Sleep

  • Core 1 (Pre-Clerkship)
    • Biomedical Science
      • Biochemistry: Fatty Acid Oxidation and Gluconeogenesis
    • Integrative Systems
      • Sleep medicine: Sleep-disordered breathing
  • Core 2 (Clerkship)
  • Core 3 (Post-Clerkship)
    • Electives that may further knowledge - Pediatric Pulmonology

  • Sudden Infant Death Syndrome (SIDS): Unexplained death of a seemingly healthy infant, usually while sleeping. Risk reduction strategies include placing infants on their backs to sleep, using a firm sleep surface, avoiding soft bedding or toys in the crib, and avoiding smoke exposures. 
  • Obstructive Sleep Apnea (OSA): Characterized by snoring, gasping, or pauses in breathing during sleep, often associated with adenotonsillar hypertrophy or obesity.  
  • Parasomnia: Includes sleepwalking and night terrors, which are common in younger children and typically self-resolve.  
  • Delayed Sleep Phase Disorder: A circadian rhythm disorder where the sleep-wake cycle is delayed, leading to difficulty falling asleep at a socially acceptable time. Commonly occurs in teens.  
  • Restless Leg Syndrome: Characterized by an uncomfortable urge to move the legs, often disrupting sleep. 

A 6-year-old child presents with episodes characterized by sudden awakenings during sleep, accompanied by screaming and signs of fear. The parents report that these episodes occur several times a week, typically occurring in the first half of the night. The child appears confused and disoriented during these episodes and has no recollection of them the following morning. The parents express concern about the impact of these night terrors on the child's overall sleep quality and daytime behavior. 

History: 

  • Sleep environment and hygiene (e.g., screen time before bed, bedtime routine) 
  • Snoring or gasping during sleep 
  • Daytime behaviors: hyperactivity, inattention, or fatigue 
  • Family history of OSA or sleep disorders 
  • Associated symptoms: leg discomfort, nightmares, anxiety 

Physical Exam: 

  • Adenotonsillar hypertrophy, macroglossia
  • Craniofacial abnormalities (midface hypoplasia, retroanathia)
  • BMI assessment for obesity-related OSA 
  • Neurologic exam: signs of restless leg syndrome, hypotonia
  • Observation of nasal obstruction or allergies

  • Primary sleep disorders (e.g., OSA, night terrors) 
  • Medical conditions (e.g., asthma, GERD disrupting sleep) 
  • Psychiatric comorbidities (e.g., anxiety, depression) 
  • Behavioral sleep issues (e.g., bedtime resistance, inadequate sleep hygiene) 

  • Referral to ENT 
  • Sleep study (polysomnography) for suspected OSA (ENT will usually place referral) 
  • Sleep diary to assess sleep patterns and disturbances 
  • Treatment of underlying conditions: allergies, GERD 
  • Behavioral interventions: sleep hygiene education, cognitive-behavioral therapy for insomnia (CBT-I) 
  • Referral to sleep medicine specialists if needed 

Anticipatory Guidance for Parents about Sleep: 

Safe sleep practices for infants are crucial in reducing the risk of Sudden Infant Death Syndrome (SIDS). Parents should always place their infants on their backs to sleep, use a firm sleep surface, and keep the sleep environment free of soft bedding, toys, and bumper pads. Room-sharing without bed-sharing is recommended to ensure a safe sleeping environment. 

Parents also play a crucial role in promoting healthy sleep habits for their children. Establishing a consistent bedtime routine, ensuring a quiet and comfortable sleep environment, and limiting screen time at least one hour before bed are essential steps to improve sleep quality. Encourage calming activities before bedtime, such as reading or listening to soft music, to help children wind down. For younger children, maintaining a predictable schedule for naps and nighttime sleep is important for regulating their internal clock. Parents should also be aware of signs of sleep disturbances, such as snoring, frequent awakenings, or difficulty falling asleep, and discuss these concerns with their healthcare provider.  

For more information on promoting healthy sleep, parents can refer to resources from the American Academy of Pediatrics (AAP), including the HealthyChildren.org website, which offers guidance on sleep habits and routines. The Bright Futures initiative also provides valuable insights. 

Summary of Normal Sleep Parameters 

  • infants (0–3 months): 14–17 hours, including naps 
  • infants (4–12 months: 12–16 hours, including naps 
  • toddlers (1–2 years): 11–14 hours, including naps 
  • preschool (3–5 years): 10–13 hours, including naps 
  • school-age (6–13 years): 9–12 hours 
  • teens (14–17 years): 8–10 hours 

  • Snoring in children should not be ignored—it may signal obstructive sleep apnea. 
  • Good sleep hygiene is vital: Consistent bedtime routines and screen-free zones can significantly improve sleep quality.  
  • Night terrors are self-limiting and typically occur during non-REM sleep, often resolving as the child matures.