Sleep problems in children – snoring, sleep apnea and other causes

Sleep problems in children include restless sleep, frequent awakenings, snoring or pauses in breathing during sleep. In children, the problems are often caused by physical conditions in the upper respiratory tract – typically enlarged tonsils or childhood polyps (adenoid vegetations) – but earache, constipation or reflux can also disrupt sleep. Only a small proportion of children who snore actually have sleep apnea, but it is relevant to have this clarified because poor sleep over time can affect the child's well-being, mood and concentration.

What symptoms do you see with sleep problems in children?

Sleep problems in children occur both at night and during the day. At night, the child may snore, breathe through the mouth, lie restlessly, sweat, wake up many times or have pauses in breathing. Some children under two years of age wake up after just 30-40 minutes of sleep and have difficulty finding peace again. During the day, poor sleep can cause fatigue, but children also often experience restlessness, irritability, mood swings and difficulty concentrating, which can be confused with other conditions. Interrupted sleep over a long period of time should therefore be taken seriously.

What is sleep apnea in children?

Sleep apnea in children (obstructive sleep apnea, OSA) is repeated pauses in breathing during sleep because the upper airways completely or partially collapse. The child typically snores loudly, has labored breathing and short pauses followed by gasps or awakenings. In children, the most common cause is enlarged tonsils and childhood polyps (adenoid vegetations), and the condition is most often seen between the ages of 2 and 6. Snoring alone is not the same as sleep apnea, but according to Ugeskrift for Læger, the medical history alone is often insufficient to determine whether a snoring child has sleep apnea – therefore, the child should be examined if there is pronounced snoring or pauses in breathing.

Why do children snore?

Snoring occurs when air has difficulty passing through the nose and throat during sleep, causing soft tissue to vibrate. In children, this is most often due to enlarged tonsils or childhood polyps that block the airway, but a blocked or chronically runny nose due to colds and allergies can also cause snoring. Occasional snoring due to colds is harmless. However, if a child snores almost every night, breathes through the mouth during the day or pauses in breathing, they should be examined by an ear, nose and throat doctor.

What are the causes of sleep problems in children?

Sleep problems in children often have a physical cause in the upper respiratory tract, but not always. The most common causes are:

• Enlarged tonsils and pediatric polyps. Enlarged lymph tissue in the pharynx and nasopharynx can, according to the national clinical guideline for tonsillectomy, block the airway and cause snoring, mouth breathing and sleep apnea. Pediatric polyps can also block the tube between the nasopharynx and middle ear, causing fluid in the middle ear and recurring ear problems. Read more about pediatric polyp removal and tonsil reduction.
• Ear problems. Fluid in the middle ear or otitis media causes pressure and pain that typically worsens when the child lies down and can lead to frequent awakenings. For persistent fluid, drainage of the eardrum may provide relief.
• Gastrointestinal conditions. Reflux or constipation can cause discomfort that disrupts sleep, especially when the child is lying down.
• Sleep habits and other conditions. Irregular bedtimes, screen time before bed, or tension in the body and neck can also affect sleep.

When the cause is not immediately found in the ears, nose or throat, we conduct a comprehensive assessment to determine what is disrupting sleep.

How is a child with sleep problems examined?

The examination begins with a conversation about the child's sleep, breathing and daily life. The specialist then examines the ears, nose and throat to assess whether there is fluid in the middle ear, enlarged tonsils or childhood polyps. Many sleep problems in children can be clarified by this clinical examination. It is always the specialist's overall assessment that determines what is necessary for the individual child.

How are sleep problems in children treated?

Treatment depends on the cause and is planned individually. If the problem is due to enlarged tonsils or childhood polyps, surgery to remove or reduce the tissue can often provide a noticeable improvement in both sleep and breathing. In the case of persistent fluid in the middle ear, drainage can provide relief. If the poor sleep is due to reflux, constipation or inappropriate sleep habits, efforts are directed towards this. In the case of pain, over-the-counter painkillers can help in the short term, but rarely work overnight and do not address the cause. It is always the doctor who assesses which treatment is the right one.

When should you see a doctor about a child's sleep?

It is relevant to seek medical attention if a child snores almost every night, pauses in breathing during sleep, breathes through the mouth also during the day or seems affected in everyday life by poor sleep. The same applies to repeated ear problems, impaired hearing or frequent awakenings with pain. An examination can clarify whether there is a cause that can be treated.

Sleep problems in children at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, children with sleep problems are examined by ear, nose and throat specialists and, if necessary, can be assessed interdisciplinary together with pediatrics. We have specially trained staff in anesthesia and recovery with experience in anesthetizing small children and anesthetize children up to 6 months of age. Examination and treatment are outpatient and are planned individually. If the cause is outside the ears, nose and throat, we will guide you further based on a comprehensive assessment. You will find an overview of all departments on our department page.

Sources:

- Weekly Journal for Doctors: Sleep-related breathing disorders – about snoring, sleep apnea and adenotonsillar hypertrophy in children.

- National clinical guideline for removal of tonsils (tonsillectomy)

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