Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

2 Tammuz 5766 - June 28, 2006 | Mordecai Plaut, director Published Weekly










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Home and Family

Sleep Apnea
by L. Raffles

Usually kids are fully awake within minutes of waking up. Does your child drag himself around the first half hour or more of the morning instead of having the bounce the others have? Do you have a child whom you know spends plenty of time asleep but still is tired in the day, falling asleep at unusual times, especially as soon as he gets into a car? If so, it may be worth considering getting a fuller assessment. The child might have Sleep Apnea.

What is Sleep Apnea?

Sleep Apnea is a sleep disorder which involves brief interruptions of breathing during sleep. This means that while the person is sleeping, he actually stops breathing for a short while. When this happens, the oxygen levels in the blood drop dramatically. When the breathing stops for about ten seconds, the brain sends a signal which (so to speak) pushes a panic button, and the person partially wakes up while struggling for breath. After the person gasps a deep breath, he will then continue to breathe normally until the next episode. People with sleep apnea can stop breathing many times in the night, constantly waking to take breaths, while in the morning they will have no recollection of any of this happening.


The main symptom for this disorder is tiredness. The person rarely falls into a deep restorative sleep that leaves him refreshed. Instead, they wake up feeling tired and lethargic, the same way you might feel after a night being woken many times by a baby. This will cause them to feel sleepy during the day. As you might know, tiredness, especially in children, will then lead to many other problems, both behavioral and in concentration and performance. They may have headaches in the mornings, be forgetful, irritable or experience mood changes.

Causes of Sleep Apnea

There are two main causes of breathing disturbances during sleep. One is due to some obstruction in the airway and is called Obstructive Sleep Apnea. The most common obstruction in this case is the soft tissue at the back of the throat, which relaxes and falls across the breathing tube, the trachea. However, sometimes there is some sort of flap, or extra bit of skin, that can obstruct the passage, a condition called a 'floppy larynx.'

The obstruction often also causes unusually loud snoring or night breathing, and this is often a symptom of Obstructive Sleep Apnea (especially in adults). The other cause of Apnea is that the part of the brain that controls breathing is in some way acting irregularly during sleep. This is called Central Sleep Apnea. Most people with Sleep Apnea will have a combination of both types.


If you suspect your child may suffer from this disorder, you could try to simply watch him while he sleeps. Remember to watch the stomach and chest, as it is often the stomach that rises and falls when breathing, not the chest, (and this is very normal and okay). If you watch the child carefully as he sleeps, you might see if he stops breathing, because the movement stops. If this happens, you will then see that after a few seconds, the child will suddenly take a deep breath. If you do see this, then it is worthwhile, if you can, to take a record of how often he stops breathing and for how long. This information can be useful to the doctor to help him make an accurate diagnosis.

Sometimes children breathe in such a light and shallow way that it is difficult to visually tell what is happening. It may be that the child does not actually stop breathing, but that each breath is partially obstructed, preventing a full amount of air from getting into the lungs. In this case, the child takes deeper breaths among other shallow ones, but without actually stopping. You may also notice the nostrils 'flare,' that is, widen at the bottom. This is to allow more air in, and is a sign that the child is not getting enough oxygen. Another significant observation is to look at the muscles between each rib. If the child breathes pushing his chest right out, while these muscles pull in, making the ribs stick out, it means that he is struggling to get air into his lungs.

It is important to note that it is normal for very young babies to occasionally stop breathing — just because they are so immature; this does not necessarily signify a problem or a danger. It would depend on the age and maturity of the baby and the frequency and duration of the episodes. If you have any concerns, you should mention them to your doctor.


It is important to treat Apnea, because besides the greatly reduced quality of life for the sufferer, it is also associated with a higher risk of heart problems. The treatments available will depend on the severity of the episodes, and the type of Apnea causing them.

There are some very effective surgical procedures which remove tissue that is causing the obstruction. Others will be helped by pillows which stop the person from sleeping on his back. There is also a special facemask which can be worn, which is attached to a machine, and gently forces air into the lungs throughout the night. People who have been helped with this and other methods report a dramatic increase in the quality of their lives and their productivity. Remember a child is used to the way he is, and he does not realize that others are not feeling what he feels, and they may not even be aware that what he is feeling is exhaustion.

Apnea is more common in men than women, and is more common in the overweight (so it is important to try to lose weight). Not all sufferers have all the symptoms, and anyone who has some of these symptoms should think about being more fully evaluated by a doctor, as it is very often missed. In fact many adults only discover after a lifetime of suffering that they have this condition.

People don't think to go to the doctor to complain of 'just tiredness' or 'snoring' (usually the spouse's or roommate's complaint). The doctor will have no reason to think of it unless the patient or parent specifically mentions the relevant symptoms. It is one of those conditions that can severely alter the quality of life, but which are relatively easy to diagnose and treat, and where you might say to yourself . . . "If only we would have known earlier."


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