Snoring and Sleep Apnea in Children

Science, Sleep Apnea

Snoring and Sleep Apnea in Children

Just like adults, almost all children will snore occasionally.

The mechanics of snoring are no different in children. Inhaled air becomes partially obstructed which causes excess soft tissue in the upper airway to flap and make noise.

But how do you know if your child’s snores are normal or not?

Normal snoring vs. sleep apnea

We all snore occasionally, particularly if we are unwell. But 10% of children will snore on most nights. This is not normal and could be a sign of something more serious [1].

1-3% of children even experience obstructive sleep apnea (or OSA for short) [2]. This is where airway blockage leads to breathing pauses – a condition that has health implications beyond sleep.

Side note: what is the difference between snoring and sleep apnea?

Normal snoring (a.k.a. “habitual” snoring or “primary” snoring) does not involve breathing stoppage. This is usually benign. When a child has sleep apnea, their breathing stops for at least 10 seconds, generally followed by a big gasp or choke. Those with OSA often snore loudly, but importantly, not all loud snorers have sleep apnea.

Obstructive sleep apnea is problematic in children

Children need lots of healthy sleep for good physical, mental and emotional development. OSA disrupts sleep, therefore sleep deprivation is the biggest concern for children with sleep disordered breathing.

Studies have also linked the sleep fragmentation experienced with sleep apnea to ADHD [3]. Even without an ADHD diagnosis, sleep deprivation can affect children’s behaviour, focus and overall development.

What causes snoring in children?

The various reasons for snoring are the same in children as for adults. Sleeping position, being overweight and allergies can all be implicated in your child’s snoring.

To understand why your child snores, try to explore their triggers:

  • Are they sleeping on their back?
  • Could dust allergies be triggering their snoring? Are there a lot of soft toys in their room that could be collecting dust?
  • Does their snoring happen seasonally? If so, could they be suffering from hay fever? Understand the other signs of this seasonal pollen allergy.
  • Is your child’s face shape responsible? A pronounced overbite (retrognathia) reduces space behind the tongue and is a common anatomical cause of snoring.
  • Is your child overweight?
  • Are they ill? If so, their snoring should be short-lived.

Unlike in adults, the tonsils and adenoids are frequently cited as causes of snoring and sleep apnea. This is because the adenoids are regions of soft tissue that (usually) disappear after puberty. Further, tonsils reach their peak mass between 5-7 years – well before a child’s airway has reached its peak size. These are therefore key obstruction triggers in childhood snoring and sleep apnea.

When is a child’s snoring problematic? The signs to look out for

There are some key signs that can suggest that your child’s snoring is a cause for concern.

5 sleeping flags are:

  1. They snore more than 4 nights per week
  2. They snore frequently throughout the night
  3. The snoring is noisy
  4. You can hear pauses in the child’s breathing
  5. They often sleep with an open mouth.

It can be hard for you to identify these sleeping flags in your child; beyond a certain age, parents don’t usually share a room with their child.

Therefore, it is important to also keep watch for these 5 flags whilst your child is awake:

  1. They have trouble waking up
  2. They are unusually irritable
  3. There are behavioural issues and problems at school
  4. You are told that they fall asleep at school
  5. They report having headaches or a sore throat.

If they are ticking many of these boxes, it is a good idea to seek advice and further investigation from a specialist.

Before a medical consultation, it is recommended that you start a sleep journal. This can help a specialist glean some insight into your child’s snoring. Focus on the 10 sleeping and waking flags above.

The logistics of listening to your child’s entire night of sleep are difficult if they are at the age where you aren’t sharing a room. This is where SnoreLab can be helpful.

Side note: is SnoreLab suitable for children; will my child’s privacy be protected?

Your child’s privacy is not at risk when using SnoreLab. We do not collect audio recordings and therefore cannot share or listen to any audio picked up by the app. We do collect some anonymised, non-audio data on the session – this cannot identify you personally and is nothing more than some numbers on a screen.

Further investigation – do children have sleep studies?

Yes, children have sleep studies too. A sleep study is a way of looking at how your child’s body behaves when they are asleep. This is the reliable way to understand their sleep disordered breathing.

The process is almost identical to adult sleep studies.

On the day of the sleep study, parents are encouraged to help make the process as normal as possible. This means sticking to normal routines, both before and after arriving at the hospital. If an afternoon nap is part of your child’s routine, then don’t deny them it.

To help make the hospital feel as comfortable and homely as possible, bring things from home that help your child to relax and sleep – whether it’s a toy, a blanket, a book or a film to watch before bed.

Your child will be “wired up” before the study starts. This involves attaching an array of monitors which can take up to an hour to set up. The key ones are:

  • Elastic chest bands. These sense the child’s breathing efforts.
  • Pulse/blood oxygen saturation monitor finger/toe clamp
  • Nasal cannula to assess airflow and look for breathing disruptions
  • Electrodes to monitor heart, brain and eye activity are less common in paediatric sleep studies but are still sometimes used.

Importantly, none of these attachments are painful and they should be attached in such a way to avoid any discomfort. Your child should have no problem sleeping with them on.

The technicians attaching these monitors are well-trained in dealing with children and allaying any fears and anxieties they may have. You as a parent can also play your part here too.

Paediatric sleep studies almost always have two beds set up – one for the child and one for the parent. Your presence should help your child relax and get the sleep needed to make the necessary measurements. People say that typically the child sleeps better than the parent!

Similar to adult studies, the session finishes around 6am. Results are analysed by specialists and will be communicated to you at a later date.

What can be done to treat children’s snoring and sleep apnea?

As with anyone’s snoring, what is the “best treatment” depends on the cause. Almost all snoring remedies apart from mouthpieces – if well matched to the cause – are suitable for children.

Surgery is recommended more for children than it is for adults. This is because children’s snoring is more likely to have a clear physical obstruction that can be corrected with surgery – namely by removing the adenoids and tonsils. Indeed, these procedures are performed more than a quarter of a million times per year in the USA alone [4]. It is generally very safe with only minor risks associated.

Such surgical interventions are usually very successful. Some research indicates that children’s stunted mental capabilities, often attributed to the sleep disturbance that accompanies sleep apnea, reverses completely 3 to 10 months after surgical removal of the adenoids [5].

Surgery is not always an option. If a child is diagnosed with OSA which cannot be managed with surgery or other measures, CPAP can also be used. Whilst CPAP can be quite a drastic change for a child to get used to, if presented and handled well by both the medical professionals and the parents, it can be extremely effective [6].

Further, it is speculated that another potential measure is doing nothing! Children develop and grow quickly so certain conditions can resolve themselves. Recent studies have shown that the non-intervention commonly referred to in the medical world as “watchful waiting” saw almost half of sleep apnea cases reversed within 7 months [7].

Conclusion

Snoring has similar causes in both adults and children and can therefore be managed in the same ways.

Occasional snoring is normal and harmless for children. However, extra attention should be paid if your child snores 4 nights or more per week, and snores frequently through the night [1].

Assess your child’s snoring with the following process:

  1. Is it caused by allergies? Does your child have any symptoms such as a runny nose; are there soft toys potentially trapping dust in their room?
  2. What position do they sleep in? See if side-sleeping reduces their snoring. You can also try elevating their head.
  3. Check if they are showing any of the 5 daytime signs of problematic snoring.
  4. If possible, make a sleep journal. Note how often they are snoring and its frequency per night. SnoreLab can help with some objective nighttime measurements.
  5. If these flags raise concerns, seek medical advice.

Age and Snoring

Causes, Science

Age and Snoring

Snoring can worsen with age, but there are things you can do to reduce your risk. It’s also important to remember that young people snore too.

“Snoring is an old person’s problem”. This statement is both true, and very false. There’s no shortage of changes that take place as we age, and a propensity for snoring is one of them.

Whilst age is a significant risk factor for snoring and sleep apnea, increasing numbers of young people and even children find themselves snoring, or even gasping and choking through the night.

Snoring’s association with age is exactly that, an association, not an inevitability. If you’ve found your snoring worsening with age, there are a few things that you can do to. Additionally, if you feel you’re too young to be snoring all the time, you’re not alone. It may be time to carefully consider its possible causes.

Why do we snore more as we age?

Our sleep changes as we age. We find it harder to fall asleep and stay there, get less sleep in general, and crucially, we’re likely to snore more. Some sources show that fewer than 10% of 17-29 year olds say they frequently snore, whilst more than 40% of over 50s do [1].

When it comes to the more dangerous prospect of sleep apnea, some 18% of people aged 65 and over are having at least 10 apneic episodes per night compared to only 3% of under 45s [2].

But why is this? Aging is inevitable, but snoring doesn’t have to be. Age-related snoring has direct and indirect causes …

Direct reason – weakened airway

Weak airway muscles are the main reason for snoring more with age.

Snoring happens when the tissue in our airways start to vibrate because it is too loose. Just as skin loses tension with age and muscles in our bodies become weaker and less toned, so does the airway. This loss of tone is particularly true of the soft palate, one of the main sources of snoring noise [2].

Throughout earlier life, women tend to snore less than men. This gap is narrowed once women reach the menopause as various physiological changes make you more likely to snore.

Indirect reasons

With age comes a few other factors that make snoring more likely:

  • Easier to gain weight. A slowed metabolism and overall decrease in physical activity make weight gain go hand in hand with age. Weight gained on the neck and midriff heighten the risk of snoring.
  • More medication. Drugs to treat high blood pressure, heart conditions and even simple pain relief medication can lead to a congested nose which makes snoring more likely. Sedatives also contribute to enhanced relaxation of the soft tissue of the throat.
  • Reduced immunity. Lots of snoring can be caused by a blocked nose; blocked noses are often the result of a cold, something you might be more vulnerable to as you age [3].

What can be done to combat age-related snoring?

Remember, snoring isn’t inevitable as you age. There are things you can do:

  • Mouth exercises. The best way to get tone back to those weakened muscles in the throat is to exercise them. Check out our guide to anti-snoring mouth exercises, an anti-snoring tactic which can be particularly helpful for older snorers.
  • Mouthpieces. Another way of tightening that loose tissue is to use a mouthpiece which brings your jaw or tongue forward. Find out more about the right sort of mouthpiece for you with our buying guide to anti-snoring mouthpieces.
  • Treat your blocked nose. Your nose can be blocked for a number of reasons, so there are a multitude of solutions. See our guide to snoring and nasal blockage to see what’s stuffing you up and what you can do about it.
  • Lose some weight. Easier said than done, yes. Impossible once you reach a certain age, no. Often, effective weight loss and retention needn’t involve a hard-to-maintain crash diet. The cumulative effect of many small, sustainable and positive lifestyle and diet changes can make a big difference. Have a look at our SMART strategy for weight loss.

Snoring is not just an “old people problem”

Despite the evidence for snoring increasing with age, we and many SnoreLab users testify that snoring is not a problem confined to older people. Yes, fewer young people snore when compared to the older population, but this “fewer” still constitutes thousands upon thousands of people [1].

Snoring has many causes and we are increasingly seeing that snoring and sleep apnea is a problem for not only adults, but adolescents and children too …

Young adults and snoring

How common is it?

There seems to be some conflicting numbers when it comes to young adults snoring. One thing however is certain: snoring is not an “old people problem”.

A survey of 12,000 high school students in Korea revealed that a startling 22.8% of them snored, with just over 1,000 even reporting experiencing sleep apnea [4].

The prevalence of snoring in university-age young adults is higher than many think. One study asked 2,200 California university students aged 18-25 about their snoring. 30% reported snoring [5].

Even anecdotally, whilst scrolling through SnoreLab’s Twitter feed at the start of the university semester in October, we see many unhappy students lament the snoring capabilities of their new roommate!

Snoring in young adults often goes unnoticed. This is due to several reasons:

  • A misconception that snoring is only a problem for older people
  • Social stigma around snoring
  • Lack of understanding of the risks, therefore a reluctance to seek help or information
  • Younger people usually sleep alone so aren’t identified as problematic snorers.

Why is it a problem?

Snoring and sleep apnea present problems for younger people just as they do for older people. As well as the risks to your physical health that sleep apnea poses (which can present more of a problem in young people), snoring amongst young adults has shown to have a negative impact on other facets of life such as mood regulation, driving safety and even academic performance [6].

One study assessed the likelihood of medical students to fail their exams based on whether or not they snored. Non-snorers had a failure rate of 13%, whereas 42% of the frequent snorers failed their exams [7].

What can be done to help?

Of course, the best treatment for snoring depends entirely on its causes, of which there are many. That said, anti-snoring product companies are putting more emphasis on the importance of snoring in younger people.

Good Morning Snore Solution have recently introduced a tongue retainer for young adults aged 16-25, based on an assumed difference in facial shape and size. Tongue retainers work by preventing your tongue falling back and blocking your airway whilst also tightening the slackened tissue in your throat.

Whilst many will be skeptical about how the mouthpiece is actually tailored specifically to this group of people, it is great to see companies in the anti-snoring marketplace taking snoring in young people seriously.

If you don’t know where to begin with your snoring, have a look at our 7 ways to stop snoring naturally and our 7 recommended snoring aids.

Children and snoring

How common is it?

Studies estimate that around one in ten children snore. On top of that, 1-4% experience obstructive sleep apnea [8], a condition all too frequently associated with older people.

Snoring in children can be relatively normal, but if they are snoring consistently throughout the night for four or more nights a week, it needs to be taken seriously [9].

Why is it a problem?

Sleep deprivation is the biggest problem for children with sleep disordered breathing. Children need lots of healthy sleep to develop well. Studies have linked sleep fragmentation with ADHD, and adolescents presenting to mental health services show a high prevalence of sleep disturbance [10].

What can be done to help?

Children have slightly different airway anatomy to adults. A common culprit for snoring in children is the adenoids – glands located near the soft palate which usually shrink and disappear later in life along with the snoring itself [9].

For that reason, surgically removing these glands is often an effective treatment method for children with obstructive sleep apnea. Some research indicates that children’s stunted mental capabilities, often attributed to the sleep disturbance that accompanies sleep apnea, reverses completely 3 to 10 months after surgical removal of the adenoids [11].

Not all children will show an improvement after this type of surgery. Much like in adults, snoring can be caused by other factors. For example, obese children and children with certain craniofacial abnormalities, show less improvement [8].

Conclusion

Age can indeed make you snore more, but snoring is not just an “old people problem”. Sleep patterns change with age but one thing remains constant: good sleep is important. If your snoring is impacting upon your sleep or health in any way, at any age, it needs addressing. Understanding and treating snoring earlier in life puts you in a better position to not snore further down the line.

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