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Excessive Daytime Sleepiness

Understanding Excessive Daytime Sleepiness

Carrie Eichler's son was having trouble paying attention in school when he was diagnosed with Excessive Daytime Sleepiness (EDS).

"When we took him into the doctor they did some screening and told me he had ADHD," says Eichler, a mother of three from Ashland, Ohio. "It didn't seem right to me. I knew it was something else. When I began asking if the ADHD could cause him to sleep walk, they referred him for a sleep study. He doesn't have ADHD, he has a sleeping disorder."

A child who regularly falls asleep in class, on the playground or at the dinner table may have a syndrome called Excessive Daytime Sleepiness.

Also called Sleepy Child Syndrome, EDS is characterized by a child falling asleep in unusual places or under unusual circumstances or a child who exhibits behaviors of being tired, or "sleepy."

The causes of EDS are attributed to various factors including other sleep disorders, such as sleep apnea, environmental disturbances, fear, bedwetting and obstructive sleep apnea, or snoring. As these interferences can cause a child to wake up frequently during the night or have trouble falling asleep at all, the child will not get an adequate amount of needed sleep, causing the sleepiness during the day. As the pattern continues the EDS gets worse, affecting their daily activity and function.

"EDS -- or Sleepy Child Syndrome -- is an often misunderstood disorder which occurs in children of any age, but is most common in those between the ages of 6 to 10 years," says Dr. Stephen Sheldon, director of the sleep medicine center at Children's Memorial Hospital in Chicago. "Sleepy children do not function as 'normal' children do because their bodies and minds have not received an adequate amount of sleep they need."

There are several levels to EDS: mild, moderate and severe or profound. With each level of EDS comes a variable number of signs and symptoms. As a child's disorder of EDS worsens, it becomes easier to identify, as the traits related to a sleepy child are more dominant and observable, Dr. Sheldon says.

While watching various home videos taken by parents, viewers are bound to see a video of a child falling asleep into a plate of spaghetti, their birthday cake or perhaps while riding on a pony at their local fair. While these images are thought of as cute and funny, Dr.Sheldon says these are perfect examples of a child with severe or profound EDS.

"Profoundly sleepy children are the ones that are easy to identify," says Dr. Sheldon. "The child who consistently falls asleep in places or situations such as their pediatrician's waiting room, under the Christmas tree, at their birthday party, at the dinner table, on the playground, at parties or while talking on the phone to Grandma are all profoundly sleepy children. These are all situations in which you wouldn't expect the child to be falling asleep and a child who consistently falls asleep under these circumstances is a profoundly sleepy child."

The mildly affected sleepy child may not even exhibit any noticeable signs of EDS. These children are very difficult to identify and diagnosis of a case of mild EDS is rare, Dr. Sheldon says. However, as the disorder progresses to the moderate level the signs and symptoms become more noticeable, but are often misdiagnosed.

"The moderate or intermediately sleepy children we know a lot less about," says Dr. Sheldon. "It isn't until the child is suspected of suffering from something else or having problems in school do medical professional even get a chance to evaluate the child and even then, a sleep disorder is usually last on the list of suspected causes."

The signs and symptoms of the moderately sleepy child are numerous. Children with moderate EDS cannot offer their full attention to tasks either at home or at school. They do not have the energy to put into homework, sports, extracurricular activities or even playing outside with friends, says Dr. Sheldon. These children have been wrongly diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) quite frequently due to their inability to concentrate on tasks offered to them.

"The symptoms of EDS are exactly the same as those that define ADHD," says Dr. Sheldon. "The symptoms of sleepiness and ADHD are identical. There is more and more data that states that a large majority of children who have symptoms of ADHD actually have the underlying disorder related to their sleep."

Diagnosing EDS

Diagnosis of EDS is a fairly simple procedure that begins at home. Once parents notice a child's sleepiness, they should begin documenting when the child is sleeping, what time of day it is, what situation they were involved in and how long the child slept before being aroused or awakened, Dr. Sheldon says. The next step is to seek medical intervention by discussing the situation with the child's pediatrician.

"The moderate to profoundly sleepy child needs to be brought to the attention of the pediatrician -- and the pediatrician needs to take these symptoms seriously and refer them for a sleep evaluation," says Dr. Sheldon. "In addition, children who are having problems in school and may be showing symptoms similar to those thought to be ADHD -- who would otherwise be a 'normal' child and does not have any kind of medical condition that would contribute to these symptoms -- also needs to have their sleep evaluated."

Carlton Stell, a father of four from Petersburg, Va. says his son's teachers asked for his son to be evaluated for ADHD.

"After hearing about EDS, maybe that's what he should be evaluated for," Stell says. "He sleeps when he shouldn't be, has a hard time going to sleep and then is awake when he should be sleeping late at night. I've already called my pediatrician."

Sleep evaluations are done either in the child's home or in a sleep disorder clinic. The child goes through the same nightly routine they normally would do -- bath, snack or bedtime story -- and then are monitored as they attempt to go to sleep. Cameras, monitors for heart rate and respiration are used to detect if there is indeed interference in the child's sleep patterns, Dr. Sheldon says. Once the evaluation is complete, medical professionals can determine what is causing the disturbance in the child's sleep as well as the best way to treat it.

"Needing a sleep evaluation doesn't necessarily mean that they need their sleep evaluated in a sleep lab overnight," Dr. Sheldon says. "But there are some that do because their sleepiness may be contributed to things such as sleep apnea or other sleep disorders that is causing an interference in their sleep patterns. These types of causes are best evaluated in a sleep lab rather then at home."

Treatment of EDS is done specifically for each individual. As some children may only require intervention in decreasing the amount of environmental interference, treatment will be immediate and results will be seen in days, Dr. Sheldon says.

However, children with profound or severe EDS may require medial attention and a more progressive treatment plan in an attempt to treat their disorder. Monitors for sleep apnea, sleep aides, medication or even surgery to reduce an obstructed airway may be require as part of the treatment for profound or severe EDS.

"Each child is different," Dr. Sheldon says. "As each child's cause or reason for their EDS will differ, so will the treatment they may need to correct it. The normal or most common treatment is simply identifying the interfering cause. Once the cause is found -- whether environmental, a fear, stress or other sleep disorder -- treatment and results are fairly quick and very responsive."

But without the proper education and understanding of EDS, its effects and its symptoms, parents and school staff cannot help a child overcome the difficulties presented by this condition, Dr. Sheldon says.

"Falling asleep is the body's natural reaction to being tired," says Dr. Sheldon. "But falling asleep too much or at times when you would normally be awake and involved is not in any way normal. Knowing this is half the battle."

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