Does Your Child Have a Sleep Disorder? with Vaishal Shah, MD, MBBS, MPH

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

The most important time of day for kids may be bedtime. Those hours when they catch ZZZs are critical to their growth, development and success. But falling asleep isn't always easy for that younger crowd. It's estimated that almost half of all children will experience a sleep disorder while growing up. That's a reality with potentially serious consequences.

Today, we're going to learn a little more about childhood sleep disorders from pediatric sleep medicine specialist, Vaishal Shah. Dr. Shah is one of the many experts at Cleveland Clinic who pop into our weekly podcast to chat about health issues affecting families like yours. Now, let's find out what's keeping kids up at night, and better yet, how we can help them rest easy.

Welcome to the podcast, Dr. Shah. With any luck, our conversation will put people to sleep.

Dr. Vaishal Shah:

Yeah, absolutely, John. I would love to prescribe everybody a nice prescription of a great night of sleep today.

John Horton:

Well, that would be a big help because getting children to sleep is just never easy for parents. And from what I've seen in looking at things ahead of this podcast, it sounds like many sleep issues with kids go beyond them just fighting bedtime.

Dr. Vaishal Shah:

Yeah, absolutely. A lot of time, when I work with parents, I say, "Look, I'm not treating just child. Getting one for many free treatment, because I'm treating the entire family. Because nobody else is sleeping there." So yeah, sleep problems are, unfortunately, quite common in kids, and quite underrecognized. And a lot of time, it's not only the child. Entire family is affected, particularly if they wake up in the middle of the night and so forth. And we see a wide variety of different ways the sleep problems occur in kids, and they come to either our clinic or attention, or seek the provider, like pediatricians' help, and so forth. And I would love to speak more about each one of them today. I'm happy to go ahead.

John Horton:

Well, we definitely will. So before we jump into what's keeping kids awake, let's spend a moment going over just how much sleep kids need. There's a big variation by age and growth stage, correct?

Dr. Vaishal Shah:

Yeah, absolutely. One of the key things I talk to parents is how much it needs. Your key indicator is one, whether your child can wake up refreshed. And how does the day then look like? Is child able to continue all the activities without having problems? Even said that there are some of the ranges according to age, and there could be variations. So I would probably say not just, "Oh, my child only needs this much," because each kid could be different. So example, a newborn child, particularly until 6 months, they have something called ultradian rhythm — means their circadian rhythm or body clock is not yet done. So they have these chunks of two hours, three hours, sleep periods, or naps. I call that, that's their job. They wake up, they look cute, they poop, feed, go back to sleep. That's all they do.

John Horton:

I remember that stage well, in mine. That is all they do.

Dr. Vaishal Shah:

Right. And our sleep as a parent can be like that during that period, too. So they can sleep almost 70% of their day, so 16 to 20 hours in a day. But it be very much broken, and so forth. Once you get to three to six months, their body clock starts developing, and some of the nocturnal sleep occurs. So as a rough estimate, I tell parents, "Between 3 to 6 months, expect by month." So if you have a 3-month child, maybe three-hour chunks, 4-month, four-hour chunks. So by 6 months, mostly about four- to six-hour chunks at a time.

And then, by the time they get to 1 year, typically, they need about 11 to 14 hours, mostly a longer chunk of six to eight hours at night, and then, it would be one to three naps during the day. With a wide range, 15 minutes to all the way three hours. And we see quite a bit of variation in that.

Once you get to after that, in toddlerhood and preschool time, that's when you need approximately 10 to 13 hours. Kids could still have naps up to 5 years of age — five to 10% of kids can still have it. There's a time period in between, between 2 and 5 years, when we see the nap fading, as gradually, naps become inconsistent, and all the sleep becomes nocturnal.

Once you get to school age, typically, most of the kids have a few exceptions and so forth. At that age, need approximately nine to 11, 10 hours on an average a night. And once you get to teenage, that's when you need almost eight to 10 and nine hours. But good luck. I hate to tell teenagers that, "You need nine hours," and so forth. They all tell me that, "I'm good with four to six hours, and there is nothing wrong with me." So…

John Horton:

It seems like it's either that or they're just sleeping nonstop. So I guess it depends what chores need to be done at that moment.

Dr. Vaishal Shah:

It seems that way, yes.

John Horton:

Now, that's a great outline, and it shows just the variation as kids get older, and how they need a little less, but still quite a bit. Now, here's the big question, though. If kids don't regularly get enough sleep, what are the consequences, beyond them just being a bit cranky the following day?

Dr. Vaishal Shah:

So sleep is important for many aspects in health, particularly mostly what we call neurological or neurodevelopmental aspect. So our attention span, memory, learning — all those could be affected by sleep. So kids who do not get sleep a lot, often are not only tired, but any of these functions could be affected. Also, executive functioning — thinking, problem-solving — which are all important for their main job, which is to learn, in the school environment, non-school environment, different kind of sports. So it could affect all of those areas, which are most important in their life as they grow up.

John Horton:

Yeah, you might see that if they're having problems. I mean, you might see it reflected in their grades if they start to struggle. I mean, that could very much be a sleep issue just showing itself in that way.

Dr. Vaishal Shah:

Absolutely. A large number … more than half of the parents come to us because they've suddenly or gradually started seeing grades falling off. Or they're falling asleep in the class, and they can't pay attention, or they're very hyperactive. And then, we connect back the dot that it could be at their amount of sleep, quality of sleep, timing of sleep, and then, try to figure out and help them. Absolutely.

John Horton:

Now, I know you had mentioned mood, too, which is always tough with kids because they tend to be a moody bunch as it is sometimes. Are there certain things you should look for if there is a sleep issue that might signal it?

Dr. Vaishal Shah:

Yeah, absolutely. So in general, mood without a mood disorder … a lot of times, we see because of the tiredness, they're not feeling great. "I don't have energy. I'm dragging throughout the day. I don't want to talk to you, I want to be in my room. I'm just taking a nap in the middle of the day when I shouldn't be. I don't want to do any kind of task," could be a sign of a sleep problem.

Additionally, sleep problems do not directly give you depression. However, we know for sure that if you have existing depression, a common mood disorder, it can really make it worse for you to either be able to treat it properly or be able to cope with that, and other therapies and so on.

John Horton:

All right, well, let's shift gears now and talk about sleep disorders in children that prevent them from getting the rest they need. I'm guessing this is something that covers a lot of ground.

Dr. Vaishal Shah:

Yeah. Quite a bit. Essentially, that's the bread and butter, what we see in our clinic. And generally, I simply tell … when I'm teaching trainees or talk to anybody else, I say to look for five or six things which will tell you whether they have a sleep disorder or not. Whether your child can't fall asleep, can't stay asleep, can't wake up, too sleepy during the daytime, or has a hard time paying attention and is hyperactive — or something funny in a fun way, I call paranormal activities at night — or some kind of abnormal movements such as screaming, crying, and so forth could signal what we call parasomnia. So look for those things. And last but not least, any kind of breathing problem in sleep, such as snorting, choking, pauses in the breathing or dry mouth or breathing through the mouth. All those could be signs of a sleep disorder. And you probably should start seeking help from that standpoint."

John Horton:

Well, like you said, that does cover a ton of ground. So I'd like to go through some of the more common sleep disorders that kids experience with you, and what can be done about them.

Dr. Vaishal Shah:

There are six groups of disorders we see. Number one, most common is, of course, insufficient sleep. We work with them a lot of time, what we call sleep hygiene. So like we take care of our body, brush or shower and so forth. It's also important that we follow good sleep hygiene. We have a consistent wake-up time. Wake-up time is a lot more important to a sleep doctor, compared to the bedtime and so forth. And then, calculating backward your age-appropriate bedtime. So having consistency, having a buffer zone right before you go to bed.

So think about it. In the morning, we wake up and we just don't rush to work or don't rush to school. We allow ourselves to wake up, get ready. We allow that buffer zone. But many times in our current wired culture, we are on the screens. We are doing something at night or we expect our brain to basically shut down and go to sleep right after that. So having that little bit of buffer zone, quiet time, relaxing bedtime is very important for amount of sleep.

Once we get through that, we many times see what we call obstructive sleep apnea or sleep-related breathing disorder, which is one of the very common disorders in our clinics. In the past, it used to be about 1 to 4% of children in the United States had it. But since the recent increase in the obesity epidemic in children, we are seeing quite a bit. Some of the literature says almost 20 to 70% of children could have that problem.

John Horton:

Wow, that is a big number.

Dr. Vaishal Shah:

Oh, yeah, it's quite a bit. So that could present in younger children as snoring, breathing pauses, breathing through mouth, waking up a lot in the middle of night, having attention problems, hyperactivity. Older children could look sleepy, or then grades falling through the cracks and so forth. So those could be the common signs which you'll see with obstructive sleep apnea.

John Horton:

And with sleep apnea, that's something that you probably need to go in and see somebody. That's maybe not necessarily fixed with some of the things you had talked about with the sleep hygiene and that. That's more for general insomnia, I take it those tips were. But sleep apnea, there's other things that need to be done?

Dr. Vaishal Shah:

So in simple language, apnea — I mean, some sort of partial or complete closure of the airway, either due to a physical obstruction, such as large adenoids and tonsils — a lot of younger kids — it's due to that. Or some form of functional obstruction, such as your muscles in the back of the throat, such as the tongue or palate are floppy. That could be due to excess body mass index or a certain type of disorder where the muscles are weak. And/or abnormal jaw structure, very narrow palate or other type of jaw structure.

So depending on each kid's feature, there are a wide variety of treatment options available. We many times do one or many to combine. For example, having adenoids and tonsils removed surgically for moderate to severe sleep apnea in many cases is first-line treatment. But that's not all. In current time, there are orthodontic treatment. There are anti-inflammatory or allergy medications, such as nose sprays or chewable tablets.

The weight management can be very helpful. Of course, CPAP and BiPAP, which are machine which provide positive airway pressure at night to keep the airways open, is also available. And last but not the least, we have a lot of innovations and technology coming. So in 2023, last year in April, the FDA cleared the new generation treatment called hypoglossal nerve stimulator, or it's sometimes popularly known as Inspire, which is an implant which stimulates to move the tongue on the palate forward. So it's cleared for the patients with Down syndrome, 13 to 18 years of age and so forth.

John Horton:

This is why it's so important to talk about this, just because there is so much out there. So there's no reason to struggle with it. You got to talk about it.

Dr. Vaishal Shah:

Yeah, absolutely. I mean, if your child has any of those symptoms, either initiate a conversation with a pediatrician or sleep physician. There are a number of centers across the United States who provide these services. We have seen some wonderful results when children get treated. So many families come and say, "Oh, this is a different child. I didn't know. Actually, I thought that was normal to snore. I thought it was normal my child was misbehaving or hyperactive. And I had a lot of problems." And then they come and, "Oh, this is completely different."

John Horton:

So we've kind of covered just, I guess, insomnia, sleep apnea. What are some of the other disorders that you commonly see?

Dr. Vaishal Shah:

And I'll go through that in a second, but even going back to insomnia for a second. So many times, when we encounter insomnia — that means the trouble falling and/or staying asleep — our approach is typical, it's threefold. We first look for root cause, such as other medical disorders like obstructive sleep apnea, something waking up children in the middle of night. Second, are there behavioral components, such as younger children can have what we call sleep association. They're associating falling asleep with certain rituals, patterns, parents needing help and so forth. Or preschool children a lot of time could be pushing the limits. We call it "curtain call." I don't want to go to bed. Or bedtime battles and so forth.

John Horton:

I remember that quite a bit.

Dr. Vaishal Shah:

Even my son, I initially had some until we worked through that, and so forth. So older children may have depression, anxiety, a number of mood disorders keeping them awake. So we try to address those root cause issues. There are wonderful therapies out there. So cognitive behavioral therapy addresses some of the thought process and behaviors around the sleep. And that's essentially the number one or the most effective long-term treatment and so forth. And a small number of children may need medications to help with insomnia, when all of this fails, or we need to have an adjunct on top of that particular channeled with the neurodevelopment.

Now a lot of time, when we say, "Oh, my child can't fall asleep," we automatically think it's insomnia, but that's not true. There could be an other set of disorder, what we call circadian rhythm disorder. One of the most common one, particularly in adolescent age, is called delayed sleep phase syndrome. In a fun language, I call it “California sleep syndrome” or “Hawaii sleep syndrome,” depending on how much delayed they are. So in a simple language, to understand, we have a clock inside the body, like clock outside. And in a medical language, we call it circadian rhythm. There's a master clock in the brain, and what it does is takes cues from our environment and tries to stay in sync with the outside.

So first of all, whose clock is wrong? No one's, right? So think about somebody living in Eastern Time Zone working first shift or second shift or third shift, somebody living here versus California versus Hawaii versus China. Everybody's on a different time zone and different clock. So what we tell is two things matter. One, what time zone you live in, and for what activity, when do you have to wake up? For example, school or other activity.

And then we calculate backward. So some individual, for example, if their school starts at eight o'clock and they need, let's say, nine hours, for example, for teenage. And they would wake up at seven, means they should be naturally feeling sleepy by 10 o'clock to get that nine hours. But many individuals either internally, means genetically entering to have later clock, or behaviorally, means externally, they have pushed that clock later. They call themselves many times a “night owl.”

John Horton:

So they're just off a little bit.

Dr. Vaishal Shah:

Yeah.

John Horton:

They're off of what the rest of us are operating on, and just there's a little delay.

Dr. Vaishal Shah:

Yeah, absolutely. And even sometimes, naturally, around 13 years, there's a natural delay, which is not even in the child's hand. On top of that, when you have a significant delay, two, three, four hours, and you can't fall asleep at the time you need to fall asleep, and then other side, you can't wake up when you need to wake up, that's the first signal for us that we know there is a circadian rhythm problem involved.

But then, if you allow them to sleep on their own time, like California or Hawaii time, they do great. They can fall asleep, no problem. They can wake up later and so forth. So that's what we call delayed sleep phase syndrome. Many times, it's misunderstood as insomnia, but we really try to differentiate in our clinic based on the history. Sometimes, we utilize sleep logs. Sometimes, there are wearable devices as a test to figure out where the clock is. The reason for that is treatment is very different for both.

John Horton:

How do you change that, then, if somebody's just off by a few hours? Is there a way to bring them into their current time zone?

Dr. Vaishal Shah:

Yeah, absolutely. If it is not completely genetically entered, it's possible to shift early. So there are a number of influences for this clock. And in the Greek language, we call it “time giver” or “zeitgeber.” It's a fancy name. So the sunlight is the most powerful zeitgeber or time giver. There's a natural hormone in … called melatonin, which follows a light and dark cycle. So that's the second-most powerful.

And third-most powerful are ritual and behaviors, timing of those. So for example, what time do you wake? Do you have to go to school? What time do you drive if you're driving as an adolescent or adult? What time do you eat lunch and dinner? So in the morning when you wake up, the sunlight is the first cue for the brain that it's time to the master clock, that it's time for me to wake up. And it wakes you up, and the melatonin turns off. And throughout the day, gradually, all these other cues are feeding into this master clock that I'm active with. That means it's going to be my wake-up time.

At night, when dark sets in, that melatonin starts going high. And it picks the time when you're naturally falling asleep. So we utilize the science to then shift the clock. So many times, we utilize specifically timed, like a bright light therapy with artificial lights, like other boxes or visors alone changing certain behaviors and very much timed melatonin. Not the regular melatonin, a sleep aid, but at a very specific time, based on calculations from the sleep logs are acting [inaudible 00:18:55] to shift this clock early, and so forth.

John Horton:

Wow, that's really amazing that we can do that, and just inch everything along and get you back onto the schedule the rest of us are on, or everyone else in the house is on.

Dr. Vaishal Shah:

A lot of times, adolescents, teenagers, when they have this issue, many times, they're blamed that they're just lazy or they're just not behaving and not waking up and don't work. Until you go into detail, and realize their clock is actually later, and it's not even in their hands to do so. And then, we shifted them like, "Oh, my God, I didn't know this, that it could be a delayed sleep phase. And that's why I can't fall asleep. And that's why I can't wake up next day." So it's possible … it's quite bit number of patients who we are able to help, if they properly follow these kinds of treatments. They need a lot of motivation to do so, but it's very effective.

John Horton:

Fabulous. And that's another reason to reach out to a specialist when you're seeing these issues. And like you said, not just assume your kid's being lazy or just doesn't want to get out of bed.

Dr. Vaishal Shah:

Many times I joke around and say, "Look, if none of this work, I'll have to ship you for the college to California or Hawaii." And we'll laugh at times.

John Horton:

Yeah, it's either address it here or move to that time zone.

Dr. Vaishal Shah:

Yeah. Yes, exactly. So we have a little laugh in the clinic with that.

John Horton:

I know we were talking ahead of time, too, about a few other issues. And I think you brought up parasomnia. What is that?

Dr. Vaishal Shah:

The other three categories we see are parasomnia, hypersomnia, or what we call rhythmic movement disorders. Parasomnias are essentially events happening within sleep, at the beginning of sleep or at the end of sleep. So there are what we call non-REM or REM parasomnia. REM means “rapid eye movement.” In a simple language, it's a dream phase of the sleep. And non-REM is basically non-rapid eye movement sleep. In both phases, you can have certain events happening. For example, sleep terrors, sleepwalking or a benign version of that called confusion arousal are all non-REM parasomnia.

So typically, in the first half of the night, particularly in younger children with sleep terror may sit up, would look completely asleep or glazed, and would have certain activities such as crying, screaming, kicking, punching, pushing, trying to talk, but the speech is not clear, which is basically sleep terror. The sleepwalking is essentially when they get out of bed with all this activity, and walk during sleep and so forth.

So in this time, what I call is a “faulty switch.” So when they have to switch between different stages at night in sleep, they get stuck between half-asleep and half-awake. So they're doing actions of both. That they look glazed as if brain is sleep, but then they're doing activities like you're awake, like walking, trying to talk, trying to do something. Sometimes, you are eating, we see, and that's many times I describe as a paranormal activity in the middle of the night.

John Horton:

It's so wild to think about, that you're sleeping, but yet your body still thinks it needs to move around and do things.

Dr. Vaishal Shah:

Exactly right. So those are what we call non-parasomnias. And then you have REM, so dream-related parasomnias, such as nightmare disorders, related to other depression, post-traumatic stress disorder. Sometimes, acting out in dreams, what we call REM behavior disorder, more so seen in the geriatric age group or older ages. You can see it in some of the younger kids, if they have narcolepsy and so forth. So there are wide variety of parasomnias we see.

And what is unknown is a lot of times, I see there are wonderful providers out there, but with non-REM parasomnia, we know that many children can grow out of it. A large amount in fact. Almost 80 to 90% by the time they are in adulthood. However, if we have sleepwalking, or your child is in a safety issue by doing all this, then that's a red flag for us. That's a long time you're waiting for them to grow out.

So there are a number of things we can do about this. And a lot of time we educate parents about what it is, how to know whether your child is basically in that event, how to manage that event. There could be a number of triggers, such as sleep apnea, or insufficient sleep are the two most common triggers. I even had pets in the room triggering. I had parents snoring triggering all kinds of events, and so forth. So we work with them on removing this trigger to reduce episodes. And a very small number of patients who are very frequently sleepwalking or are in danger, then we consider medication as the last resort if needed. So there are a number of things available out there to treat this kind of problem.

John Horton:

And then, you had mentioned also hypersomnia, which sounds close, but I'm guessing it's a little different.

Dr. Vaishal Shah:

Hypersomnia can present variety, but the key term is “too sleepy.” So it could look like, I'm just physically exhausted, tired, I wish I had a nap. Or it's not the case. I'm awake, but I get sudden, irresistible attack, out of nowhere, I'm falling asleep. It's a microsleep. Or I'm just very drowsy, just cannot stay awake. The most common reason still in the world is insufficient sleep. You're just not getting enough sleep.

However, we'll look through different aspects. Do you have enough sleep? Your timing of sleep is proper, whether you have depression, whether medications are causing it, whether you have circadian rhythm problem. And if none of those, then we worry about a set of disorders called central or brain-related disorders of sleepiness. That is where the chemicals in the brain which keeps us awake could be disrupted.

For example, narcolepsy is one example of that, where one type of narcolepsy, we know for sure what chemical is disrupted, and so on. In this case or situation, your child's ability to stay awake is little. So they will fall asleep at unusual times and places. They would have a hard time staying awake. They would have a hard time with school. And so typically, it starts in adolescence. And many times, it's not diagnosed until late because their parents do not know that this could be a possibility. Or sometimes they get labeled as something else. Or that they're lazy or they have depression or so forth, until you find a proper provider to evaluate and diagnose that.

John Horton:

Still, you just can't believe that you can be programmed in a way where you're just falling asleep throughout the day. I mean, that would be concerning.

Dr. Vaishal Shah:

Absolutely.

John Horton:

You've got to function at some point.

Dr. Vaishal Shah:

Yeah. And it could affect functioning. A lot of time, I worry when they get to teenage and start driving, right? It could be a very dangerous situation.

John Horton:

Is it that severe where you can be out driving in the middle of the day, and you just nod off?

Dr. Vaishal Shah:

Yeah, absolutely. We have had patients, particularly adult patients, who came to us because of that. They got an almost accident or near-accident. So a lot of time, not only do we treat those, but we provide a lot of counseling about driving safety.

John Horton:

One more thing for parents to worry about when they hand over the keys. As if there wasn't already a thousand things, then we have one thousand and one.

Dr. Vaishal Shah:

Yes. Unfortunately, yes. Unfortunately, though, some of the disorders, particularly narcolepsy, is lifelong, and we can't cure it yet. I mean, there's a lot of research going on in this area, and we are very hopeful that there'll be more and more modalities available. But at least there are so many advances with medications, lifestyle changes, number of other things, that we are able to help them function at a much better level. That may include schooling or driving or sports. And once they get to job, functioning at work and so forth. So I always tell patients that, "Look, if you expect for sleepiness to 100% go away, that's unrealistic. But the tools we have available, we can get you close to what your goals of functioning are." And we are able to get there in a large number of patients.

John Horton:

So Dr. Shah, if I have my scorecard right, I think we still have one more sleep disorder to go over.

Dr. Vaishal Shah:

Uh-huh.

John Horton:

And that would be, is it called restless sleep disorder?

Dr. Vaishal Shah:

Yeah, so what we call rhythmic movement. So under that, there are a few different things. The restless leg syndrome and rhythmic movement would be body rocking or head banging and so forth. But restless leg tends to be very common in adults. We are seeing more in kids, also. There is a newer diagnosis which is being studied called restless sleep disorder. In restless leg, basically, you have urge to move the leg, some sort of uncomfortable sensation, particularly in the evening or during restful activity that "I really need to move, otherwise it doesn't go away." And once you move, whether partially or completely, it improves. It can cause you trouble falling asleep, or in the middle of night if your leg is kicking due to that, it can wake you up or disrupt your sleep.

Very commonly, it is seen in children. Particularly, it can run in the family. So there's a strong family or genetic component, but then iron is a big one. So iron is a unique molecule which is important for a chemical called dopamine in the brain to function and so forth. So then, if you're deficient in iron and dopamine doesn't function well, that's when you can get those restless legs. In adults, it could be iron or it could be by itself. Dopamine itself could be a problem.

So a lot of times, we provide them a number of different ways to treat. So we replenish iron. We sometimes utilize medications, sometimes non-medication modalities like massage. A lot of time, if I see adults, I tell the spouse that, "I'm writing the prescription for your spouse to massage the leg." And they laugh at me. So light to moderate exercises or keeping good nutrition. So there are a number of things available out there for this particular disorder which we can help patient with.

And with the restless sleep disorder, it's coming up more in pediatrics, so we are seeing about six or seven of these. And it could be non-specific needs. It's just the child being very restless and no medical condition. However, it could be iron deficiency, it could be ADHD. Could be autism spectrum disorder, it could be restless leg syndrome. It could be sleep apnea itself. I have even seen children being very restless because their nose is blocked due to allergies, and they can't breathe well at night. And once we treat that, their sleep becomes more peaceful and restful.

John Horton:

That's interesting that you're seeing more cases. I mean, do we know why that is? I mean, is it just attributed to diet? I don't know. I mean, do we know, what's the cause?

Dr. Vaishal Shah:

I think it probably was already present. I think we are recognizing it more because of the new generation research coming out, particularly in children with those neurodevelopmental disorders like ADHD or autism spectrum. And understanding that there could be a sleep component, which is significant, or it is affected. There could be a vicious cycle. They could have oversleep or they could have ADHD, autism spectrum, daytime problems that's contributing to sleep. And now, we have sleep problems that's adding to that. So there could be a constant vicious circle. So I think it's just more recognition and more research that it could be a component is what I think is going on. That's why we are seeing more patients with it.

John Horton:

So when we started this conversation, you went over some things that people could do at home that were pretty simple, like just establishing a solid bedtime routine, creating a restful room, avoiding screen time right before you go to bed. And those are all simple steps you can take to maybe tackle these sleep problems. But when should you seek out professional help to address sleep issues that you're seeing in your kid?

Dr. Vaishal Shah:

Absolutely. So one, if those steps have not worked, that's a very easy and simple indication that you should seek help. There may be something else going on, or there is not properly pre-maintenance of. But if you're one of those five across the symptoms and if you're concerned about a disorder, like, can't breathe well when I'm sleeping, really can't fall asleep, school grades are affected, can't stay asleep, or trouble with waking up or too sleepy, and you have done all these simple steps, then that's a time to seek help.

Even at the beginning, if you feel, "Oh, no, I think there's something not right," it's always safe to ask a pediatrician or seek out help from a sleep provider. There are, as I said, a number of centers available out there. A number of pediatricians, you and I have seen, are very good at initial evaluation and diagnosis, like sleep studies or other things, and so forth. So many times, if they are not able to sell, they also seek out to reach out to us, and so forth. So whenever you are not making progress with simple steps, it's time. That's the time we want to ask somebody for help.

John Horton:

Well, with all the information that you've shared with us today, Dr. Shah, I feel like we're ready to put this issue to bed right now. So before we say goodbye, is there anything else you'd like to add for parents with kids who are really having trouble sleeping?

Dr. Vaishal Shah:

Yeah, absolutely. So when I came to this particular field, it was fascinating. It has grown a lot. So I always tell families, "Look, it's a very busy society. We have a lot to accomplish, and we put ourselves and our kids through that. School, activities, a number of things. Peer pressure. A lot of time, in order to accomplish those, we sacrifice sleep.” I would say everybody to do a simple experiment. If you're sacrificing sleep, instead, next few weeks, just try to get long-enough sleep, and see how big of a difference you find. And you'll be pleasantly surprised how much better your day gets, all aspect of the day.

Again, personally, in my opinion, sleep is the best medicine out there. It's free. It doesn't require prior authorization, right? Otherwise, these days you want to breathe, you may require prior authorization. So to sleep, you don't need any kind of prior authorization. And just as a joke. So utilize that to the fullest, as much as you can to your advantage. And when your children are struggling, always seek out for help. There's a lot that can be done these days to help children not only sleep better, but function better.

John Horton:

Well, I think you've given us that prescription you promised at the beginning, to get better sleep. And I really appreciate you dropping in, and sharing all of this information with us.

Dr. Vaishal Shah:

Awesome. Thank you. Happy to help anytime.

John Horton:

Sleep disorders are a common and concerning issue for kids. If your child is having trouble sleeping, focus on establishing a good bedtime routine to help them drift off to dreamland. If that doesn't solve the problem, talk to your healthcare provider to find a solution to help everyone sleep better.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only, and is not intended to replace the advice of your own physician.