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Christina Lundquist didn’t understand it.
Her son, Parker, was falling asleep in the car. He couldn’t stay awake during movies. He was failing his third-grade classes.
“His grades did not reflect what we saw his potential would be,” she said. “And I guess that’s kind of where I thought something was wrong.”
Parker’s school thought he might suffer from attention deficit disorder, better known as ADD, but Christina disagreed. She used to work in a hospital and the symptoms didn’t align with her understanding of ADD.
Christina and her husband, Phillip, paid for private testing.
“The psychologist doing the testing said, ‘His IQ did not come back as high as we were expecting. I’ve seen this in the other kids that have sleep apnea,’” Christina recalled.
The psychologist referred the family to John Schuen, MD, a pediatric pulmonologist with Spectrum Health’s Helen DeVos Children’s Hospital, for further testing. Sure enough, a sleep study showed Parker had sleep apnea.
Dr. Schuen recommended two things: surgically removing Parker’s uppermost tonsils, called adenoids, and putting Parker on a CPAP, a machine that helps certain patients sleep.
“His grades went from failing to straight A’s,” Christina said. “His brain was really shutting down from being so tired, so fatigued. …Within a week of being on CPAP, he was like a brand new kid.”
What is sleep apnea?
Sleep apnea is a disorder in which the patient’s breathing stops and starts throughout the night, which disrupts sleep. It affects children and adults in different ways: Children often experience behavioral issues, and adults often struggle with daytime fatigue.
“Clues that give parents a hint is kids’ snoring, gasping, pausing when they breathe, mouth-breathing, odd noises in the middle of sleep like coughing or choking … unusual noises like that,” Dr. Schuen said. “Sometimes there are morning headaches. When I say morning headaches, I mean they have headaches that wake them up in the middle of the night or upon waking up right away in the morning.”
There are two types of sleep apnea, Dr. Schuen said. Central sleep apnea is when the brain doesn’t tell the body to breathe.
The more common version, obstructive sleep apnea, is when the patient tries to breath, but something is blocking or obstructing the airwaves. Hence, the name.
About 10 percent of children struggle with persistent, nightly snoring, a sign of sleep apnea. About 3 to 5 percent have obstructive sleep apnea, Dr. Schuen said.
“When kids have obstructive sleep apnea, the most common reason behind the apnea is large tonsils and adenoids,” Dr. Schuen said. “Tonsils and adenoids look like golf balls in the back of your throat. The adenoids, (the uppermost tonsils), sit right above roof of your mouth. You can’t see them without special tools.”
Obesity, which leads to rings of fat in the throat or chest, can also cause obstructive apnea, Dr. Schuen said. But that didn’t apply to Parker.
When children exhibit possible symptoms of apnea, Dr. Schuen orders a sleep study.
“The study is this: We have specially designed rooms to help promote a good night’s sleep and let parents sleep next to the child in the same room,” Dr. Schuen said. “In the pediatric sleep laboratory, our sleep tech places different gizmos and gadgets on the infant or child or teen that let us assess what’s going on during sleep. During the course of the sleep study, we’ll measure an amazing amount of information: 16 different channels look at brain waves, the stage of sleep, how often they wake up, when they wake up, oxygen and carbon dioxide levels, and the sleep positions they’re in when possible apnea events occur.”
“And if they’re not breathing properly, we can determine the type of apnea and how often these events occur.”
Normal people tend to have four to six sleep cycles per night and will wake in between, Dr. Schuen said, but “you’re only awake a millisecond and don’t fully appreciate the fact that you’re awake—then, boom, back to sleep.”
But those with moderate sleep apnea can awake five times per hour, while severe sufferers can have 10 or more micro-arousals per hour.
“With apnea … particularly in kids, they might not always even awaken from sleep,” he said. “But because their oxygenation may suffer, their carbon dioxide levels may rise, or they may just shift their stage of sleep. It deprives them of good sleep.”
Sleep is closely tied to IQ and brain function. A recent study showed that kids who ate seafood slept better, and then performed nearly five points better on IQ tests.
During the daytime, kids who suffer from OSA may include “academic difficulties, problems paying attention, impulsivity and rarely, sleepiness,” Dr. Schuen said.
‘A dramatic improvement’
The sleep study showed Parker suffered from moderate to severe sleep apnea.
In July, Parker had his adenoids removed—“the typical solution,” Dr. Schuen said—but his apnea didn’t improve. Parker still struggled with focus issues and his behavior late in the day deteriorated.
Dr. Schuen ordered a second sleep study in September, which showed Parker still suffered from obstructive apnea.
He decided to put Parker on CPAP, a machine with a nasal mask that’s held in place by headgear. The mask is hooked up to a hose, which pushes air through the lungs and opens up the airways while the user sleeps.
The results for Parker were nearly instantaneous. Within a week, Christina said, Parker’s academic performance and attitude changed.
“He’s just a better child all the way around,” she said. “His behavior is better. He was acting out during that time, and that’s gone away. He was having some anger, especially toward the evening, and that has gone away. He’s sleeping all night long. Before he’d get up several times a night, but not anymore.
“And he can tell, if he goes somewhere and can’t use the CPAP, he comes home and says, ‘I need to wear the CPAP.’ He can tell the difference.”
Parker shared that he often fell asleep in class and couldn’t pay attention.
“I was so tired all the time,” he said. “Now I can stay focused longer. … I can concentrate for an hour now. It used to be 10 minutes.”
Parker loves extreme mountain biking with his father. He enjoys math and gym class. He can tell his body has changed with better sleep.
“I like gym because we get to run around and do fun stuff,” he said. “But I couldn’t really run as fast as everybody because I was so tired.”
Christina, who also suffers from sleep apnea, uses a CPAP machine just like her son. She notices similar improvements when wearing it.
“When I do wear it, I feel like I have more energy,” she said. “When I don’t wear it, I’m really cranky in the morning, even after a full night’s sleep.”
Parker says it’s a relief to no longer struggle in school.
“It made me feel really happy that I’m actually good at something,” he said. “Because I didn’t get much sleep, I couldn’t focus. It was messing me up.”
Learn more about the nationally-recognized pediatric pulmonology and sleep medicine program at Spectrum Health Helen DeVos Children’s Hospital.
By Dixie Sandborn, Michigan State University Extension
