alt therapies for snoring/apnea at night?

[hipsands]

Hi mamas!
My 2 1/2 yr old is a pretty healthy guy.  However over a month ago he got a decent case of the croup.  Honestly it could have been whooping cough...who knows.  At this point the cough is gone and he's very very healthy during the day.  However at night, just after he's fallen asleep, he still is snoring, have some sleep apnea, etc.  He's never ever had this before until he got the croupy cough.  My conventional pediatrician has seen him a few times during the month, and he thinks its just the croup still stuck in his lungs/etc and that it will clear on its own, but b/c of the apnea, has recommended I give him predisone to see if it will knock it out sooner.  After reading online, though, I'm thinking it may be more related to his adenoids (the noisy night sleeping happens while breathing through his nose, so he's becoming a mouth breather now).  He had mild bout of strep right before the croup (crazy its been a sick couple of months for this guy, very unusual!)  He has never showed allergies to any food (we do raw dairy anyway), and I've done my best to cut out all grains and sugar.  I've also been giving him extra vit C (sodium ascorbate), vit D, plus cod liver oil.  But still the noisy sleeping is persisting and despite all the side effects I'm thinking of trying the prednisone.  Anyone else had any experience with something like this??  THANK YOU for any suggestions!

S

[sbgrace]

I'd be inclined to see an ENT honestly given you know he's having apnea. You never had snoring or apnea prior to this illness?

[hipsands]

Rachelle thanks for the reply.  We've coslept with him since birth; he has absolutely never had the sleep apnea until he got the croup.  Thats why our pediatrician thinks its still the croup causing the sleep apnea.  I however am doubtful now since he barely coughs anymore (maybe just in the morning when he wakes up), he's behaving completely fine during the day; and am wondering if his tonsils and adenoids just haven't started shrinking after the illness.  Its been a month that he's had it and I can't help but wonder if they'll eventually shrink, and whether the prednisone will help the process (though I absolutely do NOT want to give him the steriods!!)

[iaindb]

Hi "S"!

I've never been to this site before now, but I found  your post while researching croup and apnea recently due to my (believe it or not) 2 1/2 year old son!  Unfortunately, he HAS had croup many times before, to the point of being hospitalised a couple of times too.  He has a floppy larynx, which made him breath noisily for the first year or so of life.  His sister has also had serious croup a number of times, but she grew out of it around 4 (quite late).

Anyway, viral croup is a swelling of the airways due to a virus (usually they have a runny nose a few days before).  It happens in adults too, but as you grow older your airways get larger so it's usually not noticed.  The morning cough could be another symptom of the virus.  In my experience sometimes I can see (hear) it happening over a few days, or sometimes I don't even know they're sick until I wake at night to them struggling to breath.  Because of this, and the severity that it has struck my 2 kids, we have to have a supply of prednisone in the fridge at all times.  I try not to use it just out of principle (I would rather suffer a mild headache than take a pill, for example) however I've never noticed any side affects, and for the sake of the kids, it gets them over the breathing issues in a hurry (I don't know how it's prescribed in the US, but we take 1 dose a day for 3 days, depending on weight).  The virus often lasts longer - you know the usual course of your kids sickness.

Just recently my son has had his most recent virus (usual runny nose) but instead of the "real" croup (ie. serious breathing problems) he's had apnea for the last few nights.  He seems to have grown out of croup, now it's turned into apnea (less serious, but still worth looking into).  He's fine during the day, but at night and in the morning has a cough, and sometimes it's still a bit "barky".  Last time this happened a few months ago, prednisone cleared up the apnea which made him sleep much better.  Unfortunately I've run out of prednisone since he hasn't had croup in a while, but he doesn't seem to be improving so I'm considering getting another prescription.

In my opinion, for the sake of a minute amount of cortico - not anebolic - steroids, and for the sake of a peacefully sleeping household, I would go for it.  You may or may not know, but apnea causes tiredness and prolonged lack of sleep can hinder the immune system from getting over what's causing the apnea in the first place.

Happy to answer any more questions you might have about it!  And remember, I'm not a Doctor, just a Dad.  Discuss your concerns about pred with your Dr - it's use has been studied many times.

cya,

Iain.

[hipsands]

Hi Lain,

I appreciate your comprehensive response!!  Its funny when I googled "croup and prednisone" I found a couple articles saying steroids are overprescribed and even a study saying that there were no difference in children who were given the steroids (all were hospitalized) vs the kids that didn't use the steroids (http://www.nejm.org/doi/full/10.1056/NEJMoa0804897 ).  I'm aware that study was looking at wheezing and not apnea specifically, but I still thought the results were important, that sometimes just waiting it out (and treating w/ steam/cool air) works just as well.  Other than that study, I was really hesitant based on the fact that I like my kids immune systems to work to clear on its own so long as no fevers, behavior changes, etc are present, even if we're not getting a lot of sleep.  My son was mostly sleeping upright on my chest at night, and I did use steam showers and cool night air every night as well, so he was sleeping fairly well overall.  *I* wasn't sleeping well but I have a lot of help so I was able to manage ok.  Though now that I think of it, he did start napping again during the day, so I guess that is a sign the night sleeping was fairly disrupted.

However despite my misgivings!, he's now on day 2 of the steroids.  Its supposed to be a 5 day rx so I'm wondering why some doc's prescribe 3 days vs 5 like what you mention?, do you know?  I know of a couple kid asthmatics who use steroids daily and they're ok :), so I keep telling myself that.  I trully just felt at the end of my rope with trying all alternative therapies I could find.  I feel like most of what I found on the internet, when sleep apnea was involved, the parents ended up having the kids get their tonsils and adenoids removed.  I was really suprised to find so many cases of that from what I read.  I personally tried large doses of Vit C, D and probiotics.  I even tried giving him a daily clove of crushed garlic but that was all but impossible to get him to swallow, even in honey!

Its nice hearing at least one other parent find that the sleep apnea is occuring w/ the croup (my son definitely had a barky cough for a week first, and even threw up some phlem at the end, which is what led me to wonder if it wasn't even pertussis).  And I'm glad to hear you say the steroids worked well to clear it! 

[sbgrace]

My son has had to oral steroids for asthma at times when it got completely out of control. These short doses (both 3 day and 5 day are short courses) are unlikely to have an serious impact on the system including the immune system. The longer courses of oral steroids for people wiht issues that need them do have serious health effects. The daily asthma steroids are inhaled and easier on the body. They do have effects though.

I hope this fixes the apnea issue for you. If not I would go on to a specialist given the serious impacts of apnea on kids (and adults for that matter)!

[iaindb]

Hi again, it's hard to say everything concisely, so I hope this one isn't too long!  I can't comment on the use of steroids for wheezing, but it definitely does work for severe croup!  But I agree, sometimes Dr's do tend to give you a prescription when waiting it out would also work.  I usually get the prescription and then wait and see - that way if something does turn severe, you only have to visit the chemist (I think you call it the drug store) instead of going back to the Dr.

wrt sleeping, even though he may be asleep all night, with each apnea event (no / difficult breath for 10 seconds or more) the oxygen level in the blood drops, and the brain then pulls you out of deep sleep into light sleep so that you breath again.  So you're eyes can be closed the whole time, but you may wake up feeling very tired.  My son at the moment is very sensitive and cries at anything, which is very unusual, so I'm assuming it's because he's not getting a proper sleep.  In his case though, every breath is difficult, and sometimes it's 10 seconds between them.  If it's mild then there's no problem with leaving it, you're the judge of how everyone is coping and sleeping.

I don't know about the 3 day vs 5 day prescriptions.  The daily dose might be different, and on top of that the concentration of the medicine might be different, so without knowing those factors I couldn't comment.  Perhaps because it's been a prolonged episode your Doctor felt the longer course was required.  You should notice a difference already though - can you tell?  If you want, record his weight, the dose, and the concentration - then next time around (let's hope there isn't a next time) you can compare.  I quizz my Dr about how they arrive at their dose as well.  It's good to be informed.

I had to take inhaled steroids when I was young - didn't work for me though.  And I had to have a large dose of prednisone (25mg/day) for a severe allergic reaction recently.  I don't think it's affected me (twitch twitch!!).  Once you get to those doses though, you start masking the body's own production of corticosteroiods so you have to go on and off in stages.

I think the adenoid / tonsil surgery is way over the top in our cases.  I think these are done for kids with apnea all the time, whether they have a virus or not.  In my case, our son sleeps like a log when he's healthy!  I'm sure that in a few years he won't get it at all.

Finally, for another alternative, look into zinc.  From what I read, regular zinc intake can lessen the severity of colds and viruses, but you have to take it before you get a cold.

Hope this helps!  PS it's iain with two i's :)

[hipsands]

Sorry about the name typo!  He's definitely still having the apnea; last night was night #2 of the steroids, and the snoring/loud noises have all but dissapeared I'm sure from the steroids, but he still is periodically having the apnea.  I put a steam vaporizor next to the bed last night, and when the apnea happened, I made a tent with a towel over his head and mine (we're still cosleeping) to concentrate the steam to his nose and it really improved it.  He woke up this morning incredibly energized (more so that usual) so I'm thinking the rx is helping, even if it hasn't cleared it yet.    

Iain, do you notice your little one also chewing on his fingers a lot during the day when he's got the apnea issues?  Thats the only other thing my son is doing that he's not done before.  All his teeth are in already so its def not from teething.  Maybe due to the mouth breathing his throat is sore also?  He did also have strep throat this fall.  What a crazy fall, he's never gotten things back to back before (strep-croup).  I've also wondered if it could all be related to the strep...who knows.    

Rachelle, yes if it doesn't clear this week or comes back by the end of the 5 days rx, I'm calling my pediatrician back and taking him back in, which I'm sure will mean a referral to the ENT.  As it is I'm talking to the pediatrician (his cell phone is always on for patients) every week.

Thanks again for all the posts/info...S 

[iaindb]

no probs, I get all sorts of weird spellings of my name!  Good to see that something is happening, even if it's not gone completely yet.  And he's not so tired, which is great.  I've never noticed nail-biting, but who knows?

Sometimes you get a run of sickness that passes around the family and sometimes everybody is healthy for ages.  Once they go to school they bring home all sorts of bugs!  The joys of parenting ;)

[hipsands]

Well it took 4 days of the 5 day steroid rx, but finally ds had a night completely free of the apnea and snoring :)  Now I guess time will tell if it will come back post-steroids?  Dear God I hope not.  Also to prevent this from happening again in the future...I'm still pretty frustrated to have not found anything alternative and reliable to try (I guess zinc will be on the list if there is a next time!). 

S

[iaindb]

It's usually a reaction to the virus, so if he's prone to it, it may happen again next time he gets a virus (keep any leftover pred in the fridge).  The good news is as they grow older they grow out of it.  All the best :)