Sleep Disorders

Does your baby cry a lot at night? Is your baby having a hard time self-soothing and falling asleep? Dr. Hava Gadassi, director of the Pediatric Sleep Disorder Clinic at Hadassah Ein Kerem and Professor Eitan Kerem, director of Pediatrics discuss:


Every parent understands the importance of sleep for a baby. A sleep schedule is an important contributor to the healthy development of infants. It is not just a chance for their body to re-energize, but it also allows the brain to grow and function properly. Babies develop during their sleep, which is why it is so important for them to get a sufficient amount of sleep. Needless to say, their parents also need to get a sufficient amount of sleep, and if the baby doesn't allow them to do that, their schedules change too. But what if their child is suffering from a sleep disorder? How can a parent tell if their baby needs help?


The Sleep Architecture

"New infants generally sleep through most of the day in short sleep cycles," explains Dr. Gadassi. These sleep cycles usually last between 40 minutes to two hours. At night, the baby will wake up based on his age – the older he gets, the longer he can wait between meals. A baby's sleep habits change as he develops. Younger infants have a more dispersed sleep architecture, which will gradually straighten itself out as the baby grows.  


"Usually, up until the age of two months, the baby is not sleeping regularly. At the age of two to four months, the baby's schedule becomes consistent, and he gets used to the same sleep times. This generally includes a morning nap, an afternoon nap, and nighttime sleep – which can include a number of awakenings. At around the time the baby turns one, one nap and a full night of sleep is enough."


Sleep has a number of stages – from semi-consciousness to a deep sleep. Throughout our sleep, we go through a number of cycles where our sleep changes from light to deep sleep; from passive to active (also known as REM). Active sleep (REM), the baby is breathing quickly and may move his limbs or eyes. During the passive stage of sleep, the baby is taking deep breaths, and won't move as often. "Babies who do not get enough uninterrupted sleep usually express their exhaustion in hyperactivity, unlike an adult, who will usually look extremely exhausted."


A baby will show signs of wakefulness at the end of each sleep cycle. This is natural. Babies who learn how to put themselves to sleep will not signal their wakefulness to their parents – who generally are not aware of these awakenings. Babies who haven't learn how to put themselves to sleep will cry and usually need help falling back to sleep. This is one of the main causes of babies waking up during the night, in addition to hunger.


Learning How to Sleep

According to Dr. Gadassi, trouble falling asleep until the age of one to two years is due to the fact that the baby doesn't know how to fall asleep on his own. At the end of the sleep cycle, the baby wakes up and needs help going back to sleep.


What can we offer at the clinic?

"This field is not very developed in Israel, nor is it very well known, which is why we opened consultation services at the clinic."


When does the baby's inability to fall asleep turn into a problem?

Over one third of new parents report that their babies have difficulty falling asleep on their own. This difficulty is a problem if the parents perceive it as such. Therefore, each family has its own definition of the problem. The most common problems are related to falling asleep or frequent awakenings, snoring or difficulty breathing. "If the parents suspect that their baby has a sleep problem, we recommend that they come see us at the clinic in Hadassah." The doctor will study the sleep patterns based on a sleep diary and will rule out other physiological problems. Treatment depends on the type of problem, in addition to the parents' input. The clinic builds a treatment plan together with the parents. The consultations provide parents with helpful tools in order to teach the baby how to go to sleep on his own.


"Part of our job is to explain to parents what is normal and what is abnormal. Some parents think that they have to check on the baby for every small noise the baby makes while sleeping. This is actually disruptive. Once they understand the sleep architecture, they change their approach."


Difficulty Breathing

Sometimes, the problems turn out to be real sleep issues. Prof. Eitan Kerem, director of the Pediatric Department at Hadassah and an expert in respiratory issues, treats problems in the upper respiratory tract in small children. "There are a number of different reasons for blockage in the upper respiratory tract among small children. Reasons include birth defects of the nose, adenoids, or allergies."


If the baby is suffering from any of these problems, he tends to eat less or gag during feeding. Babies breathe almost exclusively through their nose and only as they grow up do they learn how to breathe through their mouths. Difficulty breathing due to a narrower tract is mainly expressed during sleep, as the tract becomes even more narrow and more severe.


What to look out for?

Babies who suffer from blocked respiratory tracts generally sound raspy while sleeping, they may snore and sweat as well. They sleep with their mouths open, and a puddle of drool usually accumulates on their pillow or mattress. Their sleep is not deep and they can wake up for seemingly no reason. The more severe the problems, the worse the symptoms. The baby will cough, wheeze (even when he is awake), experience loss of appetite and hearing (due to an accumulation of liquid in the ear). In general, the problem gets more moderate the older the baby gets.


Treatment Methods

In most cases, doctors will dry out the excess fluids in the upper respiratory tract using medications. There are local and systemic medications. In more severe cases, doctors will remove the adenoids.


Professor Eitan Kerem

Dr. Hava Gadassi