Is my child getting enough deep sleep?

Many parents and individuals have concerns about whether sufficient “deep sleep” is being accomplished at night. Concerns with how patients appear or feel during the day lead them to conclude that sleep quality must be poor. They typically are hoping for a sleep study to see if perhaps insufficient deep sleep is causing fatigue or exhaustion.

There are several important learning points to review when asked about deep sleep. First, the gold standard for studying “deep sleep” is polysomnography - or an overnight sleep study. In a sleep study, we measure brain waves using EEG to see the sleep architecture and percent of various sleep stages (e.g., stage 1, stage 2, stage 3, REM and wake). A sleep study also measures breathing, leg movements, heart and oxygen function. The most common reason for ordering an overnight sleep study is to rule out sleep apnea. Generally, if a patient is not noting any symptoms of a medically-based sleep disorder (e.g., sleep apnea, periodic limb movement disorder narcolepsy), insurance will not even cover the test as the sleep study is not typically warranted. If indeed suspicious of a medically-based sleep disorder is reported, the possibility of “not getting enough deep sleep” is valid. When a patient has sleep apnea, for example, these breathing events “kick patients out” of deeper sleep stages giving them higher percentages of light sleep.

Other than having a medically-based sleep disorder, other possible reasons a patient might not get enough deep sleep, could be: 1. Pain (e.g., migraines, injury) or medical symptoms (e.g., allergies, reflux), 2. Medication effects (e.g., some medications decrease deep stages of sleep) and 3. Aging (e.g., as we get into our senior years less deep sleep can be present).

If none of these factors are relevant, we encourage patients to consider other possible reasons for appearing or feeling exhausted as sleep is not always to blame. Talking to the pediatrician or primary care doctor about fatigue might trigger an updated look at labwork to see if any findings are contributing to fatigue (e.g., thyroid levels, vitamin D, iron, etc). Sometimes mood symptoms or elevated stress can contribute to feeling fatigued. Behavioral problems might not always be due to being “overtired” and can sometimes be true behavioral symptoms. Further assessment and perhaps therapy for mood and behavior might sometimes be warranted.

Finally, sometimes, insufficient sleep related to trouble falling asleep or returning to sleep might be the cause of fatigue.

###### DrLullaby can help with behavioral sleep issues. The information provided here is not intended as a diagnosis or medical treatment, but instead meant as a learning opportunity. Please schedule an appointment with DrLullaby for more help.