Can Infants Have Sleep Apnea?
Sleep apnea (or obstructive sleep apnea/OSA) is said to affect anywhere from 4-50% (!) of the population. We will dive into those numbers a bit, but it’s been found that sleep apnea is an underrecognized and underdiagnosed medical condition, with a myriad of negative consequences on patients' health and society as a whole.
My daughter, Hannah, is one of those statistics. It was undiagnosed despite red flags and led us on a 2 year journey of advocating for her health and wellness. I’ll share more of our story throughout this blog!
Other topics and important information we’ll cover includes:
symptoms of sleep apnea infants
does sleep apnea only affect babies
how common is sleep apnea in infants
how to diagnose sleep apnea in infants
how to treat sleep apnea in infants
what causes central sleep apnea in infants
sleep apnea in infants with laryngomalacia
sleep apnea and reflux in infants
Symptoms of Sleep Apnea Infants (and Children)
There are a handful of things we’d consider “red flags” as sleep consultants when we hear them on a consult or read about them in an intake form. Now that I’ve personally been through it all with my daughter, I’m even more aware because no amount of sleep training can fix this issue!
Some common signs or symptoms of sleep apnea in infants include:
Snoring or noisy breathing
Pauses in breathing (usually lasting a few seconds or up to a minute)
Mouth breathing/open mouth resting posture
Tongue resting low in mouth/not resting in palate
A nasally voice
Restlessness during sleep
Excessive daytime sleepiness/irritability despite sleeping enough for their age
Hyperactivity during the day
Sleep walking or night terrors
Night sweats
Bedwetting
Need for a nap past the “normal” age of napping
Difficulty learning new things
Morning headaches
This isn’t an exhaustive list (but close) and you don’t need to check every box here to alert your healthcare provider- it never hurts if something sets off a warning bell for you to investigate and get answers. The worst case is your child is fine/doesn’t have sleep apnea and best case is that they end up getting the treatment they need!
Hannah’s symptoms included:
Mouth breathing/open mouth resting posture (it also changes their facial structure, narrowing their nasal passages, etc)
Tongue resting low in her palate
Restlessness during sleep
Excessive daytime sleepiness (and extremely high sleep needs)
Need for a nap past the “normal” age of napping (ie she transitioned VERY late to 1 nap and is still taking a daily nap at 4.5 years old)
Night sweats
Looking like she’d pulled an all nighter after sleeping 12-14 hours straight (because even though she’d clocked the hours of sleep, the quality of sleep she’d gotten was poor).
We also learned. that thumb sucking is a symptom because it replaces the tongue on the palate when they can’t rest. Why does this matter?
The palate or top of the mouth houses a very important nerve that stimulates the fight/flight or rest/digest systems. When the tongue. is on the palate then the nerve is stimulated for rest/digest.
If the tongue isn’t resting there, then in Hannah’s case, she put her thumb there to stimulate it.
Does Sleep Apnea Only Affect Babies?
Sleep apnea can affect anyone at any age! It’s most often diagnosed in older adults who snore, but as we’ve found, it often gets missed in infants, toddlers, and children.
The theory is just that it isn’t well known or educated enough about so the signs/symptoms get missed until it’s a larger issue.
It’s also possible that the signs of sleep apnea in children aren’t as common as signs in adults so again, it’s easily missed (or dismissed in our case).
It’s believed (as well) that it’s something children will just outgrow. (Because we know the effects of sleep deprivation as it’s well documented, years of potential sleep loss/poor sleep isn’t something I wanted to wait around for, personally!)
How Common is Sleep Apnea in Infants?
The prevalence in infants is still unknown, but between one and ten percent of all children have sleep apnea. When detected early, sleep apnea can be treated to prevent other long-term complications.
How to Diagnose Sleep Apnea in Infants?
How can you tell if a baby has sleep apnea? The only tried and true measure to diagnosing sleep apnea is with a formal sleep study. However, with symptoms, you can almost always get a diagnosis without the sleep study (like we did in our case).
Sometimes the study will be required from insurance in order to receive treatment, but it wasn’t necessary for us because of the symptoms and physical limitations Hannah exhibited that allowed for a sleep apnea diagnosis.
Here’s what the process of everything looked like for us.
I brought up the “is this concerning” talk with Hannah’s pediatrician when she was around 6-9 months old as she slept considerably more than her brother. As a sleep consultant, I knew it wasn’t great to not get enough sleep but wasn’t sure about the OTHER side of things– can you get too much sleep?
He brushed it off- she was gaining well, developing well, and wasn’t considered “lethargic” during her wake periods.
But she was awake so little for her age and slept so much that it still bugged me.
I took a continuing education class for my PT license and started diving in deeper when Hannah was around 2.5 years old. At that point, I’d had to force the 2-1 transition for her because she was still taking 2 naps at 19 months old. At 2.5, she was napping 3+ hours a day and sleeping 12+ hours at night which is definitely on the high end for her age.
I started working on weaning her from thumb sucking and started noticing the open mouth breathing/resting posture even more.
I decided to start with a dentist for an oral evaluation…. And then the pandemic hit.
We were able to see that she potentially needed a posterior tongue tie release (and they were shocked she was able to breastfeed/I had no issues with nursing her– it was actually my easiest journey of the 3 kids).
However, no one would do a release on a 2.5 year old without putting her under so we decided to explore some other avenues.
We saw a speech therapist, got a second opinion from another dentist, and was basically told we were at a stand still age wise- no release could be done and she wouldn’t be able to follow directions for myofunctional therapy.
I was devastated. After 3 months, I decided to start again because I just couldn’t accept that getting poor sleep for 3+ more years was the answer.
How to Treat Sleep Apnea in Infants?
From our experience and many in the field, it’s recommended that your providers work as a team to treat sleep apnea.
While it’s common to need to remove adenoids/tonsils, that isn’t the only treatment available and sometimes isn’t even the cause (like in our case). Sometimes it’s a symptom of mouth breathing from the inflammation.
We were able to get an airway evaluation and the dentist could see that she didn’t have anything blocking her distal airway, it was all proximal (ie in her mouth). Her palate was about 10mm too small and it was very arched.
After seeing that, I begged the myofunctional speech therapist to just TRY because Hannah was always so willing to do the activities during evaluations and participated well in examinations. We started therapy and Hannah thrived with her exercises.
The speech therapist, dentist, and orthodontist all worked together to create a treatment plan for Hannah. Here’s what we did:
Myofunctional exercises (including the myo-munchee)
Oral expansion for her upper and lower palate (couldn’t be done until her 2 year molars were completely in and that didn’t happen until she was 3 years old)
Craniosacral therapy to decrease restrictions around her oral cavity
With myofunctional exercises, she was able to regain the mobility she needed in her tongue to properly rest it in her palate (and didn’t need a tongue tie release) as well as gained the room she needed in her palate to fit her tongue/allow it to rest where it needed.
If we only did exercises but not expansion, she’d have nowhere to rest her tongue even with the mobility.
If we only did expansion and no exercises, she’d have a place to rest her tongue but not the mobility to leave it there.
This is why it has to be a multi-disciplinary approach to treatment!
In a lot of cases, you will need to see an ENT to measure adenoids/tonsils though- so don’t forget them!
When searching for a dentist, you’ll want to see an airway-focused dentist.
What causes central sleep apnea in infants?
Central sleep apnea (CSA) is when you regularly stop breathing while you sleep because your brain doesn’t tell your muscles to take in air. It’s different from obstructive sleep apnea, in which something physically blocks your breathing. But you can have both kinds together, called mixed sleep apnea.
Central apnea can occur in premature babies since the breathing center in the brain is not mature. Neurological disorders can also contribute to CSA. These include brain injuries, brain masses, Chiari malformations and certain medications that suppress the breathing.
Sleep apnea in infants with laryngomalacia?
Laryngomalacia is a congenital softening of the tissues of the larynx (voice box) above the vocal cords. This is the most common cause of noisy breathing in infancy. The laryngeal structure is malformed and floppy, causing the tissues to fall over the airway opening and partially block it.
Most forms of laryngomalacia are benign and self-resolving, meaning they’ll grow out of it and it doesn’t cause any major issues.
From CHOP, “About 5% of infants with laryngomalacia will fall into the severe range with failure to thrive, obstructive sleep apnea, and/or signs of respiratory distress including tachypnea and retractions. These children require supraglottoplasty surgery to relieve the obstruction.
In most cases, laryngomalacia in infants is not a serious condition — they have noisy breathing, but are able to eat and grow. For these infants, laryngomalacia will resolve without surgery by the time they are 18 to 20 months old. However, a small percentage of babies with laryngomalacia do struggle with breathing, eating and gaining weight. These symptoms require prompt attention.”
Sleep apnea and reflux in infants
Gastroesophageal reflux and apnea of prematurity are both common occurrences in premature infants. However, a causal relationship between the two remains controversial. Strong physiologic evidence indicates that a variety of protective reflex responses may elicit laryngeal adduction and apnea.
The evidence is really mixed on if they go hand in hand or not! From this study, “Episodes of apnea were seldom associated with GER. However, in those instances when apnea and reflux were associated, the predominant sequence of events was obstructive apnea and to a lesser extent mixed apnea followed by reflux.”
I’m always happy to share our story if it helps others advocate for their littles! If you’re not sure where to start, email me at ashley@heavensentsleep.com and I’ll help you find resources.
Medical Disclaimer:
The information provided is not medical advice. Reliance on the advice is solely at your own risk. The advice is for informational purposes only. The information provided is not intended nor is implied to be a substitute for professional medical advice. Always seek the advice of your physician with any questions you may have regarding a medical condition or the health and welfare of your child, and before following the advice or using the techniques offered in this consultation. In no event will Ashley Olson and Heaven Sent Sleep be liable to you for any claims, losses, injury or damages as a result of reliance on the information provided. While all attempts have been made to verify information provided, Ashley Olson and Heaven Sent Sleep does not assume any responsibility for errors, omissions, or contrary interpretation of the subject matter herein. Readers use any advice at their own risk.
