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8 month old with strange breathing behavior during sleep

We are concerned with an unusual breathing behavior that our 8 mo. old daughter often displays only while sleeping.  The behavior is similar to the gasping or rapid breathing one does after intense crying. However, she will do this during sleep with no apparent cause. It usually wakes us up out of a sleep as we can hear it over the monitor. It does not seem to wake her up, but she is observed to whimper and let out brief cries throughout the episode. We have never seen any color changes, so we assume she is getting enough oxygen, but her breathing does pause for about 4-5 seconds between the quick breaths. At times, the breaths are so intense she snorts. The episode will rarely stop on its own and we have to intervene. Once she is fully awake the breathing behavior stops. She usually goes back to sleep soon after and she tends to have a restful sleep the rest of the night. We recorded the behavior and showed it to several doctors including her family doctor, 2 pedi. neurologists, an ENT, and had a sleep study (results were normal). Unfortunately, no one can tell us definitively what this is. But, several theories have been given including: obstructive sleep apnea, GERD, dreaming/parasomnias, seizure activity, or just a normal part of REM sleep. However, none of these are satisfying as 1) No physical obstruction has been found that would cause obstructive sleep apnea and apnea was not seen during the sleep study 2) Our daughter does exhibit mild reflux symptoms and we have tried Prevacid, but this did not eliminate the behavior. We actually took her off the med. thinking that perhaps it was the cause as one rare side effect is abnormal dreaming 3) For a while, we were thinking that maybe it was abnormal dreams, but many doctors have said she is to young  4) EEG was done both on its own and during the sleep study but results were normal 5) All babies and adults go through REM sleep so, if it is simply that, then why isn't this behavior more widely described?  
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Avatar universal
MEDICAL PROFESSIONAL
It sounds like your daughter is having short obstructive episodes, but lot long enough to be called apneas. That's why the sleep study was negative. I'm also assuming that she's sleeping on her back, which is the position that most aggravates breathing obstruction. A couple of points/questions:

1. Does she still have these episode while sleeping in her car seat, while inclined up a little?
2. What was the dosage and frequency of the Prevacid for GERD?
3. Was she naturally breast fed or was a bottle used? And for how long?
4. REM sleep is when muscles relax the most.
5. Did you have an ENT look at the upper airway with a tiny fiberoptic camera? Was there any mention of a floppy or redundant top portion of the voice box? (laryngomalacia?)
6. Try not to feed just before bedtime as this can aggravate laryngeal reflux.
7. As long as she's growing well and her development is normal, she'll most likely outgrow it.
8. You may want to take her to see a pediatric ENT at a major academic medical center, where they see all the unusual or rare conditions.
Helpful - 2
Avatar universal
A related discussion, Infants Irregular Breathing.. was started.
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Avatar universal
Hi hadleysmom,  

I was wondering if you ever went to the pediatrician for the breathing behavior?
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Avatar universal
Wow!  Thank you for writing me!  Up until now I have felt so alone- every doctor I've been to says that they have either never seen this behavior before or have only seen something kind of similar. And, none of my friends with children has every experienced something like this. Yes, at times, I find it very difficult to fully wake her from the episode, but at times I find it very easy.  When it is easy, the behavior stops almost immediately, but when it is difficult, the behavior can go on for close to an hour. Does your daughter show any kind of reflux symptoms? even mild?  Does she show any kind of allergy symptoms sneezing, itchy nose, or nasal stuffiness?  How about any kind of apnea that you can notice?  Please keep in touch.  Perhaps between the two of us we can figure this out!  
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Avatar universal
This is exactly what my 51/2 month old daughter does and it scares the pants off of me.  She has done it about 3 times to where i have noticed and really payed attention and i have had to wake her myself before she will quit.  It is so scary.  Do you find that it is kind of hard to wake her fully?  Let me know if you hear anything different, I think i will mention it to her pediatrician.  
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Avatar universal
MEDICAL PROFESSIONAL
You've already asked all the appropriate questions. I think the next step is to get the second opinion at Boston Children's which has an excellent Peds ENT department. Hopefully they'll be able to give you some more definitive answers.

Since you've already demonstrated that her oxygen levels don't drop to dangerous levels, I wouldn't change anything you're currently doing. I do realize it can be very frightening to hear and see this happen.
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Avatar universal
Thank you for writing us back.  Below are some answers to your questions.  

1. I have never witnessed one of these episodes while she is in the car seat; however, she is only in her car seat for car rides and these tend to be somewhat brief. These episodes most often occur somewhere between 2 and 4 hours after she falls sleep and she only sleeps in that long of spurts at night. I have only observed one of these episodes during a daytime nap once. I have not tried letting her sleep in her car seat at night as she is now out of the carrier and into a toddler seat, but I have tried slightly inclining her crib. Unfortunately, this does not seem to prevent the episodes from occurring.  Also, I, at first, thought these episodes were attributed to her sleeping on her back, but I have continued to notice them even after she has learned to modify her own sleeping position to her tummy and side.
2. The dosage and frequency of the prevacid was 7 mg (1/2 solutab) once a day at first. However, around 6 months the dosage was increased to 15 mg once a day as I started to notice a slight increase in her reflux symptoms and an increase in the frequency of the breathing episodes. We questioned if the two were related. but unfortunatley, the increase in dosage did not decrease the frequency of the episodes. Just as a side note, the prevacid was started at about 4 weeks of age, but not for the episodes in question. Originally, it was started for chronic nasal stuffiness, which the ENT at the time attributed to reflux. No change was noted in her stuffiness with the prevacid, but I did notice a difference in her reflux symptoms so I kept her on it. The stuffiness continues to be a frequent symptom especially at night (sounds as though she is breathing through a partially stuffy nose), but I don't get much of a reaction from her pediatrician.  Also, the frequency of these episodes have increased since I first noticed them around 2 months of age.  At first, I observed them maybe once a month, and now I notice them at least 3-4 times a week. So, I hope you are right that she will outgrow this behavior, but it doesn't seem to be going in that direction.
3.  She has been bottle/formula fed from the beginning (Enfamil Gentlease).  I did trial Nutramigen for a few weeks which is a hypoallergenic formula, but this was to see if it would make a difference in her stuffiness and the trial was prior to the breathing episodes beginning. I did not notice a difference in her stuffiness during this trial period so I put her back on the Gentlease.
5.  The ENT did look at her upper airway with a fiberoptic camera and findings were unremarkable.    

We do have an appointment with a pedi ENT from Children's Hospital in Boston in a couple of weeks, which we are looking forward to. Do you have any suggestions for questions we can ask now that you have some further information?

One last question, how do you think we should handle the episodes?  Should we just let them go or should we try and intervene by waking her? Sometimes they last as long as an hour.
Helpful - 0

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