What is baby sleep apnea?
Baby sleep apnea is a condition where a baby’s breathing pauses during sleep. These pauses — or apneas — can last for a few seconds and may occur multiple times throughout the night.
Scary? Absolutely, but they’re not always a cause for concern. It’s relatively common for there to be a certain amount of instability in an infant’s breathing. Even the healthiest of tots can experience a brief pause in breathing during sleep now and again. But that said, it’s still worth knowing what’s normal, and what might need a closer look.
What are the symptoms of baby sleep apnea?
Suspect your tot may be struggling with sleep apnea? Look out for these symptoms:
Snoring: Not the cute little snuffles, but loud, uneven snoring.
Breathing pauses: Gaps in their breathing that last longer than a few seconds.
Gasping or choking: Sounds like they’re struggling to catch their breath.
Sweatiness or clamminess: Sweating is not always a cause for concern (it may just be because your baby’s room is a little warm) but if your baby often wakes up with a sweaty or clammy forehead, it could be a sign of sleep apnea.
Fussiness or restlessness: Constant tossing, turning, or frequent night waking could be due to sleep apnea.
Feeding struggles: Sometimes a lack of sleep can throw off your little one’s appetite.
Blue lips or blue skin: This symptom is serious — if you see it, call 911 immediately.
There are two main types of sleep apnea in babies: Obstructive sleep apnea (OSA) and central sleep apnea (CSA).
Obstructive sleep apnea
OSA occurs when something physically blocks the baby’s airway, such as enlarged tonsils, adenoids (small tissue lumps in the upper airway), or even poor muscle tone in the throat.
The hallmark of OSA is snoring. But unlike the soft, almost soothing snuffles you might expect, OSA-related snoring is often loud and punctuated by pauses in breathing or choking sounds. The baby’s chest might visibly heave as they work harder to breathe during these episodes.
Risk factors:
Premature birth: Premature tots might still have underdeveloped airways.
Big tonsils or adenoids: These can block airflow during sleep.
Neuromuscular disorders: Conditions like Down Syndrome or cerebral palsy are known to increase the risk of OSA.
Family history: If sleep apnea runs in your family, your baby might be more prone to it.
Cleft palate: Babies with a cleft palate may have a smaller airway, leading to a heightened risk of OSA
Secondhand smoke exposure: Another reason to keep the air clean around your little one!
Central sleep apnea
Central sleep apnea (CSA) is different from OSA in that there’s no physical blockage. Instead, the problem lies in the brain’s communication with the respiratory system. It’s as though the brain “forgets” to tell the baby to breathe for a few seconds.
CSA is more common in premature infants, as their central nervous systems are still developing. However, it can also be seen in full-term babies with underlying neurological or cardiac conditions.
The signs of CSA are often more subtle than OSA. You might notice brief pauses in your baby’s breathing without the gasping or snoring associated with OSA. While these pauses are often harmless and resolve as the baby grows, prolonged or frequent episodes should always be evaluated by a doctor.
Risk factors:
Prematurity: Babies born before 34 weeks are at higher risk.
Infections: Severe infections like meningitis can impact the brain’s ability to regulate breathing.
Head trauma: Injury to the head or brain can disrupt the signals that control breathing.
Toxin exposure: Exposure to harmful substances, either during pregnancy or after birth, can affect brain function.
Metabolic disorders: Where your baby has trouble processing amino acids or fats.
Heart conditions: Things like congenital heart defects can play a role.
Neurological issues: Anything that affects how the brain works might cause CSA.
How is baby sleep apnea diagnosed?
If you suspect your baby is suffering from sleep apnea, your first step is to get them to your pediatrician or doctor.
They’ll start by asking about your baby’s symptoms, sleeping habits, and feeding patterns. If they suspect sleep apnea, they may even refer your baby to a sleep specialist.
The sleep specialist may perform a polysomnography (also known as a sleep study) on your baby. This test will measure your little one’s breathing, oxygen levels, heart rate, and brain activity while they sleep. Typically, this will be done in a hospital or specialized sleep center, but in some cases, they may allow you to take the test at home.
Sometimes, X-rays or MRIs are used to check for physical blockages, or blood tests to rule out any related conditions.
In the case of premature tots, we understand just how concerning health issues like these can be. But while receiving a diagnosis of OSA or CSA can feel scary, keep in mind that long-term complications with infant sleep apnea are relatively rare.
How is baby sleep apnea treated?
How your baby’s sleep apnea is treated largely depends on how severe it is, and what’s causing it. For mild cases, your doctor might recommend simple adjustments like:
Changing sleep positions, such as having your baby sleep on their back with their head slightly elevated.
Using a humidifier to keep airways moist and reduce irritation.
Addressing underlying causes, such as allergies or infections.
For more severe cases, or those caused by medical or developmental issues, treatments may include:
Surgery, if enlarged tonsils or adenoids are causing the obstruction (called an adenotonsillectomy).
Medications, in rare cases, to stimulate breathing in babies with CSA.
Oral appliances that are placed inside your tot’s mouth to expand the roof of the mouth and nasal passages, or move your tot’s jaw and tongue forward to keep the airway open.
Continuous positive airway pressure (CPAP), a device that gently blows air into your baby’s airway to keep it open — though its use in infants is very rare and always carefully monitored by specialists.
What about toddler sleep apnea?
Sleep apnea isn’t just a baby thing — it can affect toddlers, too. Just like with infants, toddler sleep apnea comes in two forms: obstructive sleep apnea (OSA) and central sleep apnea (CSA).
Much like infants, the signs and symptoms to keep an eye out for are:
Loud snoring: If your toddler sounds like a tiny chainsaw at night, it might be worth investigating.
Breathing pauses: Gaps in their breathing, followed by gasping or choking, can be a sign of sleep apnea.
Restless sleep: You may notice your child constantly tossing and turning or waking multiple times, or frequently changing positions to find a more comfortable way to breathe.
Mouth breathing: Chronic mouth breathing, even when awake, can be a sign of an airway issue.
Daytime fatigue: If your toddler seems extra cranky, sleepy, or has trouble concentrating, it could be from poor-quality sleep.
Behavioural changes: Symptoms such as increased irritability, difficulty focusing, and hyperactivity can sometimes stem from fragmented sleep caused by sleep apnea, and are often misattributed to temperament or “typical” toddler behavior.
Growth: Untreated sleep apnea in toddlers may sometimes lead to poor growth due to disruptions in growth hormone production during sleep. It’s important to monitor weight gain and overall health.
If you’re noticing these symptoms, start by chatting with your pediatrician rather than trying to self-diagnose the issue — the symptoms listed above are not necessarily signs of sleep apnea, and it can be easy to misinterpret them as just that.
Your paediatrician might refer you to an ear, nose, and throat (ENT) specialist or recommend a sleep study to get a clearer picture. The good news? Most toddlers with sleep apnea respond well to treatment, and addressing it early can make a big difference in their mood, energy, and overall health.
As in many situations as a parent, observation is key — for example, you might consider using a baby monitor with audio to detect signs of laboured breathing, or keeping a sleep diary to document symptoms and patterns. This information can then be shared with your pediatrician to help them reach an accurate diagnosis.
Remember — if you suspect your tot’s suffering from sleep apnea, it’s always best to consult a medical professional rather than trying to diagnose the issue yourself. They’ll guide you through the process of diagnosis and treatment, ensuring your little one is able to get a peaceful — and safe — night’s rest.
Reviewed by Rosey Davidson, Sleep Consultant, founder & CEO, in December 2024.