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Ask Dr. Sears: Diagnosing Sleep Difficulties

Q. My 6-year-old son can't seem to get a good night's sleep. He's still in the habit of napping every day, which I allow because he's so often tired. I realize that napping might be contributing to his sleep issues, but what do you think could be the underlying cause?

A. It's unusual for a 6-year-old to still need a daily nap and to sleep poorly at night. Both issues point to the possibility of an underlying medical problem. Recent studies show a link between poor sleep and certain learning disorders, including attention deficit disorder (A.D.D.). Another possibility is obstructive sleep apnea (OSA), a condition in which a child's breathing passages are partially obstructed by either large tonsils, or plugged nasal passages, or both. The child's difficulty getting enough air at night interferes with the natural cycling of light and deep sleep, which is necessary to feel rested. (Breathing problems often surface during sleep because the muscles that keep the airways open naturally relax, lessening the amount of air a child inhales.) Here's how to determine the cause of your son's sleep problems, plus home remedies and tips for better sleep:

Videotape your child's sleeping habits 

Record him for at least an hour while he's asleep. When you view the tape, pay particular attention to his breathing patterns. OSA symptoms include loud snoring, noisy breathing, and frequent 10- to 15-second pauses in breathing, followed by loud catch-up breaths. The catch-up breath is often accompanied by a restless startle, even though your child may still appear to be asleep.

Have your child's airways examined

If your recording shows symptoms of OSA, bring the tape to your doctor. Ask him to check the latency of your child's breathing passages, and to note if he has enlarged tonsils, adenoids, or swollen nasal passages from allergies (sometimes it's the adenoids that obstruct breathing). Consider visiting a pediatric ENT specialist, as enlarged adenoids can be difficult to detect in a routine examination.

Allergy-proof your child's sleeping environment

Stuffy nasal passages are a common cause of poor quality sleep, so dust-proof your child's sleeping environment by removing all dust collectors—fuzzy toys and pets included—from his bedroom. A high-quality HEPA air filter can also help (be sure to buy one that promises to clean a larger square footage than that of your son's room). Prior to bedtime, try my nasal passage-opening regimen. First, the nose hose: Spritz a few drops of saltwater solution (1/4 teaspoon of salt mixed with 8 ounces of warm water) into your child's nasal passages, and have him blow his nose well. Then, the steam clean: If you have a facial steamer, have your child steam his nose for five minutes before bed. Having clear breathing passages will do wonders for his sleep.

Give your child food for sleep

Omit foods with high sugar and caffeine content from your child's diet—these "wakers" will only perk up the brain when it should be relaxed. Instead, give him foods that contain tryptophan. This protein/amino acid makes neurochemicals such as serotonin and melatonin that help the brain go into sleep mode. Calcium- and protein-rich foods are also good choices, as they help the brain manufacture melatonin. Try carb-and-calcium combinations such as milk and a whole-grain cookie, whole-grain cereal with milk, half a peanut butter sandwich on whole-grain bread, or apple slices and cheddar cheese.

Don't worry, be sleepy

Finally, be sure your child is relaxed before going to bed. Avoid TV and computer use for at least an hour before bed—the bright lights are too stimulating. And there's always that tried-and-true standby: a relaxing back rub and a bedtime story.