Can we talk about some of the daytime symptoms in children with sleep apnea?

I'm curious, I've read several articles about how OSA can be misdiagnosed as ADHD, or at the very least there is a connection to ADHD and OSA.

Do any of you on the board have children that have been diagnosed with ADHD? Mine has. If there are any of you whose children have been labeled ADHD and their sleep apnea has been treated for awhile, have you seen improvements with their "ADHD"?

My son is very hyperactive at times, especially at night. He also spaces out during the day and has trouble staying focused. He can be pretty difficult at times....little behavioral quirks....like overreacting to things.  He is very hard to get to take a nap or fall asleep at night, he fights it like there is no tomarrow. He seems out of it a lot, when you talk to him, it's like he's somewhere else. He's been in a special pre-k program for behavioral disorders for two years and has done really well, so well, that we are going to try regular kindergarten this year.

Have any of you experienced these types of issues? What other things have you noticed during the day that you associate with the sleep apnea?

Have any of you seen a dramatic improvement in your child's behavior, learning, developement, etc. since seeking treatment for apnea?

I found this article about adhd and osa.          

pretty interesting     http://www.webmd.com/news/20060403/tonsil-surgery-helps-kids-adhd

Hi there, I am brand new to this forum so I don't have a whole lot of knowledge or insight into cpap therapy.  I do, however, have an 8yo daughter who has worn cpap since she was 4 and I can tell you that, from the very first night of use, our quality of life has improved dramatically.  She was never dx with ADD or AHDH, but interestingly enough, one day she was at her doctor's office.  She stood up and sat down and stood up and sat down -- she was 4! She was restless! But her doctor looked at me and said "I think your daughter has sleep apnea"  Hah, I said.  Of course she doesn't, she doesn't snore, she sleeps through the night (and into the morning).  she naps for 2-3 hours a day.  I couldn't imagine this kid was sleep deprived.  doc said he believes that the majority of children with ADD or AHDH have osa and wanted her tested just to rule it out.  Lo and behold, she has apnea and was put on a cpap that same day.  SHE WAS A DIFFERENT CHILD from that moment on!  Biggest change - the drama in the household, a big reduction in tears and whining and moping and grumbling.  The dark circles under her eyes were reduced within 3 days (I hadn't even noticed them until they went away).  Having said all that, she has been on cpap now for 4 years and I can always tell when they need to tweak her pressure because those "behaviors" crop back up.  She can't remember facts to save her life, she can't memorize poems for school, her head is always laying on the desk when she studies, she slumps, she picks on her brothers, she cries easily, etc.  So right now we are doing a 5-day autotitration study and in the 3 days she's been titrated, I've seen the most amazing difference in EVERYTHING.  First of all, she was only getting 9cm of pressure on her fixed machine.  Why 9? Because her last overnight study had 17 minutes at 9 and learned that she did better than 8.  So they guessed 9 would be good.  But with this autotitration machine, her pressure starts at 7 and by 4 hours into the night she is up to 15.5.  It seems to hold steady between 12-13 for the remainder of the night, and drops back to 7 just before she awakes.  But most importantly, I've got my daughter back!  She is kind, loving, sweet and rested.  She bounds out of bed in the morning, happy and loving. I've ALWAYS had to wake her in the morning -- even though bedtime is 7:30 p.m.  But now she awakens on her own.  No more purple circles under her eyes.  She is alert and sitting up straight.  The little things are the most powerful -- she sits up straight!  she reads for pleasure (a major chore just last week), she remembers what she's doing, she doesn't feel that everyone is picking on her all the time and most of all, she isn't so clumsy.  She was ALWAYS getting hurt... in just 3 days of sleep she hasn't bumped or broken anything (truly, this in itself is worth the price of the machine!)  Sorry for the long explanation -- but I just wanted to say that sleep deprivation seems to have major daytime consequences -- most of which I thought were personality, until cpap -- now I know she was just tired.  so tired.

Camaja:  Thank you so much for your reply, I cried when I read it. It's absolutely inspirational, and I can't wait to get my son's treatment underway.

I had almost the exact same experience you described at the doctors office, except when my son was bouncing off the walls, the doctor suggested ADHD instead of sleep apnea. I tried to accept it..believe it..but my heart kept telling me to look for other answers. BTW, It was my other son who had the actual doctor's appt for a bad cold, but Caden was so wired during the office visit that the doctor focused his attention on him instead. I so wish that one of the umpteenth doctors he has seen would have considered OSA before now.

The behavioral issues that come along with this have impacted our whole family. Like you mentioned, the drama in the household, the crying, the extreme grumpiness - it makes the simplist daily tasks monumentous for everyone. When I would try to talk to other parents about it, opinions varied so widely that I didn't know what to think. I would get the, "oh, he's just being a boy" or "you should really get him put on meds."  But it's not so black and white-when it's your child.  

Even though we still have a long way to go with his treatment, I'm absolutely convinced that OSA has been his problem all along- it just makes total sense- the poor kid is exhausted, I'ld be a grumpy mess too, if I was suffocating every night. So many things you mentioned in your post sound just like my son. It was so awesome to read how your daughter improved so quickly after she was put on cpap.  It really gives me something to look forward to.            

Parents really need to know that behavioral problems, even hyperactivity can be a symptom of a sleep disorder. There is not enough information out there.

Thanks again.

Oh Kimista! I am so glad that you recognize your son in my daughter's experience.  I believe so strongly in the link between behavior and sleep apnea that I sound like I'm a salesperson for cpap!  The change in my daughter's behavior was nothing short of miraculous, and I am confident that you will get similar results when your son is hooked up and resting again.   Sorry if this grosses you out - but this little story packs a powerful punch.  On the very first night that she wore cpap, I went in to cover her with a blanket and noticed that she had a very large BM in her pants.  She was 4, well past nighttime accidents and I couldn't rouse her to get her to the bathroom.  My husband carried her, groggily to the bathroom and we cleaned her up and put her back to bed.  Mind you, this was not a "little" accident - it was practically a man-sized BM!!!.  So the next day her doctor calls and says "So, how did the first night go? Did your daughter tolerate the machine?"  I said, "Yes, she tolerated it with no problem.  EXCEPT that she had a massive BM in her pants in the middle of the night... that's not good."  And I will never forget what her doctor said next: "Oh no, that IS SO GOOD.  Your daughter slept for the first time in her life last night and she was so relaxed that she was able to pass this (giant!) BM without so much as waking.  You've got a very tired child, this will help."  She's never had an accident again, but it hit me like a ton of bricks: my daughter had the first night of (real) sleep of her life at 4 years old.  It never happened again, and we are always having to tweak her settings as she grows, but it truly is an amazing treatment for these kids.   Like I've mentioned before, I can ALWAYS tell when her levels need to be adjusted because suddenly, she turns back into the cranky, weepy, grumpy, mean little child she was before cpap.  So then we up the levels and voila, she sleeps again!  She still has never had a dream though... I don't know when / if she ever will.   Please keep me posted on your son's progress!

Are you kidding me? I've got two boys, nothing grosses me out....I was LMAO when I read that. But seriously, that is so profound.....to think that some of these kids have never really slept (in a restoritive way) their whole lives. Poor little things. But it's great to know it's treatable in most cases.

That's interesting about the lack of dreams.....any idea what causes that?

We go Wednesday to go over the results of his sleep study with the ENT, I'll keep you posted.

Wish I did know why she doesn't dream.  Maybe someone on this forum has that answer, or maybe it's unrelated to her apnea.  I've been hoping that this titration would get her to dream, but she says "no" every morning when I ask.  Does your son dream?

I am really excited to read the posts here, it gives me some hope that things will improve at our house.

I have a 2.5 year old son who has excessive temper tantrums which is what got me started on this and we are only at the beginning.  So far we have had it confirmed from his pediatrician that he as enlarged tonsils and adenoids and some fluid build up behind his ears.  We are trying to set an appt with the ENT.

Anyway I was literally at my wits end with his temper tantrums.  Granted he's in his twos but 2-5 hours a day of crying, whining, general unhappiness is very hard to cope with on a daily basis.  His first pediatrician (who I've stopped going to) acted like I was exaggerating and just unable to handle a normal 2 year old, finally hypothesized that it could be ADD and gave me a referral to a psychiatrist.  He had a lot of the symptoms of ADD but I was of course hoping for it to be something else.

Then I came across OSA and realized that he had the classic symptoms: snoring and sounding like struggling for air at night, sleeping in a strange posture of extreme arching backward of head, mouth breathing during the day, excessive head sweating at night, long day time naps of 3-4 hours and of course irritability, low frustration level and impulsivity (in otherwords hours and hours of temper tantrums! ) So Monday we go to an ENT and see what they say.

It's a little hard because we live overseas right now, I only speak a little of the language although my husband is fluent but they do things differently and when I asked my new pediatrician about a sleep study she indicated that that wasn't normal here.  She also wanted to "wait and see" and said that it's not serious - well, when you live with a child with such long temper tantrums every day it feels like life and death and when you realize that that snoring and struggling for air at night could mean that they aren't getting enough oxygen, I can't understand this "wait and see" business!    We'll have to see what happens at the ENT.

Really enjoyed everyones post on happier children - it gives me hope!

I am new to the forum and have a son that was recently diagnosed with OSA at the age of 8.  He began wearing his CPAP last week and feels most comfortable in a full face mask because he is a mouth breather, however I am looking for ideas of other devices.  What seems to work best with your kiddos?

Hi!  I can't offer suggestions on other mask designs because my daughter isn't a mouth breather, so she uses the nasal mask.  She's been on cpap for 4 years now and we have found it very difficult to find comfortable, well-fitting masks for my petite daughter, so if he is comfortable and compliant with the full-face mask, you've definitely got a winner!  We just switched machines from a resmed 7 to a remstar M autobipap and are THRILLED with the improvement in her sleep quality... but we continue to struggle with finding masks to fit her tiny face.  Did your son adjust well to the cpap? I was pleasantly surprised that my daughter adapted so easily - children are much more adaptable than grownups at times!

Hey thanks so much for commenting on my mask reply.  Actually we expected to break him in slowly, however he ended up taking off like dream and he is wearing it approximately 3hrs per night, which we are happy with at this point.  He is on a Remstar Cflex machine and he seems to breath very easily with it.  The full face does seem to work well for him because he is a mouth breather, we have tried a nasal mask, but it seems he will have to maybe just work into it.  He leaves it on a whole 5 minutes and then says he can't breath.  I just worry about the risks of aspiration with a full face and the sleep lab would like to free his face up more due to growth of facial bones and because he is an allergy boy to take pressure off of his sinuses.  I am very excited to learn more about all of the children out there with OSA issues.  

I am just wondering if anyone has any input on how quickly your children took off with their CPAP units.  Our 8 year onld son has been wearing his just now a week with a starting pressure of 5.  We've tried full face, nasal pillows, and a nasal mask.  He is a mouth breather so seems to do better  with full face mask, he enjoys the pillows, but they seem to make his nose itch.  The longest length of time he has worn his CPAP continuously is 2 hours.  Then he wakes up in a complete groggy state pulls it off and isn't awake enough to put it back on, even with assistance.  Total he wears it approx. 3-3.5hrs per night.  Am I expecting too much, by hoping that he would be wearing longer by now?  He does usually wake up 2-3 more times throughout the night and will place himself back on the machine.  I think there is a possibility that he needs more pressure than 5.  He has only had his 1st night study done, wondering about an auto titrating machine?

My daughter had immediate improvement when she started -- but she wears the mask continually, about 10 hours a night, so she was getting the benefit of better sleep from day 1.  It's hard to say if an auto titrating machine will be much help unless he can sleep longer with the mask.  Even the auto machine will start at 4 or 5... and increase as needed.  My daughter requires 20+ pressure about 90% of the time, and that is  A LOT of wind blowing in her face... but when she starts off at night she's only at 7 and falls asleep easily.   I'm no authority on the subject, but I think trying to keep it on him for longer periods of time at 5cm is a good start.  It may be that 5cm is TOO much pressure when he first falls asleep...  If he requires higher pressure (which the auto machine will deliver, as needed), he will have an even harder time keeping it on if he's struggling with 5cm.  Having said that, I do wish that we had done a titrated study much earlier in the process -- my daughter was at 6cm for a year, then up to 7, 8, 9 etc because they were basically guessing at the pressure.  When they finally did a 5day home titrated study they learned that she needed 20+cm and still has apnea... but I honestly don't think we would have been successful with those high pressures, had she not had the time to adjust to the lower pressure.  With a titrated study (at least ours), they still need the 8 or so hours of compliance to determine the best pressure settings.   BTW, I don't know how the nasal pillows work because our doc didn't want her to use it because he thought there would be too much wasted air.  When she has a poor fit on her mask she gets itchy eyes from the leaking air.  Could that be making his nose itch?  Are there other masks your DME provider can suggest? I'm going to try to post a picture of the mask my daughter wears.  She just recently started wearing this and likes it much better than her last mask because it doesn't have a forehead piece.  The mask is called mirage kidsta.  If the picture doesn't show up, I'll be happy to e-mail it to you to see if this is something that might work for your son.
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I think that your son wearing the mask for three hours in the first week is great! Hannah (who is also eight) wore hers for about three -four hours a night for about the first two or three weeks. Gradually it got to be more time. She has been on it about four months now and is pretty much fully compliant. She still has occasional nights where she rips it off her face but that is even getting less and less. I think the first month or so was the hardest and then we started working out all the glitches and now have it down to a science. It takes time.Even adults have issues getting used to the whole thing.Hannah has a full face mask and I do worry about aspiraton too, but she is a major mouth breather. Even though she is eight I am keeping a baby monitor on her and a night vision camera - just so I can see if she needs help quickly.


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Heather-Mom to Hannah(8-hose head) and Logan(4), wife to Paul (also a hose head)

Good to hear that it takes a while to adjust...  I can't even imagine if I had to start my daughter on it NOW; she was a lot easier to "manipulate" at 4 years old than at 8 yo!!   I would imagine that the older they start, the longer the adjustment period.  

I sometimes wonder if we'll EVER get rid of that baby monitor!