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Sleep apnea and impulse control-hyperactivity issues in 3yo

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Sleep apnea and impulse control-hyperactivity issues in 3yo

Postby tpendleton » Fri Jan 23, 2009 12:27 am


I just found this forum, I'm so glad to read other stories. I have been getting bits and pieces of info from the web and my docs but we are still in the discovery process for the extent of my 3yo daughter's sleep apnea. She's had one sleep study and was diagnosed with severe OSA, she's already had her tonsils and adenoids removed. Her sleep improved from where she started (multiple night wakings, night terrors, impulse control problems etc). We are scheduled for a follow up sleep study due to recent concerns the surgery did not resolve her problem completely. Post surgery, she has had at least one episode of blue lips in the morning which my ENT says he does not believe is sleep apnea related due to the lips staying blue longer than a few seconds after her becoming awake, and impulse control, behavioral problems. Most recently tonight, she had another episode of night terrors.

All that and my main questions right now are:

What kind of Drs. should we be seeing, we are currently seeing only our Pedi and ENT.

How do we address the daytime affects of this disorder (impulse control issues etc.) while we are trying to resolve the sleep issue? Hopefully some of you have some insight on this b/c I have not found anything of value on the web and my ENT only says it should resolve when we get the sleep issue resolved.

Any other info you may want to share is greatly appreciated.

Thanks for reading and best wishes for you and your kidlets as you deal with this.
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Re: Sleep apnea and impulse control-hyperactivity issues in

Postby ApneaKiwi » Fri Jan 23, 2009 4:32 am

tpendleton wrote:What kind of Drs. should we be seeing, we are currently seeing only our Pedi and ENT.

How do we address the daytime affects of this disorder (impulse control issues etc.) while we are trying to resolve the sleep issue? Hopefully some of you have some insight on this b/c I have not found anything of value on the web and my ENT only says it should resolve when we get the sleep issue resolved.

Hi there, I'm not up with pediatric sleep medicine, but where adults are concerned, people usually see an accredited sleep medicine doctor (traditionally these have come from the pulmonology field, sometimes known as respiratory or thoracic medicine). It may be that now the surgery has been tried, you may be able to focus on sleep medicine and the pediatrician and finish up with the ENT.

I can understand you feeling that the ENT's reassurances aren't much help in the day to day management of your daughter's behaviour. It could be 2-3 months away, which is a loooong time. The pediatrician may have particular skills in this area, or may refer you to a child psychologist or therapist. I think there is alot of value in meeting with other parents and learning the strategies they use with their kids who have similar issues. Alot of it is about providing structure and planning ahead, and keeping her safe. If you have to keep her inside with the doors and windows locked to stop her running out onto the road for a few months then so be it. Some parents of children with ongoing impulse control issues have to do this for 10 or 15 years. You may need to bring in people to supervise her for a few hours a week so the rest of the family gets a break. If she is struggling with being at a childcare centre, bring her home. A low stimuli environment is better. Don't feel you have to go to restaurants and supermarkets with her if it is going to make you tear your hair out. Keep in mind that there is age-appropriate behaviour, then there are the effects of her sleep disorder. If you find value in reading about the techniques used for kids with ADHD then that is great - it doesn't mean she has ADHD, just that her (temporary) behaviours are similar and may be manageable in much the same way. I hope that helps and that her sleep problems get resolved asap.
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Postby TiffanyAcuff » Fri Jan 23, 2009 6:07 am

I agree with some what has already been said, but here are some thoughts...

1. If her tonsils and adenoids have been removed, then there is nothing left for the ENT to help you with.
2. Find a pulmonologist or a neurologist who specialize in sleep disorders and get her in ASAP. They will be better able to help you get the root of the problem.
3. The blue lips thing is concerning and should probably have some attention paid to it by a cardiologist.
4. You will probably need to find some creative ways to deal with her behavior in the meantime. You might try working with her childcare provider to establish a VERY predictable routine, that even you can follow through with during the weekend (Obviously with some modifications...You won't have circle time in your living room)....

Your peditrician should be able to refer you to a cardiologist for the blue lips and you might have to do some research in finding a sleep disorder specialist that does pediatrics, then ask for a specific referral to that doctor.

Good luck...Keep asking questions....It's a long hard road and we've been knowingly walking it for almost 3 years now with our son and will soon be facing one with a new baby (who hopefully won't have the apnea, but no one is holding their breath on that one!!)

Tiffany, mom to a frightening intelligent 2 1/2 year old, who can't remember how to breathe once he falls asleep!!
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Thanks for the great comments and suggestions!

Postby tpendleton » Fri Jan 23, 2009 2:38 pm

Thank you all
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Postby Vicki » Fri Jan 23, 2009 5:19 pm

ADD and ADHD have a clear association with OSA in pediactrics patients. That is why you daughter's doc. said that once the OSA is under control it may very well help with the attention deficient. It is the way children react to the extreme fatigue. Read this for more info. on that subject:

ASAA information for parents

To find a doc. accredited in sleep medicine near you, contact the American Board of Medical Specialties at www.abms.org. They may even be able to help you find someone whose specialty is pediatric OSA which would be ideal.

The blue lips may not be related to OSA and need to be addressed ASAP by some other specialist.

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Postby shelee » Sun Jan 25, 2009 8:14 pm

Just a quick comment.... There are things that the ENT is able to help with other than just removal of tonsils and adenoids. Things like deviated septum, cleft palate, allergies, anatomic abnormalities, etc can be something that a good ENT can help with and can be attributing to sleep apnea. My son had a T&A at 20 months and still had an AHI of 12 2 years later. He was also "hyperactive" due to lack of good sleep and that didn't go away until we started to treat his apnea with a vpap. Night terrors can be fairly normal at that age. Did your dd only have obstructive apnea, or did she have central apnea as well?? My son was waking up like you'd mentioned immediately following a central apnea episode (usually when they were 30 seconds or longer) but I was able to comfort him and get him back to sleep. My daughter, on the other hand, would wake up screaming from night terrors and wasn't fully awake. If I tried to comfort her it made things much worse and could take 30 minutes or so to get her settled down again. I don't know the answer to he blue lips, but there are other causes besides apnea. Typically with apnea, the o2 sats drop down but then come back up quickly after a breath is taken. I don't know which doctors are best for your daughter but I can tell you that my son is followed by a pulmo, neuro, allergist, ENT and a GI for sleep issues. My daughter is followed by an allergist, ENT and a pulmo.
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Postby tatamom » Sun Jan 25, 2009 10:45 pm

How long has it been since her tonsils and adenoids were removed? It can take quite a while for them to heal completely (2-3 months or more is what we were told). I'm glad to hear that she is better than she was before and I understand your frustration at not having a complete cure.

Three year olds are in a tough spot. They are not babies nor are they school aged. Impulse control takes time to develop. Has anything else changed in her life that could contribute to her behavior? That being said, I am aware of a 3yo who is having adenoids/tonsils removed with an anticipation of better impulse control. I sincerely hope it works for this child.

Lips should not be blue unless a cupcake is involved. Someone else needs to see her for that.

My neighbor was told that her child had night terrors, when she--a ped knew bettter. It turns out that he was having night time seizures. She does need to be seen by a board certified pediatric sleep specialist if possible, and possibly a pedi-neuro as well.

Apnea in children is complex and may require a number of different specialists doing their parts to get the whole picture in focus. My daughter is followed by a pedi/pulmo/sleep doc and was followed by pedi neuro for restless leg syndrome/peroidic leg movent disorder untill he could not make any more positive contributions to her care, as well as pedi-GI and pedi ENT because her face is still growing.

Susanne and Chris -- her 9yo mini-hosehead --now on night # 469 and a lifetime to go.....
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