Overview

Overview

At Cleveland Clinic’s Sleep Disorders Center, our multidisciplinary program is dedicated to the diagnosis and treatment of sleep disorders in children and adults. Our team approach unites pediatric sleep experts, neurologists, internal medicine, family medicine, pulmonary and critical care medicine specialists, psychologists, psychiatrists and otolaryngologists, under one roof.

Cleveland Clinic’s Sleep Disorders Center is accredited by the American Academy of Sleep Medicine. The center is part of Cleveland Clinic’s Neurological Institute, whose neurology and neurosurgery programs for children and adults consistently have been ranked as national leaders by U.S. News & World Report’s “America’s Best Hospitals” survey.

Specialized Pediatric Treatment

Sleep problems may be seen in 25 to 30 percent of infants and children at some point in their lives. While sleep disturbances are often temporary, they can be long-standing or associated with other medical problems.  Cleveland Clinic’s Pediatric Sleep Disorders experts are available for consultation at Cleveland Clinic Main Campus, Fairview Hospital, and Hillcrest Hospital.  

Our pediatric sleep disorder providers also participate in or support various multidisciplinary clinics including Be Well Kids weight management clinic, Pediatric Complex Airway Voice and Swallowing Clinic, Pediatric Craniofacial Clinic, and Pediatric Down’s Syndrome Clinic, to provide care for children with specific disorders. Patients needing behavioral treatment will be supported by providers who are specially trained in pediatric sleep behavioral health. Specialists in child neurology, pulmonary medicine, pediatrics, child psychology, psychiatry, and ear nose and throat surgery work closely with the sleep specialist to diagnose and treat the full range of sleep-related issues. After obtaining a thorough medical and sleep history, our specialists may recommend a medical treatment or a behavioral technique to help improve your child’s sleep. Adjustment of your child's sleep schedules can be helpful in many instances.

We offer pediatric sleep studies at a variety of locations across Northeast Ohio. While older children and teens can have a sleep study at any of our locations, sleep studies for younger children and children with developmental delays or special needs are conducted in Cleveland Clinic’s Main Campus sleep lab at Intercontinental Suites or, in some cases, North Olmsted sleep lab. Our highly skilled technical staff members are trained to work with children as young as newborn babies.

We perform a variety of testing for sleep disorders: including Polysomnogram (PSG), Positive Airway Pressure Titration (PAP titration), Maintenance of Wakefulness Test (MWT), Multiple Sleep Latency Test (MSLT), and Actigraphy.

What We Treat

What We Treat

Children spend a substantial part of their lives asleep. In fact, in infancy and early childhood, the developing brain seems to need more time asleep than it does awake. This underscores the importance of sleep in the overall well-being of a child.

A sleep disorder is characterized by a disturbance of normal sleep patterns. Problems may range from insufficient or unrefreshing sleep, bedtime settling problems or sleep walking to more serious conditions such as sleep apnea and narcolepsy. If not treated, sleep disorders can become serious enough to interfere with normal physical, mental and emotional functioning, possibly leading to an inability to get up in time for school, daytime moodiness, irritability, lack of focus in class, and significant behavioral and learning problems. Substance abuse and absenteeism are known to occur. Some sleep disorders are serious enough to cause adverse effects on the body, specifically the heart and lungs.

When should I suspect that my child has a sleep problem?

Symptoms of a sleep problem can range from very subtle to very obvious, and may include the following:

  • Snoring
  • Mouth breathing in sleep
  • Pauses in breathing while asleep - also called apneas
  • Frequent awakenings
  • Waking up choking or gasping for air
  • Difficulty falling asleep at bedtime or staying asleep through the night
  • Bedtime struggles
  • Difficulty waking up in the morning
  • Falling asleep at unusual places and circumstances such as school, activities, homework
  • Poor school performance
  • Moodiness
  • Inattention
  • Tiredness
  • Unexplained episodes at night - screaming, crying, walking or other unusual activities during sleep
  • Restless sleep or kicking a lot in sleep
  • Bedwetting

We evaluate and treat children and adolescents for the following sleep disorders:

Sleep Study

Sleep Study

Your Child’s Sleep Study

To prepare for your child’s sleep study, parents are encouraged to review the Children’s Sleep Disorders and Frequently Asked Questions (FAQ) with your child prior to your scheduled sleep study.

During the sleep study, Cleveland Clinic offers comfortable accommodations for you and your child. For overnight visits parents, who are required to stay for the duration of the child’s testing, will sleep in a separate bed in our large, comfortable rooms.  To accommodate children of any age, a bed and crib are available. Attached full bathrooms offer privacy and the convenience of a shower so your child can go directly to school the next day. A TV and selection of children’s programming will provide entertainment while our child-friendly technologists apply sensors for testing. You are encouraged to bring your child’s favorite personal items like snacks, teddy bear or pillow.

Weekend testing is available in our sleep labs.

Accommodations

Special Health Care Accommodations

Cleveland Clinic prides itself in providing streamlined care for children with special medical or behavioral needs.  Each room is equipped with appropriate cribs and beds with safety guards for the special needs child.

Our Team

Our Team

Clinical Staff

Jennifer Brubaker, PhD, CNP
Jennifer Brubaker, PhD, CNP
Certified Nurse Practicioner
Anne Banas, CNP
Anne Banas, CNP
Certified Nurse Practitioner

Pediatric Sleep Behavioral Health

Ethan Benore, Ph.D.
Ethan Benore, Ph.D.
Department Chair

Adolescent Sleep Behavioral Health

Nursing & Administrative Staff

  • Christina Sandor, RN - Care Coordinator
  • Kim Vargo - Administrative Staff
Appointments

Appointments

To make an appointment with a pediatric sleep disorders specialist:

Sleep Clinics

Sleep Labs

Hotel-based sleep laboratories have dramatically improved patient satisfaction, as overnight sleep testing can be performed in the comfort of a hotel suite, often quite close to home.

For patients of all ages (newborn to 18 years), and children and adolescents with developmental disabilities, special needs and/or certain types of medical conditions our main campus location is available:

Intercontinental Suites
8800 Euclid Ave.
Cleveland, OH 44106

These locations are avilable for patients 13 and older without developmental disabilities or special needs:

Courtyard by Marriott
5051 West Creek Road
Independence, OH 44131

Courtyard by Marriott Airport North
24901 Country Club Blvd.
North Olmsted, OH 44070

Fairfield Inn & Suites by Marriott
3750 Orange Place
Beachwood, OH 44122

Hillcrest Hospital
6780 Mayfield Rd.
Mayfield Heights, Ohio 44124

Hilton Garden Inn
8971 Wilcox Drive
Twinsburg, OH 44087

Virtual Visits

Whether you're a new or existing patient, you can get an initial evaluation or follow-up care from a Sleep Disorders Center specialist using your phone, tablet or computer. This means there's no travel or parking, less waiting and significant time savings. Call 216.636.5860 to schedule a virtual visit for you or a loved one and get details on cost and set-up instructions.

Learn more about virtual visit options for scheduled appointments.

Parent Resources FAQs

FAQs

Does Cleveland Clinic accept pediatric patients?

Yes, patients of all ages can be scheduled for a sleep study at Cleveland Clinic.

All requests for sleep studies are reviewed by a clinician and a Pediatric sleep medicine consultation might be required prior to obtaining the study.

Do the parents stay with the child?

One parent or guardian must accompany the child under 18 years of age, and the parent is required to stay in the Sleep Center for the entire duration of the testing. No charge will be applied to the parent / guardian or caregiver for their stay with the child.

Can a parent sleep with the child in bed?

The quality of your child’s test is very important. Parental co-sleeping with your child can affect the quality of the sleep study. Your help prior to and during the study is very critical in obtaining the best results from your child’s sleep study but we ask that you refrain from sleeping with your child during the sleep study.

What can we expect during the study?

  • Upon arrival the child and parent will be assigned to a room that has a bed / crib for the child and a bed for the parent / guardian / caregiver
  • The parent and/or child will be given paperwork to fill out in the room
  • Please stay as quiet as possible during the sleep study, do not use electronics when the child sleeps, and if your child wakes up let him/ her fall back to sleep on his/her own
  • You are expected to come at the specific time scheduled and the sleep study will be finished between 5 a.m. and 6 a.m. the next morning.

Can the glue be washed out of the patient’s hair before leaving?

Yes, we recommend you try to remove as much glue as you can with water and a warm cloth, than wash your hair.

What if my child has allergies?

Please alert the scheduler if your child has any allergy issues so we can help better address and accommodate any allergy the child has.

How do I prepare my child for a sleep study?

  • On the day of the study, avoid the following:
    • A nap
    • Caffeinated beverages
    • Chocolates
  • Meals are not provided in the Sleep Center. Please plan accordingly by making sure the child has dinner before arriving. Also, please bring snacks, if needed, for before and after the study.
  • Have the child shower before arriving. Do not apply skin creams, lotion, or hair products
  • Please bring any special blanket, stuffed animals, or pillow for child’s comfort, but do not place them in the bed after the child is hooked up.
  • Bring comfortable attire consisting of a top and bottom without zippers. No silk or silk- like material.
  • Bring enough bottles and formula to last throughout the night.
  • Don’t forget a sufficient supply of diapers and wipes.

Is TV available?

Yes, each room is equipped with a TV at no extra charge.

Does Cleveland Clinic provide Nursing or Caregiver Services?

Nurse and caregiver services are not available. The caregiver present with the child will be expected to perform all of the child’s care throughout the duration of the study. Please notify us if the child has a disability that requires special assistance.

Can my child take his/her medications?

Please bring all regularly scheduled medications and plan for the child to take the medications unless your physician instructs you otherwise.

Does the test hurt?

No. the test is non-invasive and not painful.

Can the patient use the bathroom during the sleep study?

Please notify the technologist and they will unhook the leads which allow the child to get up and go to the bathroom.

Will my insurance cover a pediatric sleep study?

Most insurance providers will cover pediatric sleep studies. Our Financial Counselors will start the pre-authorization for you, but please check with your insurance provider if you have any specific questions regarding out-of-pocket costs associated with your child’s sleep study.

How long does it take to get the results of the pediatric sleep study?

Results will be available in 1-2 weeks. All studies are read by qualified sleep clinicians and will be sent to your ordering health care provider. These results can be discussed during a follow-up appointment.

For Medical Professionals

For Medical Professionals

Refer a Patient

  • Appointments:216.636.5860 or 216.444.KIDS
  • General questions or to reach a Pediatric Sleep team member: 216.444.2165 option 5
  • Fax: Referral forms: 216.445.6205; other documents: 216.636.0090
  • Online: Send us an email
  • Online: Make an appointment

To refer a patient via fax please download and complete our physician referral form and fax using the number above.

Frequently Asked Questions – Providers

DrConnect

Stay connected to patients you refer to Cleveland Clinic through online updates and electronic medical records.

Patient Screening and Triaging

For information about screening and triaging children with Sleep Disorders, review:

Treat, Test or Turf

FAQs for Providers

FAQs for Providers

What are the common symptoms which may suggest that my pediatric patient may have a sleep problem?

Snoring, pauses in breathing during sleep, mouth breathing, restless sleep, excessive daytime sleepiness, difficulty falling and/or staying asleep, difficulty waking up in the morning, abnormal sleep behaviors such as screaming, crying, walking in sleep, and constant leg kicking.

What tools can I use in my practice to screen patients for sleep disorders?

Asking in depth questions about your patient’s sleep habits is key to screening for sleep disorders. The BEARS mnemonic (B=Bedtime Issues, E=Excessive Daytime Sleepiness, A=Night Awakenings, R=Regularity and Duration of Sleep, S=Snoring) yields significantly more information than a simple “does your child have any sleep problems?” screening question. Positive responses should serve as a flag to delve deeper.

What are the resources available to parents to understand normal sleep and sleep problems for their children?

We recommend you provide these references to your patients:

What type of sleep disorders are managed by a pediatric sleep expert?

Obstructive and central sleep apnea, insomnia, circadian rhythm disorders, restless leg syndrome (RLS), narcolepsy, other types hypersomnia,  and parasomnias such as sleep terrors, sleep walking, rhythmic movements in sleep such as body rocking, head banging, sleep problems in other medical conditions including but not limited to Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder, children with developmental delays, genetic syndromes, and neurological conditions.

What is the role of sleep behavioral/psychology provider?

Behavioral sleep providers can evaluate and treat many cognitive and behavioral component of various sleep disorders, including insomnia and circadian rhythm disorders. For example, sleep onset associations, bedtime resistance, limit setting problems, anxiety, bedtime fears etc. They may also assist with Positive Airway Pressure (PAP) therapy acclimation.

Can I directly refer to sleep behavioral/psychology provider?

Yes, you can refer directly to a behavioral sleep provider. Generally, the  behavioral sleep provider will screen for other sleep disorders and seek assistance from sleep medicine team if needed.

What is a sleep study?

“Sleep study” refers to group of nighttime studies most common of which is polysomnogram (PSG). PSG is objective way to evaluate for various sleep disorder. During a PSG, a patient’s brainwaves (measured by EEG or Electroencephalogram), heart rate, breathing and limb movements are monitored. PSGs are typically one night study attended by a sleep lab technician and take place at a sleep lab, which may be located in a medical facility or a hotel. PSG is most often used to assess sleep related breathing disorders (e.g., obstructive or central apneas, hypoventilation), to titrate CPAP or Bi-level PAP, or to assess periodic limb movements. Please see description of other types of sleep studies below.

What are the indications for sleep study?

Indications for sleep study include snoring and sleep related breathing disorders, and excessive daytime sleepiness.  PSGs are particularly useful in assessing for sleep related breathing disorders in the child with obesity, developmental or neuromuscular disorder, craniofacial abnormality, school failure or behavioral problems. The overall prevalence of sleep apnea is 1 to 3 percent among otherwise normal children, 15-63% in obese children, 20 to 30 percent in children with ADHD, and 50 to 75 percent in Down syndrome.

What is the difference between types of sleep studies?

Different type of sleep study include regular PSG, PSG with extended EEG, home sleep apnea test (HSAT), multiple sleep latency test (MSLT), positive airway pressure (PAP) titration study or maintenance of wakefulness test (MWT).

A polysomnogram (PSG) is a monitored study obtained in a sleep lab. It is used most often to assess sleep-related breathing disorders. During a PSG, a patient’s brainwaves (measured by EEG or Electroencephalogram), heart rate, breathing and limb movements are monitored. PSGs are typically a one night study attended by a sleep lab technician and take place at a sleep lab, which may be located in a medical facility or a hotel. PSG is most often used to assess sleep related breathing disorders (e.g., obstructive or central apneas, hypoventilation), to titrate CPAP or Bi-level PAP, or to assess periodic limb movements.

A PSG with extended EEG a.k.a. double study include additional EEG leads, where one may study nocturnal motor phenomena (e.g., atypical or resistant parasomnia, seizures).

Evaluation of excessive sleepiness may call for a PSG with a daytime sleep study called multiple sleep latency test (MSLT) in some cases. The multiple sleep latency test (MSLT) objectively measures daytime sleepiness and averages the time needed to fall asleep over five nap opportunities during the day. It is done immediately following an overnight PSG. While useful in diagnosing narcolepsy, the MSLT requires planning to minimize confounders, such as drug/medication effects, prior sleep deprivation, or mistiming of the test as in the case of circadian rhythm disorders. Maintenance of wakefulness test (MWT) is typically performed to monitor response to treatment of sleepiness disorders. A prior sleep consult is strongly suggested. 

What is a home sleep apnea test?

A home sleep apnea test (HSAT) is an abbreviated sleep study that monitors a patient’s breathing, snoring, and oxygenation during their sleep in their home. HSAT is indicated for adult patients who have a high likelihood of sleep apnea without any other significant comorbidities (cardiac, pulmonary or neurologic). HSAT is not validated in children and thus not performed at the moment.

When should I refer patient to sleep expert?

  • When a suspected sleep disorder is resistant or needs more time or attention than a simple clinic visit allows.
  • When a child with developmental delays or special needs requires a sleep study or when extreme anxiety even to a simple PSG for OSA is predicted.
  • When CPAP/Bi-level PAP is required. Children more than adults need careful mask-fitting, habituation and education.
  • When hypersomnia is a significant complaint. A consult will help assess the need for a next-day MSLT, actigraphy study, or analysis of sleep logs for confounders.
  • When RLS is suspected. A consult can evaluate secondary causes and comorbid periodic limb movement disorder (PLMD).
  • When parasomnias are severe, frequent or dangerous, or when nocturnal motor activity is suspicious for seizures. An expanded sleep study with full EEG or extra-limb leads may be needed.

What is Actigraphy?

Actigraphy is a non-invasive method to monitor rest and activity periods and thus understand sleep-wake patterns. When undergoing actigraphy monitoring, the child will wear a device that looks like a watch on their wrist. Typical actigraphy monitoring lasts 1-2 weeks. During this time the child/parent will be asked to complete sleep logs for further understanding of the child’s sleep patterns.

Do I have to refer to sleep specialist in order to obtain a sleep study?

No, a sleep consult is not required to obtain a sleep study.

When should one order a PSG rather than a consult?

A diagnostic PSG can be ordered for suspected obstructive sleep apnea (OSA) in an otherwise normal child with low likelihood of other diagnoses (e.g., circadian disorders or central hypersomnia) or comorbidities (e.g., developmental delays or craniofacial abnormalities).