Sleep Apnea in Infants and Newborns: Signs & Solutions

Sleep is one of the most important parts of how a baby grows and develops. But sometimes, breathing troubles during sleep can keep infants and newborns from getting the rest they need. In some cases, these problems can be serious for a baby’s health.

One condition that often surprises parents is sleep apnea. This happens when a baby stops breathing for short moments while sleeping.

In this article, you will learn what infant sleep apnea is, what types there are, why it happens, and what signs to watch for. We will also talk about how doctors find it, ways to treat it, and tips for watching over a baby’s sleep at home. If you are a new parent worried about your baby’s breathing or just want to be prepared, this guide can help you understand what to look out for.

What Is Infant Sleep Apnea?

Baby sleep apnea is a type of sleep-related breathing disorder in which a baby’s breathing stops and starts many times while they are asleep. These pauses in breathing are known as “apneas.” Doctors usually define sleep apnea as pauses lasting around 20 seconds or longer, though shorter breaks might also count if they come with other problems like a slow heartbeat, changes in skin color, or lower oxygen levels.

Newborns, particularly those born a little early, frequently pause their breathing for a few seconds. But in sleep apnea, these pauses happen more often, last longer, and can affect how much oxygen a baby gets, how well they sleep, and how healthy they are overall.

Older children or adults with sleep apnea might snore loudly or feel tired during the day. Babies, though, often show different signs, such as changes in their skin color, trouble feeding, or slow weight gain. We’ll go into these signs more closely in the next sections.

Simply, infant sleep apnea means a baby is pausing their breathing more often or for longer stretches than what’s normal. Although it can feel scary, many babies, especially those born early, grow out of it as they get older and stronger. Still, it’s good to know the signs and talk with a doctor if you have any worries about your baby’s breathing during sleep.

Types of Sleep Apnea in Babies

Not all sleep apnea in babies happens for the same reason. Doctors sort it into different types based on what is happening in the baby’s body when the breathing pauses occur. Understanding these types helps parents know what to watch for and helps doctors choose the safest and most effective treatment.

Obstructive Sleep Apnea

When a baby's airway is blocked while they sleep, it results in obstructive sleep apnea, or OSA. Even though the baby’s brain and chest muscles keep trying to breathe, air cannot pass through easily because the airway becomes narrowed or completely closed. Babies with OSA may appear to be struggling to breathe. Parents may observe gasping, snoring, noisy breathing, or breathing pauses.

Sometimes, the baby’s chest and belly move as though they are trying to breathe, but no air gets through. OSA can interrupt sleep and lower how much of oxygen the baby’s body gets while resting. If it goes untreated, it can affect growth and development, since healthy sleep and steady oxygen levels are so important for a baby’s body.

Central Sleep Apnea

Central Sleep Apnea, known as CSA, is different because it is not caused by something blocking the airway. The baby's brain, on the other hand, temporarily forgets to signal the body to breathe. The baby just doesn't try to breathe during these pauses. There is only a brief lapse in the brain's instructions, no physical blockage.

Central apnea is more common in premature babies, whose brains and nervous systems are still developing, but it can also affect full-term infants in some medical situations. In contrast to obstructive apnea, parents may not notice obvious signs of struggle or hear noisy breathing.

Without medical supervision, caregivers may find it more difficult to identify CSA because the baby may just pause breathing quietly. While newborns sometimes experience brief pauses, frequent or prolonged central apneas require medical attention.

Mixed Sleep Apnea

A baby with mixed sleep apnea has both central and obstructive apnea. Central apnea can occur when the brain fails to send the signals required for breathing. In other cases, obstructive apnea results from the airway becoming blocked even when the brain sends the signals.

Mixed apnea is often discovered during sleep studies, where doctors can see both patterns happening in the same baby. This type can be more complicated to treat because care must address both the brain’s signals and the physical openness of the airway.

For parents, it can be especially confusing because symptoms can overlap, and a baby might seem fine at one moment but have problems during another part of sleep. Doctors rely on careful testing and monitoring to figure out which type is stronger and to decide on the safest treatment plan.

Causes of Sleep Apnea in Infants

Babies may have sleep apnea for a variety of reasons. Sometimes it is related to the way their brain instructs their body to breathe, and other times it has to do with the shape of their airways. The common causes of sleep apnea are listed below:

Causes of Obstructive Sleep Apnea

OSA occurs when a baby's airway is physically blocked during sleep, making it difficult for air to enter and exit. The following are more common causes that can block a baby's airway:

• Small or Abnormal Airway Structures: Babies born with small or differently shaped airway parts might have narrower passages than usual, which makes it easier for soft tissues to block the flow of air during sleep.
• Craniofacial Anomalies: Infants with facial or skull abnormalities may have airways that are more prone to collapse or obstruct during sleep.
• Low Muscle Tone: Some infants have weaker airway muscles. This could make it harder for the airway to remain open while you sleep, which could result in blockages.
• Gastroesophageal Reflux (GERD): GERD happens when stomach contents flow back into the throat. This can cause swelling or irritation, which can narrow the airway and contribute to obstructive sleep apnea.
• Cleft Palate: Babies born with a cleft palate have gaps or openings in the roof of their mouth. This can affect how the airway functions and raise the chance of it becoming blocked during sleep.
• Enlarged Tonsils or Adenoids: Large tonsils or adenoids can take up extra space in the airway. When a baby lies down, this makes it easier for the airway to become partly or fully blocked during sleep.

Causes of Central Sleep Apnea

CSA is different because it’s not caused by anything blocking the airway. Instead, it happens when the brain briefly stops sending signals to breathe. These are some factors that might raise the risk of central sleep apnea in babies:

• Underdeveloped Brain Centers: Babies, especially those born early, might have brain centers that are still maturing. This can lead to pauses in breathing because the brain is not consistently sending signals to keep breathing steady.
• Neurological Conditions: Babies with conditions that affect the brain or nervous system might have trouble managing their breathing during sleep, causing short periods where breathing stops.
• Infections Affecting the Brain: Serious infections like meningitis or pertussis can harm how the brain controls breathing rhythms, increasing the chances of central sleep apnea.
• Head Trauma: Babies who have had a head injury might have damage to parts of the brain that control breathing, causing pauses in breathing during sleep.
• Metabolic Disorders: Certain medical conditions can affect how a baby’s body handles energy or chemicals. When this happens, it might be harder for their brain or muscles to keep breathing steadily during sleep.
• Arnold-Chiari Malformation: Babies with this condition have some brain tissue pressing into the spinal canal. That pressure can make it tougher for the brain to manage breathing the right way.

General Causes of Sleep Apnea

Not all causes of sleep apnea fit perfectly into one category. Some factors can raise the risk for both types of apnea or simply make it more likely that a baby will have breathing trouble while sleeping. These include:

• Premature Birth: Babies born before full term might have brains and lungs that are still developing, making it harder for them to breathe smoothly during sleep.
• Low Birth Weight: Babies who are smaller at birth may have organs, including parts of the brain that control breathing, that are not fully mature, putting them at higher risk for sleep apnea.
• Down Syndrome: Many babies with Down syndrome have differences in how their airways are shaped and how their nervous systems function, both of which can lead to sleep apnea.
• Family History of Sleep Apnea: Babies with close relatives who have sleep apnea may face a higher risk as well. Genetics can influence how the airway develops or how breathing is managed during sleep.
• Exposure to Toxins: If a baby comes into contact with harmful toxins before or after birth, it can affect how their airway or nervous system grows. This might increase the chances of sleep apnea in the baby.
• Exposure to Secondhand Smoke: Breathing in smoke from people nearby can bother a baby’s airway, causing swelling or narrowing that makes it harder for them to breathe well while sleeping.

Signs and Symptoms of Infant Sleep Apnea

Recognizing sleep apnea in infants can be difficult because they have no way to describe what they feel. For this reason, parents and caregivers need to observe for any small changes that could suggest a problem. Noticing these signs early and talking with a doctor promptly plays an important role in keeping a baby healthy and helping them develop as they should.

Below are common signs and symptoms that may suggest an infant has sleep apnea.

• Pauses in Breathing: Infants may stop breathing for at least 20 seconds during sleep. Even shorter pauses can be concerning if they occur frequently or are accompanied by changes such as a slowed heart rate or alterations in skin color. These pauses are often silent and might only be noticed by someone closely monitoring the baby while asleep.
• Snoring: Snoring in adults is common, but it’s pretty rare for infants. In babies, snoring might sound like a gentle rattle, a rougher noise, or even a sort of vibration. It could mean the baby’s airway isn’t completely clear.
• Labored Breathing: Some babies look like they’re working too hard just to breathe. You might see their chest or belly moving a lot, their nostrils flaring, or hear loud breaths even while they’re asleep.
• Gasping or Choking: A baby may suddenly gasp for breath or make choking sounds during sleep. It can look as though they’re trying to catch their breath after a brief pause. This is understandably unsettling for parents or anyone watching over them.
• Blue or Pale Skin Color: A baby's skin may turn blue or pale around the lips, face, or fingertips if their oxygen levels fall. They simply appear paler than normal at times. A doctor should be consulted immediately if the color of your skin changes while you're sleeping.
• Sweating During Sleep: Heavy sweating at night, even when the room feels cool, might mean a baby is working harder to breathe. Parents or caregivers may feel dampness in the baby’s hair or notice moisture on clothing, particularly around the head and neck area.
• Mouth Breathing: Babies normally breathe through their noses. If a baby often breathes through their mouth during sleep, it could be a sign of nasal congestion or another issue making breathing more difficult.
• Frequent Waking: Sleep apnea might cause a baby to wake repeatedly at night or seem restless overall. They may cry, fuss, or keep shifting position, which makes it harder for them to sleep deeply and restfully.
• Difficulty Swallowing: Some infants with sleep apnea have difficulty coordinating breathing and swallowing. This may lead to coughing or choking during feeds, frequent spit-up episodes, or discomfort while drinking milk.
• Feeding Difficulties: Feeding can be tiring for infants who have sleep apnea. They might not finish their bottles or breastfeeding sessions, take longer to feed, or need to pause to catch their breath. Over time, these difficulties can contribute to inadequate weight gain.
• Poor Weight Gain: Sleep apnea can make it harder for babies to feed well or get enough rest. Over time, this might cause slower weight gain or cause them to fall below normal growth charts. Doctors sometimes refer to this as “failure to thrive.”
• Recurrent Respiratory Infections: Babies who have sleep apnea might come down with frequent colds, nasal congestion, or lung infections. Ongoing breathing challenges can make them more likely to get infections in their airways.
• Excessive Daytime Sleepiness: Although babies naturally sleep a lot, those with sleep apnea might seem overly sleepy even when they’re awake. They could be hard to wake for feedings or appear tired much of the time, despite getting sleep at night.
• Irritability or Fussiness: Some babies become more irritable or are harder to soothe. Poor sleep and lower oxygen levels may leave them uncomfortable or distressed.
• Developmental Delays: When sleep apnea is severe or lasts a long time, it can slow a baby’s growth and development. Parents might see delays in milestones like smiling, rolling over, sitting up, or babbling.

How Is Sleep Apnea Diagnosed in Infants?

Diagnosing sleep apnea in infants can be more complex than it is for older children or adults since babies cannot describe what they are feeling, and pauses in breathing may be subtle or easily overlooked at home.

Doctors rely on gathering medical history, performing physical exams, and ordering specific tests to find out what happens during a baby’s sleep and to identify the type and seriousness of sleep apnea.

Initial Hospital Evaluation

Shortly after birth, doctors usually monitor a newborn’s breathing, heart rate, and oxygen levels, especially if the baby arrives early or has existing health concerns. These early checks in the hospital can help detect any signs of breathing difficulties.

Doctors also look at the baby's physical characteristics for any indications of neurological or airway disorders. However, in some babies, symptoms may not appear until after they go home, making follow-up visits with a pediatrician essential for identifying sleep apnea as early as possible.

Diagnostic Tests

If sleep apnea is suspected, doctors may advise certain tests to confirm the condition and learn more about what’s behind it. These tests can help decide whether the apnea is obstructive, central, or mixed, and how serious it may be.

• Physical Exam: A doctor examines the baby’s overall health and inspects areas like the mouth, nose, throat, and facial features for signs that could indicate airway blockages or structural differences. Yet, since some symptoms may not appear during a short visit, a physical examination by itself might not always identify sleep apnea.
• Polysomnography (Sleep Study): This test is regarded as the most accurate method for diagnosing sleep apnea. It records information about a baby's heart rate, breathing patterns, oxygen levels, brain activity, and movements while they sleep. These results help doctors in determining whether apnea is central or obstructive, as well as how often and how long breathing pauses occur. Sleep studies for babies may necessitate an overnight stay at a specialized sleep facility.
• Airway Endoscopy: In this procedure, doctors use a slim, flexible tube with a tiny camera to look directly inside the baby’s airway while the baby is either sedated or sleeping. This allows them to spot physical blockages, unusual structures, or parts of the airway that might collapse during breathing.
• Imaging Studies: Tests like neck X-rays or CT scans help doctors get a clearer view of the shape and size of the airway, jaw, or facial bones. These images can help diagnose structural issues linked to obstructive sleep apnea, like a small jaw or other differences in facial structure.
• Pulse Oximetry: Using a tiny sensor applied to the skin, this simple test measures the oxygen levels of a baby while they sleep. While it doesn’t give as much information as a full sleep study, it can detect drops in oxygen that might suggest breathing troubles and show the need for more in-depth testing.

Treatment Options for Sleep Apnea in Babies

Treating sleep apnea in infants depends on the type of apnea, how serious it is, and whether any other health concerns are present. Many babies, particularly those born prematurely, eventually outgrow sleep apnea as they gain strength and their nervous systems mature.

Still, some infants need medical support to maintain healthy oxygen levels and good sleep quality. Doctors create treatment plans carefully, always aiming to keep babies safe while avoiding treatments that may not be necessary.

Medical Management

Some babies require medical interventions to help manage symptoms or treat conditions that might contribute to sleep apnea.

• Supplemental Oxygen: Giving a baby more oxygen during sleep helps maintain stable oxygen levels. It is commonly used to treat premature babies and those with mild sleep apnea who don't need more involved treatments. Typically, the oxygen is delivered through small nasal tubes as the baby rests.
• Medications for Reflux: If GERD is making breathing problems worse, doctors may prescribe medicine to reduce stomach acid and lessen irritation in the airway. Addressing reflux can sometimes improve symptoms of obstructive sleep apnea.

Devices, Therapies, And Surgical Options

Some infants need additional support beyond observation or medication. The goal of these therapies is to maintain an open airway and encourage healthy breathing while you sleep.

• CPAP Therapy: Continuous Positive Airway Pressure, or CPAP, gently delivers air through the baby's nose to help keep their airway open while they sleep. Certain infants with obstructive sleep apnea who have not responded to other treatments may benefit from CPAP, even though it is more common in adults.
• Apnea Monitors: These devices measure a baby’s breathing and heart rate during sleep. If breathing stops for too long, an alarm sounds to alert caregivers. Apnea monitors can provide extra reassurance for babies at higher risk, especially after leaving the hospital, but they are not a cure for sleep apnea itself.
• Airway Surgery: Surgery may be required in certain cases to address structural problems like a cleft palate or to remove obstructions in the airway, such as enlarged tonsils or adenoids. Surgery is typically reserved for cases in which no other treatment has worked and where the advantages of the procedure outweigh any possible risks to the developing baby.

How Parents Can Monitor Sleep Apnea at Home

Caring for a baby who may have sleep apnea can feel overwhelming, but parents have an important role in noticing early signs and keeping their child safe. While medical professionals focus on diagnosis and treatment, there are practical things parents can do at home to watch for symptoms and create a safe sleep setting. Below are some ways parents can help monitor and support their baby’s breathing while they sleep.

• Tracking Sleep Patterns: Keeping a daily record of your baby’s sleep habits can help reveal patterns or changes over time. Note how long your baby sleeps, how often they wake, and any unusual signs during sleep, such as gasping or restless movements. Sharing these details with your doctor can help guide treatment plans.
• Recording Symptoms: Write down any symptoms you find concerning, like pauses in breathing, changes in skin color, sweating, or difficulties with feeding. Include how often these symptoms happen and when during the day they occur. This information is very helpful for doctors trying to assess the severity and type of sleep apnea.
• Maintaining a Safe Sleep Environment: A safe sleep space is vital for every baby, and even more so for those with breathing concerns. Babies should always sleep on their backs on a firm, flat surface without pillows, loose blankets, or soft bedding. Instead of treating sleep apnea, sleep positioners or wedges can increase the risk of Sudden Infant Death Syndrome (SIDS), so they should only be used if a doctor specifically recommends it. To protect your baby's health and well-being, it's crucial to keep the sleeping area smoke-free and to adhere to safe sleep practices.

When to Call a Doctor

Although newborns may experience brief breathing pauses, some symptoms should not be overlooked. Parents should be able to recognize the warning signs of a baby's breathing issues. It's important to contact a doctor right away if you observe any of the following signs. Early medical attention guarantees your baby gets the right care and helps keep them safe.

• Persistent Breathing Pauses: If a baby often stops breathing during sleep, especially for 20 seconds or longer, or has shorter pauses along with other worrying signs, it’s important to have a doctor check for possible health issues.
• Color Changes: If a baby's skin, lips, or fingernails suddenly turn blue, purple, or appear abnormally pale, parents should take special notice. These changes may be signs of low oxygen levels, so it's important to get a doctor to check the baby as soon as possible.
• Difficulty Feeding: Some babies have a hard time feeding and might seem worn out quickly while nursing or using a bottle. If a baby coughs or chokes during meals or isn’t gaining enough weight, it’s wise to talk with a doctor to make sure there’s no underlying health problem.
• Frequent Awakenings: A baby who wakes up repeatedly during sleep, seems restless, or cries often may be experiencing breathing issues that should be discussed with a doctor.
• Concerns About Development: Parents should speak with a doctor if their baby appears delayed in reaching milestones like smiling, rolling over, sitting up, or babbling, since untreated sleep apnea can sometimes affect development.

FAQs

Can a newborn baby have sleep apnea?

Yes. Sleep apnea in newborns is real and occurs particularly in babies who were born before their time or those with medical issues. Sometimes, babies stop breathing for 20 seconds or longer while they sleep. Detection at an early age can assist in keeping them safe and promote healthy development.

What is the most common cause of apnea in newborns?

The biggest reason is being born too soon. When the babies are born prematurely, the region of the brain that enables them to breathe may not be well developed. In babies born on time, things like airway problems or reflux can also lead to apnea.

How does sleep apnea affect a baby?

Sleep apnea may lower a baby’s oxygen levels, disturb sleep, and bring on feeding troubles, slow growth, and delays in development. Without treatment, it might harm the heart, lungs, and general health. Early detection and care help prevent problems.

How long does apnea last in newborns?

Significant apnea usually means pauses of at least 20 seconds, though shorter ones with other symptoms also matter. Many preemies outgrow apnea by 44 weeks after conception. If apnea keeps happening beyond that point, a doctor should evaluate the baby.

Can a baby die from sleep apnea?

Severe sleep apnea that goes untreated can drop oxygen levels and cause serious problems, but most babies do well with proper medical attention. Watching for symptoms, getting a diagnosis, and following treatment plans lowers the risk. Any changes in breathing should be checked quickly.

How to prevent sleep apnea in babies?

Sleep apnea isn’t always something you can prevent. Still, parents can help lower the chances by setting up a safe sleep area, keeping babies away from smoke, and treating things like reflux. Seeing the doctor regularly helps catch any problems before they get worse.

Will my baby outgrow sleep apnea?

A lot of babies, especially those born early, grow out of sleep apnea as they get older and their bodies develop. Still, some may need treatment if it keeps happening. Regular doctor checkups are a good way to make sure your baby is staying healthy and progressing well.

Conclusion

For any parent, the thought of their infant having sleep apnea can be frightening, but understanding the condition and its symptoms can have a significant impact. While some babies may require medical assistance to breathe safely and continue to grow, others may be able to overcome sleep apnea on their own. The most important thing is not to ignore any concerns that you may have.

Consult a doctor if you observe any of the symptoms listed in this article, such as unusual breathing or feeding difficulties. You and your child can both sleep better and feel more at ease if the issue is identified early and treated appropriately.