Snoring and sleep problems in children

What are the common signs of sleep problems in children?

Sleep problems in childhood can present in a number of ways, including:

• loud snoring
• gasps and pauses in between breaths
• restlessness
• mouth breathing
• excessive sweating

Sleep problems may also cause symptoms or side effects that present more subtly and are less clearly related to sleep. For example hyperactivity, academic underachievement, inattentiveness, and reduced growth.

What is snoring?

Snoring is a noise that occurs during sleep, when your child is breathing in (inhaling). This is caused by a blockage in the breathing passage, which is obstructing air flow from the nose and the back of the mouth into the lungs.

The typical ‘snore’ sound is caused by the vibration of tissues in the throat as the air passageway opens and closes. How loud your child’s snores are will depend on how much air is passing through and how fast their throat tissue is vibrating.

Snoring might get worse as your child enters deeper sleep, and it’s often more marked during REM (rapid eye movement) sleep, which is when our muscles are the most relaxed.

What are the common causes of snoring in children?

Snoring is very common in children. Almost all children will snore on some occasions, and 8-15% of children snore most nights.

In most children, if there isn’t a serious underling cause such as sleep apnoea, and the snoring isn’t because they stop breathing or can’t get enough oxygen, we will class it as ‘primary snoring’, which is not a cause for concern.

Snoring is often a temporary problem in children, caused by transient issues such as viral upper airway infections or seasonal allergies.

However, there are some occasions when a child’s snoring indicates something more serious.

When is snoring a cause for concern?

The presence of certain underlying health problems can increase the chances that snoring will be a cause for concern. These include obstructive sleep apnoea (OSA), abnormalities of bones in the face and skull, neuromuscular illnesses, gastroesophageal reflux, and obesity.

There are symptoms you can look out for that are warning signs for when snoring might be a cause of concern. These are grouped into nighttime symptoms and daytime symptoms.

Night symptoms include:

• loud snoring
• restless or disturbed sleep, where your child wakes frequently
• mouth breathing
• long pauses in between breaths during sleep (OSAS)
• signs of choking, gasping or snorting (OSAS)
• coughing
• sleep walking or talking
• sleep terrors (night terrors)
• excessive sweating

Day symptoms are generally caused by lack of sleep and include:

• difficulty waking up
• not feeling refreshed after a long sleep
• frequently feeling sleepy during the day
• inattentiveness
• hyperactivity and impulsiveness
• nasal speaking voice

Sleep problems can have a serious impact on children of school age. They might have learning difficulties, underperform academically, and may have behavioural issues. They are often labelled as inattentive, lazy or naughty. They might also struggle to gain weight, complain of headaches, and be irritable, agitated, aggressive and cranky.

If your child snores and you also notice any of the above symptoms, you should seek medical attention, for example from a paediatric sleep specialist.

Are some children more prone to snoring?

Although mild snoring is widely prevalent across children of all ages and ethnicities, certain underlying conditions can predispose your child to snoring.

These include allergic rhinitis (hay fever), cerebral palsy, neuromuscular conditions including muscle weakness (hypotonia), abnormalities of the delicate facial structures or the skull bones, obesity, sickle cell disease, gastroesophageal reflux and syndromes like the Down’s Syndrome or Primary Ciliary Dyskinesia.

What types of treatment are available to stop snoring?

The treatments available for snoring will depend on what is causing the problem. A sleep specialist will help you to identify the causes and decide on the best treatment for your child.

The most common reasons for snoring in children are enlarged tonsils and adenoids, which might require removal in severe cases.

Children with nasal blockage related to a deviated nasal septum, nasal polyps or narrowing of the nose from birth might require surgical intervention.

Quite commonly, snoring is caused by allergic rhinitis (hay fever) and a treatment strategy of allergen avoidance (if possible), antihistamines and nasal topical corticosteroids sprays may prove beneficial.

Rarely, when corrective surgeries and medications may not be able to offer benefits, a child may be considered for non-invasive ventilation therapy (also known as CPAP therapy). Other ancillary measures like anti-reflux medications and weight loss strategies may also be considered for treating sleep apnoea.