S8:E73 - Maggie Lavender, MSN, RN, FNP-C: Sleep, Narcolepsy, and Kid's Health - Airway First

Episode Transcript
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(00:00):
Hi everyone, and welcome to another video.

(00:29):
Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James.
My guest today is Maggie Lavender, a board-certified family nurse practitioner licensed in the state of Texas with a specialization in sleep disorder, medicine, and neurology.

(00:51):
She attended Louisiana State University's Health Science Center, where she received her Bachelor of Science in Nursing.
Maggie began her career working in a pediatric intensive care and burn unit.
She later moved to Houston and continued her career in a neuroscience intensive care unit at a level one trauma center.

(01:13):
She then completed her Master of Science in Nursing and Postmaster's Emergency Nurse Practitioner Certification simultaneously at the University of Texas Health Science Center.
She joined Comprehensive Sleep Medicine Associates alongside Dr. Gerald Simmons in 2012.
She has evolved to be a recognized nurse practitioner specialist on a national level and currently functions as a consultant and lecturer on the management of narcolepsy patients.

(01:46):
At the CSMA, she specializes in comprehensive sleep disorders, neurology, and epilepsy.
You can find out more about Maggie at csma.clinic.
And now let's jump into today's episode with our guest, Maggie Lavender.
Awesome. Thank you so much for joining us today, Maggie.

(02:08):
Thank you for having me. I'm excited.
Yeah. Yeah. And for those who may not know, I met you. I actually didn't meet you until this past April, which seems surprising to me.
At the SEC Sleep Conference in Houston.
Then you work with the CSMA and you were one of the speakers at the event.

(02:30):
Correct. So I work under Dr. Gerald Simmons and of course the SEC conference is a conference that this was actually our 20th year that Dr. Simmons has done.
It's an education conference where we it's unique in that we combine providers, medical providers and the dental practices so we can all collaborate on what's the best treatment outcomes for our patients with sleep apnea.

(02:52):
So it's very exciting.
Yeah, it was a great conference. And I mean, obviously, little bias because Dr. Simmons is on our advisory board, but it really is truly an outstanding conference.
And I'll put the link in the show notes for anybody that would like to attend, but the collaboration between physicians and dentists and all ally professionals because my functional therapists are there.
And it's just, it's really a great event. And it's so, so, I mean, I thought I knew a lot when I started the conference and walked out quite a bit more educated. It's really a great event.

(03:26):
So I've been there over the Dr. Simmons for 11 years now. So this was my 11th one to attend and I literally learn amazing numerous things every single year.
So I can see how yeah, yeah, and we'll put a link to that because I know I'm not mistaken. Early bird registration is going on now for next year's event.
So correct. Yes, get in. I can't recommend it enough.

(03:47):
That's a great, great, great event. So let's transition over to you personally. So I'd like to kick off our discussion about where your passion for nursing and care first began.
So believe it or not, I knew that I was going to be a nurse since I was four years old.
I was the child that was putting band-aids on my baby dolls and wanted to make sure that I took everyone's pain away.

(04:12):
As I got older, I realized that nursing and medical was a little more than just taking a person's pain away.
That was my path. I did everything to keep it on path and I was going to be a nurse. And then when I became a bedside nurse, I realized I wanted to take it further.
And I had, at that time, I was in intensive care and I was like, look, I'm just seeing well trauma intensive care.

(04:36):
And I had a lot of surgical patients and I was like, I really want to make sure that these patients are not in pain.
So I thought anesthesia was the route I was going to go.
And I was lined up and submitting all my grad school paperwork for nurse anesthetists.
And I had an amazing mentor as one of our intensivists and he just sat me down after one long night of procedures at bedside.

(04:59):
And he was like, you know, maybe you can do what you want, but let me have a conversation with you. And he says, I just don't think anesthesia is the right field for you.
Not that you can't handle it, but you need to be with patients. You need to be able to educate, work with families and talk with patients.
Your patients need to hear you and they don't need to be sleeping the whole time they're with you.

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And I kind of was like, man, you should have told me this long time ago, like, why are you doing this now? I'm literally submitting my stuff this week.
But it really, you know, went straight to my heart and I was like, maybe he does have something because I love working and communicating with my patients and maybe, you know, my field or my gift from God is not just taking pain away, but maybe preventing the pain or whatever it is from even happening.

(05:43):
So I really took it to heart. I was like, I'm going to go with it. So I switched gears and went to nurse practitioner role and never looked back.
I'm a certified family nurse practitioner with a background in emergency medicine because of my trauma background. So I'm post-mastered.
And I walked into with Dr. Gerald Simmons thinking his practice was a neurology practice because that was my background. And little did I know there is a mostly sleep practice with neurology and epilepsy involved.

(06:11):
And immediately my passion went into sleep because until your sleep is affected, you don't realize how much sleep is involved in your life and how much our day to day, our overall health is impacted by our sleep.
And by educating and working with my sleep patients, I am making that impact and spreading awareness and really changing lives on a daily basis just by letting someone go to sleep.

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So it's kind of funny, you know, I was told that you don't want to be dealing with sleep patients because you need to educate, but now I'm back in the sleep world in a different aspect, educating my awake patients on how to sleep better and how to fix their lives.
So it's been a passion. I'm very grateful that God touched me and talked to me, you know, as a young child and I couldn't be more happy where I'm at.

(06:55):
It's amazing the way you're talking to so many clinicians on this show. There pass me. You think you're going one way and you just end up somewhere else and it's where you're meant to be.
And the other thing I think is really interesting is you, I can try to remember exactly how you phrased it, but that when you're missing sleep, some people don't realize and that to me was one of the most profound takeaways from the conference for me.

(07:24):
People don't realize they're missing sleep. They think I go lay down. I got eight hours. I get up my go to work. Well, you were in there for eight hours, but did you actually get through your full cycles? Yeah, I was the quality there.
And our bodies are amazing bodies. Our brains are amazing. God created us, right? And so we go through these compensation modes and I have patients that were drugging here, you know, by spouses because they had to do a DOT for work.

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And they're like, I don't have any problems. I'm just here because they said I snore. They don't even snore. Like I'm here just to get my job. And we went through and these patients have diagnosis and we treat them and they come back and they're like, I never knew I didn't feel good until I feel great.
And you just, your body is an amazing machine. I'm going to call it that. It's going to do its job for survival and we just don't know how much we can do it better.

(08:16):
Right. Right. And that's kind of the whole point of the things we talk about here when it comes to sleep and airway. So many children are walking around out there and they're compensating.
Their little bodies are already compensating. So, but we're starting to see the repercussions and things like ADHD diagnosis.
Right.
Right. And so that's why these kind of conversations are so critical.

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And it's proud to whenever we're breathing poorly in our bodies compensating, these kids are growing and structurally they're changing and it's only going to create worse problems later and you know, damage hard and cause GI issues.
And I mean, everything is intertwined with appropriate sleep growth, immunity.
Yep, it is. It's all connected.
And that's why we want to get children fixed before six in these critically formative years. And that includes sleep and airway so that they have a truly robust health span as they continue through life.

(09:14):
And I think spreading awareness, not only to providers and dental practices that are seeing pediatrics, but to just the general public, because sleep issues are not just a tired kid sleep issues presented so many different ways and we have to start knowing what to look for what to screen for what to bring up to your
providers if they're not asking the right question. So we have to really start looking at ourselves and our own children to say, Hey, are we having issues? Let's do a checkout. You know, let's let's run through and do an inventory of what's really

(09:43):
going on in our household and what can we do to make things better? Yeah, absolutely. And I guess to that, let's talk a little bit about specifically sleep testing and treatments.
Correct. Because there is a difference, right? The way you approach this for adults versus children. Correct. So the biggest thing is really as far as testing and approaches, there's no major, major difference.

(10:08):
The biggest difference is going to come between pediatrics and adults is really collecting the history, asking and probing the right questions from the provider. You really want to hone in when you're talking to an adult, they're going to tell you, I'm tired, you know, I have to take a nap or my eyes get heavy.
They're older, they have better verbiage to explain what's going on. As a child, they may not acknowledge that their feeling of what they're feeling is because they're tired, right? And children don't always present tired. How do children present?

(10:38):
Pranky, irritable, behavior issues, poor focusing. So as providers, we need to understand that children and adults present differently.
In children, you may present with some snoring and it's going to be more milder. You know, very rarely are you going to have the child who's snoring and sucking in the curtains, as we say.
You're going to have more of those little meow, you know, the little purrs and the snoring. Open mouth breathing is a really big one. Restless sleep.

(11:06):
We often see, and you know, not until we ask the questions to the parents, yeah, that kid moves all over the bed, like I don't understand whenever he hops in our bed, he's all on top of us. Or children complain of pain in their legs, you know, just cramping sensations.
And it often gets ruled off of, oh, it's just growing pains or oh, they ran through heart at recess. Start listening because these are big red flags and kids. Not all the time doesn't mean it's a bad thing, but we have to listen to what the kids are bringing us because it's not your typical symptoms.

(11:38):
What can that mean? The leg cramps?
Restlessness, periodic limb movements of sleep, restless leg syndrome. Those could all be fragmenters of the child's sleep for sure.
And it just doesn't quite know how to explain they have ants in their pants, you know, an adult. How you, I got to wiggle my foot and they feel better kids don't really connect that all the time, especially the younger population.

(12:01):
And bedwetting, you know, it's not just, oh, you know, they're just a late bloomer, you know, bedwetting after, you know, their potty train during the day, why can't we get nighttime potty training under control.
And sometimes there is a bigger meaning to that. And difficulty waking in the morning. We know no one wants to jump out of bed automatically and be, you know, the big sun flower and happy and rosy and ready to go.

(12:24):
But is it overly cranky? Is it we have, you know, the kid is very slow, slow moving. And then of course, obviously daytime sleepiness.
And adults again, snoring, pausing and breathing, gasping for air. Those are obvious ones. They also have abrupt awakenings during the night and they don't quite know how to explain it or they just say I just toss and turn all night.

(12:46):
I just feel like I'm up all, you know, every two hours looking at the clock. And they're better able to explain that daytime sleepiness, that lack of motivation.
And they may talk of morning headaches or of course, some more restlessness. But what we have to look at is what do these sleep problems become if we don't address them at the appropriate age.

(13:08):
If we don't address appropriate sleep and quality sleep and children, it does lead to behavioral problems, poor academic performance, you know, it doesn't teach them emotional regulation because they just don't have the capacity to handle what's going on in life.
And that's why we have to look at things like brain change, develop anxieties, depressions and things like that.
Right.
An adult, it leads of course to mood changes. When I don't get enough sleep, I'm moody. We all know that. Yeah.

(13:33):
Everyone is. So imagine these poor little kids who don't have that emotional regulation. Their poor little brains that doesn't even have a chance to figure out how do I perform in this situation because I don't have enough energy or capacity to even comprehend what's going on with them.
In adults, it also leads to decrease libido. That's how we actually get some males and our practice that that's what brings them in.

(13:56):
And they don't even understand the link. And then of course, difficulty concentrating during the day and poor memory issues. Again, it's all about how do they present.
Are we asking the right questions? Okay.
When you bring it back to testing.
Everybody should need a sleep study if they come in with any of these symptoms. Ideally getting these patients in the lab for a very detailed testing is the route to go.

(14:21):
That's much easier in the pediatric population per insurance requirements. As an adult, we have we're forced to be focused more on home studies and getting things rolled out on home studies first and home testing mechanisms.
But in children, majority of the time we do have the liberty to be able to pull them in the lab and get those more detailed testing first. So my advice to parents is if your provider does give you the option of, you know, which one would you choose?

(14:47):
Please pick the in lab. You're going to get a much better understanding of what's going on with your child because it looks at movements. It looks at these odd little nuances that are going on that could be fragmenting your child's sleep.
And it's not the obvious snoring, pausing, gasping decreases in oxygenation that the home studies pick up. So home studies often miss things.
And follow your gut. If for some reason a pediatric kid did have a home study and the doctor's like, nope, there's nothing there. The home study was negative. But in your gut, you know, there's something still possibly going on with your kid.

(15:18):
Push to get that in lap because you may get the bigger picture and a better understanding. So that's a super important note.
So again, just the differences is presentation. How do we approach those situations and then understanding what are the contributing factors behind it?
Yeah. And for as I speak as a parent, I'm sure other parents think this is just the thought of taking my child when either of them were teeny into a sleep lab is a little scary.

(15:47):
So for parents that are concerned about that, I just kind of want to, you know, plant the seed that we do have a series coming up with JT and some internal sleep technicians that are going to walk us through.
What does it look like? Let's do a tour of a lab. Let's look at what the study looks like and what you can expect so that we can take some of the fear out of it so that you can approach it in a calmer manner.

(16:10):
So hopefully then that rubs off on your child and they'll feel calmer and safer because it is scary if you don't know.
It is very scary and that's what I do with my pediatric patients in the office. I let them go look at the sleep lab. I let them look what the room looks like.
And there's a lot of wires on these kids and it's overwhelming for adults.
Sure.
So what I tell my kids is I bring it into their world. What's important to their kid? You know, are they into Superman? Are they into superheroes? Are they into princesses and unicorns? And I use the wires and say it's going to give magic powers and you know we want to see who's that little superhero inside of you and you know just make it into a language that they can understand.

(16:48):
And then moms and dads who are listening, you know, we don't like to bribe our kids and use you know gifts as rewards, but this is one of those things.
Explain to the kid why this is important. You know what is your concern for them and we want to make sure you're getting you know good, good sleep so you can grow and get strong muscles and go play ball or whatever they're interested in.

(17:09):
And use it to their advantage. And then if they can do really good behavior because kids ultimately want to do right for their parents, right? Sure.
They can show us good behavior and show us how big of a boy or a big of a girl they are to be able to complete that study for us on their best behavior. Then they get a treat.
Either it's an ice cream cone or that new little toy they were wondering and I'll never forget when I posed this to a little boy in my practice and mom was in there and the little kids eyes and smile just lit up and the boy goes I know exactly what I want.

(17:41):
I was like oh that's exciting. Is it you know one of your superheroes because he was into spider-man at that time. He goes no I want a yacht and I go mom and I did.
I'm like you handle that conversation. Right. I think there needs to be some boundaries here. Again, how big or small your gift needs to be.
But that is a motivation for the child because they do want to make us proud and impress us. So we present things like that and then they get a small reward in the end. Everyone wins.

(18:12):
So yeah, in their language.
And I love that. I think that is just such a beautiful way to approach it. And that's great. So now let's talk a little bit.
Yeah, so I think in order for parents to fully understand what's the differences of adults and children. I think we need to just go down the basics a little bit and understand what is sleep and why is sleep important.

(18:39):
So everyone just thinks sleep is a part of the day and if we you know can only get a couple hours tonight it's not a big deal.
The kids have late sports they'll catch up later. It's a much bigger picture than that. Okay sleep is important and critical for all ages.
But it's especially important for children. Okay sleep plays a pivotal role into how we grow, how our emotions form, how we're able to understand and articulate our emotions, our concentration, our growth hormones, you know, do we want to be have strong muscles, strong

(19:12):
bones, things like that. And most importantly our immune system. There's lots of research out there that shows poor sleep quality and quantity are entered intricately related and linked to physical and emotional health, regardless of age so all ages.
It is linked to our physical and emotional health for children if we leave sleep disorders untreated, it can lead to major academic struggles. These kids are labeled a, you know, on a daily basis of 80D and ADHD.

(19:40):
And put on all these long lists of medicines that have a list of side effects. What if we just looked at their sleep that could be an issue and behavior and developmental issues abnormal and unhealthy way.
We live in the United States guys obesity is one of our biggest biggest problems we have and yes we don't always have the best lifestyles, but proper good quality sleep is how our metabolism forms how our metabolism speeds.

(20:05):
So it's very important into continuing to control our weight. Problem socializing, you know, children's developing our brains are developing when we're young and again we're taking in all of our social cues, putting them in our brain trying to understand and how to, you know, reciprocate that action back.
If our brain is not performing to peak capacity, kids are not understanding those social cues and how do we handle those certain situations and anxieties and other psychological issues can develop. And then there's a slew of any other condition, because everything is linked back.

(20:38):
And again, some of these disorders again can continue into adulthood a lot of your anxieties, depressions, chronic fatigue issues, poor performance at work, just overall self confidence issues if you're, you know, underscoring and you're underperforming compared to your peers.
How does that make your confidence feel when it's just because you were really tired and having to deal with those situations.

(21:00):
And can't sleep or lack of quality sleep. I guess I should start labeling me at that right. Quality sleep because you can sleep for eight hours, but quality sleep.
Correct. And also impact even in children, diabetes. Absolutely. Absolutely. Diabetes, cardiovascular status, GI status, everything gets leaked. And as a child, you don't want to think of those bigger pictures, but we have to.

(21:25):
We have to. We have to. Our lifestyle in the United States, we have to put diabetes. We have to put cardiovascular cholesterol, blood pressure, stroke risk. We are seeing it in younger and younger ages.
So it's not just adult diseases anymore. And again, you set the stage and you train your body how to perform when we're babies. And so that's where it starts. And so we have to continue that mindset through the whole lifespan.

(21:50):
And as well. So once again, we're back to that zero to six. If we can get it.
Exactly. Let's take it a little bit further because I think we need to look at a little bit deeper understanding of whenever you're in your provider's office and you did have a sleep study and they're going through things.
Let's look at how sleep staging is important and what actually happens whenever we are sleeping at night. It's not just we close our eyes, lay quietly for six to eight hours, wake up and boom, there's a lot going on whenever we are sleeping.

(22:18):
And if we can understand that it does a lot better.
Okay, then I share my screen real quick. And we're going to go through and look at some sleep staging.
So I'm not going to read this slide verbatim, but I have it here because I want to everyone to understand that there are different stages of sleep and everyone has their own interpretation of them.

(22:39):
But the idea here is there are stage one, which is very, very light sleep, or very, very light sleep stage two, which is a little bit deeper, but it's still considered light sleep.
Stage three is slow wave sleep. And then of course we have room. Everyone knows about room because that's when we dream right and everyone thinks room is the most important room is important, but it's actually stage three.

(23:01):
And that's why we have our restorative sleep. That's where, you know, our body really works itself. This is where our tissues repair and grow and we have cell regeneration. This is where immune system strengthens.
And the reason I bring this out is in children, when kids and children sleep cycles contain a relatively large amount of slow wave stage three sleep compared to adults.

(23:25):
Okay, this is your non dreaming state. It is that restorative sleep that we talk about as deep sleep in early adulthood, the amount of slow wave sleep begins to decline.
Okay, so why is it so important to look at sleep at very young ages, because if majority of majority but a good portion of the pediatric world sleep is in that stage three restorative growth state sleep.

(23:52):
And our kids aren't getting it or getting the right amount of it or it's always broken in pieces through the night.
What are we setting our kids up for we're not giving them the proper opportunities to grow and heal and build that strong immune system to protect them for what's to come later in life.
It's important to note that you don't just go stage 123 room, and then you know all night long, a cycle last typically 90 to 20 minutes and 90 to 120 minutes and that means all sleep stages, and then you start over.

(24:23):
Earlier in the night you have lighter phases of sleep as majority of the time, and as each cycle recycles towards the end of the night, your deeper phases of sleep your stage three and run become more apparent.
So it's important that we focus on quantity at this point that if you're only allowing four hours of sleep, you're not allowing yourself to go through enough cycles, which is why it's important to make sure we are giving the right age group, the right amount of time of sleep so they can cycle

(24:53):
properly and allow us to get through those stages and get to those restorative phases of sleep during the night.
Now if we talk about quality, I can give you eight hours 12 hours but if it's not quality and fragmented we're still not going through those stages as we should so it's a very, very important.
Now, when we look at what can happen if we are fragmenting our sleep and waking these kids out of their stage three sleep, not me physically gone shake the kid and wake them up, but if you're having other issues fragmenting their sleep.

(25:27):
Your stage three can cause mental foggyness sleep inertia that means you're slow moving in the morning. And this can impair alertness attention and working memory. Again, what are we setting our kids up for if we're just not understanding these dynamics of sleep.
And then it's important to note and I said it before but I'll say it again, your body takes advantage of these deep phases of sleep your stage three and your room sleep, it repairs our injuries and it reinforces our immune system.

(25:57):
This is where we're going to strengthen and heal ourselves of are we fighting with just the simple little cold, you know it takes time to get over little codes.
This happens you know this is where your body takes those germs and builds its little attack systems against the germs so we can get better.
But guys we live in a world now where with tons of autoimmune issues, right. It goes back to strengthening our immune system when we're younger and in teaching and training our body how to have a strong immune system and how to use it effectively.

(26:28):
Okay, so I think that's super important that we all know that's hugely important basis.
Yeah, and it's hugely important and fragmented sleep. I kind of like to play off that a little bit because one of the things we're hearing about so much in the news right now and just in online and everywhere has to do with social media and screen time and how it's impacting

(26:50):
Yes, children's mental health. Well, and if we dig a little deeper.
Now it's impacting their sleep so you know we're backing into it again into that root cause. So, you know, let's talk a little about about what are some of the possible impacts and how we as parents can help without isolating our kids or preventing them from doing their work because

(27:13):
so many kids it's not just high school anymore. It's elementary junior high. They're working and books are gone. We're doing everything online and on iPad so how do you
protect your child's sleep but still you know make it to where they can do what they need to accomplish.
So there's a lot of talk out there and there's a lot of different perspectives and I think the biggest perspective is understanding social media and understanding screen time.

(27:41):
It has its positives. Don't get me wrong right and we need to use videos man all day long right.
We need to use those positives to our advantage and our children's advantage because again we can learn a lot of things with.
I'm not really going to say social media but we can learn a lot of things with screen time right because it can be educational movies it can be you know looking up articles and reading and and in educational videos.

(28:06):
But we can also have our kids because we're not paying attention to what's on their screen going down wrong paths on YouTube or any of those right and expose our kids to very dangerous people very dangerous situations that their little
brains and hearts are not ready to handle. So I think when we look at social media and screen time. The first thing we need to say is supervision supervision supervision we need to put safety nets on those devices so we know what our kids are doing.

(28:34):
We don't want them to accidentally get into something and their innocence is taken away and they don't even know it. So that's first and foremost that's outside of the sleep world.
And that's just my mommy heart talking there. And but when we look at the mental health impact I think it's that's a good bridge into that because again what do we expose them to.
Okay. And when you look at how do screens and how do social media in particular impact our mental health. Let's look at and think about when our kids are on screens what are they not doing.

(29:04):
They're not being outside. They're not socially connecting with people. Everything's behind a screen. Where's yourself confidence building where is your social social skills building you know can you actually hold a conversation with a person and not type it on a computer screen.
You know can you not type it with emojis or all these shorthand versions of I don't even know what the languages are anymore. And that's when I really start feeling my age they don't know how to communicate with the younger generations.

(29:29):
But we know can our kids socially survive. No, not if we're hidden behind screens all the time so that's number one.
But the mental impact is anxieties, depression, loneliness, fear of missing out. And it's important in particular with social media that we teach our kids that everything's not what it seems on screen.

(29:51):
Right you know, and there's I think you know showing kids examples of you know here's this wonderful picture there's tons of stuff online again.
There's a lot of things on screen time. There's tons of things out there that can explain it to our patient that this is just one snapshot and you don't know what's two inches from that picture you don't know, you know, that they can put on a bunch of makeup and a smile and that's not really

(30:12):
what's going on. And so things on social media can look wonderful but you don't know the whole picture. And so it doesn't give the real reality that other people may struggle to or other people may have bad days, and make them feel that they're the only one that had a bad day.
That can create anxieties and the fear of missing out on things we don't ever want to miss out you know we want to be involved in everything, but if you don't understand the whole picture that life's not all about what it's what it shows on camera that it's going to create mental issues

(30:43):
it's going to create major self-esteem issues. And I think we have to put those safety nets on our screens and on our social media and you know we can debate back and forth what's the appropriate age to introduce these things and you know I think some of this is out of our control because it's being forced upon younger and younger ages in schools and communicating you know when we don't want to.

(31:07):
And guys it starts to what example are we setting for our kids are we always on social media are we always on a computer or on our phones when set of interacting socially with our kids.
We're sitting across the dinner table with them and we're on our phone and we're not talking how was your day like what you used to do in the olden days. Let's talk you know what did you experience today what did your friends talk about.

(31:28):
And one set one example is we were at a restaurant with my kids and I didn't think anything of it because this is how I raise my kids, they brought their color books and their crayons while we were waiting for dinner and they were coloring and we're all interacting and we're coloring with them and this woman that I had no idea who it was she came to me
she goes it is a pleasant surprise to see this that you don't see it often. And it kind of was like, oh, like, yeah, I did a good thing but I never paid attention to it but when you start around.

(31:58):
No one on tables are talking in restaurants anymore. They're on social media, and they're trying to figure out what selfie I could take or what food picture I can take to post it, instead of enjoying in the moment and experiencing those social needs that we have so I think it's very
to stick a step back and look at what role model are you doing and what our kids being raised as you know and I think that's that's a big step here.

(32:22):
It's huge and I mean and I take that even one step further.
Especially that I personally didn't see it as much with the littles but start putting junior high and high school children in your car, right and my, my daughters and their friends, they pile in and I can remember.

(32:44):
The first group when they would pile in.
They did talk to each other, right they did the normal thing like we did they're all sitting on top of each other and there's music and we're doing great.
You fast forward now, about eight years later, the same kind of scenarios and I'm looking in the backseat and there's a lot of a lot of.
And I'm going, I'm sorry, what are we doing.

(33:07):
And they kind of talk to each other but not really because they're all they're talking to each other because if you would look at their phones, they're texting back and forth to the person who's there.
They're snapchatting each other. Yeah, so it's permeates in these places and you think, wait, I'm controlling your screen time but you're in the car and you're doing it's constant.
So that has to be impacting their little brains and the way they sleep is their brain is so stimulating.

(33:35):
So let's take it that good, good probe into the next step. How is our sleep in fact it impacted. So we have the mental aspect. Now let's look about the sleep aspect.
So when we are on phones computers, iPads, whatever you want to call them nowadays them sure there's more that I don't even know. It is harder to fall asleep.
So we have we it's proven it's harder to fall asleep and I'll get into why, why that happens.

(33:59):
But there's also, again, screen time is not all bad, because there are helpful things that we can do. Okay, there are, you know, storybooks that we can do use, you know the Kindle paper lights that don't have the dangerous lights things like that.
We can help kids relax with audio books or meditation recordings or things like that. And that so we still can use digital things it just doesn't have to be actual screen times.

(34:24):
So think about what options are we using. Now screens can delay brain signal to prepare for sleep, and it leads to this difficulty of falling to sleep or sleep quality and it alters our sleep architecture.
So let's break that down. That was a lot of words there and yeah, let's break down what does that mean. So it can alter sleep architecture and give us difficulty falling asleep, because those lights in that sensory disrupts our melatonin production.

(34:54):
Okay, by disrupting our melatonin production it can shorten our room duration back to our sleep staging a little earlier.
We need that stage three and we need that room is our restorative sleep. So when you decrease your melatonin production it can shorten your room duration and room is crucial for memory consolidation emotional processing cognitive function.

(35:16):
I don't know about you guys but for me there's a lot of words we keep repeating that are in our mix here and all going back to the same thing.
So these digital screens emit light that keeps us awake and it suppresses that melatonin secretion into our brain, and that keeps us from falling asleep.
So let's take it a little bit further so we can better understand this stuff. So melatonin we need, and it's a natural thing we have in our body. And when the sun goes down, our melatonin level start coming up.

(35:45):
And then our melatonin is what prepares us for sleep it doesn't put us to sleep but it prepares us for sleep. Okay.
So if we're preparing ourselves for sleep and melatonin is coming up, we go to sleep. And as we sleep through the night our melatonin levels go down.
And when the sun is coming up in the morning our cortisol levels come up. And that's where we start waking up. Okay. So if we're decreasing or suppressing that melatonin secretion to our brain, we're just delaying the ability for us to be able to go to sleep.

(36:13):
And so we are throwing off our circadian rhythm. All right. Light is the primary external cue that syncs our circadian rhythm. And we can go into all the, you know, medical processes of how the light comes through our lens and the kids have bigger lenses than adults.
And so we're going to go to sleep. And we're going to start learning the wrong rhythm. And if we sleep on the wrong rhythm, things start to happen. Again, I won't bore you with all that.

(36:45):
But melatonin and cortisol levels have to follow at night. And if we have cortisol, when we're not supposed to have cortisol, it prevents sleep. It just creates a mass disaster. And again, immunity is affected.
So we have to follow our natural circadian rhythm. Blue light, which comes from these devices, it is the most efficient at suppressing melatonin production.

(37:11):
And I don't like to use the word efficient because we think efficient is a good thing. It's a good thing. It's a bad thing here. Blue light is the one that suppresses the most melatonin production.
So don't think efficiency here is good. This is bad. Blue light is really bad for our melatonin production. It is what arouses us and inhibits our ability to go to sleep.
Also, what does these screams do? We're on social media. It's already brought in that anxiety and frustration or whatever it is. And now you're hyped up. You have this adrenaline surge and it's time to go to bed.

(37:43):
I don't know about you guys, but if I'm stressed out and frustrated, I'm going to bed anytime soon. You need some decompression time. And so again, it just delays that ability to fall asleep.
I'm excited. Maybe whatever they watch, they just dress them out, but they're watching tic-tac and they're up and dancing or they're giggling.
Exactly. And we're all guilty for it, but one thing leads to another and you're swallowing this and swallowing that. And before you know it, three hours have passed.

(38:13):
I was about to say how many of us have it's been a really stressful day. I'm just going to relax.
Just for a minute. Yeah.
So when sleep is affected, it causes distractibility, slower metabolism, emotional dysregulation, and again, poor attention. These are the terms we keep saying that it's dealing with poor sleep.

(38:40):
So guys, we have to set the tone. We have to lead by example.
The biggest question is what as parents can we do? Parents, grandparents, aunts, uncles, whoever you want to call us, what can we do to help our kids?
Lead by example is number one. Be that role model of good behavior.
I like to use the terms of digital liberation or digital curfew. Those are terms in the sleep world.

(39:04):
And this is exactly what it says. Liberate from the device.
Give a curfew. We all know what curfew means. Shut down, be home. You know, don't be out there.
Curfew. Digital items need to be locked up or put away or checked in by the parent.
And we have to again, lead by example, I know I keep saying it, but it's super important.
Research shows that as parents, we have a bigger effect and a bigger influence on how our children are going to behave.

(39:33):
Because of what we do. Okay.
Again, children learn from their surroundings. So if we are putting out poor eating habits or asleep hygiene, you name it, the kids are thinking this is normal.
Let me do what mom and dad do because they want to make us happy. So they do just like us. They're making us happy and proud, but we're doing it all wrong.

(39:54):
Okay. So one of the biggest and easiest things we can do to improve our children's sleep quality is helping them unplug.
And literally, I like that term because that's what it means unplug the digital device and help them quote unquote unplug their brain, help them decompress, show them that we don't have to rely on something else to help us decompress.

(40:18):
Again, get that self regulation and teach them how we can do it naturally. Go back to old fashioned ways, prayer time, snuggle time, relationship building, you know that that's for game.
Yes, bring things back to where they're not individualized stuff behind the screen. Okay.
We should be removing these digital cues from our ourselves and our children. Research goes back and forth but the consensus is typically two hours before bed and that's what I tell my patients.

(40:49):
Give yourself that two hour window and that seems impossible. But it's really not when you think about it. Okay.
Two hours before bed gives you some family time gives you time to go take that hot bath which is super important for regulating and getting our bodies ready for sleep.
It's not really that big of a time. Okay. Set boundaries around screen time. We often use screen time as that reward or that punishment.

(41:15):
Don't do that because it's it's it's sending the wrong signal of controlling behavior. And again, I started this section by saying screen time is not necessarily bad.
But when you use it as a reward or a punishment, it's something that's controlling. Okay. It shouldn't be that way because if you, you know, reward or it's a punishment but then school puts the kid in front of the iPad.

(41:37):
Well, they're a punish from the iPad but they have to do schoolwork. So just avoid the whole situation and set boundaries around it.
Pick a consistent time of the day that they're able to use it or if they have to do it for school, it is only for school and designate social screen time at a different part of the day or only on the weekends or something like that.
Make it consistent. Okay, we kids get confused if we make a rule one day change it the next consistency is key children thrive on this. Okay.

(42:07):
And again, the role should be set for their family. You can't tell the kids they can't be on it and then the adults they're in front of them doing the same thing and not using that time to socialize with their kids.
Yeah. If we have older children, teens, tweens, adolescents, involve them in that decision making process. Don't just lay the law, say, Okay, this is what we what mommy and daddy feel that we need to do.

(42:32):
So we can move into the decision making of what time do you think would work best, you know, do you feel that your brain works best for homework at blah blah time or, you know, can we allow when you come home from school 20 minutes to social on screen time and then, you know, to let you relax and then go from there, you know,
into the discussion, whatever they decide doesn't have to be what the rule is, but make them involved and that they're a part of it and they're typically going to follow suit by being involved a little bit better give them that sense of empowerment.

(43:03):
Okay.
Rebecca, you brought up a good point of sometimes this is out of our control school nowadays are so much screen time there's no more textbooks there's no way that we were taught backpacks are empty ours were so heavy they have maybe like an iPad and that's what's in the back.
And that's young age have some have phones now not because and there was a research article on this too. Not because parents wanted to give kids phones at this such young age, but life is dictating it like there's apps that these kids need to be doing on phones.

(43:36):
You know, we're in sports for so many hours a day and you need safety control of your kid to know where they are and, you know, watches and all these things so we're looking things up how many times in our life did you hear the phrase go look it up well that meant the encyclopedia Britannica that everyone
has it in their hands and now they have and it's wild. Yeah.
So, sometimes it's out of our control and we can lay the law as hard as we can but we have to be realistic you know we can't lay the law if schools are infringing on our home life right so on things that we cannot control.

(44:09):
How do we manage it and I think that's a big important step to understand, and that is going to be, you know, shifting the time of the day if we can to when you come home from school, there's no there's no social media there is no social, you know time,
we can't crack the phone it is only schoolwork. Let's get it done as fast as we can and get that that digital out of our life for that night you know revolve around those things. But how do we protect our kids and how do we protect ourselves from these uncontrollable situations when they physically have to be on that

(44:40):
computer or have to be on that iPad to do their homework.
And the next thing is mitigating the blue light effects, right we talked about how blue light is so bad for you know our melatonin productions and preparing our bodies for sleep. So that's the biggest thing we're worried about mitigated.
Okay, hopefully, doing schoolwork is not going to cause, you know, all of this crazy emotional thing and make it frustrated but hopefully it's not going to cause all this crazy excitement but focus on the blue light.

(45:06):
And then we can change the devices have them on an automatic clock set that they switch to night mode, right that I had the process where it peels out some of those blue light effects, put blue like blocking glasses on the kids, you know, and they have tons of different ones in pediatric
sizes out there.
So, a thing that we can do in our, in our home is the night lights that are around our home, switch them over to red lights. Okay, so red lights have research that it can help maintain the circadian rhythm, because again it has the least potential effect to suppress the melatonin.

(45:40):
So, little things like that can help us.
Okay.
And so, again, control what you can but on the fact that there's issues we cannot control do things to protect our kids and protect ourselves by lessening that blue light effect.
And the biggest take home message is more than just punishing our kids from social media and screen time. It's thinking about when we're on social media and screens what are we not doing.

(46:08):
And less screen time means more healthy world time, more healthy family time, more healthy exercise time, more healthy social time. These are the, the, the, the necessities that these kids need to thrive to be healthy.
So, we're technically doing our kids an injustice if we're showing them a world nothing more than just a screen. Let them live the world, let them experience it, and not always have them impacted behind a screen.

(46:37):
And I would even add to that more healthy creative time.
Correct.
Because I used to hear.
You can't hear me bored.
Yes, I used to hear all the time. If Becky found a piece of buzz, she would be off in a world for two or three hours making it into a game playing and I'm thinking, really? Okay.
But then I think back, how much time did I do weird things like that or I'm in the backyard and there's a leaf and a stick and some rocks and I built this crazy fort and I was having an adventure.

(47:05):
I mean, it's, you gotta let that creativity out and creativity.
You know, that's a, that's a topic on and of itself, but creativity, again, goes back to building your, your self confidence, you know, giving them that sense of look what I did.
Look what I was on my own, a sense of pride.
You know, it also creativity is not just being creative in the artsy world. It's creativity helps you think outside the box. It problem solves, you know, it builds.

(47:34):
You know, touch and feel and relationship development. So creativity is huge. And, you know, we are growing our kids in this world and even us, like, there's always something busy in our brain.
We need to be bored. We need to allow our brains quiet time so it can process the day. And by processing our day, we build on our emotions.

(47:56):
We learn from how things went wrong of how we can do it better. We're, we're always stimulating ourselves at this point and we're not having that quiet decompression time.

(48:26):
You're listening to airway first with today's guest, Maggie Lavender.
You can find out more about the Children's Airway First Foundation and our mission to fix before six on our website at children's airwayfirst.org.

(48:56):
The CAF website offers tons of great resources for both parents and medical professionals.
Visit our parents portal, clinicians corner, resource center and video library to see for yourself.
We encourage parents to join the Airway Huddle, our Facebook support group, which was created for parents of children with airway and sleep related issues.

(49:18):
You can access the Airway Huddle support group at facebook.com backslashgroups backslash airwayhuddle.
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child might have an airway issue, contact your pediatric airway dentist or pediatrician.
And now let's jump back into today's episode.

(50:06):
Yeah, I like that.
It's hugely important.
Yeah, and definitely even for adults, because there are times now having done these podcasts and things and learned so much that I guess I didn't realize before.
I always have music going. I always have something going. Even if I'm not in front of the computer, I will just turn it all off and just kind of sit there.

(50:35):
And I think there's a bigger question to that is, why are we always using the stimulation to ourselves, right? Why can't we just do a task without having music blaring?
Is it because we're tired? And if the world quiets around us, what happens, right?
And again, we're doing these things to prevent us from being tired because we have all these things to do, but we're only hurting ourselves. We're making ourselves more tired by not giving ourselves this quiet time to reflect, to grow, to strengthen.

(51:08):
And so, yep.
I agree. And I think this is a good time to bring up a word that I now hear it because I'm listening for it, but I hadn't really heard it until I sat in that conference.
Yes.
Ipersomnia.
Yes.
I think it's super important. And I'm going to say the word again because it's often misstated. But if we say the word clearly, it makes sense.

(51:33):
Hypersomnia. Hypersomnia. Okay.
Hypersomnia is sleep. Hyper means more. So more sleep. That doesn't mean I'm telling you to get more sleep. It just means that we have a symptom of more sleep or let's change a little bit to more sleepiness, more sleep tendencies.
So hypersomnia is on the forefront because, again, the world is becoming that way. The world is a very fast paced world.

(52:00):
And we're just running the rat race all the time. And it's coming out that we're just tired. We can't keep the pace anymore. And so what is this term?
And medicine we always knew was there. We labeled it as other things, fatigue, chronic fatigue syndrome, whatever these things are. But now medical classification has found a term for it.
And it encompasses all these things. But it is our job as clinicians, but it's also the general public's job to understand what this term means. And again, start doing that self inventory of, is this what I'm experiencing?

(52:31):
Or is it just because maybe I did have only two, three hours and I guess I was up with my kid all night or, you know, I had to study for finals and I'm just tired today because I had a really bad night last night.
But that bad night is night after night after night and it's not just one tired day. It's day after day, month after month, year after year.

(52:52):
We can no longer label it as I'm just tired. It's a bigger picture. Okay.
So I'm going to share my screen again because I think we need to break this down and understand this a little bit further of what is this hypersomnia.
So when we look at it, hypersomnia is a classification of disorders and hypersomnia is a group of long lasting chronic sleep disorders of the brain.

(53:16):
They cause what we're all familiar with excessive daytime sleepiness. This is a strong daytime sleepiness or need to sleep during the day, even though we had enough sleep at night and the word enough is used broadly here because enough at this point is referring to just the hours of sleep.
Not referring to the possible quality. Okay.

(53:39):
So people with hypersomnia disorders may have other symptoms that affect their sleep and ability to function during the day. Again, let's get to the root cause.
Is it because you were up all night feeding the baby and they had a rough night or, you know, were you working on that project super late or you had eight to nine hours of sleep but it was poor quality.
Let's get down to the root cause because if we only fix the bandaid and some hypersomnia issue, we're not getting to the root cause and it's only become a bigger issue later when these treatment issues don't treat it anymore.

(54:12):
Patients with hypersomnia often live without a correct diagnosis for a very long time because A they may not be able to explain it, right? Or it's just like you just live a very stressful life or oh you are a new mom or oh you started a new job.
You know, there's always an excuse that we can peg it with but they may not get the correct diagnosis for a long time. They may blame themselves and struggle to keep up with work, studies or relationships.

(54:36):
They may go to, you know, primary care who then gets them to psychiatry who then labels us on depression and the real issue is they're just tired.
Of course they don't have the drive to do anything and the energy to do anything and so yeah that's viewed as depression but it's just because they're physically tired.
Yeah, for brain fog, yeah.
Right. So let's go through a little bit more. Let's look at some examples of hypersomnia disorders.

(55:02):
Climbing Levin syndrome, very, very rare disease and I'm not going to go into all these but I want to label them here.
Narcolepsy, there's two types, type one with cataplexy, type two without cataplexy, idiopathic hypersomnia, hypersomnia and narcolepsy associated with other disorders, shift work, illness, pregnancy, medications, side effects, congestive heart failure, stroke.

(55:25):
You know, there's the list can go on.
For this topic today, I want to focus on some of the most common ones that we typically see and we see it in all age groups. Narcolepsy, type one and type two and idiopathic hypersomnia.
All right, so let's go through a little bit further.
And narcolepsy in children, by the way, that's another one.
That's another whole topic.

(55:47):
I didn't really get that until I went to the conference and I just had one of those points where I just kind of sat there staring at the screen as it was being presented.
I'd never in a million years knew that was the thing.
Yeah. So the thing about narcolepsy is, in all honesty, it is a pediatric disease, but it is misdiagnosed or missed for years.

(56:10):
And it is not really diagnosed in patients until late teens, 20s, 30s.
You know, some people are being diagnosed 60s and 70s for the first time in their life when this is a pediatric disorder.
Okay. And this is a whole topic of itself, but I just want to skim the bases here.
Yeah.
Because as parents, we need to be, again, exposed to these possible scenarios and start, you know, doing that evaluation of what's going on with our families and our children and ourselves is, could this be one of the differential diagnosis?

(56:41):
Could this be one of the question marks? Okay.
So narcolepsy is the impaired ability to regulate sleep wake cycles. So it's not just, you know, the do's big, low movie show or, you know, all the TV shows that we see that these patients are just dropping and falling asleep, you know, standing up and all these things.
Those do happen, but that's not the typical. All right. This is just your body's inability to regulate sleep wake.

(57:05):
So your body wants to sleep at the times that it's supposed to be awake and your body wants to be awake at the time that it's supposed to go to sleep.
There's just no balance. I like to explain to my patients as the on off switch.
A non-narcolepsy patient turns their switch on in the morning. Here or there, if we had a rough night, we may click it off during the day, take a quick map and turn it back on.
And then bedtime comes and we turn the switch off. Narcolepsy patients, their switch is just up and down all day long. It's on and off and on and off. And it's just a dysregulation.

(57:34):
They have frequent lapses into sleep and these could be brief seconds. OK. And then there's elements of sleep while they're awake. They may not even know it. OK.
And you're in these lapses. This is those moments that I think we've all had where you're sitting there and going, I don't remember driving.
Correct. Correct. Correct. And that brings up a whole other topic because it could be this, that you had a little micro sleep mode or it could be that there was a little micro seizure, you know, an absence seizure that happened.

(58:01):
So if those experiences are happening, don't assume that it's normal. Bring those up. There may be a further issue in those. OK. And it could just be you're just so tired.
Your brain took a half of a second just to pause. Right.
Sleep for a minute. Yep.
Bring those up. It's important for your provider to know that this is something you are experiencing and it's not a normal occurrence. OK.

(58:22):
And I would think that's probably why these are harder to identify in kids, too, because how many kids are going to come up to you and say, I was walking down the hall and I don't remember.
Correct. Correct. Because they got distracted. That's what get labeled, you know, often. That's what it's labeled, right?
Or you're ADHD.
And if the kids always did this, how do they know that there's something not there? So that's always one of the questions that I do ask my pediatrics and my adult patients, because again, it's not something that they would bring up on their own.

(58:49):
So very good point there. In the narcolepsy patients, the biggest question that they have to themselves is, am I awake or am I asleep? Am I working on auto mode, like robot mode or am I like really sleeping?
I don't quite know. And one of the things that's often missed with narcolepsy is you think these patients are just overly sleepy, right? These patients sleep all the time.

(59:11):
These patients are overly sleepy. But when it's actually time to sleep at night, they have very disruptive sleep. They have difficulty falling asleep. They have, you know, they wake up multiple times.
Again, it's that dysregulation of the sleep wake cycle. So they're not just always sleepy. Okay.
When you look at excessive daytime sleepiness, which is a symptom of narcolepsy, but it could just be a symptom of hypersomnia as well, is the intent urged to fall asleep throughout the day.

(59:37):
Sleepiness is usually the most challenging symptom here. Okay. They may doze off with little to no warning and given situations. All right.
They usually sit down or they're working at a computer and their eyes get really, really heavy and they kind of, you know, and the site though is we've all done that on that rough afternoon, right?
Yeah.

(59:58):
But it's a here or there for narcolepsy patients. This is an everyday occurrence. Okay. And the, you often think that narcolepsy patients sleep more because they're sleepy all the time than a non-narcolepsy patient, but it's not really true.
It's just they're so broken sleep throughout. It's just erratic. Okay. So they don't actually sleep more than the healthy non-narcolepsy patient in a given 24 hour period.

(01:00:25):
And they, and I just talked about this, they may continue doing tasks while they're asleep. It's that autonomic behavior. I mean, that automatic behavior, that robot mode we may talk about.
And some terms that they refer to this is that highway hypnosis. Okay.
Again, non-narcolepsy patients, we have had these times where we robot mode it, right?
But narcolepsy patients, this is all the time. Like they go through a lot of their day just in pure robot mode.

(01:00:51):
A short 15 minute nap can substantially improve alertness for a few hours. Okay. That's a big cue here that in non-narcolepsy patients, a short 15 minute nap, like, we need more, right?
And narcolepsy five minutes, 10 minutes can make a world of difference to them. And this suggests that the sleepiness of narcolepsy is caused by a problem of the brain circuits that normally promote full alertness rather than poor quality or inefficient sleep.

(01:01:19):
When a healthy patient goes to bed, they go through the full sleep cycle, like I talked about earlier. And then I can last you know, the 90 to 120 minutes before they reach that room cycle. Okay.
And that's where we categorize sleep. And narcolepsy patients, they fall asleep pretty quickly. Okay. And they can be in as little as a few minutes, they can go into room.

(01:01:40):
So they have a very rapid onset of room because their body is craving that sleep mode.
Yeah. And this also occurs in very vivid dreams, even in their nap. So that's another specific symptom of narcolepsy.
And again, you don't have to know everything about narcolepsy. But again, it's just something to be aware of and maybe start questioning.
Maybe do some research on your own to again do that inventory of your children or yourself and bring some of those symptoms up to your providers.

(01:02:08):
So we bring it down to kids is how do kids again present differently? Well, sleepiness may present with a reappearance of regular napping, you know, this you have this kid who's out of that normal napping mode, right?
They're not in preschool age or toddler age anymore. But they kind of start falling asleep in the car every day when you pick them up. They're kind of like on the weekend.
And if you don't give them the screen time, you know, stimulus, then maybe they are dosing a little bit more. So this reintroduction of nap time is happening, even though you did not reintroduce it.

(01:02:40):
And the, and again, you know, this is kind of going into a little bit more detail. How do we really go through looking at and diagnosing a hypersomnia, narcolepsy type thing.
There's a specific test caught a main, a mean sleep latency test. This is how fast is a person going to sleep and it's done through a series of multiple naps during the day.
But in adolescence, the most common ideologies of short sleep onset in this test is often with multiple room states. Okay, this is due to chronic sleep deprivation or delayed sleep phase disorder.

(01:03:11):
I'm not going to go into major details, but that's just kind of your medical diagnosis that we have an understanding of what's going on here.
But this is something you would see in a sleep lab. Yes, this is the sleep lab.
And this next one I can't stress enough here is tired children don't always present as tired. They present as behavioral problems. Okay.

(01:03:34):
And this one to me is the most heartbreaking because this is the one we see with heroin sleep disorders all the time.
Yes. And in narcolepsy, this is a big deal. They present with behavioral problems at the onset of the disorder. Whereas adults, I just can't function. Okay.
But outside of narcolepsy, this is a big sleep disorder issue that children present with. Right. They get cranky. They're in a tension span. They're hyperactivity.

(01:04:00):
Oh, my kid not tired. They're hyperactive. Right. Are they hyperactive?
They're trying to stay. Yeah. We understand, but we don't get the whole picture because we're mislabeling things over, you know, because we're not asking the right questions and probing ourselves.
Inintentiveness, insomnia, lack of energy, bizarre hallucinations.

(01:04:21):
They can also lead to psychiatric misdiagnosis, ADD, ADHD. You know, I hate to say it, but I feel like these diagnosis are being handed out like candy nowadays because we're not getting to the root causes of the issue.
And whenever I get young pediatrics in my office and they have that label or the parents ask, you know, I think my kid has this, this is suggested by the school or this was suggested by the neighbor or the teacher.

(01:04:45):
And I send them down that testing. And my first answer is no. Let's look at our sleep first. Then we will decide because I hate to give a label to anyone, especially a child that that's not really what's going on.
And I do not want to give medication to anyone, but in particular to a child, if I really don't need it. And if it's a bandaid to the situation, I agree. And that to me is why that is so heartbreaking.

(01:05:12):
Yeah, because it's just so prevalent. It's on stimulants and it breaks my heart because again, you know, I think about everything I put into my body and everything I put into my kids.
Now, don't get me wrong. My kids don't have junk here or there, but I feel guilty for it. Like we are the advocates for our kids.
We have to really make sure what we're exposing our kids to and what we are putting into their body is the thing to make them the most healthy. And when we start giving our kids stimulants, yes, there's a slew of side effects.

(01:05:43):
But I think to, if I'm giving them this thing that's making their body do whatever ABC, and I'm not allowing the body to learn how to do it on its own.
I'm only causing more issues later that their body didn't learn how to do it. Right. So stop bandating a situation and let's get down to the root cause.
I rather every pediatric kid have sleep looked at and ruled out as it's not an issue. Then we missed it and never looked at it. Okay, so if you think there are issues going on with behavior or sleep or moodiness or movements and sleep, go get a sleep

(01:06:20):
evaluation and rule it out with an in lab study, not a home study, rule it out with an in lab study and just rest your mind, rest your heart. Okay, I wrote it out. Let's keep that you know digging further.
And then of course, when we look at medications to fix this ad-DADHD, it often mask the symptoms of narcolepsy and therefore we've missed it again. Okay.

(01:06:41):
This is another big hypersomnia diagnosis that I am so excited about because this never had a label. All right. And, and I know we don't like to label I just said it but sometimes we need to write because by being able to label something we can treat it.
Okay, and this is super, super, super important one here.

(01:07:02):
The idiopathic hypersomnia. This is a chronic sleep disorder of the brain and the causes unknown. That's why it's idiopathic. We have ruled out every other possible cause for a person to be sleepy but we just don't have we just don't know why.
All right.
We ruled out poor sleep quality. We ruled out, you know, restlessness at night. We ruled out the breathing issue. We ruled out short sleep time. We know we ruled out poor sleep hygiene. We ruled out narcolepsy ruled out all these things. But the patient is still tired.

(01:07:32):
Still happening. Right. Okay. And this happens very common. And before we had a label for this, these poor patients couldn't get the help they needed. We just didn't have anything to treat them.
This is not a disorder of room sleep like narcolepsy. There is no room sleep present on the napping test. Okay. Just this is the patient who also sleep quickly and they're just overly tired.
This affects them.

(01:07:53):
They're just not restoring. They're sleeping but they're just not restoring.
Correct.
Correct. And then this is your patients who sleep long. This is your long sleep periods. Okay.
So possibly these kids that just sleep and sleep and sleep.
Right. Right. And that brings up a good point is my, you know, I have parents that say, oh, they're a great sleeper. They can sleep through anything.
Yeah.

(01:08:14):
Red flag.
Okay.
Because, you know, they sleep 12 hours.
Red flag. You know, like, if you think that your kid can sleep through anything and drop to sleep at the drop of a hat, that's not normal. Okay.
Idiopathic hypersomnia affects the brain's ability to control sleep and wakefulness.
The sleep drive is too active. Therefore, the sleep mechanisms are dominating. Okay. So again, not on off switch.

(01:08:40):
This sleep is impinging on it more and it's saying, I'm going to, I'm going to win. I'm going to win. I'm going to win. I'm going to win.
And it wins. Okay.
Causes of excessive daytime sleepiness in which there is a strong need to sleep during the day, even though there was enough sleep the night before.
They take those long naps, but they just don't feel better upon awakening. So again, these patients have the longer sleep periods in the 24 hour period.

(01:09:07):
Okay.
People who have idiopathic hypersomnia may spend most of their day sleeping, thinking about it, craving it, even fighting the urge to sleep.
And this can severely impact their quality of life.
When you break down to some of these things, these patients have to prioritize what can they get accomplished in that day or what are they're going to miss that doesn't seem so important to them so they can get that nap in.

(01:09:31):
Okay.
And that's easier explained as an adult. But what about these kids? Right. Look at their emotion status. Look at what brings them joy. And if you know, go and ride their bike and playing with their friends makes them so excited.
But yet, they don't go ride their bike quite a few times a week. Right. They're missing out on those things because they're tired. Okay, so again, we have to be creative and how we're thinking about these typical scenarios and adults, but making it be on the kids age level and what you know what brings them joy.

(01:10:09):
So that's kind of we again, we just have to think about why are we sleepy. What could be the underlying cause. Is it something in our behavior that we're doing wrong. You know, not I'm not giving enough time to our kids sleep, you know, nowadays sports, goodness gracious sports are going into long evenings
right now and sports are great and that that's a whole another positive team building, you know, athleticism exercise. We can go through it but put ourselves in the priority list. A kid's sleep is very, very important.

(01:10:42):
And once you have sleep that it takes so long to overcome it and keeping kids on strict schedules. There is a little flex in there but again, we're training their brain we're training their circadian rhythm.
We just allow their sleep schedules to be erratic and oh, we'll keep them up to 1am tonight and just let them sleep in the morning. Well, that's going to wreak havoc on their following day. So again, as parents, we are the drivers of our children's health.

(01:11:07):
We need to start thinking about those things. Yeah. Yeah. And that's understood. And I think all of us this is a take mom guilt park it over there. I think we've all you have older kids especially have been guilty of it's summer.
Enjoy. Correct. You still got to put some parameters around that because it really is. It's chaotic. Yeah. And also, I mean, whether or not we've done that or we've we've controlled a little more during the summer.

(01:11:34):
How do we, as parents, correctly transition them back to get them ready for school now without just completely undermining their sleep. Correct. So good, good point there and I think we need to reword the question.
And instead of saying how do we get our kids back from a summer schedule to a school schedule. It's how do we get them off of a school schedule to a summer schedule. Right. And when we pose it that way.

(01:12:01):
When I, I mean, you just said it as parents know no guilt on anyone. Yeah, I've done it all over. I've done it.
They have to be ready for no role. Let them stay up a little bit later. As much fun parent we want to do. That's not necessarily the right thing by our children. Now I'm not saying they have to go to bed, you know, the sun's still up in the summer, but we cannot have their schedule shift by five hours.

(01:12:26):
We can't we have to make it pretty tight. Okay.
So, when we look at sleep transitions, it is important that we maintain a regular wake up and bedtime hours and bedtime hours and bedtime routines. Okay, we may shift it slightly when we cross over to summer or Christmas break or whatever it may be, but we should not deviate by hours.

(01:12:48):
Okay.
Research shows that summer means they're shorter durations of sleep and more fragmented sleep.
Right. Why is why is summer related with shorter durations of sleep and more fragmented sleep. Well, some say it's due to the daylight hours. Right. It takes us longer to go to sleep because it's still daylight outside earlier in this conversation.
I live in a place where it's daylight till 10. Right. So we talked about this conversation. What happens when the sun goes down. I'm a lot on and starts building up. So the sun's not going down.

(01:13:18):
Melatonin levels are not following suit. Okay. So, when we look at this, you know, what can we do to help this. So start blocking out the kids rooms, you know, use, use thicker curtains so that they're not exposed to that sunlight.
Dumb the house lights, lower the shades in the evening time, make the home environments being indicative of that darkness so our melatonin levels can start rising. Also, keeping the house cool. I live in Texas. It's hot. Okay. We have electric bills to keep that house cool.

(01:13:48):
But do the best that you can. Maybe ceiling fans, things like that. Cool those sleep environments down because that's how our body naturally is going to want to induce sleep. When our temperature drops, our body naturally wants to induce sleep.
Which earlier we talked about, you know, that hot bath before bedtime, keeping those routines. That's because as we raise our body temperature in that hot bath, when we step out, our body naturally has about a 30 minute window.

(01:14:14):
As the body temperature drops, we're not actually going to want to induce sleep because it's that temperature drop. So that goes back to that cool environment. Okay.
When we look at how many hours are we supposed to be getting to sleep? Well, depends on where, what age group you fall in. Okay. And so understanding how much sleep we're supposed to get. I didn't take quality.

(01:14:37):
That's a different topic. How much sleep we're supposed to get can better help us gauge that schedule and gauge that routine for our family and our children. Okay.
So age, according to the Academy, American Academy of Pediatrics, three to five years, years of age need 10 to 13 hours of sleep. Okay. And I often hear, Oh, well, my kid takes a three hour nap and they get this many hours of sleep.

(01:15:02):
And this is trying to be consolidated. Okay. So 13 hours.
Not humiliated. It's this big chunk. You need to consolidate it to bringing it back to sleep staging earlier. Right. We have to allow enough time to go through those cycles and get that slow wave sleep that we need.
So the next to 12 years should be nine to 12 hours. 13 to 18 years, eight to 10 hours adults, you know, around that eight hour mark. So know your age group. Again, these are not set in stone, but this should be our guides.

(01:15:34):
What about the little famous just like little, little zero to two.
They're different because their sleep is not so much as consolidated. They're going to be, you know, they're going to have those daytime naps. Don't take those naps away from those kids, right. They they're they're allowed to have those naps and just, even if they're not, you know, some kids just fight naps, you

(01:15:55):
still have to designate that quiet rest time. Again, make it quiet for our brain to decompress. All right, so decrease that stimulation there.
It's important to instill structure. Okay, structure in our life, but especially structure in our sleep. Okay, kids know if there's roles, it must be something important. Okay, sleep is the most important.

(01:16:22):
All right, so develop that structure structure and sleep routines protect kids by regulating that compulsory daytime physical activity. We shut in the day down.
It limits caloric intake. They're not junk eating at night. They're not getting, you know, the sugary right because we were expecting it's time to start getting ready for bed.
It reduces the opportunity for that excess screen time. The kid got bored and you know they're tired. They're bored. So what do they do grab that screen or, you know, go to the TV and then allow for consistency of that schedule.

(01:16:53):
So if you build that structure into your daily family routine, it allows for that consistency because consistency is key here. Okay, great.
Deviation happen. Life happens, but the big most of the day to day we need to be consistent. So your question here was how do we get back to the school schedule, right?
Well, number one, don't deviate so far on your summer schedule and then you'll have an easier time to get back to your school schedule.

(01:17:19):
Like an hour to maybe at most. Yeah, so that's yeah, at most. And again, it shouldn't just be like free for all. Slowly go this way and then slowly go back. Okay.
And again, we typically do way better on weekdays than we do on weekends. No, it has to stay consistent. Okay, as much as we can here.

(01:17:40):
And remember, the longer we let our kids sleep in in the morning to catch up on their sleep, we're wreaking havoc on their ability to go to bed at night.
Okay, our body has to have a certain amount of time to be awake before it's naturally going to want to go to sleep.
So we start fighting that innate circadian rhythm again. So we're going against ourselves here. Okay.

(01:18:04):
As we prepare to get our kids ready for school. What's the first thing we do school supply list, right?
Hello shoes, all that. No one talks about sleep. Okay, until oh God, school starts in two days and we're like going to bed. We haven't. Yeah, we're not ready.
Your first thing to do to get ready for school is get that sleep schedule on track. Okay.

(01:18:26):
It is one of the most important things we can do for our kids. It leads to better grades because they can concentrate better. They are less hyper.
They have the ability to critically think and plan because their brain is well rested. Okay, it improves their immune system because what happens when we get to school, we're exposed to all these germs again,

(01:18:47):
those classrooms. So it improves that immune system to allow the better ability to fight those common illnesses that they are going to be exposed to. Again, fight the ability, right?
It doesn't say they're not going to get them. We're still going to get them. But it gives their immune system a push. Okay.
Routine and consistency. I know I keep repeating it, but it's key. Kids learn what to expect and it becomes non-negotiable.

(01:19:11):
We don't want to fight with our children. We want to avoid those tantrums, right? So they know what to expect. They know bedtime is this, you know, and go from there.
My kids know, eight is late. Eight is late. Like, it is bad, right? And I started that when my kids were first speaking, eight is late.
And so they know how to read the clocks and see they know it's getting close to eight. Eight is late. So, you know, set that consistency.

(01:19:37):
And if you stick to it, the kids know, I'm not going to win tonight. There is no extra game. There is no extra this because it is bedtime.
Routine and consistency helps also the kids feel safe and secure. And they give them that security of knowing what to expect.
It helps them fall asleep faster on their own and develop their own body clock. When we are just, you know, all over the place, kids can't, again, regulate.

(01:20:02):
They don't understand what's happening. They have to process and like, why are we doing this? Well, why are we doing this? And what's going on?
It creates this anxiety or this stimulation for them. If they know to what to expect, they feel safe in their environment. They feel secure, right?
We always want to make kids feel older and part of the process. They know it's bedtime. Let me start getting myself ready. Okay?

(01:20:25):
Okay.
Oh, yes.
Oh, no, I was just saying.
And then develop a routine. Okay. Again, should not be a fight. Develop a routine. Again, this is that socialization routine of getting that bath done, having that, you know, their favorite book, allow them time to tell you about their day or, you know, we have a thing, you know, snuggle time at night, go tuck each kid in their bed.

(01:20:48):
And again, this doesn't have to be an hour. This is going to be pretty quick as you get it down to a routine. But you want to empower that kid with a sense of peace. And you want them to go to sleep feeling like they are on top of the world.
Why? Because it's going to give them a better sleep quality. And then when they wake up in the morning, they're not as stressed. They may still be moody, but they're not as stressed and that prevents morning fights.

(01:21:14):
Because what this morning fights do sets the tone for the day. Right. You put them to bed on top of the world. We wake them up feeling even more on top of the world and they are ready to conquer and attack anything that comes their way during the day.
So when we think about it that way, it that's how we should be doing it. Give that sleep a very positive environment.

(01:21:35):
When should we start switching our kids to the sleep schedule?
I did a lot of research on this and the consensus is a good two weeks before school. Okay, if you know your kids have a harder transition or you've had a super crazy summer and maybe your sleep schedule deviated a little bit more than you wanted to start a little bit earlier.
But typically two weeks allows for that good transition. Okay.

(01:21:58):
So how does this work is you typically start by adding 20 minutes earlier at night. Okay, and then you can deviate depending on how far your schedule got shifted. But if you add 20 minutes earlier on your bedtime, by two weeks, you should be ready and back on your sleep schedule.
You should not be back on sleep schedule the night before school. Right. This is supposed to get them a two week period of getting back to sleep schedule and having them there a little bit before school starts.

(01:22:26):
This sleep schedule and our transition can be harder with adolescents and teens. Well, why is that your first thought is because they want to break the rules and they want to you know push our limits. Yes, that's a given, but there's more to it than that.
The adolescents and teens have they release melatonin later in the day. So they already have a delayed sleep drive. Okay, so we have to work against that and if we start pushing their their sleep time up, we're working against our natural system.

(01:22:56):
Okay, so back to what I said earlier, how can we work with this work on dimming the lights, you know, dimming the lights in the evening, brightening the lights in the morning.
Low lights increase melatonin production, bright lights produce cortisol to help us wake up. Alright, so start using your home environment.
Adolescents and teens, they can have good educated conversations with you, explain the importance of sleep. Why are we doing what we're doing. And you know, maybe again, use things on their terms.

(01:23:26):
Good sleep allows strong muscles allows you to do better at sports or allows for growth or related to what is important in their life at that time.
All right. And then of course we talked about it earlier but limit that digital stimulus. All right screen. Yeah, all of that.
And then last thing, we're human, we don't do the books all the time and life happens it throws us curveballs all the time.

(01:23:52):
And if you kind of deviated on your summer schedule a little more than you want it, and two weeks came and gone before school before you even realized it and or you're just a procrastinator.
This is how we should do it. You don't have enough time to add those 20 minutes each night, right. So what we should do is you should wake up the kid at the time they need to be for school.

(01:24:13):
That should be your first action. Instead of adding to the sleep time, wake them up at the time they need for school.
That's not consistent. Okay, and then their natural sleep rhythm again will kick itself back in. They will get a little more tired because they had less sleep.
A little bit earlier. They'll be a little more tired earlier in the evening. So I don't recommend this, but we're human and if you got to do it, this is the way we do it. Okay.

(01:24:35):
That's your Hail Mary.
That's our Hail Mary last, last go. All right. So that should be kind of what we can do and just remember be humble, give yourself some grace. Right.
We are all human, but as parents, I can't speak more to we are the advocate for our kids. Let's lead by example. Let's be on the lookout of what are potential dangers, what are potential things our kids are going through.

(01:25:00):
And if you're suspecting some things that kids may not know how to verbalize it for you. So you start asking those probing questions. And again, you know, I resisted a presentation on communication.
Not all providers are looking for these things because they're, you know, we don't have enough time in the day to handle all of the stuff we have to handle. But if you feel something in your gut, do your research, know that these are issues.

(01:25:25):
You probe the provider with the questions. Hey, I've noticed this in my child lately. What should we do? Or they're blowing it off. Close it again. This is really becoming an issue and I didn't notice this two months ago, one year ago, you know, this is becoming a bigger problem.
How can we address this? So again, speak up for your child. And really, if this is something that truly concerns you, make sure your voice is heard. And remember, you were the voice of your kids when they can't justify for themselves.

(01:25:54):
I love it. So well said. And to me, that is the number one.
I guess charge that we have for this airway mama bear movement.
Ask the questions. Be the advocate.
And mama bear is always, you know, we think that we have to take control of the situation. I just gave you the example as you kind of did at that point.

(01:26:15):
But as kids, they, they handle way more than we give them credit for, right? Absolutely.
Empower your kids to be a part of their journey. Right.
Don't feel that, oh, they're so little. They won't understand. Use terms that they understand.
The reasons of baby doll needs a nap. Use terms of sports and dinosaurs and whatever you need to recharge that unicorn. Let's recharge that magic.

(01:26:42):
So we can start these educational processes very early on. And the more we do it, the better it's going to work. And your kids are going to be healthier because of it.
Yeah. And not only that, we're teaching them to be empowered to take control of their own health span as they grow.
Correct. Right. Which unfortunately a lot of us, and again, no shade. We didn't know very different world. We weren't in charge of that.

(01:27:09):
Like no one taught us. And so now here we are raising kids.
So of course, you know, we're stumbling. We're a little glaring on what we do in.
They didn't give us a handbook on how to raise kids. They gave you a baby and sent you out the hospital. So we learning as we go.
But empowerment is a long way and role modeling and leading by example.
And I think about that all the time, you know, I have a daughter and a son and they're very strong willed and as hard as it is right now, I just tell myself that they're going to be great adults when they're older because that strong will is their sense of empowerment is their voice.

(01:27:41):
It may not be used properly at this time, but that's part of growing up and figuring it out.
And don't you want to be that role model to them to show them how to use that voice and use it properly.
You know, they want to see that mom or dad and uncle, grandparent, whatever it is fighting for them. Not this fighting, but right.
Right. And standing up for how you believe. And guys, again, it's just role modeling do what's right.

(01:28:07):
We are the molders of our children. That's what God made us to be. Let's mold them into being better versions of ourselves in every aspect, not just behavior, but sleep, but health in general.
Yep. And I'll tell you, it's interesting something because I have one more question I really want to touch on.
But one thing that I had to take away from the conference, the sleep conference.

(01:28:29):
It kind of goes back to the role modeling, which is why I think it's appropriate to bring it up here.
I'm sitting here thinking I'm not on my phone that often. Right. I know I check it when I'm out and about because I'm, you know, I work.
I work remotely. So yeah, you know, or I went ahead and turned on the little thing to track it because it was recommended at the conference.

(01:28:51):
Surprise. Surprise. And I went ahead and turned it on for my tiny people to low and behold.
Now, granted, they were both a little bit more than me, but I thought.
There's that role modeling. Where else are they going to get it from? I don't realize. And I think that's the case with most of us.
You know, even at night, I thought I was doing so well when I came back. It's quiet and I'm reading like I used to before bed. No TV.

(01:29:14):
I didn't realize I picked up my phone about four times.
It's just so you don't think about it because I was seeing what time it was or I had it on sleep and silence.
But I was still checking it. I don't even know why because I didn't realize they did it because it's just a part of us now.
It's our extra limb. You know, kids are doing just out there of, you know, look at look at this generation and ask them how they do it.

(01:29:35):
Look at this generation and ask them how they enter a phone and look at this generation and like there's a huge gap.
Like I just to think back when, you know, we didn't have cell phones when I grew up, like what's our parents do?
Like it's so funny now to think like, what do you mean you didn't have a phone? Like how did you notify like my dad goes fishing like that?
What did you do? He's like, well, I would have drowned like that's just what it is.

(01:30:00):
You just hope you're a good swimmer. That's all you could have done that one. Yeah. Exactly.
Like the world is at our fingertips literally because we have that extra limb attached to us 24 seven.
And again, good or bad, you have to you have to make that journey for you.
Exactly. Two sides to every coin.
So I want to touch on briefly because this was it's kind of a big deal.

(01:30:23):
You spoke recently in Scotland.
I did a conference and I'm just curious about what you're hearing at that conference.
And as you travel abroad, when it comes to sleep and airway, I mean, is this something that's picking up momentum in the medical communities around the world?
Are there lessons and treatments that you might not have caught up in the US yet, but that we could learn from?

(01:30:46):
So I think this is this is a great question.
So yes, I was very fortunate. I was able to go to Scotland and speak at Ipsa, the International Pediatric Sleep Association conference.
And I met with medical providers and major medical gurus from all over the world.
And it was a very humbling experience because it reminded me of how small the world really is, right?

(01:31:11):
They didn't look different from us. They didn't talk different from maybe a little accent, but we're all doing the same thing.
We are all out there doing what we feel is best to better our patients, right?
And there's not that much difference going on in other countries than what we're doing.
The research is there and we are all, you know, trying to dive in and better understand sleep.

(01:31:33):
And I have to say sleep is coming a long way. There is more emphasis on pharmaceuticals. There's more emphasis on research funding.
There is emphasis on sleep and it's not just because it's the hot topic and it's the new way to give a diagnosis and make money as some patients refer.
But we're finally understanding the importance of sleep in our life. You know, this was a missing component of medicine.

(01:31:57):
We were always, okay, we have a problem. Let's fix it.
But we never really got to, well, why do we have the problem? And we're finally able to start backtracking and sleep is really becoming the topic now, not because it's being both popular.
But it's because we're really seeing it's a huge piece of the puzzle, the missing piece of the puzzle that we've been looking for for so long.

(01:32:18):
So yeah, there's three, right? There's airway, there's nutrition, there's sleep.
Correct.
If those aren't working together, your little three-legged stool is out of whack.
And a wobble. And wobble doesn't get you very far. So yeah.
So again, small world, it was a very humbling in that regard because we're all doing the same thing.
And some of the big topics that, you know, we discussed in the US, but we're seeing brought up internationally is looking at iron and ferritin, right?

(01:32:46):
You know, for a while it was the big kick on, oh, we need to make sure everyone's vitamin D levels were up and get some more sun and oh, don't forget to wear sunscreen.
Vitamin D was a big one.
Right.
Now we're looking at iron. Okay, we're looking at ferritin. And why is this so important? Well, let's first understand what's happening.
Okay. So when we look at disrupted sleep, yes, it's an airway issue sometimes, but sometimes it's a movement issue. It's a restless issue.

(01:33:12):
So what is causing it? Are these just wiggle worms that we're having in, you know, that they're wiggling in their sleep? You know, are these wiggle worms that just can't sit still and they, you know, we look at them like, oh, that's the
nervous person there just bouncing their leg all the time. No, it's an issue that's going on. And a lot of it links back to iron and ferritin.
Okay. So everyone knows iron. We're all, you know, we've been taught that so long. Oh, hemoglobin and hematocrit.

(01:33:37):
Right. I was going to say you need it for blood. Yeah.
I can go into major detail. There's, you know, all kind of iron binding capacity ferritin, transferrin, blah, blah, blah. I'm not going to bore you because I'm going to bore myself because it's complicated.
But when we look at restlessness, the big one we look at is our ferritin levels. And ferritin is our storage level of iron or the amount of iron we have stored in our body.

(01:34:02):
Okay. So why is this important? Well, we all have dopamine in our brain. Dopamine is a transmitter that does all sorts of good things helps us still good helps us regulate sleep helps it, you know, all sorts of things, but dopamine has a regulatory
state in our restlessness. So what ferritin does is ferritin ferritin helps the dopamine in our brain work better. If the dopamine in our brain works better, it's going to calm those restless sensations down for us.

(01:34:32):
Okay. So in, in restless sleep is a huge topic now we're diving in deeper to this and there's all sorts of debate on, are we doing the right first, you know, line medicine, therapy and all these things.
And again, when you look at patients, is medicine always the answer, maybe not go back to the root cause right. Maybe a person's low ferritin is what is contributing to their restless at night and maybe we don't need that pharmacological medicine or prescription to fix this that has another

(01:35:03):
little side effects. So diving into how important ferritin plays in sleep regulation and disrupting sleep with movement. It's really big and that is a topic abroad, like it's everywhere it's in the US we just discussed it at sleep.
In 2024 the national conference out in Houston, and we, you know, it was brought up in pediatrics and they're looking at, you know, it's never too young to start looking at it and what are the levels we should be seeing in a non sleep world a non restless world.

(01:35:35):
And ferritin can actually be pretty low and it doesn't cause any issues right when it comes to a sleep road and you're trying to hone in on what are these fragmenters of sleep and you have this wiggle worm in your office, what could be a cause ferritin at one point we wanted to above 50 and
100 said above 75. And what we're looking at now is research has shown dramatically that we really need a bump it above 100. Oh, wow. You would be quite surprised how many of us are held holding on a daily basis, much lower than 100.

(01:36:08):
Okay, I know my eating habits all I can imagine.
Eating most people are probably hanging out not getting the iron they need. They're like me you just rushing to the body is absorption, you know, sometimes patients just aren't absorbing you can eat all the red meats and dark leafy green vegetables you want but your body is just not absorbing.
I can put you on over the counter, you know ferritin vitamins your body may not be absorbing. So it's not just checking the levels and putting you on replacements. It's continuing to check and make sure your body is absorbing.

(01:36:38):
Actually, I recommend a dietary changes or vitamin supplements. Some patients are they're so low they're needing infusions, right.
Getting these these these ferritin levels up is making a huge difference in these restlessness and sleep. So that's a big topic.
Another one on the horizon and I was kind of shocked and this was my first international conference and I loved every minute of it. But when you looked at you know how we practice differently. One of the biggest ones that I picked up on was the use of melatonin.

(01:37:11):
Right. So melatonin you can buy at the gas station like yeah everywhere.
Everyone recommends oh you having a sleep problem here's your melatonin oh this here's your melatonin and there's no FDA regulation on melatonin in the US so you can have.
I just say that's mind blowing that's the second time I've heard you say that and that is mind blowing to me what's more mind blowing to me and what made me really go oh my God was we have no FDA regulation on melatonin.

(01:37:40):
In some countries it is considered a controlled substance. And we have no regulation on it like I was mind blown. So, I mean I think on some of your issues but there is you know multiple presentations on melatonin but one presentation really brought it to light is they
laughed out every single country of the typical dose usage of melatonin. Okay, there's countries again as a controlled substance but are using like point one and point two you know milliliters or milligrams.

(01:38:11):
And this is in adults and in children we're using 20 and 30 milligrams.
Salt like here.
And melatonin for you and melatonin for you. Horrible and what your thought has or thought of in the US is well melatonin is in our body it can't be that harmful just here's a little bit excess right.
Right.
So, when you start giving your body melatonin or things that doesn't need what happens, our body doesn't produce it. So we're just compounding this issue. But it is not so good. Okay, because melatonin in the United States is not just melatonin anymore.

(01:38:49):
We're just grabbing bottles because it says melatonin right and if they sell a 30 milligrams little is good lot must be better so let's just grab the 30. We're not reading the backside of the label or the small fun.
Over the counter melatonin are mixed with so many things. Okay, that we don't even know, and they don't have to even put it on the label.

(01:39:13):
So again, this conference there is some talks going on and someone did a presentation that they took us melatonin compared to their other countries regulatory melatonin, and they looked at this is with the bottle states.
And then there was no CBD is in it there was no nothing. And when they actually looked at the medication and the testing on it. It was 500 times more than what was labeled in CBD was not even one of the labels on the medication.

(01:39:43):
I don't know about you, but I don't want to just be randomly throwing CBD at my kid at 500 times is normal level. Like, so again, we're missing the boat on the US is melatonin and so I'm not saying don't use it.
I'm saying, let's talk to our medical providers and have that discussion. If you feel that it could be something to benefit your kids or yourself, right, and then ask your provider, what brand do they recommend, you know, because they all work different extended release

(01:40:12):
sustained release, you know, immediate release. What do all these terms mean, don't make that judgment by yourself, use and talk to your medical provider who should be educated on this or is not going to seek out some more information to do what's the safest route for you.
Okay, we're back to that advocacy thing again right and advocate ask your questions don't be scared.

(01:40:33):
Because maybe that sustained release is what's causing your fatigue during the day or that morning hangover so being knowledgeable on the provider and the patient is a big one but that that was my big take home ferritin and melatonin from International Sleep Conference.
We are now seeing, you know, the US is a little bit more understanding of hyper not understanding but a little bit more treatment options for our hypersomnia disorders because it's it's that's what's the big topic now. And we now have even had some new pediatric indications for medications and some new ones on the

(01:41:04):
horizon, which is very exciting because we have opportunities to better help our kids, and we're already using these medications and adults and have seen huge improvements and now we're opening it up into a safety category for our pediatric patients that can get them as well.
And again, you know, the across the world, I can say, we are looking at focusing on root causes of these sleep disorders and the behavioral impact on related to sleep. And so I'm very excited to be a part of the sleep community because we are all doing the same thing and

(01:41:39):
we're truly trying to fully understand how sleep is impacting our everyday life and what's the impact we're having on our kids by not providing that you know that safe zone of sleep for them. And I love seeing the landscape, just the last three to five years, the way it's
changed where you're seeing here in the US more conferences like the SEC sleep because it's we want everyone there right it's not just Dennis it started as Dennis and now it's grown to this collaboration and there's collaboration cures or airway blues at these

(01:42:13):
conferences are growing to bring in the entire allied professional community dental and medical everyone together. And then you're starting to see more of these gatherings and are nationally like World Sleep or the inspiration by integration that's been made in
Australia in August that capital be a part of. It's just to me amazing to see this huge shift happening at this global global level.

(01:42:41):
You are absolutely correct and even more than just your medical conferences, you're seeing more patient awareness family centered of these these disorders and I think that's huge.
We don't like labels right what do you do whenever you get a medical label you will first your natural instinct is to get in a corner and want to cry right I'm labeled have this like how is this going to affect my life.

(01:43:08):
And then you're going to web and you're going to get a little excited because maybe you have a label and you're not crazy you know that everyone told you were crazy and so you have this this fixed feeling.
But these these patient and family conferences allow you to know that you're not alone, and it gives you that voice or that reasoning that you can go talk with normal people who are dealing with the same things you're doing and know that you don't have to do it

(01:43:33):
along. Yeah, I agreed, I agreed and I love watching this grown evolve in my perfect world as we continue this evolution.
Some of these larger conferences, you're going to take the parent and the layman conferences and start to merge them.
So that's the only way we are all going to be speaking out of the same hymnal and parents will understand the questions to ask and then now providers are going to understand why parents are asking these questions to me that is the next evolution.

(01:44:00):
I think you know the world has changed that the general population would go to the medical professionals to be like what's wrong with me solve it, and that's where it stopped right they must have everything on the medical professionals.
As medical professionals now our job is cut out for us, because not only do we have to say I think this is blah blah blah we are coming.

(01:44:22):
Our patients are coming to us going, I've done all my research and I've done this and I've done this and I think I have blah blah blah blah blah and I want to do this treatment and I want to do this.
And it is our jobs to break down where are they getting their education from what sources are they using. I love that my patients are educated because I'm brought stuff from my patients on a daily basis that I was like wait I didn't even know that was an option.

(01:44:45):
I'm going to get back to you let me go research this something for you. I love the education out there and if we can bridge it together.
More minds think alike more minds can do things like this is amazing. But again, no more sources and let's work together and empower each side of the dynamic so right by the way tick tock is not a source my friends.

(01:45:06):
I'm just going to throw this out there now sorry.
I'm not a source. Well you still only have the label Wikipedia but you got to go a little bit. Yes, yes, please do your research. Hey, I saw this on tick tock thing. Please don't do that.
Yes, yes. And I want to talk about, you know, another big exciting thing in the field of sleep medicine. Yeah, and especially for cat is looking at what is on the horizon for children's airways.

(01:45:34):
So, back to old medicine, it was, I have a problem. How do I fix the problem now, right. Now we're looking at preventative measures, and a better understanding of sleep medicine the structural changes that happen with sleep medicine.
We are better being able to screen out our adolescents and screen out our babies and, and you know, you know, it goes back to these infants, you know, breast is best because of the whole manipulation of the mouth and functional dynamic and structural changes that happen versus a

(01:46:09):
child fed child. And again, I'm not opening up that debate that's not what this topic is just we're getting a better understanding. And there's so many sleep professionals who have actually gone through schools, you know, years and years and hundreds and
millions years back and, and looking at dynamics and what they ate back then and you know everything nowadays is easy mush you know, I was gonna say it's so soft. Yep, we're not chewing we're not exercising or draw.

(01:46:38):
So we're weakening the entrance and the dynamic of our airway and we are seeing the deficits we are paying the price now. And so, understanding this, we are better able to assess out these kids and provide earlier intervention for our children to help prevent some of these
long term effects of poor sleep, poor airway, all of these things. So how are we doing this. Well, we're looking at you know use of home testing mechanisms again I said in labs are best, but in some geographical areas it's just not doable.

(01:47:12):
Right.
And what if you have this overly sensory kid that getting them into the lab is just not going to work. Maybe we can do something in their home environment. Something's better than nothing. Right. Great. Yeah. The use of telemedicine we can thank COVID for bringing that into the world.
We were fortunate that we were doing that pre COVID. But telemedicine brings us access to patients all over the world. And it used to be you can only see the specialists in your hometown.

(01:47:38):
And it's been in patients in many different countries like it brings you to the specialists you need.
And even in dental right I will add on that because Dr Felix Liao was the first one that came on here and was talking about no no no I work with providers that may not have trained in airway the way I did.
But because of telemedicine, I can now have that patient because I'm yes these collaborations are happening all over the globe.
And you know the use of wearable devices they're all out there. How can we use them how can we educate our patients of what to believe on the data and you know there's just a whole dynamic on that.

(01:48:09):
And that was a big talk at our big topic I should say multiple topics and talks on wearable devices at sleep 24 early intervention with with dental devices and orthodontics.
We used to think that orthodontics can only be done in you know age 12 ish, you know, no, we're starting orthodontics on infancy, you know, very, very young children with these two of all things that start expanding out and opening up that airway.

(01:48:35):
And what I mean by that is, if we work with proper breathing style, not mouth breathing focusing on nasal breathing keeping the mouth holes, where's the proper tongue placement.
All of that allows for palatal growth expansion and if we can start that in infancy or very young children. No I'm not saying like they want a birth but very young children.

(01:49:01):
We can make a difference and we can start growing into stronger, wider, more open mouth palates, which is opening the airway. So that's the kind of orthodontic treatment we want not retractive braces.
And we can make a difference in the way that we can do that.
So that's the kind of way that we can do that.

(01:49:22):
And so we need to be more proactive and prevent the problem from happening and we are seeing it in the pediatric world right now.
It's the most amazing and fascinating way right now. And because it's finally getting the attention it's needed it's getting you know medical funding it's needed and you know no we're not just selling CPAPs know I don't make a dime on any CPAP that I'm sending up with my patients.

(01:49:51):
It's so much more than that in figuring out how can we prevent these health consequences from happening when it was a sleep problem, a structural sleep problem.
And that was one of you know a big take home of as a world, not just us as a world, we are working on that dynamic and putting you know all these great minds together.

(01:50:14):
We're going to move mountains and I'm very excited to be a part of it.
It is it's an amazing time for sleep and airway and nutrition. It's just the three the three like it's still suddenly coming to the forefront, and we're learning how it all works together.
Yeah, and using our tongue we use our tongue all the time but are we using it correctly functional therapy is a really big thing of strengthening that tongue and our mouth muscles to do what it's supposed to do proper placement speech development you know nutrition how we're eating so it's all interlaced and it's just it's a lot amazing.

(01:50:49):
The more you submerge yourself in it and get you know the better understanding. It's it's wonderful and if you feel you know the best advice I can give to my parents is if you feel your providers just not getting it.
Go out and find that provider they're out there do your research again not Wikipedia, but do your research and and follow your gut and get out there because there are professionals who are out there.

(01:51:15):
We want to help we want to help in any way that we can. And you know we are not looking just to solve the problem that's already there we want a lot of prevention.
It's always such a pleasure to get to talk to you. And I always I always feel so full when I talk to you because this the information that you have to share and the way you present it.

(01:51:36):
It's just it's wonderful so thank you for everything you've just shared with our parents today. Thank you for giving me the opportunity I, I love what I do and you know again I'm blessed to.
Be in this field I never would have thought this was my path but my path found me and I couldn't be more excited to help and spread knowledge and you know just help in any way that I can to get better sleep for a better life.

(01:52:00):
We appreciate it. Thank you Maggie.
Thank you.
Thanks again to today's guest Maggie lavender for sharing her amazing medical insight on sleep and airway and each of you for listening to today's episode.
You can stay connected with the Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn and YouTube.

(01:52:23):
Don't forget to subscribe to the Airway First podcast on your favorite podcasting platform so you won't miss an upcoming episode.
If you'd like to be a guest or have an idea for an upcoming show, shoot us a note via the contacts page on our website or send us an email directly at info at children'sairwayfirst.org.

(01:52:45):
Today's episode was written and directed by Rebecca St. James, video editing and promotion by Ryan Drone and guest outreach by Kristy Bojinkian.
And finally, thanks to all the parents and medical professionals out there that are working hard to help make the lives of kids around the globe just a little bit better.
Take care, stay safe and happy breathing everyone.

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S8:E73 - Maggie Lavender, MSN, RN, FNP-C: Sleep, Narcolepsy, and Kid's Health

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}S8:E73 - Maggie Lavender, MSN, RN, FNP-C: Sleep, Narcolepsy, and Kid's Health