Sleep Problems: Questions and Cases

Prantik Saha, MD

Learning Objectives:

1. To describe the evolving nature of sleep cycles in babies in the 1st year of life.
2. To evaluate and appropriately counsel for sleep association problems
3. To diagnose and appropriately counsel for nightmares and night terrors
4. To describe well-defined risk factors as well as currently debated associations for SIDS
5. To evaluate for obstructive sleep apnea, to describe its associated signs and symptoms, and elucidate current treatment strategies

QUESTIONS

1. The parents of a 3 month old infant are exhausted because their baby gets up approximately 3 times at night for feedings. They would like to know how they can get their baby to sleep through the night. What would you recommend to them?

 

2. You are seeing a 9 month old baby girl in your clinic and the mother complains that she has not been getting enough sleep at night. While her baby goes to sleep quite easily, she gets up every 2 or 3 hours throughout the night, crying and fussing. The baby usually falls asleep around 9PM in the mother’s arms while she rocks her; then she is put in her crib shortly afterwards, only to wake up a couple of hours later. The mother picks her up, soothes and rocks her, and she is back to sleep once again. Yet, two hours later, the baby wakes up crying again. What do you think is happening? What guidance would you give the mother?
   
   
3. A 2 year old child is brought to your clinic because the parents are frightened by his nightmares. Recently, he has started getting up a few hours after falling asleep, thrashing about and sometimes screaming. During these episodes, he is sweating profusely, and the father, who is a paramedic, notes that his pupils are dilated and his heart is racing. The parents try their best to wake him up, but to no avail. About ten to twenty minutes later, he falls asleep again, and the parents wake him up to make sure he is all right. At that point he does wake up, seems completely fine, and in fact, does not go back to sleep so easily. What do you think is the problem, and how would you guide the parents?
   
   
4. You are seeing a two week old child in your clinic for the first time. During your intake, you find out that a distant cousin on the paternal side died of SIDS three years ago. The mother also states that she co-sleeps with her baby every night, because she finds it easier to nurse her in this way. What other information do you want to know? How would you counsel her with regards to co-sleeping?
   
   
5. On a routine well child care visit of a 5 year old girl, the parents state that she snores every night and appears to stop breathing occasionally while asleep (not every night). She doesn’t take any naps during the day and doesn’t have any daytime sleepiness. What other questions would you ask and how should you proceed?

References

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