Spring 2010 - SSM Cardinal Glennon Children's Medical Center

10
Mekhi Stokes, 5, rests his head against his mother,
Tankya Hilliard’s shoulder.
“Are you tired” asks board certified Sleep Medicine specialist
Shalini Paruthi, M.D., and Mekhi brightens with a smile.
Mekhi has been visiting SSM Cardinal Glennon since 2007,
and he is getting results. After his first sleep study, he had his
adenoids and tonsils taken out and his nose passages shrunk.
He then had a follow-up sleep study in May 2009.
Mekhi no longer wakes up in the middle of the night from
night terrors, he hasn’t complained about his legs feeling tingly
and his snoring has greatly subsided, Hilliard says. Today
Dr. Paruthi reviews his medications and recommends a sinus
wash to help his runny nose.
Mekhi is one of several children seen by the Sleep Services
team, which is led by Co-Directors Dr. Paruthi and Glen Fenton,
M.D. Since Dr. Paruthi joined Cardinal Glennon in the
fall of 2008, the three-bed Sleep Lab has upgraded all of its
equipment, and the Sleep Center received accreditation from
the American Academy of Sleep Medicine in the summer of
2009.
Cardinal Glennon’s Pediatric Sleep and Research Center is
the only accredited and entirely pediatric-focused program
in Missouri, helping patients from age 1 day to 22 years.
With the accreditation, the Sleep Center can now guarantee
patients the highest quality of care for all sleep disorders
including:
Living With
Sleep Disorders
Shalini Paruthi, M.D., helps Mekhi Stokes, 5, listen to his heartbeat during his Sleep Services appointment
in January. The SSM Cardinal Glennon Sleep Center has helped Mekhi with night terrors, restless
leg syndrome and snoring.
Insomnia: Two main types: (1) difficulty falling asleep or (2)
difficulty staying asleep. Insomnia causes and treatments vary
by age. For younger children, bedtime routines, regular bedtimes
and wake times and special techniques can help. Older
children can use strategies to help them relax. Medications are
used when necessary.
Sleep Apnea: 3 to 5 percent of children have obstructive sleep
apnea, in which a blockage of the airway exists during sleep,
often due to large tonsils and adenoids.
• Night time symptoms: snoring, breathing pauses,
sweating, tossing and turning or bedwetting.
• Daytime symptoms: hyperactivity, headaches,
heartburn/reflux and excessive daytime sleepiness.
• Treatment may involve outpatient surgery to remove
adenoids and tonsils or the use of a CPAP (Continuous
Positive Airway Pressure) machine when sleeping.
Restless Leg Syndrome: Occurs in 2 percent of children and
is a significant contributor to insomnia. It is often confused
with growing pains. Children often describe pain or sensations
in their legs at bedtime or during the night, saying it
improves with movement or rubbing the legs, and is worse
with inactivity. Often due to low iron stores in the body and
can be treated with iron supplementation. Caffeine intake or
vigorous exercise can worsen condition.
Night Terrors and Nightmares:
Terrors: Children appear awake, but are asleep as they run,
kick and scream through the house. Episodes typically occur
during partial awakenings/arousals from sleep. Treatment
focuses on the underlying cause of the arousal, such as sleep
apnea or restless leg syndrome. Parents should make
the house safer by removing sharp corners and
using door alarms.
Nightmares: Typically happen in later hours of
sleep and most children remember them vividly. If a
particular dream recurs, imagery rehearsal is recommended,
in which the child and parent talk about
the bad dream(s), and come up with alternate,
satisfactory endings. This is done for 10 to 15
minutes before bed for four weeks.
Narcolepsy or Other Hypersomnias:
Narcolepsy is now understood to be an autoimmune
disorder, with an environmental trigger and a
peak incidence near 15 or 16 years of age. It can be
diagnosed and treated successfully in most children
using lifestyle modifications and stimulant medication.
Watch Dr. Paruthi’s Sleep Services presentations on
Pediatrics on Demand and earn CME credit.
www.PediatricsonDemand.com
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