As an overview of Part I and Part II, we shared some of the signs and symptoms as well as the factors and origins of sleep disorders and sleep apnea. Problems with cognitive functioning and neurobehavioral performance can develop if sleep disorders are overlooked and could be misdiagnosed as ADHD behavioral difficulties, while sleep apnea can continue to cause physical and emotional harm to a child such as obesity, diabetes, and depression.
This final portion of the series is to share treatment options that parents can consider and discuss with their child’s healthcare provider who may give a diagnosis of ADHD. There are alternative avenues to consider for treatment and there is an increasing need for healthcare and childcare providers to work with one another to evaluate all best options to provide treatment.
The key to appropriate treatment and therapy is identification of the type of sleep issue. This may entail a detailed history and examination by the treating physician and may require a polysomnography or a sleep study. Surgery and pharmaceuticals should be considered only as a last resort.
Below is a list of various treatment options:
- Oral Appliances
- Positive-Pressure Ventilation (CPAP)
- Nasal Strips
- Sleeping Position
- Nasal Fluticasone
- Nasal Steroids
- Tongue Reduction
- Bariatric Surgery
- Weight loss and exercise should be included for patients who are overweight or obese.
Dr. Steven Y. Park, an otolaryngologist and sleep medicine physician says, “Although adenotonsillectomy is the No. 1 recommendation by most pediatricians, sleep doctors and otolaryngologists, research shows that overall ‘success’ is 60-80% over the short term, with no good studies long-term.” Surgery for children who are obese is not usually sufficient - tonsillectomy cures only about 50%.
If weight is not an issue, the skeletal structure needs to be evaluated because children with sleep apnea tend to have smaller jaws than average, and the tongue may be too large for the jaw space. This is where the dentist is a critical member of the sleep medicine care process along with the primary care providers to ask parents whether their child snores.
Continuous positive airway pressure (CPAP) is generally prescribed as the first treatment for sleep apnea but he compliance levels are drastically low, and essentially ineffective because the patient stops using it due to discomfort.
Oral Appliance Therapy (OAT) is a logical and effective alternative because of its comfort, convenience, and mobility. There are also orthodonic treatment methods such as mandibular advancement device (MAD) or the tongue retraining device (TRD). MAD lowers the jaw forward and down slightly, which keeps the airway open during the night. The TRD is a splint for the tongue, holding it in place to keep the airway as open as possible. “Functional orthodontics can be started in school-aged years to not only straighten teeth, but also to enlarge the jaws and the airway,” Park said. “Palatal expansion is another option for some children.”
It is critical that primary care providers and pediatricians to work together with other healthcare professionals that a child has in order to work as a team to thoroughly evaluate and consider all possible underlying issues when reviewing ADHD symptoms before making a diagnosis. They should rule out other possible issues that could mirror ADHD symptoms and it is imperative to take a holistic approach when treating and diagnosing childhood disorders to more accurately and precisely determine and treat root causes rather than individual symptoms. Speak with your pediatrician or primary care provider if your child experiences signs of sleep apnea or behavioral problems hyperactivity.
Co-authored with Lily Mai
The information provided is for general knowledge and discussion about medicine, health and related subjects. The words and other content provided in this article and any linked materials, are not intended and should not be construed as medical advice.