If your baby or toddler is waking often at night, you are no doubt struggling to find the reason why (and that list of reasons for night waking can be long!). You’re no doubt doing all you can to ensure your baby is well-rested with adequate daytime naps, well-nourished, comfortably-dressed at bedtime, and that you always kick off the night with a sleep-inducing bedtime routine.
And if you’ve been reading our blog for awhile, then you may also be working on sleep coaching by gently weaning your child away from sleep associations, and ensuring that your baby or toddler can fall asleep independently. (That is the root of sleeping through the night, after all.)
BUT…what if you’ve done your due diligence, and your baby is STILL waking often at night? Or, even worse, what if your baby is waking often at night, and is cranky and grumpy and seems overly tired during the day?
We’re looking in today’s article at an under-diagnosed, often-hidden reason why a number of babies and toddlers wake at night and aren’t getting the rest they need: sleep apnea.
Why Sleep Apnea May Be Pediatric Medicine’s Most Damaging Oversight
First, a disclaimer – we are not doctors, and we do not dispense medical advice. If you suspect your child has a medical condition that’s affecting sleep, we urge you to make a beeline for your doc’s office, and to get an evaluation by a medical professional.
Okay, now that that’s out there – let’s talk about sleep apnea. If you’re like me, sleep apnea is a term that’s barely on your radar as a parent – because isn’t that something that adults suffer from?
Well, yes – but kids do, too. Including babies. And it’s becoming clearer and clearer that sleep apnea (particularly obstructive sleep apnea, or OSA) is wildly under-diagnosed among children. Statistically, around 1-3% of children have diagnosed sleep apnea, but according to this article, it’s more probable that 10% of children actually have this problem.
Why does this matter? Because sleep apnea causes a whole host of serious problems, including developmental delays, failure to thrive (in infants), ADHD (in big kids), memory and learning problems, headaches, frequent nighttime waking, chronic over tiredness, and general crankiness and irritability. In rare cases, the complications of sleep apnea (including frequent exhaustion and irritability) can lead to extreme problems, like the case of a young Chicago boy whose sleep apnea made him so tired, it nearly caused him to be expelled from school and sent to a behavioral health hospital.
These serious complications of sleep apnea in children have led some to call its under-diagnosis pediatric medicine’s most damaging oversight.
Why Sleep Apnea In Babies and Toddlers Matters, Too
Do a quick Google search, and you’ll see that the majority of sleep apnea articles out there are geared towards adults – and that makes sense, when you consider that sleep apnea affects more adults than it does children. It’s also true that children will often outgrow mild sleep apnea problems, while adults won’t.
But here’s the thing – sleep apnea in babies and toddlers absolutely shouldn’t be ignored, or dismissed as a small or insignificant problem. Sleep apnea seriously impacts your baby’s oxygen levels at night, and is damaging to the overall quality of your child’s sleep. Babies and toddlers with sleep apnea tend to wake more often at night than kiddos without, and even when they’re asleep, their sleep isn’t as high-quality as the sleep of child without sleep apnea.
Types of Sleep Apnea
Let’s back up a bit and identify the two main types of sleep apnea that you’ll want to be aware of: Central Sleep Apnea and Obstructive Sleep Apnea. Obstructive sleep apnea is the more common type, and impacts older babies, toddlers, children, and adults. With obstructive sleep apnea, sleep is interrupted because the airway is actually partially blocked (which can happen for a variety of reasons). Central sleep apnea is less common, and usually occurs in premature babies; with central sleep apnea, the brain fails to send the proper signals to the muscles that control breathing.
An easy way to keep this straight is to remember that obstructive sleep apnea means your child has trouble breathing due to the airway being blocked; central sleep apnea means your child stops breathing altogether for a brief period of time (up to 20 seconds, usually).
Now, it’s important to note that while central sleep apnea is not the same thing as SIDS, it can be fatal – therefore, it’s important to treat it seriously. Here’s a tip from Miriam, our resident nurse:
“Pauses in breathing of 19 seconds or less are common in newborns, and as long as it is not accompanied by a slowed heart rate, change in color or muscle tone, it’s considered to be harmless and common. If pauses in breathing are 20 seconds or longer, however, or less than 20 seconds but accompanied by a slow heart rate, change in color, or muscle tone then it’s time for a trip to the ER for diagnosis.”
Keep in mind that premature infants are especially prone to central sleep apnea, and typically need to wear apnea monitors to ensure safe nighttime sleep.
Symptoms and Causes of Sleep Apnea
So, what are the signs of sleep apnea for which you should be on the lookout? Glad you asked! Central sleep apnea is fairly easy to detect – your baby will stop breathing for a noticeable period of time – but obstructive sleep apnea can be much harder to spot. It also tends to last much longer than central sleep apnea, and not all children outgrow it.
Significant symptoms of obstructive sleep apnea include…
- Snoring
- Loud, noisy breathing (especially mouth breathing)
- Frequent nighttime wakings
- Early morning waking
- Restless sleeping, and strange sleeping positions
Additional problems that may be related to sleep apnea, but aren’t necessarily red flags, include….
- Recurring sore throats or tonsillitis
- Asthma that isn’t well-controlled, despite medication and medical care
- Constant ear infections
- Constant overtiredness, despite a healthy sleep schedule and healthy sleep habits.
Once your child is older, you’ll want to watch for these “big kid” symptoms of sleep apnea:
- Daytime sleepiness at preschool or during class, in spite of what seems like adequate nighttime sleep.
- Difficulty waking up in the morning
- Difficulty falling asleep at bedtime.
- Bed-wetting (in children who are potty-trained and otherwise dry during the day)
- ADD or ADHD diagnosis that isn’t helped by medication
One Last Word: Fixing Sleep Apnea May Not Fix All Your Sleep Problems
If sleep apnea is your baby or toddler’s ONLY sleep problem, then getting medical care and addressing the sleep apnea may very well mean your sleep issues are solved.
However, if your child does not yet know how to fall asleep independently, and relies on you for help with falling asleep, then addressing the sleep apnea – while it’s a step in the right direction – will likely not lead to sleeping through the night. Instead, you’ll need to focus on gently teaching your baby how to fall asleep without your help. And you don’t have to do that alone – you can call in a pro to help! Our team of expert sleep consultants is ready to create a Personalized Sleep Plan® just for your family. The plan will walk you through every step of the sleep coaching journey, and will be 100% personalized to your child’s personality and needs, and will mesh with your parenting goals and philosophies.
Browse our list of consultation package options here.
Once you make your choice and purchase, you will immediately receive an e-mail with your Helpdesk login information. You’ll be able to log in and get started right away – it’s that simple!
My 3 yr old has been waking at night sometimes as much as every hour. He snores, has a little bit of apnea, mouth breathes, always seems to have a cold or slight allergies. Am I looking at tonsillectomy?
Hi Whitney,
Thank you for visiting us at The Baby Sleep Site! I’m sorry to hear you son is waking so much at night. While we do work with children who have sleep apnea and other medical conditions, we are not medical professionals, and always recommend talking with your child’s doctor first before implementing any sleep coaching. If your son is dealing with apnea, his pediatrician will be able to help you explore the best treatment options for him. Good luck with everything!
Hi Emily,
My 13 month old is being looked at for possible obstructive sleep apnea. I’ve suspected she has had it from day dot. She is under a paediatric doctor and an ENT specialist. We are waiting on a hearing test and an overnight Oxygen monitor. I’m getting quite frustrated as it’s taking so long to get a confident diagnosis. She wakes so much over night and seems so thirsty all the time. She is able to self settle. I’m quite strict on bedtime routine as she is number 4 bub. Thought I had the sleep stuff all sorted. She has taken it to a new level of night waking. I’m hoping we don’t have to wait too long to get this all sorted and we can all get some much needed sleep.
@Lucy, Thank you for taking the time to comment and for sharing your story. I am sorry to hear about the medical issues your daughter has been having. Hopefully her medical team can find out what is going on and help you get better sleep for the whole family! Hang in there!
Thanks…we were quite relieved too…and thanks for spreading the word…it’s not always “just cute” when a child snores!
@ Melanie – exactly! In fact, most snoring isn’t cute at all, since it’s a sign of an underlying issue that needs to be corrected. My oldest son’s snoring was our first sign that he had enlarged tonsils and adenoids, and needed a tonsillectomy.
Thanks again for sharing your experience with us, Melanie!
Our son did/does not have OSA, but his snoring definitely did impact his ability to sleep (and ours!).
@ Melanie – I’ll bet! So glad to hear the snoring wasn’t a sign of a more serious underlying problem, though…that can be scary. Thanks for commenting, Melanie, and happy sleeping to you and to your family! 🙂