affect the entire career of the young person.This may also require help from a psychiatric colleague.
Other investigations in children with hypersomnia may include blood profile including Thyroid function tests, sleep wake diary, overnight pulse oximetry, polysomnography, X ray of the neck to assess the size of the adenoids, tests for possible neuromuscular disorders depending on the clinical evaluation.
Therapeutic interventions for obese children will require appropriate dietary management, exercise and psychological counselling for the child and family.
Excess use of electronic gadgets amongst children / teenagers is growing a major concern which can result in significant sleep related problems.
Teenagers are prone to road traffic accidents as a result to excessive sleepiness in view of their life style changes with late night sleep. Many of them are therefore very irritable and have problems adjusting with the family, friends and in the society.
Healthy sleep habits, avoidance of excess cell phone use, e books before bed time, avoidance of caffeinated drinks, alcohol and good physical exercise and routines are important preventive measures.
Rarely CNS stimulants may be required to correct this problem.
Hypersomnia is a rare and less known problem in children. It is essential to have an early and appropriate diagnosis for this condition. It is vital to have the right intervention only then it may help in alleviating many long term issues in the child and family as a whole.