Restorative sleep, a crucial, yet often overlooked element of health, has a profound impact on children’s cognitive, emotional, and physical well-being. The Pediatric Sleep Disorders Center at Arkansas Children’s Hospital (ACH) has dedicated over 40 years to researching, analyzing, and treating pediatric sleep disorders. Dr. Supriya Jambhekar is the Medical Director of the ACH Sleep Disorders Center, ensuring every child has the opportunity to achieve optimal health through the transformative power of sleep.
Common Types of Pediatric Sleep Disorders
There are several different types of pediatric sleep disorders, many of which involve trouble staying or falling asleep.
“Inadequate sleep is especially common in teenagers,” Dr. Jambhekar says. “Poor sleep, which involves difficulty initiating and maintaining sleep, also referred to as insomnia, is also fairly common.”
Other sleep disorders include obstructive sleep apnea (OSA) and parasomnias, such as sleepwalking, night terrors, and confusional arousal. Hypersomnia, or excessive daytime sleepiness, which could be primary or secondary, is also common.
“Hypersomnia could be secondary to multiple other conditions or reasons,” Dr. Jambhekar explains. “This could be inadequate nighttime sleep, other sleep disorders including OSA, and a condition called delayed sleep phase syndrome, among others. Narcolepsy and idiopathic hypersomnia are two disorders associated with primary hypersomnia.”
While there are no widely published numbers for pediatric sleep disorders in Arkansas, 34% of children in the U.S. suffer from sleep disorders. “We could assume the prevalence in Arkansas is roughly the same,” Dr. Jambhekar says. “OSA is more common in obese children and adolescents. Given the high prevalence of obesity in Arkansas (ranked 12th out of 51), it is very likely that we have a high prevalence of OSA in the state.”
Sleep: The Cornerstone of Well-Being
Sleep affects many of our other bodily functions, including:
- Wakefulness
- Attention
- Focus
- Memory
- Learning
- Mood
- Behavior
- Metabolism
- Hunger
- Hormonal imbalance
- Immunity
“Sleep disorders, including OSA, are associated with symptoms of ADHD, poor school performance, memory loss, mood disturbances, behavioral problems, and worsening of psychological and psychiatric symptoms,” Dr. Jambhekar adds. “Sleep disorders are also known to worsen diabetes, hypertension, cardiac issues, headaches, and seizures. OSA is also known to make nocturnal enuresis worse.”
Inadequate sleep is also known to affect immunity, including response to vaccines, and to be associated with obesity.
A 40-Year History of High-Quality Care
Dr. Debby Fiser founded the Pediatric Sleep Disorders Center in 1983. At the time, it was known as the Apnea and SIDS Center. Since June 25, 1987, the Center has maintained full accreditation from the American Academy of Sleep Medicine (AASM), demonstrating its position as the premier pediatric sleep center for the state of Arkansas.
“The AASM standards for accreditation have been the gold standard by which the medical community and the public evaluate sleep medicine facilities,” Dr. Jambhekar says. “Achieving AASM accreditation demonstrates a sleep medicine center’s commitment to high-quality, patient-centered care through adherence to these standards.”
Undergoing a Sleep Study
Sleep specialists typically diagnose sleep disorders via a sleep study, a unique type of test that involves patients sleeping through the night in a temperature-controlled room. Dr. Jambhekar explains the process:
“Once a sleep study is ordered, our schedulers work with insurance and the parents and schedule the study. The parents are sent multiple reminders regarding the study and instructions regarding how to prepare. The patient arrives with a parent at the registration. Our sleep technician will pick up the patient and parent and escort them to the sleep lab. They are then taken into their room, and hook-up (i.e., application of all equipment) is performed. The patient sleeps in the room. The accompanying parent sleeps in an adjoining room. They are woken up, and the equipment is disconnected. Then, they go home.”
The ideal temperature for the sleep lab is between 65–68°F (or up to 69°F in infants). Too cold for you? Well, there’s actually a fascinating reason why the rooms are kept this cold. It all comes down to your circadian rhythm.
The Cool Side of Sleep Science
“Thermoregulation during sleep is a crucial factor for sleep quality. The sleep cycle is regulated by the circadian rhythm,” Dr. Jambhekar explains. “The circadian rhythm is based on the light-and-dark cycle of the sun and controlled by the part of the brain called the suprachiasmatic nucleus, located in the hypothalamus. This master ‘body clock’ gets its cues from a number of environmental and personal factors, including the amount of exposure to light, exercise, eating pattern, work, and, of course, temperature.”
A healthy body temperature is typically around 98.6°F, but your body temperature can fluctuate by about 2° throughout the night. “The drop in temperature starts around two hours before going to sleep (around the time the sleep hormone melatonin is released),” Dr. Jambhekar says.
“During sleep, body temperature continues to fall, reaching a low point in the early morning and then gradually increasing as the morning progresses. Lower room temperatures at night can help these natural temperature variations.”
Thermoregulation is like gardening. You must create the right environment for seeds to germinate. Just as seeds require the right conditions to start the germination process, your body needs a cooler environment to signal that it’s time to enter into a deeper, more restorative type of sleep. Lowering the temperature of the sleep lab is like preparing the soil with the right conditions for germination.
“The body cools down during sleep by transfer of heat away from the core,” Dr. Jambhekar says. “Cooler surrounding temperatures help this while warmer temperatures make this more difficult. Sleep quality and time spent in different sleep stages are also affected by the temperature. Warmer temperatures can lead to difficulty falling asleep or disturbed, uncomfortable, restless sleep and may cause a reduced amount of restorative sleep.”
What Do You Actually “Study” During a Sleep Study?
To put it simply—sleep! At ACH’s Sleep Center, sleep studies are typically done to look for sleep apnea. “Thus, during a sleep study, we primarily measure the following:
- Airflow (via nose and/or mouth)
- Electroencephalography (EEG) for sleep staging
- Electrooculogram for eye movements, which helps to stage REM sleep
- Chest and abdominal wall movement to differentiate between obstructive and central apneas
- Pulse oximetry for oxygen saturation
- End-tidal CO2 levels to look for ventilation and serve as an additional flow channel for children
- Electromyography (EMG) in the legs for leg movements
- EKG
- Video recording of the patient”
Preparing for a Sleep Study
Typically, very little prep is needed for an outpatient sleep study or polysomnogram. “Essentially, it is as if the patient is coming in for a sleepover,” Dr. Jambhekar says. “We send instructions about what to do before you arrive, such as eating, limiting caffeine intake and daytime naps, and bringing items that make you feel comfortable.”
Most of the preparation occurs at the sleep center. Sensors and belts are applied to the patient to monitor brainwaves, muscle tone, breathing, heart rate, heart rhythm, and leg movements. “We ask that the patient and parent watch a video that shows the hookup process to help them become more comfortable with the procedure,” Dr. Jambhekar adds. “They are encouraged to ask any questions they have regarding the study before they arrive.”
Sometimes, patients may be unlikely to tolerate a polysomnogram and may not feel comfortable with all of the hook-up elements. This may particularly occur in those who have developmental delays or autism. To help with situations like this, the Pediatric Sleep Disorders Center offers polysomnogram desensitization.
“This is a way for children and parents to work with our sleep psychologist to practice having some of the sleep study equipment placed on them, which will hopefully result in their better tolerating a future polysomnogram.”
Sleep Study Scoring
At the Pediatric Sleep Disorders Center, the sleep study is first scored by a sleep technician. The reporting physician then reviews it in detail. The report is then sent to the ordering physician, who contacts the patient/parent regarding the care plan.
“Occasionally, when the sleep study shows severe findings, the patient has been referred from our sleep clinic; we may hold back the patient for further management, especially if they are traveling from far away. Sleep studies that show severe abnormalities are usually scored as urgent, and the ordering physicians are sent urgent messages regarding these findings,” Dr. Jambhekar says. “Very rarely, a patient may require inpatient management for the sleep issue.”
Sometimes, abnormalities or scans may also require further monitoring or neurology clinic evaluations to define the abnormalities.
State-of-the-Art Sleep Studies
The Pediatric Sleep Disorders Center offers many other sleep studies typical of other centers across the U.S., including diagnostic tests, oxygen and ventilator titration, and multiple sleep latency tests (MSLTs). However, it offers a few services not available in many other sleep centers.
“We have two dedicated RTs that work with patients seen in the sleep clinic for positive airway pressure or PAP use. This is a service that is not available in many sleep clinics,” Dr. Jambhekar says. “We also have a CPAP adherence program where an RT and a psychologist work closely with the patient and parent to help with adherence to PAP use. This is a state-of-the-art program not necessarily available in all sleep centers.”
The sleep center also has the capacity to send patients home with actigraphy watches that track sleep at home. The sleep lab can also be used to perform car seat challenge tests.
Final Thoughts
Despite sleep’s critical role in health and functioning, sleep problems in children are highly underdiagnosed. It is important that all children and adolescents get adequate and healthy sleep. Therefore, it is extremely important that during health maintenance visits, providers screen for sleep disorders with available tools and take a basic sleep history.
“Providers can contact the sleep center if they believe that their patients need an urgent evaluation. Almost every time they call, we work in these patients,” Dr. Jambhekar says. “Providers are also welcome to order polysomnograms if there is any concern for OBA; however, we would recommend referring for an evaluation in our clinic rather than ordering polysomnogram for any other sleep concerns, as polysomnogram is not the best initial evaluation for other sleep complains.”
The ACH Pediatric Sleep Disorders Center currently consists of a clinic staffed by two board-certified pediatric sleep physicians, two APRNs, one sleep psychologist, two respiratory therapists working in the clinic, and two daytime sleep technologists scoring sleep studies in the sleep lab during the day. The sleep lab consists of five beds and operates seven nights per week except on holidays.
“We have eight full-time and five prn night-time sleep technicians. We are currently only performing sleep studies in the ACH Little Rock location but have hopes to open two beds in our ACH Northwest location, too,” Dr. Jambhekar says.
For more important healthcare topics, follow AFMC on Facebook, Instagram, LinkedIn, X, and YouTube.
Subscribe to our newsletter for the latest news and updates, including the most recent episode of AFMC TV.
Meet Dr. Jambhekar
Dr. Supriya Jambhekar is a Professor in the Department of Pediatrics at UAMS and Medical Director of the Arkansas Children’s Hospital’s Pediatric Sleep Center. With a background in Pediatric Pulmonology and Sleep Medicine, she has dedicated her career to managing pediatric patients with sleep disorders.