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Solving Sleep Disturbances in Children and Teens

New Pediatric Sleep Center Opens in New York City

NEW YORK (Apr 3, 2012)

Haviva Veler, M.D.
Haviva Veler, M.D.

Sleep-related issues are among the most common issues parents deal with on a daily basis. "Many of these issues are more behavioral in nature – babies who don't sleep through the night or toddlers who refuse to go to bed," says Haviva Veler, M.D., Director of the new Pediatric Sleep Center at NewYork-Presbyterian Phyllis and David Komansky Center for Children's Health/Weill Cornell Medical Center, and an expert in sleep medicine.

"Later on, many adolescents suffer from excessive daytime sleepiness, mostly because of sleep deficiency and delayed sleep phase syndrome," says Dr. Veler. During adolescence, adult-like sleep disorders start to emerge. These include insomnia, narcolepsy, and restless leg syndrome. Many sleep disorders are organic and relate to breathing at night, such as obstructive sleep apnea."

Sleep Apnea in Children

Snoring is the most common symptom in children with obstructive sleep apnea. "About one in 10 children snores at night," says Dr. Veler, "but only one to two children who snore will have sleep apnea. Sleep apnea is more likely in children who snore very loudly or who snore every night, not only when they are sick or congested. Other nighttime signs of sleep apnea are breathing difficulties or even choking. Some parents actually see pauses in their child's breathing."

Children with sleep apnea wake up frequently during the night. According to Dr. Veler, "They don't know why they wake up, but their sleep is interrupted and therefore they are tired during the day. Some children can have enuresis (inability to control urination) as a result of sleep apnea, causing them to wet their beds until a later age."

The most common treatment for obstructive sleep apnea is surgical removal of the tonsils and adenoids, if appropriate. Other treatments may include the use of CPAP (continuous positive airway pressure) – a mask worn over the nose and/or mouth while sleeping to help the child breathe more easily during sleep.

Children with syndromes that affect their facial size, such as Down syndrome, children with a history of lung or neuromuscular disease, and those who are obese are among those at higher risk for sleep apnea.

Lack of Sleep and Learning Disabilities, Other Impacts

Dr. Veler also examines the daytime consequences of sleeplessness. "Is the child sleepy during the day or is he hyperactive?" she asks. "When young children are tired they don't slow down or fall asleep as is seen in adolescents and adults. Rather, they will become restless and be unable to concentrate – behavior that is very similar to hyperactive disorders. Sleep apnea is very prevalent in children with attention deficit hyperactive disorders, or ADHD, and in children with both sleep apnea and ADHD, treating the apnea can improve their behavior."

Disturbed, fragmented, or lack of sleep can impact a child's daytime alertness, concentration, and behavior. "Sleep disorders can cause daytime dysfunction in children, and can lead to learning disabilities at school," notes Dr. Veler. "It is extremely important to obtain a diagnosis and begin management of sleep problems early on in order to avoid consequences that can impact the child's future."

Pediatric Sleep Medicine: Care Tailored for Children's Unique Needs

According to Dr. Veler, sleep disorders in children are very different than adult sleep disorders. It is important for parents to consult a pediatric sleep specialist for optimal care. "For example, pediatric obstructive sleep apnea – an obstruction of the upper airway –differs completely from adult apnea," says Dr. Veler. "In adults, the most common reason for sleep apnea is usually related to obesity. In children, the most prevalent reason for sleep apnea is enlarged tonsils and adenoids. Younger children with sleep apnea can actually be underweight because they work very hard to breathe at night. Moreover, the treatment for childhood sleep apnea is significantly different than what is acceptable in adults. Because of their developing brain and the significant consequences of sleep apnea, management is indicated in children with milder stages of sleep apnea."

The Pediatric Sleep Center also focuses on the environmental needs of young patients. Room details are designed with children in mind, from furniture choices to color schemes. Providing kid-friendly distractions such as DVD players and WiFi availability are an important part of making children and their families feel "at home." Each patient's room includes a private bathroom, and a bed that is age-appropriate.

Sleep Studies: What to Expect

At the Pediatric Sleep Center, a diagnosis begins with a comprehensive sleep history and physical examination. The definitive diagnosis is done by polysomnography, also known as an overnight sleep study.

In a sleep study, leads – or little stickers – are placed at various points on the child's body to monitor sleep quality and structure, the effort of breathing, oxygen saturation and carbon dioxide levels, as well as heart rhythms, muscle tone, and leg movements. No needles are used; the study is painless.

The children's sleep study takes place in a warm and cheerfully decorated room equipped with relaxing amenities. Parents are invited to stay overnight with their child, while technicians monitor the child continuously and also provide one-on-one care for physical and emotional support. "The parent's role is important," says Dr. Veler. "Parents provide a source of comfort and give the child a sense of security. If their child has a blanket that they fall asleep with or a favorite video, the parents are asked to bring them in as well."

Prior to the sleep study, the sleep team explains what is involved to the parents and their child to help with their expectations and minimize any anxiety over the study. Children usually fall asleep readily and sleep throughout the night regardless of having leads attached to them and sleeping in a strange environment.

The Pediatric Sleep Center: Comprehensive Care for Children and Teens

At the Pediatric Sleep Center, Dr. Veler and her team diagnose and care for infants, children and adolescents with any type of sleep disorder, including:

  • Sleep-disordered breathing/snoring
  • Apnea of infancy
  • Behavioral problems (bedtime struggles, night wakings)
  • Parasomnias (sleep walking, sleep terrors)
  • Narcolepsy
  • Circadian rhythm disorders (delayed sleep phase syndrome)
  • Movement disorders (periodic limb movement disorder, head banging)
  • Upper airway abnormalities

The Pediatric Sleep Center also address breathing problems that occur at night that are secondary to an underlying disease, such as muscle weakness or chronic lung disease, which can cause shallow breathing and low oxygen levels at night.

The Pediatric Sleep Center collaborates with a wide range of pediatric specialists to address the needs of children with sleep disorders. Affiliated with NewYork-Presbyterian Phyllis and David Komansky Center for Children's Health – a leader in children's health – the Center has access to top-ranked pediatric pulmonologists, pediatric otolaryngologists (ear, nose and throat specialists), pediatric neurologists, and child psychologists. Dr. Veler and her colleagues develop individualized treatment plans that can include devices that support breathing during sleep, medications, surgery, and/or behavioral therapy. The Center's staff provides comprehensive follow-up with patients and coordinates care with the child's primary physician.

Dr. Veler is board certified in pediatrics, pediatric pulmonology, and sleep medicine, and is an Assistant Professor of Pediatrics at Weill Cornell Medical College.

Contact the Pediatric Sleep Center

To schedule an appointment or refer a patient, please call (646) 962-3410, or visit the Komansky Center for Children's Health website at nyp.org/komansky.

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