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SickKids program aims to eliminate sleep problems bedevilling kids

Epidemic of sleep apnea related to obesity and a risk of heart disease, demands an urgent response.

Sleep technician Jeremy Gibbons gives a sleepy Shy'n Leon a pat on the head as she begins a polysomnogram, or sleep study. (Steve Russell / Toronto Star) | Order this photo

Sleep technician Jeremy Gibbons places a mesh hood over a sleepy Shy'n Leon to keep all the sensors in place as she sleeps. He's getting her ready for a polysomnogram, or sleep study. (Steve Russell / Toronto Star) | Order this photo

“No,” Gibbons reassures her. “Remember from last time? Just tapes and stickies.”

Half an hour later, Shy’n’s eyes are heavy and she looks “like a robot” Gibbons informs her, a sleepy robot with wires connected to two thick belts around her middle, with more wires taped to her legs, a monitor on her big toe, and half a dozen or so wires in her hair with a net covering to keep it all firmly in place in case she rolls around in her sleep.

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She will sleep, eventually — after some coaxing, a bit of TV and a juice box — and while she does, SickKids will gather valuable information.

By monitoring Shy’n and other children for eight to 10 hours overnight as part of a polysomnogram, or sleep study, doctors can tap in to what it is that makes them lethargic, cranky, anxious and sometimes obese.

They can help treat kids who suffer from sleep apnea (where the childrens’ breathing pauses, often taking them out of a deep sleep), respiratory failure and sleep related behavioural problems.

“At the core of all that is sleep,” says Dr. Indra Narang, director of sleep medicine at the hospital. “People have so many social demands, sleep is not given the priority it should.”

It’s a simple message, Narang says, but it’s one that still astounds.

When Gibbons asks Loyarl Leon, Shy’n’s mom, how much sleep the kindergartener gets, she answers eight to nine hours. Shy’n is finicky to get to bed, her mom says, and doesn’t usually sleep until around 10 p.m. “Tired is her middle name,” she adds.

Adolescents sleep an average of two hours less than they did 20 years ago and suffer from sleep problems, such as sleep apnea, which in turn cause other health issues.

In trying to keep up, the SickKids’ program is swamped.

They see four kids every night, seven nights a week. It’s double the number they used to see, but its going up yet again to six kids a night as the hospital hopes to cut the waiting list down from nine months.

Typical referrals range anywhere from “this child is snoring and stops breathing at night,” Narang says, to “this child is obese, snoring, gasping at night and is sleeping excessively during the day and can’t function.”

By using the wires to track carbon dioxide levels, oxygen saturation, brain waves, chin muscle movement and more, the clinic can make a huge difference, she says.

In younger kids such as Shy’n, adenoids and tonsils can cause the sleep issues and while removing them is usually the solution, most doctors won’t operate on young children without a referral from the clinic, Narang says.

Shy’n is several months post-surgery and sleeping better, Leon says. She’ll come back every six months to a year to check in.

Sleep technician Jeremy Gibbons places a mesh hood over a sleepy Shy'n Leon to keep all the sensors in place as she sleeps. He's getting her ready for a polysomnogram, or sleep study. (Steve Russell)

Many of the other patients SickKids sees are obese. Sleep apnea is a common complication that adds to the issue, Narang says.

“If you sleep badly, your body doesn’t feel refreshed, and you feel very tired during the day, and being tired stimulates different hormones, hormones that make you want to eat,” she says.

After being fitted with a machine that helps pump oxygen to maintain better levels of the gas, one boy lost 25 pounds, because he had the energy to eat well and exercise, Narang says.

“We have to get on top of this epidemic,” Narang says. “Long-term sleep apnea is linked with an increased risk of death from heart disease.”

But even as the program and the need for it grow, there’s still a struggle to get people to understand the importance of sleep medicine, Narang says.

“It’s partly due to a lack of awareness. Even my colleagues who do (adult) sleep medicine find it hard to believe children can have similar sleep disorders.”

It’s something she’s trying to change.

SickKids hosted two separate pediatric sleep symposiums in 2011 and 2013 showcasing the benefits the clinic has had and encouraging others to follow suit and Toronto is a world leader in sleep medicine with more than 70 sleep labs in the city, the highest concentration in the world.

“All this has been slow,” she says, “but it’s certainly happening with vigour now.”

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