1 00:00:00,000 --> 00:00:22,080 Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First 2 00:00:22,080 --> 00:00:29,360 Foundation. I'm your host, Rebecca St. James. My guests today are Dr. Joanne Engelby and 3 00:00:29,360 --> 00:00:36,400 Dr. Eva Stack. Dr. Engelby started out in Children's and Community Dentistry and then 4 00:00:36,400 --> 00:00:42,880 moved on to working in general practice where she's been for the past 30 years. She has an active 5 00:00:42,880 --> 00:00:48,560 interest in the treatment of snoring and sleep apnea and is on the board of British Society of 6 00:00:48,560 --> 00:00:54,720 Dental Sleep Medicine, completed the master's class in dental sleep medicine and is a member of the 7 00:00:54,720 --> 00:01:00,960 American Academy of Dental Sleep Medicine. She teaches dental sleep medicine to other dentists 8 00:01:00,960 --> 00:01:06,800 and is trying to increase awareness in the UK of the importance of an unobstructive airway 9 00:01:06,800 --> 00:01:16,720 for all ages. You can find out more about Dr. Engelby at sleepbettermanchester.co.uk or 10 00:01:16,720 --> 00:01:29,040 Jo at parkfield-dental.co.uk. You can also read her full bio in our show notes. Hailing from 11 00:01:29,040 --> 00:01:36,880 County Claire in the west of Ireland, Dr. Stack studied at University College Cork where she won 12 00:01:36,880 --> 00:01:44,400 awards for her clinical work and research. Dr. Stack is a general dentist with an interest in 13 00:01:44,400 --> 00:01:50,240 how function and structure come together to affect our airways sleep, breathing and facial form. 14 00:01:51,120 --> 00:01:55,360 She offers myofunctional therapy alongside orthodontic treatments. 15 00:01:57,520 --> 00:02:02,480 She has completed a one-year orthodontic certificate in London and is trained with the 16 00:02:02,480 --> 00:02:08,880 Breed Institute in Los Angeles for treatment of tongue ties. She's an avid learner and takes 17 00:02:08,880 --> 00:02:14,800 courses and attends conferences to keep up-to-date with current thinking and has a keen interest in 18 00:02:14,800 --> 00:02:22,560 research having most recently been published in the British Dental Journal. She is qualified as a 19 00:02:22,560 --> 00:02:27,920 myofunctional therapist and as a board member of the British Society of Dental Sleep Medicine. 20 00:02:27,920 --> 00:02:37,360 She is the Breed Institute ambassador. You can find out more about Dr. Stack at foreversmile.com.uk 21 00:02:38,080 --> 00:02:50,640 and onclinic.co.uk. And now let's jump into my interview with Dr. Joe Engelby and Dr. Eva Stack. 22 00:02:51,760 --> 00:02:56,240 Perfect. Thank you both for joining us on the podcast today. I appreciate it so much. 23 00:02:56,240 --> 00:03:03,040 My pleasure. You're welcome. Awesome. Awesome. So let's go ahead and we're just going to jump 24 00:03:03,040 --> 00:03:09,600 right in just for those who really aren't familiar with dental sleep medicine. Can we talk a little 25 00:03:09,600 --> 00:03:17,680 bit about what this is and how this is different from traditional dentistry? Dental sleep medicine 26 00:03:17,680 --> 00:03:23,840 is a relatively new area of dental practice to us in the UK. It's the discipline concerned with the 27 00:03:23,840 --> 00:03:31,040 study of oral and maxillofacial causes and consequences of sleep-related problems, 28 00:03:31,040 --> 00:03:39,120 which sounds very complicated. It does. But it means we're assessing the airway, the space at the 29 00:03:39,120 --> 00:03:49,520 back of the mouth for airways and to treat it if appropriate with an oral appliance. So if you 30 00:03:49,520 --> 00:03:57,040 have an airway with some obstruction, it causes sleep fragmentation. And depending on its severity, 31 00:03:57,040 --> 00:04:06,480 it can just be a simple snore to something more complex of complete obstruction. And the name 32 00:04:06,480 --> 00:04:13,200 given to the group of airway dysfunction that we have is sleep-disordered breathing. And it's 33 00:04:13,200 --> 00:04:22,080 characterized by snoring and an increased effort to get breath. So how would a patient end up in 34 00:04:22,080 --> 00:04:29,360 your office? Are they referred or do you do traditional dentistry and sleep? How do they end up there? 35 00:04:29,360 --> 00:04:38,240 I do both. And now we incorporate questions in our routine medical history. Do you snore? 36 00:04:38,240 --> 00:04:46,000 Does it bother you? Does it bother your partner? And then we are in a perfect place because we see 37 00:04:46,000 --> 00:04:52,800 patients with their medical history coming in and their comorbidities to just listen and chat and 38 00:04:52,800 --> 00:04:59,040 then assess what's going on in their mouth and airway. Because there's a lot of signs we can see 39 00:04:59,040 --> 00:05:05,360 that shows that they may be at increased risk of having this sleep-disordered breathing. From a 40 00:05:05,360 --> 00:05:12,000 young age up to adults. And it isn't a static condition. So somebody can start with snoring 41 00:05:12,000 --> 00:05:19,040 and it can progress to something further. But snoring has been considered in the past just 42 00:05:19,040 --> 00:05:26,160 irritating noise. And now we are much more aware of the importance and significance to health 43 00:05:26,880 --> 00:05:34,160 and development. And I would add, I know that we used to think it was cute. I did even. With 44 00:05:34,160 --> 00:05:38,320 my children when they would snore, when they were asleep, oh, aren't they cute? Listen to the little 45 00:05:38,320 --> 00:05:46,240 tiny snore. But it's incredibly detrimental to children as well. It really is. And snoring, 46 00:05:46,800 --> 00:05:52,400 as we said, is a sign of restricted oxygen. And not many of us would like to consider our children 47 00:05:52,400 --> 00:06:00,080 having restricted oxygen. No. They behave in a very different way. So for adults, you get a lot of 48 00:06:00,080 --> 00:06:09,040 medical issues. And in children, you get a lot of behavioral issues. So I don't know how much 49 00:06:09,040 --> 00:06:18,400 your listeners know about the physical effects of sleep apnea in an adult and the long-term effects 50 00:06:18,400 --> 00:06:24,400 or whether this is just about children and where would you like us to go? 51 00:06:24,400 --> 00:06:30,160 Well, we focus on children. However, one of the things that I think is an important 52 00:06:32,080 --> 00:06:38,800 point concept to make sure that we hammer home to parents is why it's so critically important 53 00:06:39,600 --> 00:06:44,640 to take care of this in children because of the effects that it can have in adults. So 54 00:06:45,280 --> 00:06:49,120 I'd love to just kind of veer off into that for a few moments to talk about, you know, 55 00:06:49,120 --> 00:06:55,440 how this can manifest in the health implications that happen in adults. 56 00:06:55,440 --> 00:06:58,880 Eva, should I do this bit? You do children? 57 00:07:00,080 --> 00:07:08,240 Yeah, let's do that. Okay. It can be as acute as a bad night's sleep in layman's terms, 58 00:07:08,240 --> 00:07:13,440 we all feel worse. We're tired, we're groggy, we're hungry, we're irritable. But actually, the 59 00:07:13,440 --> 00:07:20,080 continual lack of oxygen initiates loads of systems to go into high alert and a chain of 60 00:07:20,080 --> 00:07:27,040 reactions to many body systems. A, it prevents you from going into a deeper reparative stage of 61 00:07:27,040 --> 00:07:32,240 sleep. But physically, the effects of apnea really affect the sympathetic nerve system, 62 00:07:32,240 --> 00:07:38,400 into this fright or flight, complete stress all through the night and repeatedly. And that can 63 00:07:38,400 --> 00:07:44,720 affect every system from hypertension and cardiovascular systems to metabolic and insulin 64 00:07:44,720 --> 00:07:52,800 resistance to it can affect your immunity, it can affect the rate of cancer of some sorts, 65 00:07:52,800 --> 00:08:01,360 Alzheimer's, atherosclerosis, it's huge. You know, the chronic effects are the diabetics. 66 00:08:01,360 --> 00:08:09,760 There's so many more diabetics who have apnea, in fact, most of them, two thirds, I think it is, 67 00:08:09,760 --> 00:08:20,000 have some form of apnea. So, really, it's a huge implication and a lot of days are lost, 68 00:08:20,000 --> 00:08:28,160 monetary, work wise, health wise. And that's only to the person who's snoring. The person next to them 69 00:08:28,160 --> 00:08:35,360 is pretty disturbed a lot of the time and it can run. Right. It can impact them. And it's two of the 70 00:08:35,360 --> 00:08:41,840 things you mentioned, well, I mean, there's several, but two in particular, I think are not ones that, 71 00:08:42,880 --> 00:08:47,360 as laymen, we would automatically go to and think, oh, sleep apnea can lead to this, 72 00:08:47,360 --> 00:08:52,560 cancer and Alzheimer's. So, those are recent things that have just come out that, 73 00:08:52,560 --> 00:08:59,760 really, that completed stress, complete stress reaction of your sympathetic nervous system 74 00:08:59,760 --> 00:09:06,880 can affect so many things. And the immunity and the inflammatory response and everything 75 00:09:07,760 --> 00:09:13,600 is put into this stressful, increased high alert state. And they've been shown to be linked to both 76 00:09:13,600 --> 00:09:21,360 of those. Wow. And another one I'd add is the rates of sleep sort of breathing in pregnancy are 77 00:09:21,360 --> 00:09:27,360 highly, are often increased, you know, a little bit more weight carried, a lot more stress in the body. 78 00:09:29,200 --> 00:09:36,400 And also some lack of, you know, less good quality sleep in general, because of discomfort. 79 00:09:37,120 --> 00:09:42,960 And the effects on babies is quite interesting in moms who have sleep sort of breathing. So, 80 00:09:42,960 --> 00:09:50,880 it tends to be a cycle that will then continue. So, yeah, it's really quite interesting. And 81 00:09:50,880 --> 00:09:58,400 I mean, it's quite early in research in that field. But certainly, there are ways of kind of, 82 00:09:59,200 --> 00:10:05,760 there are some case reports at the moment of treatment for women who develop sleep apnea during 83 00:10:05,760 --> 00:10:12,960 pregnancy and treating it. And, you know, I think that's a really, really important piece, because 84 00:10:12,960 --> 00:10:21,760 if mom isn't breathing well, reduce oxygen to baby, and the effects potentially on, you know, 85 00:10:21,760 --> 00:10:28,480 the development of baby is really interesting. And I think that's a piece that we will be visiting 86 00:10:29,280 --> 00:10:37,280 in the future. I think, hopefully, you know, it'll be a case that, you know, all women who are 87 00:10:37,280 --> 00:10:43,760 pregnant at a certain point would have a sleep test, because I think it's a relevant piece to the 88 00:10:43,760 --> 00:10:45,760 next generation being healthier. 89 00:10:45,760 --> 00:10:50,480 I think it's hugely relevant. And it's not something that we talk about much at all, 90 00:10:51,760 --> 00:10:56,240 which is sad. And you go through all of these pregnancy classes and they teach you all these 91 00:10:56,240 --> 00:10:59,680 things, but at no point does anybody say, hey, how are you sleeping? 92 00:10:59,680 --> 00:11:07,200 I think in general, the link of different health issues isn't always related. I'm only talking 93 00:11:07,200 --> 00:11:14,080 about from Britain, that medic, it's come new that the link of different symptoms, such as 94 00:11:14,080 --> 00:11:20,640 hypertension and acid reflux and tiredness and headaches and all things like that could be 95 00:11:20,640 --> 00:11:26,720 suggestive of an increased risk of apnea. You know, the medics haven't been taught that we 96 00:11:26,720 --> 00:11:31,200 as dentists are just too much about that. And it's really important. 97 00:11:31,200 --> 00:11:36,240 It's hugely relevant. That's part of why we're here. And I think I say it on every podcast. 98 00:11:38,240 --> 00:11:42,560 To parents as well as medical professionals, you don't know what you don't know. You weren't 99 00:11:42,560 --> 00:11:48,640 taught we didn't learn this when we were growing up either. So we're all kind of in the same boat 100 00:11:48,640 --> 00:11:53,920 trying to learn together. So that's something very important to remind ourselves. 101 00:11:53,920 --> 00:12:00,400 And I probably, if you don't mind, I'm going to want to circle back because you mentioned, 102 00:12:00,400 --> 00:12:06,400 it's not something we've talked about much on the podcast, pregnancy and sleep apnea 103 00:12:06,400 --> 00:12:12,400 and the impact it can have not only on the mother, but on baby. I'm going to just kind of 104 00:12:13,040 --> 00:12:17,600 guess, you know, some of the impacts are definitely stress related to the child. 105 00:12:17,600 --> 00:12:22,080 So I'm going to just kind of guess, you know, some of the impacts are definitely 106 00:12:22,080 --> 00:12:28,480 stress related to the child. So could the child develop sleep or sleep or breathing issues? 107 00:12:28,480 --> 00:12:33,440 Could it cause the child to have higher blood pressure impact their development? 108 00:12:33,440 --> 00:12:35,760 What kinds of things are we seeing so far? 109 00:12:36,640 --> 00:12:40,560 Well, I would expect so those two biggies really would be the hypertension 110 00:12:40,560 --> 00:12:48,400 and the diabetes risk. Because both of those we know physiologically are two major effects of 111 00:12:48,400 --> 00:12:58,640 having apneas. So I think it would be really interesting to see where, I mean, it's not 112 00:12:58,640 --> 00:13:03,840 something that I've come across in the research. It's just a few colleagues have done kind of case 113 00:13:03,840 --> 00:13:12,160 reports on pregnant women. But I think it would be really interesting to see because we know that 114 00:13:12,160 --> 00:13:20,640 if you're having desaturations that your body becomes more stressed, we know that that stress 115 00:13:20,640 --> 00:13:24,800 is going to raise the cortisol. We know that cortisol is going to wreak havoc with the blood 116 00:13:24,800 --> 00:13:30,960 sugars. So, you know, absolutely there are women who develop gestational diabetes who have, 117 00:13:32,240 --> 00:13:36,400 you know, who are just having all the Coca-Cola, but there are plenty that aren't. And, 118 00:13:36,400 --> 00:13:45,120 you know, if you were to look at them from an oral and functional perspective, I think it would 119 00:13:45,120 --> 00:13:52,560 be interesting to see how they're breathing. There's a beautiful study that someone ought to do. 120 00:13:54,080 --> 00:14:00,720 Perhaps myself and Joe will body together at some stage. And these are things that 121 00:14:00,720 --> 00:14:07,120 we're, I guess we're just not considering right now. And then the other one is we know that if we 122 00:14:07,120 --> 00:14:13,600 have the more apnea you have, the more likelihood you have of hypertension. And we know that hypertension 123 00:14:13,600 --> 00:14:20,000 in pregnancy can cause preeclampsia, which can cause early birth. You know, a lot of the kids 124 00:14:20,000 --> 00:14:29,120 in NICU will be because of preeclampsia mums. And, you know, we have to consider why absolutely 125 00:14:29,120 --> 00:14:36,480 the pressure of pregnancy is going to possibly increase the blood pressure. But is it an apnea 126 00:14:36,480 --> 00:14:44,000 issue? You know, I don't think it's been linked yet, but or confirmed in research. But there's a good 127 00:14:44,000 --> 00:14:54,320 hypothesis there, I feel. A huge, absolutely. So in general, so go ahead. Those people with apnea have 128 00:14:54,320 --> 00:15:00,720 five times as likely to have drug resistant hypertension and double the rate of someone 129 00:15:01,440 --> 00:15:06,320 having diabetes, stroke, and congestive heart failure of those without 130 00:15:06,320 --> 00:15:10,880 disordered breathing. Now, those are two facts I come back to each time and think, 131 00:15:11,520 --> 00:15:17,920 God, why aren't we more aware of this? Because those two statements are huge. 132 00:15:17,920 --> 00:15:30,080 Yes, yes, they are. They really are. Five times. So one of the things I have found over the course 133 00:15:30,080 --> 00:15:35,360 of doing this and speaking with other medical professionals is there was something, some kind 134 00:15:35,360 --> 00:15:43,680 of catalyst that transitioned you into sleep and airway. You know, doesn't seem like anybody, 135 00:15:43,680 --> 00:15:50,080 most people came out of medical school with this focus. So what was it for each of you? 136 00:15:51,840 --> 00:15:58,240 With mine, mine was the fact that I've been with my husband now for 35 years, 137 00:15:58,240 --> 00:16:05,120 and I used to just beg him to let me get, please, just give me 10 minutes, I'll be asleep. 138 00:16:05,920 --> 00:16:12,800 And it was everything was fine until one night I woke up and I was a good sleeper and I didn't 139 00:16:12,800 --> 00:16:20,240 used to wake and I heard this foghorn next to me. And I thought, I'm going to kill you if you don't 140 00:16:20,240 --> 00:16:27,520 stop snoring. And then he stopped snoring. And for one little moment I thought, oh, I'm powerful, 141 00:16:27,520 --> 00:16:36,160 I've just killed him. Oh my God, I'm evil. And then he started to snort and gasp and breathe again. 142 00:16:36,160 --> 00:16:44,080 And it's terrifying to lie next to somebody and breathe. And I actually woke him the next morning 143 00:16:44,080 --> 00:16:50,320 and he's a medic and said, are you aware this is what happened? I even quite horribly recorded him 144 00:16:50,320 --> 00:16:57,120 to say, this is what you sounded like. And this is about 15 years ago. And then I started to look 145 00:16:57,120 --> 00:17:04,320 into it and I made him a little prototype of some impression material in his mouth and that used to 146 00:17:04,320 --> 00:17:11,360 fall out. And now we have gone to bespoke beautiful appliances. And now beforehand the guy's on the 147 00:17:11,360 --> 00:17:17,120 ski trip. Nobody wanted to share a room with him. They said, nice guy when you're awake, but when 148 00:17:17,120 --> 00:17:23,360 you're asleep, it's hideous. And the guy who drew the short straw this year, he hasn't been for a 149 00:17:23,360 --> 00:17:32,640 few years, signed him off as absolute delight. No, not whatsoever. So, you know, when we can get great 150 00:17:32,640 --> 00:17:40,560 treatment outcomes. But that's what lit my fire. And now it's fantastic to make people feel better 151 00:17:40,560 --> 00:17:46,560 to improve the quality of our patient's life. And you see people come back with their mojo and you're 152 00:17:46,560 --> 00:17:53,600 reducing their risks of significant disease. So even if you catch it later in life, you can have 153 00:17:53,600 --> 00:18:00,720 an impact on their overall health span. You can it's been shown that you can slow down the rates of 154 00:18:00,720 --> 00:18:07,040 things. It depends what we're talking about. And I'm not sure how much studies have been in. A lot 155 00:18:07,040 --> 00:18:13,040 of more studies have been done about CPAP and the reduction in risks. And now as we're introduced, 156 00:18:13,040 --> 00:18:20,640 our oral appliances, we hope they're the same effects. But again, there's another study. 157 00:18:20,640 --> 00:18:24,080 Yeah. Oh, wow. And what about you, Dr. Stack? 158 00:18:24,080 --> 00:18:32,880 So when I was, oh dear, have I lost you guys? No, no, we're here. 159 00:18:35,040 --> 00:18:43,760 So when I was at university, my final year case was, was my father. And I, you know, took him from, 160 00:18:44,800 --> 00:18:49,920 you know, a mouth that hadn't been worked on in a long time. And I saw him like 20 times. 161 00:18:49,920 --> 00:18:57,040 And we fixed him right up good o and I got my honorary degree and all was well. And 162 00:18:58,640 --> 00:19:10,880 four years later, my dad passed away very suddenly. And it just puzzled me as to what 163 00:19:10,880 --> 00:19:18,000 on earth was going on, which made me, you know, think about all of the potential symptoms that 164 00:19:18,000 --> 00:19:23,920 really put me down on a rabbit hole. I was really keen to work out why my dad just was there one 165 00:19:23,920 --> 00:19:34,160 minute and not anymore. So then I kind of looked at all the images and pictures I had of his mouth 166 00:19:34,160 --> 00:19:41,360 and realized that he constantly mouth breathed. He had a narrow palate. He had worn teeth. He had a 167 00:19:41,360 --> 00:19:48,080 high malin patty. He would wake up several times during the night. It's just the checklist. 168 00:19:49,520 --> 00:20:01,120 The checklist. Yeah. And that obviously is very personal and hard, but I would not want that to 169 00:20:01,120 --> 00:20:12,000 happen to anybody else's father. And that is why I am so passionate about trying to make change 170 00:20:12,000 --> 00:20:22,560 and trying to influence some difference because yeah, lives can be shortened and that causes 171 00:20:23,440 --> 00:20:28,400 pain all around. And if it's not necessarily shortened, you know, you can live with a lot of 172 00:20:28,400 --> 00:20:41,120 comorbidities that are unpleasant and just give you less life quality. And, you know, we 173 00:20:42,320 --> 00:20:50,160 are very quick to look at pharmacological treatments for different conditions, but, 174 00:20:50,160 --> 00:20:57,920 you know, fundamentally you sleep well, you eat well, you move well, you breathe well. 175 00:20:59,280 --> 00:21:07,600 You know, those pillars are going to lead to a better life. And it's amazing to have, 176 00:21:09,600 --> 00:21:16,560 yeah, within my own profession to have the ability to make a change. So that is why I like 177 00:21:16,560 --> 00:21:25,360 working in this area, which is, yeah, that's it. And that's something that I do find that anyone 178 00:21:25,360 --> 00:21:29,520 that has done the research, first of all, there's something that gets them here. They don't just 179 00:21:29,520 --> 00:21:34,480 stumble upon it usually. There's something and there's this passion once you see it, once you 180 00:21:34,480 --> 00:21:41,760 understand it and you realize, as you said, it's not just how it would impact your health span, 181 00:21:41,760 --> 00:21:48,240 it's your quality of life. And it's something so simple. I mean, it's relatively simple by comparison 182 00:21:48,240 --> 00:21:53,360 to, you know, having to live with diabetes or Alzheimer's or some of these other things that 183 00:21:53,360 --> 00:22:03,120 will come down the road because of it. It's so simple. So I saw something, I'm not sure how 184 00:22:03,120 --> 00:22:08,000 recently you posted this, but there was a link between snoring and mental health. 185 00:22:08,000 --> 00:22:17,120 And I really want to talk about this because the US Surgeon General has indicated this is 186 00:22:17,760 --> 00:22:23,760 one of his big initiatives is mental health, specifically in children. And more studies 187 00:22:23,760 --> 00:22:28,160 have come out that, you know, mouth breathing and sleep apnea, they're impacting 188 00:22:30,080 --> 00:22:37,520 children and their mental well-being, depression and anxiety, which is off the charts in the US, 189 00:22:37,520 --> 00:22:44,320 as well as globally, but specifically here. So can we talk a little bit about how sleep apnea 190 00:22:44,320 --> 00:22:53,520 does impact children and their mental health? So snoring is the sound made when the tissues 191 00:22:53,520 --> 00:22:58,560 have a restricted airway. And there's from a little bit, there's a spectrum from a little bit 192 00:22:58,560 --> 00:23:04,160 of resistance to more until there's a complete blockage that can happen multiple times a night. 193 00:23:04,160 --> 00:23:09,680 And as we've said that multiple times a night puts your body into stress and your whole body's in this 194 00:23:10,400 --> 00:23:18,320 active stress situation physically and mentally. And adults with sleep apnea often suffer from 195 00:23:18,320 --> 00:23:23,520 daytime sleepiness and long-term cardiovascular effects and diabetes. And the kids whilst they 196 00:23:23,520 --> 00:23:28,800 might be storing that for later are much more likely to have behavioral problems, cognitive 197 00:23:28,800 --> 00:23:34,400 problems, development and growth. They have poor memory and concentration, they have behavior which 198 00:23:34,400 --> 00:23:42,720 mimics ADHD and in some studies they've shown that there is an increased incidence of ADHD with mild 199 00:23:42,720 --> 00:23:48,800 and moderate. And it says that about one to five percent of children have obstructive sleep apnea 200 00:23:48,800 --> 00:23:56,560 and it's commonly under diagnosed. And it's, you know, kids can play up, we all know that we're 201 00:23:56,560 --> 00:24:04,720 perhaps not as patient when we've had a bad night's sleep. But if that's chronic, then we become less 202 00:24:04,720 --> 00:24:12,240 alert, less cognitively able, we're less able to learn with our mood alertness and performance. 203 00:24:12,240 --> 00:24:18,960 And we often have more rebelliousness, hyperactivity, impulsiveness, we have difficulty 204 00:24:18,960 --> 00:24:24,400 controlling emotions. And most teams anyway are just learning or kids are learning to control 205 00:24:24,400 --> 00:24:32,720 the emotions, they don't need the extra hassle of reduced oxygen brings. There's interesting 206 00:24:32,720 --> 00:24:39,520 studies shown that after often children have problems because of large adenoids or tonsils. 207 00:24:40,080 --> 00:24:47,440 And they've shown that in some, then there is a significant positive impact on behavioral problems 208 00:24:47,440 --> 00:24:58,480 such as inattention, hyperactivity, oppositional defiance and conduct disorder after adenadontis 209 00:24:58,480 --> 00:25:12,000 electomy. I find that a lot of teeth around. And the mean scores of ADHD and all the behavior issues 210 00:25:12,000 --> 00:25:17,600 decrease significantly after the surgery to the extent that the parents weren't bothered about 211 00:25:17,600 --> 00:25:22,960 the behavior. Now, I don't think it ever goes back down to the baseline group. And you do have a 212 00:25:22,960 --> 00:25:29,520 high risk of it recurring, particularly if you've got higher AHI or you've got high-och palette or 213 00:25:29,520 --> 00:25:37,520 a Malanpati score of two to four, that's the rating we give to the space and have a crowded or 214 00:25:37,520 --> 00:25:43,520 referents at the back. There's more risk if they're male or over seven, if they've got allergic 215 00:25:43,520 --> 00:25:51,840 rhinitis or asthma or if they're of African American race. So there are factors that do 216 00:25:51,840 --> 00:25:58,880 affect it, but on the whole, there was a significant increase in behavior. 217 00:25:58,880 --> 00:26:10,640 You mentioned something that, if you can speak to it, males over seven. So why are they different? 218 00:26:11,600 --> 00:26:19,040 Not quite sure. It could be that males have a longer soft palate. I'm not sure, Ithara, you sure? 219 00:26:21,040 --> 00:26:25,360 Well, I guess the cranium would have pretty much developed at that point. 220 00:26:25,360 --> 00:26:38,960 So I'm not sure, but I'm just thinking on a, so if the soft tissues haven't caught up with the 221 00:26:38,960 --> 00:26:45,920 heart tissues, then potentially that's why, because at that age, we're pretty much 222 00:26:45,920 --> 00:26:53,520 facially developed. There's 80% of our efficient developments done by age six, so there could be 223 00:26:53,520 --> 00:26:59,200 that too, but I'm not entirely sure. I'm not sure either. I don't know whether you're starting from a 224 00:26:59,200 --> 00:27:05,760 different place, either. Yeah, yeah, just curious. Another, this one point that I think is quite 225 00:27:05,760 --> 00:27:12,160 mind-blowing as well. The brain constitutes only 2% of the whole body, but it uses up to 20% of the 226 00:27:12,160 --> 00:27:18,240 total metabolic oxygen. And it's thought the conditions that reduce the metabolic oxygen affect 227 00:27:18,240 --> 00:27:24,640 the brain and cause cognitive and neurobehavioral impairments. Right now, we have seen that, 228 00:27:24,640 --> 00:27:31,840 that it can decrease a child's IQ up to 10 points, which is staggering. 229 00:27:33,600 --> 00:27:36,640 It really, oh, that's a huge number. 230 00:27:39,920 --> 00:27:45,040 It's an extra thing to throw up a child who's learning how to regulate emotions and their 231 00:27:45,040 --> 00:27:52,640 weight. Anyway, it's an extra thing that we can do something about. And there's some things we 232 00:27:52,640 --> 00:28:01,440 can't do about, but that is something we could. So we've talked before about the Malan Patty score, 233 00:28:01,440 --> 00:28:06,640 and I'll make sure to put, for those who haven't seen, I have a visual that really shows the four. 234 00:28:06,640 --> 00:28:18,800 So they'll have a perspective of what we're talking about. How do you know, though, that just removing 235 00:28:18,800 --> 00:28:24,480 the tonsils, for example, would be enough? Or do you even have to go that route if you can look at 236 00:28:24,480 --> 00:28:32,000 a child's mouth and say, oh, they have no room? Where do you start? It's a few things. I've got a 237 00:28:32,000 --> 00:28:39,920 is of a child's adenoid face. Okay, see that with an elongated face, and you have Venus pooling, 238 00:28:40,480 --> 00:28:48,560 and it looks a sort of different sort of face there. Often where they've got a narrower, 239 00:28:48,560 --> 00:28:56,400 they've got a high-volted palette, narrow jaw, narrow face, and often their head is, if I show 240 00:28:56,400 --> 00:29:02,560 that, is forward. Their posture is ever head forward as they're trying to get more airway. So 241 00:29:02,560 --> 00:29:08,160 sometimes you see a child as they walk in. I think we might have lost Eva. I see that. 242 00:29:09,600 --> 00:29:14,560 I'll watch for her to pop back in. Okay. And so a child can often have dark 243 00:29:16,080 --> 00:29:21,360 bags under their eyes, and then open the mouth, and you see quite often worn teeth, 244 00:29:21,360 --> 00:29:27,360 because worn teeth and Bruxism is often now thought to be a sign more related to some sleep 245 00:29:27,360 --> 00:29:34,960 disordered breathing. Which is grinding your teeth, correct? Yeah. Okay. So you often see that, and then 246 00:29:35,600 --> 00:29:42,560 the jaw, top jaw, typically we want it to sit outside the bottom jaw, and in a lot of these 247 00:29:42,560 --> 00:29:49,440 cases, you've got a mismatch, and everything's very narrow, and there's nowhere for the tongue to go, 248 00:29:49,440 --> 00:29:55,760 except backwards. When a child then lies down, the tongue goes back, they've already, if you open 249 00:29:55,760 --> 00:30:01,840 their mouth, you can sometimes see the tonsils kissing, and it's called kissing. As they're 250 00:30:01,840 --> 00:30:08,400 meeting at the back, and the tonsils are the tissue at the back of the mouth, and the adenoids are 251 00:30:08,400 --> 00:30:14,160 the tissue at the back of the nose. And if you've got that inflamed tissue at the back of the nose 252 00:30:14,160 --> 00:30:22,720 and the throat, then you are hampering that child's ability to breathe. So you could start there as 253 00:30:22,720 --> 00:30:27,840 you're trying to bring the jaw forward and make some of the other adjustments just for the immediate 254 00:30:27,840 --> 00:30:37,520 relief? Well, I think at that point, I would ask someone, do they snore? Have you been to 255 00:30:37,520 --> 00:30:46,400 C&E&T opinion? Before I started playing, I would at that point refer on, I think it's 256 00:30:46,400 --> 00:30:51,200 appropriate that if there's a significant other problem, we try and get that long term. 257 00:30:52,000 --> 00:30:57,840 And some children grow out of some of the adenoid chronic things and don't need surgery. 258 00:30:58,880 --> 00:31:02,720 Okay, that's interesting, because this is now the second time I've heard this mentioned. 259 00:31:02,720 --> 00:31:08,400 And how do you know when to do it, when not to do it? Because I've also heard something very similar 260 00:31:08,400 --> 00:31:12,800 about a tongue tie, which I was under the impression you always take those out, but apparently, 261 00:31:12,800 --> 00:31:14,160 you don't always treat those. 262 00:31:14,160 --> 00:31:36,880 You're listening to Airway First with today's guests, Dr. Joe Engelby and Dr. Eva Stack. 263 00:31:38,560 --> 00:31:42,800 You can find out more about the Children's Airway First Foundation and our mission to fix 264 00:31:42,800 --> 00:31:51,440 Before Six on our website at childrensairwayfirst.org. The CAF website offers tons of great resources 265 00:31:51,440 --> 00:31:57,760 both for parents and medical professionals. In our Parents Portal and Clinicians Corner, 266 00:31:57,760 --> 00:32:03,360 you can find educational and informational content, including videos, blogs, our recommended 267 00:32:03,360 --> 00:32:10,480 reading list, comprehensive medical research, podcasts, events, parent support, and educational 268 00:32:10,480 --> 00:32:17,280 opportunities. Parents are also encouraged to join the Airway Huddle, our Facebook support group, 269 00:32:17,280 --> 00:32:21,440 which was created for parents of children with airway and sleep-related issues. 270 00:32:22,400 --> 00:32:29,680 You can access the Airway Huddle support group at facebook.com backslashgroups backslash airway 271 00:32:29,680 --> 00:32:35,200 huddle. Are you a medical professional or parent that is interested in being a guest on the show? 272 00:32:35,200 --> 00:32:40,320 Then shoot us a note via the contacts page on our website, or send us an email directly at 273 00:32:40,320 --> 00:32:48,240 info at childrensairwayfirst.org. As a reminder, this podcast and the opinions expressed here 274 00:32:48,240 --> 00:32:53,440 are not a medical diagnosis. If you suspect your child might have an airway issue, contact your 275 00:32:53,440 --> 00:32:59,600 pediatric airway dentist or pediatrician. And now let's jump back into my interview with today's 276 00:32:59,600 --> 00:33:15,520 guest, Dr. Jo Ingleby and Dr. Ifa Stack. 277 00:33:24,240 --> 00:33:28,560 I'll leave Ifa to talk tongue-tied, but with the adenoids, I don't know when you need any 278 00:33:28,560 --> 00:33:36,800 endiculants. Okay, got it. Got it. With regard to the adenotant, adenotant left me. Obviously, 279 00:33:36,800 --> 00:33:43,920 if we don't need to put a true surgery, that's better. But if the tissues are chronically damaged 280 00:33:44,960 --> 00:33:49,520 or chronically inflamed to the point that they're not going to come down, then, you know, 281 00:33:49,520 --> 00:33:58,480 I think it becomes a no-brainer if it reduces the breathing space. But children do grow out of 282 00:33:59,600 --> 00:34:05,760 tonsils and adenoids. They do tend to get smaller from the age of six. And also, the other thing is, 283 00:34:07,200 --> 00:34:13,920 you know, if there's allergies and there's a change to that exposure, then that can reduce 284 00:34:13,920 --> 00:34:24,800 the size of the tonsils. And the other thing is there has been the UN study, which I'm sure 285 00:34:24,800 --> 00:34:36,400 you've all come across before, where expansion of the palate has led to reduce tonsil size, but 286 00:34:36,400 --> 00:34:58,240 it's still so new. And it will take time for this to filter through to dentist, doctors, 287 00:34:58,240 --> 00:35:07,200 midwives, everybody, because it should be a multidisciplinary approach as well. But with 288 00:35:07,200 --> 00:35:13,440 increased awareness, hopefully parents become more aware, dentists become more aware, and we can all, 289 00:35:14,000 --> 00:35:20,080 there are, in Britain, hopefully there will be more myofunctional therapists to help. And, 290 00:35:20,080 --> 00:35:28,880 you know, we can start treating these patients in a conservative, prevented way. 291 00:35:28,880 --> 00:35:33,280 Right. So we're getting to the root instead of let's just keep putting band-aids on it, 292 00:35:33,280 --> 00:35:40,000 and let's just give them medication and understood. So you mentioned myofunctional therapy, 293 00:35:40,000 --> 00:35:47,040 which was an excellent segue for my next question. So, Dr. Sack, let's talk a little bit about how 294 00:35:47,040 --> 00:35:54,240 myofunctional therapy plays into sleep hygiene, as well as sleep apnea treatment. 295 00:35:56,160 --> 00:36:00,960 Okay. So I would separate sleep hygiene and sleep apnea treatment. So sleep hygiene is 296 00:36:02,640 --> 00:36:13,200 things that we can all be doing to improve our sleep architecture. So, you know, the amount of 297 00:36:13,200 --> 00:36:19,520 deep sleep we're going to get, etc. So that's to do with, you know, how we live our lives on a day 298 00:36:19,520 --> 00:36:28,000 to day basis. So how, you know, how we're eating, how far away from our, our night we're asleep, 299 00:36:28,000 --> 00:36:34,880 we're eating, how far away from our night sleep we're eating, you know, how well hydrated we are. 300 00:36:35,440 --> 00:36:40,560 And, you know, what we've done in the hour or two before bed, light exposure, first morning 301 00:36:40,560 --> 00:36:48,320 night exposure, sunset exposure, you know, our melatonin levels, you know, it's pretty easy 302 00:36:48,320 --> 00:36:54,000 to get it right if you follow the, if you follow what we're supposed to do. And if you have a really 303 00:36:54,000 --> 00:36:59,360 easy life that means that you can just go and look at the sunrise and go look at the sunset and 304 00:36:59,360 --> 00:37:04,640 take on your ear outside and not be exposed to toxins and, you know, eat all organic food and, 305 00:37:04,640 --> 00:37:11,680 you know, have, you know, not have conversations at late at night on computers and all those things. 306 00:37:11,680 --> 00:37:18,960 So, the two people in the world that can do that. So for the rest of us, right? 307 00:37:18,960 --> 00:37:23,040 I should have my blue blocking like goggles on that would be really impressive. 308 00:37:24,080 --> 00:37:31,440 Just with my lips are good. But yeah, so, so all those sorts of things would kind of fall under 309 00:37:31,440 --> 00:37:38,800 sleep hygiene. And then, you know, stress relief, breath work, all those, you know, 310 00:37:38,800 --> 00:37:44,400 we're looking at myofunctional therapy, we're looking more at actual targeted exercises to 311 00:37:45,600 --> 00:37:53,360 treat the hormonal dysfunctions that we present with. So whether that is weak lip support, 312 00:37:53,360 --> 00:38:00,640 causing, you know, mouth breathing, whether it's a tongue, that is a bit floppy, whether it's a tongue 313 00:38:00,640 --> 00:38:07,920 that quite doesn't fit into the roof of our mouth, whether it's a tongue tie, whether we have, you 314 00:38:07,920 --> 00:38:17,760 know, TMJ problems because of poor chewing, you know, whether we can chew at all, a host of issues. 315 00:38:18,800 --> 00:38:26,480 And those are structural and functional issues that need therapeutic support rather than 316 00:38:26,480 --> 00:38:33,200 being a case of, well, you know, because we could have amazing myofunctional support, but if you 317 00:38:33,200 --> 00:38:38,080 decide to drink three bottles of wine before you go to bed, it doesn't make any difference. 318 00:38:38,080 --> 00:38:42,640 It's not going to be good. Or similar, if a kid has, you know, lots of skittlings before bed, 319 00:38:43,600 --> 00:38:51,040 you know, so it's managing two different things. But it's for, you know, for families, it's very 320 00:38:51,040 --> 00:39:02,480 much on mom and dad or mom or dad or parents, whatever that looks like to manage both hygiene 321 00:39:02,480 --> 00:39:06,720 and both and all the therapies and whatever else comes with that. 322 00:39:06,720 --> 00:39:12,320 And together. So for parents that are, and we've got a few things on our website, which I'll make 323 00:39:12,320 --> 00:39:18,160 sure we include a link to hear about what good sleep hygiene looks like. But for parents that are 324 00:39:18,160 --> 00:39:24,800 just becoming aware and overwhelmed, which is what we find a lot when parents, you know, find out 325 00:39:24,800 --> 00:39:31,200 what's going on, what are a few things they could start with, you know, that would be pretty impactful 326 00:39:31,200 --> 00:39:35,280 when it comes to sleep hygiene, just, you know, with a younger child, what are some things they could 327 00:39:35,280 --> 00:39:36,800 start with initially? 328 00:39:37,680 --> 00:39:38,960 Screen time is a big one. 329 00:39:40,960 --> 00:39:42,480 Overall or just before bed? 330 00:39:43,280 --> 00:39:44,160 Overall. 331 00:39:44,160 --> 00:39:57,120 Overall, we weren't designed as humans to be in front of screens. So, you know, that's a given. 332 00:39:57,120 --> 00:40:01,760 But certainly later on the evening, certainly the less green time, the better. 333 00:40:03,200 --> 00:40:10,320 You know, light exposure, having, you know, less blue light generally, you can put dimmers in your 334 00:40:10,320 --> 00:40:16,400 light, you can have certain wattage on your, on your lights, lots of hydration, 335 00:40:17,920 --> 00:40:24,160 you're not eating too close to bed, looking at your sugar, kind of consumption throughout the day, 336 00:40:26,560 --> 00:40:31,760 breath work, if it's possible. There's some simple but take a breathing exercises that 337 00:40:31,760 --> 00:40:33,360 can be done that are quite nice. 338 00:40:33,360 --> 00:40:39,840 You know, trying to get the kids outside if you've got green space. 339 00:40:41,840 --> 00:40:46,320 You know, it's not easy, man. It's really not easy. 340 00:40:46,320 --> 00:40:47,200 No, it's not. 341 00:40:48,080 --> 00:40:54,800 But, you know, at the weekends, making sure that there is outside activity, you know, 342 00:40:54,800 --> 00:41:03,520 just trying to live as naturally as possible is a good way to think this is the way we should 343 00:41:03,520 --> 00:41:11,280 be helping our sleep. Because, you know, we used to be able to sleep pretty well. And we now have 344 00:41:11,280 --> 00:41:17,600 so many toxins all around us, along with all these toxic lights that are not good for us either. 345 00:41:17,600 --> 00:41:26,880 Right. And as a mother of at least one that's still in school, that has everything on an iPad, 346 00:41:27,520 --> 00:41:32,000 back in my day, we had the backpack with all the books. And the worst we had to worry about was 347 00:41:32,000 --> 00:41:37,120 throwing out a shoulder or a rubber, something with a heavy backpack. I'll take that. But to see 348 00:41:37,120 --> 00:41:42,480 a child that has no books and they're constantly on their iPad, everything is on the iPad, the book 349 00:41:42,480 --> 00:41:48,160 is on there, the homework is on there, the lectures are on there. You know, it's one of those I would 350 00:41:48,160 --> 00:41:53,440 just like to rally that please bring back the books. That's all I'm saying. I think to have a 351 00:41:54,880 --> 00:42:03,440 time that stops that and then a transition of relaxation before a regular bedtime is at least 352 00:42:03,440 --> 00:42:09,440 something you can do. If we could all get much more fresh air and all go back to whatever. But 353 00:42:09,440 --> 00:42:16,640 that is unlikely to happen when all your work is on your iPad. Exactly. It is. Right. And my 354 00:42:16,640 --> 00:42:21,520 heart goes out to the kids that were like me, they were doing homework late into the night, 355 00:42:21,520 --> 00:42:25,920 especially the teenagers. You have after school events, you have band, you have cheerleading, 356 00:42:25,920 --> 00:42:29,760 whatever. And you have a job and then you come home and you're with your family. 357 00:42:30,320 --> 00:42:36,000 And then you're doing homework late into the night. We're just basically handing these 358 00:42:36,000 --> 00:42:45,280 children health issues. Yeah. And it's not just children. It's throughout. I have a five-month-old 359 00:42:45,280 --> 00:42:50,960 baby. He's not really exposed to screens just yet, but that's going to come. And it's really 360 00:42:50,960 --> 00:42:57,280 interesting because I'm currently working through sleep learning and the pattern that 361 00:42:57,280 --> 00:43:08,560 we're that's known to work would be, you know, feed, then feed in a kitchen in the kitchen 362 00:43:08,560 --> 00:43:14,480 so that they get used to eating their last meal in the kitchen, then take them up to the bath, 363 00:43:14,480 --> 00:43:21,440 have a nice relaxing bath, then do a baby massage, then have a read of a book, then say your prayers 364 00:43:21,440 --> 00:43:29,760 and go to sleep. And, you know, actually, that's a pretty good way for it. No, but it's a pretty 365 00:43:29,760 --> 00:43:35,840 good way for us all to be living this night. It is. It is. We've been out for a walk, you know, 366 00:43:37,600 --> 00:43:42,160 and all of those things are setting him up to have a good night. Well, I hope to have a good 367 00:43:42,160 --> 00:43:48,800 night. But, you know, we know that those are things that are going to improve sleep architecture. But, 368 00:43:48,800 --> 00:43:54,080 you know, it's and that's how we used to live like not that long ago. Like when I was at university, 369 00:43:54,080 --> 00:44:00,640 which I qualified 10 years ago, I wasn't really in the library late at night with a laptop. I 370 00:44:00,640 --> 00:44:07,520 was there with books, like in highlighters, you know, I think, you know, in a very short period 371 00:44:07,520 --> 00:44:14,800 of time, everything is online, you know, I'm any online, any postgrad programs I'm doing now, it's 372 00:44:14,800 --> 00:44:18,960 all on the computer, you know, even more and more and more. And I would expect you probably for you, 373 00:44:19,520 --> 00:44:26,080 in your career, you probably would have gone from never using a computer to now spending about 50% 374 00:44:26,080 --> 00:44:31,920 of your time on a computer right now. I think we all have to be aware, though, that it wouldn't 375 00:44:31,920 --> 00:44:37,280 be practical to say to everybody, you can't use your iPad, your child who is all the time on. 376 00:44:37,280 --> 00:44:45,920 We just have to have limited as much as we can get out there and get as much natural bits we can do 377 00:44:45,920 --> 00:44:54,560 going on. Give us a time period of, as Eva says, some gap between whatever we do and sleep. Can't 378 00:44:54,560 --> 00:45:02,400 it's not just a light switch you can turn off, and then suddenly have no effect. No, no, and your 379 00:45:02,400 --> 00:45:09,520 mind needs to wind down. Yep. And I also think just to add to this on the personal side, 380 00:45:10,480 --> 00:45:16,320 from doing these podcasts, I've caught my own behaviors, you know, I was 30 years ago because 381 00:45:16,320 --> 00:45:21,600 I'm old. In college, I was that child that was at the library late at night working, but it was 382 00:45:21,600 --> 00:45:27,600 with books. So I'm used to being up late and reading before bed, but life happened and technology 383 00:45:27,600 --> 00:45:33,360 happened and children. And at some point, I got into this horrible habit of, well, let me just 384 00:45:33,360 --> 00:45:39,920 unwind by playing some games on my phone until I fall asleep. So, you know, even I have had to 385 00:45:39,920 --> 00:45:45,920 backpedal my behavior and I'm finding, you know, this is, as parents, this is something I think we 386 00:45:45,920 --> 00:45:52,960 can do. We're showing our children what to do. So put that phone down, don't pick it up, have a book, 387 00:45:52,960 --> 00:45:58,240 you know, maybe sit outside with a cup of tea and talk to your spouse before you go to bed and 388 00:45:58,240 --> 00:46:05,440 or something just change. And some of it is some of us are natural larks and some of us are natural 389 00:46:05,440 --> 00:46:11,440 owls. And we do have to acknowledge that as well. But I mean, a lot of teenagers would like to start 390 00:46:11,440 --> 00:46:17,520 their day later on. That's other programmed. Yeah, I wasn't, but apparently other children are. 391 00:46:17,520 --> 00:46:23,520 So, but it's about actually just acknowledging what's going on. And if you cannot, if you are 392 00:46:23,520 --> 00:46:28,560 struggling with your sleep or your child is then to actually look at what's going on and seeing 393 00:46:28,560 --> 00:46:36,480 what can you do to help and make it a more natural or a more regulated, you know, what's going to 394 00:46:36,480 --> 00:46:42,240 increase the likelihood of you having a better night's sleep. Yeah. Yeah. And I know we've touched 395 00:46:42,240 --> 00:46:49,360 on this a little bit, but just to kind of package it up in a nice little way for parents. What are 396 00:46:49,360 --> 00:46:59,280 some home things we can do to help our children with? Not just sleep, but maybe sleep apnea or 397 00:46:59,280 --> 00:47:05,600 what kind of exercises or things should we be doing as they're coming up? I know that baby lead 398 00:47:05,600 --> 00:47:10,720 weaning is something that is now being talked about because we're giving our children all these 399 00:47:10,720 --> 00:47:18,000 soft foods and we're all guilty of it. So, letting them chew is good for them. It's going to 400 00:47:18,000 --> 00:47:22,720 strengthen the jaw. It's going to help bring it forward. What are some other things that we as 401 00:47:22,720 --> 00:47:28,720 parents could be doing to help our children? Encourage nasal breathing would be one of the 402 00:47:29,280 --> 00:47:35,840 ones I'd say as much as you can. Make it a game. Check that they can. 403 00:47:35,840 --> 00:47:48,640 Yeah. Take them to someone who can help them. Yeah. I mean, from birth, like, 404 00:47:50,400 --> 00:47:56,480 breastfeeding if possible and if desired, and if desired, then having support for feeding 405 00:47:57,600 --> 00:48:03,440 because we know that tongue-tie weights are probably higher than what's, you know, 406 00:48:03,440 --> 00:48:10,240 if I'm Brazilian with a 20% there is tongue-tie. So, you know, that's 20% of people who will have 407 00:48:10,240 --> 00:48:18,480 issues from get go with feeding. So, breastfeeding is one and allergies is the other. 408 00:48:19,360 --> 00:48:28,160 You know, looking at diet and what diet interventions may cause, may cause any kind of reflux 409 00:48:28,160 --> 00:48:37,440 and then encouraging, even with the babas, encouraging nasal breathing through oral 410 00:48:37,440 --> 00:48:47,840 motor exercises, which would be done with a physio or OT, speech and language service, 411 00:48:49,920 --> 00:48:56,480 or an ABCLC or a tongue-tie provider or an easy above together or an osteo. But there's 412 00:48:56,480 --> 00:49:02,320 numerous people that would be involved in that team. And then once they get, as you described, 413 00:49:02,320 --> 00:49:08,640 once they start to wean harder foods ideally and if possible continued breastfeeding. 414 00:49:09,840 --> 00:49:17,520 Because that deep latch, our ancestors would have breastfed till about the age of four. 415 00:49:17,520 --> 00:49:28,960 And we know that that was related to having a wider palate. And that's something that obviously is 416 00:49:28,960 --> 00:49:37,840 incredibly demanding on the whole family, particularly your mum. So, you know, the way, 417 00:49:37,840 --> 00:49:46,320 the real, how realistic that is, is questionable in our modern times. But it's certainly baby 418 00:49:46,320 --> 00:49:52,960 leg weaning and really, really looking at reducing allergens, where, you know, whether it's just 419 00:49:53,680 --> 00:50:02,960 dairy, whether it's a dander from animals, you know, anything that might potentially 420 00:50:03,680 --> 00:50:11,840 increase any inflammation in the, in the, in the airways is something to be reduced, looking at, 421 00:50:11,840 --> 00:50:22,880 maybe increasing filtration for the air, reducing air conditioning. Again, making sure that you're 422 00:50:22,880 --> 00:50:28,880 trying to live in an environment that's less toxic. I mean, so much of this stuff is so high 423 00:50:28,880 --> 00:50:35,200 and mighty, you know, it really, really is. Because, you know, we really have damaged our 424 00:50:35,200 --> 00:50:42,000 environment significantly and our way of living in a natural, in a natural way. But, you know, 425 00:50:42,000 --> 00:50:48,960 again, just going back to trying to live as, as primitively as possible. And then, you know, when, 426 00:50:49,520 --> 00:50:58,560 when, when I was getting into kind of three, I would say would be, I mean, I don't tend to 427 00:50:58,560 --> 00:51:04,080 work very well with three year olds, but certainly kind of four or five, you're starting to get a 428 00:51:04,080 --> 00:51:10,000 little bit of cooperation. And then doing some, some or more exercises. And there are some amazing 429 00:51:10,000 --> 00:51:15,520 myofunctional therapists, I think Barbara Green, she's amazing. She does the most incredible work 430 00:51:15,520 --> 00:51:24,240 with like 18 month olds. And they're doing all of this fabulous myofunctional therapy work and 431 00:51:24,240 --> 00:51:31,840 really doing great. But for me, like you're thinking you're going to get cooperation 432 00:51:31,840 --> 00:51:40,640 or sometimes three plus, yeah, sometimes far higher. And sometimes you got a really 433 00:51:40,640 --> 00:51:47,440 cooperative three year old. And I think it's a total lucky dip. I don't think it's, 434 00:51:48,400 --> 00:51:54,800 I'm sure there's a bit of parenting involved. But I think sometimes it's a lucky dip. So you just 435 00:51:54,800 --> 00:52:03,120 don't know what you're going to get. But yes, doing basic exercises, doing breathwork, you know, 436 00:52:05,120 --> 00:52:10,800 yeah, doing different games to promote nasal breathing, something like putting a lollipop stick 437 00:52:10,800 --> 00:52:15,120 between the lips and holding that for three minutes, so that they're breathing through the nose. 438 00:52:16,160 --> 00:52:21,040 You know, they're not holding that lollipop stick with their teeth. And if they can't, if you can't 439 00:52:21,040 --> 00:52:27,200 breathe through your nose for three minutes, that's a direct referral to an ENT. If you 440 00:52:27,200 --> 00:52:30,080 can breathe through your nose for three minutes, you can breathe through your nose for your whole 441 00:52:30,080 --> 00:52:36,720 life. There's a really fabulous book by Patrick McKeown. Close your mouth 442 00:52:39,120 --> 00:52:44,000 and save your life or is it just change your life and change your life. Yeah, a small little book. 443 00:52:44,000 --> 00:52:50,320 And that's a really, really cool little book that you can, you know, it's a pretty simple, 444 00:52:51,520 --> 00:52:57,040 simply illustrated book. So, you know, easy enough to start with, with young ones, 445 00:52:57,040 --> 00:53:01,680 but they've got to be compliant. They've got to want to be there, you know, and, you know, 446 00:53:02,400 --> 00:53:09,120 and every kid hits that at a different point. Obviously, and unfortunately, or maybe not so 447 00:53:09,120 --> 00:53:14,240 obviously, but it's the kids that often need that help the most, that are least interested in 448 00:53:16,080 --> 00:53:25,680 partaking in that. And that's just an unfortunate reality of how things are right now. And 449 00:53:27,680 --> 00:53:33,200 just really difficult for parents who find themselves in that situation. Because the last 450 00:53:33,200 --> 00:53:37,600 thing you want to do is force a child in doesn't want to do something to do something because it's 451 00:53:37,600 --> 00:53:43,680 just for every reaction you got an equal and opposite for every action you got equal and 452 00:53:43,680 --> 00:53:52,720 opposite reaction, right? So it's just trying to meet the method level. And then upwards from seven, 453 00:53:52,720 --> 00:53:58,960 I think my functional therapy is pretty, pretty standard. You can do early intervention orthodontics, 454 00:54:00,480 --> 00:54:07,200 you know, depending on the, again, the patient and the skill of the practitioner, you can start 455 00:54:07,200 --> 00:54:13,840 that from kind of two or three sometimes. I mean, I'm not, I'm not treating that young. I kind of 456 00:54:15,440 --> 00:54:20,960 four or five would be where I would be like, okay, we can, we can look at doing some, you know, 457 00:54:20,960 --> 00:54:29,760 our past development, if that's, if that's seemingly necessary. And then, yeah, from kind of 458 00:54:29,760 --> 00:54:39,600 70s, you've got your window of growth for early orthopedic appliances. And a lot of the facial 459 00:54:39,600 --> 00:54:49,760 growth is done around puberty. So, I mean, the job will so will still grow. The job and the female 460 00:54:49,760 --> 00:55:00,000 stops to grow at 18. No, no, Joe, correct me. Is it the girls are 18, the boy, the 21? Yeah, that's 461 00:55:00,000 --> 00:55:09,120 what it is. So this continued job growth until that point. So, you know, you can manipulate growth 462 00:55:09,120 --> 00:55:20,240 all the way up until that stage with appliances. And at any point, I think my functional therapy is 463 00:55:20,240 --> 00:55:26,320 helpful. The thing about my functional therapy is you must be tough. If you work out really hard 464 00:55:26,320 --> 00:55:33,200 and you get great strength, and then you just let it all, you know, weaken again, and it will 465 00:55:33,200 --> 00:55:39,440 probably go back to you. Yeah, absolutely. And unfortunately, this is why my functional therapy 466 00:55:39,440 --> 00:55:49,440 doesn't get maybe the respect that it deserves, because it's a constant effort. But similarly, 467 00:55:50,000 --> 00:55:58,640 you know, going to the gym is a constant. If you, you know, if you work out every day for 468 00:55:58,640 --> 00:56:03,680 six months, and then you just don't, you'll look great for a little while, and then it'll 469 00:56:04,480 --> 00:56:12,800 weaken a little bit. So, yeah. But I mean, if you, so the goals of my functional therapy is to 470 00:56:12,800 --> 00:56:20,480 integrate patterns, and normal muscular patterning, so that you know how to use, 471 00:56:20,480 --> 00:56:29,600 you know how to use muscles in the correct way, and you learn to integrate those, but 472 00:56:31,680 --> 00:56:38,560 you need to give up the work. Right, right. And then later, as adults, you've got all 473 00:56:38,560 --> 00:56:45,600 appliances, which Joe's been talking about. So I'm going to put you both on the spot, and this is 474 00:56:45,600 --> 00:56:53,760 strictly just opinion. But from this side of the pond, it appears as though your side is a little 475 00:56:53,760 --> 00:57:03,920 ahead of this train, this change that we're seeing as far as airway and sleep and the impacts that 476 00:57:03,920 --> 00:57:10,880 it's having and putting together these diverse teams. So it's not, you know, over here, everything 477 00:57:10,880 --> 00:57:16,560 is very siloed, pediatricians and dentists, everybody siloed, but it appears that there seems 478 00:57:16,560 --> 00:57:24,320 to be a little more cohesion, and you might be a few steps ahead at the moment. So what's driving 479 00:57:24,320 --> 00:57:31,600 this? I'm not sure that's totally the case. Okay. Yeah, I would say the same. That's what it looks 480 00:57:31,600 --> 00:57:40,000 like. Okay. I think the nice guidelines change, and that's the National Institute of Clinical 481 00:57:40,000 --> 00:57:46,160 Excellence. And that's a body that assesses current practice action plans, and it evaluates the 482 00:57:46,160 --> 00:57:51,360 outcomes on results and the benefits are cost wise and to the patient and everything. And they 483 00:57:51,360 --> 00:57:58,640 changed in August 21. And they acknowledged oral appliance therapy as an alternative treatment for 484 00:57:58,640 --> 00:58:06,240 mild to moderate sleep apnea, if they choose not to have CPAP, or if they cannot tolerate CPAP. 485 00:58:06,240 --> 00:58:13,680 Now, we all know that CPAP is great if a patient wears it. And there's many things that make it 486 00:58:13,680 --> 00:58:21,520 that the compliance or success aren't as good. And the other options are oral appliance therapy. 487 00:58:22,160 --> 00:58:30,880 And it works. And since that has come in, we have now been trying to get that as part of 488 00:58:30,880 --> 00:58:38,320 integrated into a treatment option in our health service. And that has been a long process. And 489 00:58:38,320 --> 00:58:46,000 we're also trying to now contact, and I think it's more on a personal level, I've contacted the ENT 490 00:58:46,000 --> 00:58:51,840 specialist near me. I've contacted the sleep clinics, I get referrals, you asked me earlier, 491 00:58:52,400 --> 00:58:58,960 how I got patients, and I have receiving referrals from the sleep clinics for about 10 years, because 492 00:58:58,960 --> 00:59:05,200 they knew before the nice guidelines changed that if we've got a patient with this and they're not 493 00:59:05,200 --> 00:59:09,840 really holding on this works great. And then when I'd sent them back for sleep tests, they'd go, 494 00:59:09,840 --> 00:59:17,200 hold on, this works and they're using it. So although it is slightly less effective per time, 495 00:59:17,920 --> 00:59:26,560 in some cases, because a patient tolerates it and complies much better with it, you get equal 496 00:59:26,560 --> 00:59:35,200 effect for the mild and moderate. And so really, they were surprised when they did post-sleep 497 00:59:35,200 --> 00:59:41,120 tests afterwards on the success, they rang me excitedly and said, but it really works. Yes, 498 00:59:41,120 --> 00:59:49,440 I know. So I think it's on a personal level. And then it has to drift down with education, 499 00:59:49,440 --> 00:59:58,160 and it's a lot of the medical tools of the medical publishers to say, can I put on a 500 00:59:58,160 --> 01:00:04,160 webinar to just show you how these group of symptoms could be suggestive of sleep apnea? 501 01:00:04,800 --> 01:00:10,320 And that, you know, there's a two year waiting list for our sleep clinics. Meanwhile, we could make 502 01:00:11,600 --> 01:00:17,680 make them an appliance and see if that works, or we could do a home sleep test. And this sort of 503 01:00:17,680 --> 01:00:24,400 thing, you know, let's try and work more in together. Because if we check if a patient can breathe 504 01:00:24,400 --> 01:00:30,080 through their nose and if they can't, then I'd re refer back to an ENT, you know, to say, hold on, 505 01:00:30,080 --> 01:00:36,240 we've got a problem, you know, let's together and try and make. And in some cases, with some adults, 506 01:00:36,240 --> 01:00:42,960 when somebody's not being able to comply with CPAP, to wear an appliance with that and have adjunct 507 01:00:42,960 --> 01:00:49,200 dual therapy can be extremely successful because the side effects of a CPAP of high pressure and 508 01:00:49,200 --> 01:00:56,560 arophagia and that horrible feeling of full of air, you can have much lower pressures when you 509 01:00:56,560 --> 01:01:04,480 open up the airway by wearing an appliance. So that's another option we've got. And so we are 510 01:01:04,480 --> 01:01:11,760 trying to make this more multidisciplinary, increase awareness. Because we as dentists, 511 01:01:11,760 --> 01:01:16,560 patients come to see us, we're in an ideal position, they come every six months, we have a look, 512 01:01:16,560 --> 01:01:24,320 we chat, listen to them, they trust us, you know, it's that feeling of, yes, oh, God, my wife's not 513 01:01:24,320 --> 01:01:28,640 let me in the bedroom. And you know, for some people, that isn't an issue. And other people are 514 01:01:30,080 --> 01:01:38,320 desperate to please help me. Right. And it's, we're in a great position to see the risks, 515 01:01:38,320 --> 01:01:44,880 assess them and treat them if appropriate. And it's that multidiscipline approach. That's one 516 01:01:44,880 --> 01:01:50,800 of the things that we rally for. Absolutely. Because then you're treating them as a whole patient. 517 01:01:50,800 --> 01:01:55,680 Absolutely. And we're looking at their whole health. And we can, we in Britain aren't allowed to 518 01:01:55,680 --> 01:02:02,320 diagnose sleep apnea, but we can refer for that. We can do some home sleep testing and get that 519 01:02:02,320 --> 01:02:08,880 reported by a physician or a physiologist. Yeah, we can gain information. And, and, you know, some 520 01:02:08,880 --> 01:02:15,920 GPs, medical practitioners are becoming a little more aware because nobody's been taught this. 521 01:02:15,920 --> 01:02:21,200 We're all sort of, thank you. And we're all fumbling all the way through. Right. Right. 522 01:02:22,000 --> 01:02:28,880 Right. As fast as we can. So at the end of every episode, I always like to hand the floor back 523 01:02:28,880 --> 01:02:37,280 to our guests and let y'all have the final word. It can be for our parents. It could be for other 524 01:02:37,280 --> 01:02:41,280 medical professionals, but just, you know, final thoughts from each of you. 525 01:02:43,840 --> 01:02:44,320 Eva? 526 01:02:45,760 --> 01:02:50,320 Um, final thoughts, sorry, Joe, go first because maybe... 527 01:02:50,320 --> 01:02:59,440 Okay. I would say awareness. I want more awareness. I want nasal breathing, more awareness. And 528 01:03:00,800 --> 01:03:09,360 go online, rally, find, find someone who'll help you. Contact us, contact your American Academy 529 01:03:09,360 --> 01:03:14,720 of Dental Sleep Medicine. There are people out there. It is the messages getting out there. We 530 01:03:14,720 --> 01:03:21,440 just need to increase awareness on other medics, other specialties, and just keep showing that this 531 01:03:21,440 --> 01:03:29,440 can work. And we can really improve people with a little appliance instead of a CPAP or surgery, 532 01:03:29,440 --> 01:03:35,760 or, you know, we're helping them with my functional therapy. We can help them positively change their 533 01:03:35,760 --> 01:03:49,120 own health risks without medication. Yep. And my thought would be, um, follow your gut instinct 534 01:03:49,760 --> 01:04:02,480 if you feel as a parent that something is not right, then seek someone who will listen 535 01:04:02,480 --> 01:04:07,680 to your concerns because you're probably right. 536 01:04:12,160 --> 01:04:21,920 And to professionals, I would say you want to know what you know, and what we got taught at 537 01:04:22,880 --> 01:04:30,640 medical and dental school, half of it's probably outdated. So we got taught anatomy and physiology 538 01:04:30,640 --> 01:04:36,960 so that we could understand how the body works. And sometimes we need to 539 01:04:39,600 --> 01:04:46,560 go back to that unpack presentations of what is coming to us in our practices. 540 01:04:48,000 --> 01:04:54,720 Yeah. Yep. There you go. Continually learning. Yeah, absolutely. I cannot thank you both enough. 541 01:04:54,720 --> 01:05:00,960 This has been illuminating and informative and just truly a pleasure. So thank you both. 542 01:05:00,960 --> 01:05:08,080 Yeah. Podcasts like this do spread the word and increase awareness. So thank you. Absolutely. 543 01:05:09,520 --> 01:05:16,560 Thanks again to today's guests, Dr. Joe Engelby and Dr. Eva Stack for sharing their medical insight 544 01:05:16,560 --> 01:05:22,400 and each of you for listening to today's episode. If you're new to our podcast, please don't forget 545 01:05:22,400 --> 01:05:27,520 to subscribe. And if you enjoyed today's episode, leave us a review or comment telling us about 546 01:05:27,520 --> 01:05:33,360 what you enjoyed most. You can stay connected with the Children's Airway First Foundation by 547 01:05:33,360 --> 01:05:41,200 following us on Instagram, Facebook, Twitter, LinkedIn, and YouTube. Parents can also join us 548 01:05:41,200 --> 01:05:47,680 via our Facebook Parents Support Group, the Airway Heddle, at facebook.com backslashgroups 549 01:05:47,680 --> 01:05:54,480 backslash airway huddle. You can also find tons of great content for parents and medical professionals 550 01:05:54,480 --> 01:06:01,440 alike via the Parents Portal and Clinicians Corners on our website. If you'd like to be a guest or 551 01:06:01,440 --> 01:06:06,720 have an idea for an upcoming episode, shoot us a note via the contacts page on our website or 552 01:06:06,720 --> 01:06:14,240 send us an email directly at info at children'sairwayfirst.org. And finally, thanks to all the parents 553 01:06:14,240 --> 01:06:18,880 and medical professionals out there that are working to help make the lives of kids around the globe 554 01:06:18,880 --> 01:06:44,880 just a little bit better. Take care, stay safe, and happy breathing, everyone. 555 01:06:48,880 --> 01:07:08,880 Bye.