By Kathleen Yount

Pediatric sleep specialist Richard Kravitz, MD, remembers the days when the television turned to static at 2 a.m. “It used to be that people went to bed after the sun went down,” he says. Now, like the adults who are raising them, many kids are chronically sleep-deprived. But this condition in children can look much different than the shuffling, bleary-eyed yawning seen in overtired adults. Some kids, when they’re too tired, actually become hyperactive.

Kravitz says that inadequate sleep is as big an issue as disturbed sleep among his young patients. “I’m getting more and more referrals for kids who are having serious problems in school or elsewhere, and it turns out that they are simply chronically tired,” he says. “Many parents don’t understand how much sleep their children need. Teenagers need nine or more hours a night, and young children need even more. If a child is sleeping six or seven hours a night, that’s just not enough.”

Kravitz also gets a lot of referrals at the end of summer break—because after a season of family vacations and shared hotel rooms, some parents discover that their kids are not the restful sleepers they may previously have seemed.

“About 7 to 10 percent of children snore,” Kravitz says. While snoring on its own was once considered a benign condition in children, it’s now a flag for further investigation. “If they snore, you gotta ask more,” he says.

This is because snoring can be a signal of obstructive sleep apnea, which affects 2 to 4 percent of all children. Kravitz notes that the number-one cause of apnea in children is not obesity, but rather structural problems in the airway. “It’s mostly big tonsils and adenoids,” he says, “though obesity has shot up as a cause.”

Since children with sleep apnea generally don’t suffer from problems such as hypertension and heart disease, the effect of sleep apnea on these illnesses isn’t as great a concern as it is in adults. What is often an immediate complication is attention deficit disorder (ADD), a diagnosis that many children with sleep apnea also carry.

“In my opinion, before a child is put on Ritalin, that child should also be evaluated for sleep apnea,” says Kravitz. “Treating the apnea may obviate the need for medication.”

Above all, it’s important to remember that children with sleeping problems are not miniature adults with sleeping problems, Kravitz says. “Kids can present in ways that are a lot more subtle, so you need to cast a wider net.”