1. She presented with scary feeling, seen ghost, stories full of horrifying imagination. At 7 years, sleeping with mum and dad on the same bed. Mum complained she was quite restless at night, keep changing position until the end of the bed. Due to unnoticed insomnia, she required extra day sleep, making her wake up till 12.00 noon. In the daytime, she was over-active and had abundance eating as if she is discharging unfulfilled wishes.
2. Mum claimed she was easily fatigued and lethargic. Slightly overweight since young, she has had rhinitis, sinusitis when she was five. Nasal Spay was prescribed and she recovered. Until around September when she had developing sleep problem associated closely with abnormal behavior.
3. Obstructive sleep apnoea in young children is rare and most of the time overlook by physician treated children for sinusitis and tonsillitis. Most doctors do not ask about sleep pattern in children. They assume children sleep soundly especially when they are sleeping with their parents.
4. This kid has sleep deprivation characterized by symptoms of fatigue, listlessness and overactive behavior the next morning, the mom noticed she was moving and turning in bed. Sometime children who do not get enough sleep would show moodiness and tantrums behavior.
5. In most cases, removing the tonsil or adenoid would solve the problem. Medical treatment for sinusitis and URTI help in the minority of cases on a temporary basis as illustrated earlier on in this case. CPAP machine can be quite intimidating for children in the beginning. Proper diagnosis needs to be done in sleep lab before starting CPAP.