Restless sleep disorder in kids

Emily Caveness, 9, has always been a very active sleeper. When her lack of restful sleep began to disrupt her and school life, her parents sought the help of sleep medicine experts at Seattle Children’s, where they first learned about troubled sleep disorders in children.

An international panel of sleep experts is adding a new pediatric sleep disorder they call Restless Sleep Disorder, or RSD, to the radar of parents and pediatricians.

Under the direction of Seattle Children’s Pediatric Sleep Specialist Dr. Lourdes DelRosso, the group shares their consensus on a medical definition of RSD in a new article published in Sleep Medicine. RSD is known to occur in children between the ages of 6 and 18 and can cause attention disorders, mood and behavior problems, and other problems at home and at school due to poor quality sleep.

“We in sleep medicine have for many years recognized a sleep pattern that affects a child’s behavior but did not meet criteria for other known sleep disorders or restless sleep-related conditions such as obstructive apnea or restless legs syndrome,” said DelRosso . “This work provides a consensus on a definition and diagnostic criteria for RSD and offers a new tool to help more children with troubled sleep.”

When sleep is not restful

Restless Sleep Disorder In Kids

The Caveness family.

Melissa Caveness, of Ellensburg, Washington, sought the expertise of a sleep specialist when the youngest of her three daughters, Emily, started school and struggled to stay focused. She was moody and impatient with her friends. Her parents noticed the bags under their daughter’s eyes and suspected that it could be related to her sleep.

“From the start, Emily seemed very active in her sleep,” said Caveness. “Over the course of a night, she rolled around, kicked and moved her arms and head. She almost fell out of bed several times. We tried everything to help her – lavender and chamomile, melatonin, strict sleep schedules, whatever – but nothing worked. “

After mentioning it to her pediatrician on Emily’s charity visit, she referred her to the Seattle Children’s Sleep Medicine Clinic. It was there that the DelRosso family first met to go through the results of Emily’s sleep study. DelRosso told them about her ongoing research at RSD. Based on the results of the sleep study, DelRosso thought Emily met the development criteria for RSD and asked if the family would be interested in participating in her research.

“My hope was to give Emily a good quality of life since she is just getting started,” said Caveness of her decision to include Emily in the study. “I want her to have friends and attend school. Everything we can do to make her feel good is important. “

Definition of restless sleep disorder in children (RSD)

Restless Sleep Disorder In Kids

Seattle Children’s Pediatric Sleep Specialist Dr. Lourdes DelRosso, chaired an international panel of sleep experts to define restless sleep disorder (RSD) as a new pediatric sleep condition.

DelRosso says the Caveness experience isn’t unique. In her ongoing research to describe RSD and identify treatment options, DelRosso found that approximately 7% of children referred to her clinic were qualified for restless sleep disorder.

“Wrestling in your sleep, sleeping like a helicopter, or flogging in bed – these are a few words parents have used to describe their children’s sleep,” she said. “The first step in addressing this disorder in children is to realize that this is not a good night’s sleep.”

DelRosso and the committee reviewed all of the available literature to establish eight agreed criteria for diagnosing RSD. These include strong body movements during sleep, symptoms that last for over three months, and the resulting impairments during the day.

Referral to a sleep study is required to RSD. DelRosso hopes the publication will create greater awareness of the disorder among general practitioners and pediatricians.

“If a parent or carer thinks their child has a sleep disorder, they should speak to their doctor first,” she said. “They can assess the problem, rule out other causes of poor sleep, and determine if a sleep study is needed.”

Iron supplement for restless sleep disorders

Restless Sleep Disorder In Kids

After Emily’s parents received iron supplement for RSD, they quickly saw a drastic difference in their daughter. “It was amazing,” said her mother. “She slept better. She wasn’t that moody. She wasn’t on the floor of her bed in the morning when we woke her up. “

The good news is that once RSD is identified, it can usually be easily treated with an iron supplement.

“There is a lot of evidence to suggest a link between movement disorders and iron deficiency in the brain,” said DelRosso. “For children with RSD, we recommend checking their levels of a protein needed to store iron called ferritin and, if they are low, start supplementing with iron.”

At Seattle Children’s, DelRosso leads studies on the use of oral and intravenous iron to treat RSD at the Center for Clinical and Translational Research. Emily took part in one of the ongoing studies where she was given a single intravenous iron infusion after a test showed her ferritin levels were extremely low. She then took an oral iron supplement every day for three months for maintenance.

Her parents quickly saw a drastic difference in their daughter.

“It was amazing,” said her mother. “She slept better. She wasn’t that moody. She wasn’t on the floor of her bed in the morning when we woke her up. “

Over time, Emily will have her iron and ferritin levels tested again and may need to take additional supplements if they drop too low.

Since a sleep study can take up to a few months to complete, according to DelRosso, parents can try adding iron-rich foods like spinach and certain cereal products to their child’s diet while they wait for their appointment. You can also ask your pediatrician to check your iron and ferritin levels, as in some cases it may be appropriate to start iron supplementation before the sleep study.

“It brings quality of sleep back into the equation”

The new diagnosis also underscores the importance of good quality sleep for children and adolescents.

“As pediatricians, we often focus on the amount of sleep and tell parents that your child needs 10-11 hours of sleep each night,” said DelRosso. “The really exciting thing about moving forward with this new diagnosis is that it brings sleep quality back into the equation. Not only should a child sleep well, we also want to make sure that it is of good quality. “

The Caveness family are grateful that the diagnosis has helped Emily, now 9, thrive.

“She is our most energetic child,” said Caveness. “It’s been a long way to get here so it’s worth seeing how she loves her friends and school. Knowing about her diagnosis also put her in control. Emily now realizes when she feels tempted and may need to see a doctor. She doesn’t just wake up grumpy and hates the world. “

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