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Hi everyone and welcome back to Airway First, the podcast from the Children's Airway First

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Foundation.

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I'm your host, Rebecca St. James.

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Today's episode is a bit different than that I've invited an entire panel of luminaries

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and medical professionals who are incredibly passionate about airway and sleep health to

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join me.

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Each one of the guests today participated in some form or fashion in the SEC sleep conference

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that was held in Houston earlier this month.

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The guest panel includes Dr. Dave McCarty, Dr. Bill Harrell, Dr. Rob Beese, Jayton Techjandani

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and Dr. Gerald Simmons.

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We're going to cover a wide range of sleep and airway related topics.

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So pull up a chair and settle in and join me and today's panel and today's episode of

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Airway First.

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All right.

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Good evening and thank everyone for joining us for a very special episode.

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It's our first panel ever on the podcast.

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So thanks for joining us, gentlemen.

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We're happy to be here.

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We're happy to be here.

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Thank you for inviting us.

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I live here.

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Absolutely.

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So just so that our audience understands a little bit more, recently we were all part

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of an event in my beautiful hometown of Houston, Texas that was hosted by Dr. Simmons and

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the Sleep Education Consortium.

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So there was a lot of information that I learned as an attendee of the event and thought this

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would be really an amazing opportunity to share it with some of our parents.

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So that is why we are all here this evening.

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So Dr. Simmons, would you like to do a little intro about the SEC and the event?

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Sure.

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Great.

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Well, thank you very much.

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So now I'm a neurologist, sleep disorder specialist and when I first got involved in

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this field in my fellowship at Stanford University back in 1991, it sort of was very mind boggling

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to me that I had gone through all those years of medical school and gone through a highly

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regarded residency program.

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And here I was doing my fellowship.

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And within the first few weeks, I learned so many things that I couldn't believe I didn't

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already know because I realized how fundamental they were to overall health care.

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And amongst these were things that related to breathing and just some of the basics of

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obstructive breathing.

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And it was just very mind boggling.

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So once I finished, I was in academics, I was involved in teaching, but then I transitioned

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into the private sector.

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But I had this underlying desire to help continue to spread the word to other health

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care professionals because I realized there's a big gap in our health care system.

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Just like I realized that when I first was doing my fellowship, here I was now in private

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practice and I realized that so many physicians who are already done with their medical education,

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they have no method of really getting up to speed to learn what I call basic truths of

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overall health care and sleep, which really you consider a nutrient, you can't live without

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sleep.

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And there are so many things that can destroy the quality of your sleep.

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And amongst those epidemiologically or in terms of the frequency, the most frequent kinds

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of problems relate to abnormal breathing during sleep.

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And but I wanted to come up with a course that can be done on an annual basis to teach other

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health care professionals about sleep.

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And so I started this nonprofit organization back in 2004 called the Sleep Education Consortium.

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And every year we have a conference to teach health care professionals about sleep.

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And the perspective I had gained to a great extent because of my collaboration with Dr.

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Rob Vies, who's here joining us tonight.

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When I was at UCLA, I was educating and I already realized the airway is going to be

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influenced by the mouth and the jaw position and we'll get into more grinding, lynching

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and the significance of all that later.

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But so I wanted this conference to not just be for physicians, but also for dentists.

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And then I also wanted to have one of the themes about collaboration.

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So this has been going on.

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We just had our 20th year of doing this consortium, this annual event, and it's grown in its complexity.

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It's now actually a three day event for dentists, two days for physicians.

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And we take people that don't know anything, we bring them to where they know quite a bit.

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They're going to learn more in those three days than they would ever have learned in

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medical school because in medical school, unfortunately, medical students over four

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years are learning up to maybe four hours of anything related to sleep.

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That's it.

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And in an airway about the same or less.

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Well, yeah, that's only a fraction of the four hours.

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So, so anyhow, rather than going into great detail on that now, everyone here was at the

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consortium conference and I'll just quickly go and introducing other people that are here.

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So I mentioned Dr. Dr. Rob Vies, who is a dentist.

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He's a CEO of Space Maintainers Laboratory that makes appliances.

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He's been on the faculty at USC, went to dental school there and he's been involved in dental

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education for many, many years and actually got me involved in helping him put together

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back in the 90s educational materials for dentists.

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But so he's on the panel here.

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We have Dr. Bill Harrell.

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He's an orthodontist who has also involved in academics in Alabama and the university

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there and he's involved actually in helping coming up with new technologies.

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He was very involved with cone beam CT scans from the early development and he's on the

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cusp of new trends of orthodontics and he was also a part of our faculty at the consortium.

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We got Dr. Dave McCarty.

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He's an internal medicine sleep specialist living in Colorado, Colorado Springs.

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No, Boulder.

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Boulder, Colorado.

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Oh, shame on me.

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But previous to that, he was actually running the sleep lab over in LSU, Louisiana.

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He trained at Harvard.

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He went to medical school.

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Duke, extensive background.

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He recently just came out with a book on sleep apnea empowered and to actually educate

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healthcare professionals on this topic.

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And so he's well versed in every aspect of sleep medicine.

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And then we also have Jayton Chandy who's actually a sleep technologist who work, he's

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at the basic ground level, taking care of patients at night.

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I mean, he's beyond that now.

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But that's where he started.

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His introduction to sleep was functioning as a sleep technician and then also getting

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an engineering degree and taking his knowledge of engineering and applying it to being a

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sleep technologist.

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He's a great educator.

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He's helped many, many technologists get their training and become certified.

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And he's actually currently the vice president of the Texas Society of Sleep Professionals.

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So he's a very knowledgeable person and involved in many different aspects of sleep medicine

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as well.

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So we're all here.

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We had a much larger faculty conference.

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Yeah.

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Like 17 people.

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Is that 17?

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I think it was close.

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I think faculty members total.

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But we have the subset here that I think can handle pretty much most of the questions that

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would come up regarding the conference.

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And thank you for having us here.

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And Rebecca, bets in your hands.

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Awesome.

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Well, thank you very much.

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And I'll just say that parents had so many questions and I was fortunate enough to attend

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all three days and even got to bounce around some of the hands-on events, which was really

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cool.

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So what I did was for parents that are interested, I'll make sure there's links to everything

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so you can go to everybody's website.

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You can see their LinkedIn.

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Many of these gentlemen have been on the show already, so you'll be able to see their podcast.

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But you can check out the conference.

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You can see that just so much information was covered.

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And I just kind of handpicked a few pieces that relate to things that our parents have

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asked about before.

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So we're going to start with the fact that at the conference we did talk about children

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and adults, but today we're really just going to focus on kids.

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So I want to start with, let's first define sleep-roxism in TMJ.

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I think parents kind of have a basic understanding of that, but let's go ahead and level set

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with that.

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And then how does it present in children?

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I can start.

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Absolutely.

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So looking at it from the parent's point of view, I think one of the things that I hear

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all the time as a practicing dentist is a mom or dad coming in, usually a mom, saying,

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I hear my child grinding their teeth at night.

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Is that normal?

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This is a good news, bad news question, because the bad news is most of my peers, unfortunately,

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will say to that parent, well, let me look.

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And they open the patient's mouth and they look in there and they may see a little bit

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of wear on those baby teeth, children's teeth, or in the mixed dentition, they may see a

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little bit of wear.

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And particularly when they still have their baby teeth, their primary dentition, and they'll

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look at the parent and they'll go, well, don't worry, that's normal.

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And let me assure you that there's absolutely nothing normal about that.

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So there's the idea of what's normal, like the normal variation is normal, healthy is

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the question.

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It's the fact that it's common.

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Yeah, common is common.

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And widespread doesn't make it healthy, right?

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Exactly.

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Yeah.

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Exactly.

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To your point, Dave, is it's very common.

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And the other part that's common is the unfortunate response by dentists who aren't just aren't

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aware of that.

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And this is why we're here to try to educate the parent.

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One of the things I'd like to see accomplished today is that if we can give you parents a

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little bit of knowledge, it's going to spur you on to further ask the dentist and point

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some of those dentists in the right direction to help them.

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I mean, I want the parents to help the dentists and any other primary care physician to then

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help them.

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I mean, this education has to go all the way.

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So the first thing that you need to know is it may be common, but it's not particularly

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healthy.

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And the only other thing that I want to say right away is one of the things that dentists

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will do right away in my process of trying to educate you parents there is they'll say,

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one of two things, well, we'll watch it.

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One of the things I hate the most because I'm going to watch you get ill.

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I'm going to watch your problem get worse.

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God, I hate that.

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And then the second thing is, well, let me make you an appliance that will give you a

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bite plane, something that will stop the teeth from being ground away.

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And that's what they know.

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And not only you mean you're talking like a night guard.

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I'm talking more like what would be a retainer, Holly type retainer that has a biting surface

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in the front teeth.

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So it separates the back teeth.

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And when they close on the front teeth, they can't grind their teeth.

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They're hitting the bite plane.

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And that's a common thing that dentists will do because that's what they know.

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But the focus is on protecting the teeth, not in figuring out why the teeth are wearing

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away, right?

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Well, they don't even know.

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And let's just...

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They don't even know that it's a sign and symptom of an airway problem.

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And I'll let Jerry go from there.

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Well, so let's just expand the definition now.

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So grinding.

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So what is Bruxism?

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So Bruxism actually is no longer considered just the grinding, but also the clenching.

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So if you're clenching your teeth at night, it's also considered Bruxism, sleep Bruxism.

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Now once that child has that kind of an appliance, they may be protecting their teeth and they

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may not be moving back and forth, but they're clenching into that appliance.

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And they're building up all those musculature here.

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And their joint may be protected because they've opened up the space.

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So there's not going to be as much pressure right on the joint itself, but there's still

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a tendency to be clenching.

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Now when a child's clenching or grinding, what are they doing?

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They're keeping their jaw forward because when they relax, the jaw may be falling back.

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And that's the problem is that the airway is prone to obstruction.

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And so the clenching or the grinding becomes a protective mechanism to help keep the airway

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open.

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So it's an abnormal phenomenon that's occurring as a reflex to protect the airway.

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You know, it helps to sort of point out that this is a symptom of a larger problem.

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This is the body's attempt to compensate for a stressor on the system.

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And so just by protecting the teeth, we're not solving the problem yet.

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The stressor is still there, in other words.

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And I think that's the point is that the grinding of the teeth is just a sign of an internal

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problem that still needs to be solved.

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So you're saying this and so what proof do we have?

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I mean, it's easy for us to say this conceptually, it makes sense.

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But how do we know what proof is there?

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Well, I'll just point you to several studies that have looked at children that have enlarged

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tonsils and looked at the frequency of bruxing that occurred in these studies and found that

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anywhere 25, 35, 40% of those kids were bruxing at night.

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Then they had their tonsils taken out.

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And that opened up the obstruction.

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And then the frequency of bruxing dropped down to 10%.

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And so their occlusion, people say the bruxing is because of the occlusion is off because

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of the alignment of the teeth are off.

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But by taking out the tonsils, you're not changing the alignment to the teeth.

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It's the same.

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You're getting the improvement because you opened up the airway by getting rid of the

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obstruction of the tonsils.

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Now, getting the tonsils out is not going to resolve the problem in most of these cases

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indefinitely.

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It's going to help the problem.

241
00:16:43,120 --> 00:16:44,880
It's going to help open up the airway.

242
00:16:44,880 --> 00:16:51,240
But usually these children have other aspects of having compromised airways.

243
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And maybe it might be several years later that they're going to demonstrate more of the problem.

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But the main point to make here, though, is that opening up the airway improves the bruxism.

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And we now know there's also from children that have been diagnosed with sleep apnea

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that we've put on C-PAP, the mask that hooks up to a tube to a machine.

247
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And now C-PAP is not a long-term solution.

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I call it a transitional therapy.

249
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So we use it temporarily while orthodontics can be done to open up the airway for long-term

250
00:17:23,480 --> 00:17:25,080
management.

251
00:17:25,080 --> 00:17:31,880
But the bruxing will stop when we put the child on the C-PAP because now they're airways protected.

252
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So one of the things that I'm sorry, Bill, go ahead.

253
00:17:34,960 --> 00:17:38,000
It's all right, because I'm going to bring you up into this, too, Rob.

254
00:17:38,000 --> 00:17:45,280
You know, in dental education, and you probably were the same, Rob, we would talk about bruxism

255
00:17:45,280 --> 00:17:48,280
in children, especially in the primary dentition.

256
00:17:48,280 --> 00:17:51,440
Like you said, it was kind of considered, well, this is normal.

257
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You know, the baby teeth are softer than the permanent teeth, and they just wear like that.

258
00:17:58,720 --> 00:18:05,040
And again, what Jerry brought up earlier was we thought in dentistry that it was all related

259
00:18:05,040 --> 00:18:09,760
to, well, the bite soft, and so they're trying to grind their teeth.

260
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Well, that's not true.

261
00:18:13,320 --> 00:18:20,880
And the problem is in the primary dentition, if you look at the wear pattern from a dentist's

262
00:18:20,880 --> 00:18:26,240
standpoint, if you look at the wear pattern, it's not that much about side to side.

263
00:18:26,240 --> 00:18:30,160
It's front to back because they're trying to open up the airway.

264
00:18:30,160 --> 00:18:32,040
So finally, we're getting a little smarter.

265
00:18:32,040 --> 00:18:39,360
But dentists are taught that the baby teeth are softer and they just wear naturally, and

266
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it's a normal thing.

267
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But you know, within the recently, like Jerry brought up, some of these studies have kind

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00:18:46,280 --> 00:18:51,600
of opened our mind a little bit better to the reason why.

269
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Because these kids aren't, we think about adults doing grinding too, and we say it's

270
00:18:57,920 --> 00:18:58,920
stress.

271
00:18:58,920 --> 00:19:04,000
What are kids, what's their stress level, unless they're abused or something like that?

272
00:19:04,000 --> 00:19:09,360
I mean, they don't really have much stress, so it's got to be from something else.

273
00:19:09,360 --> 00:19:10,920
So go ahead.

274
00:19:10,920 --> 00:19:12,320
Okay, thank you.

275
00:19:12,320 --> 00:19:16,600
What I was going to say is just trying to leave messages for the parents, like what's

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00:19:16,600 --> 00:19:17,880
the next step for you?

277
00:19:17,880 --> 00:19:24,120
So when we talk about Bruxy, it would be, number one, pay attention.

278
00:19:24,120 --> 00:19:30,120
And we're always trying to figure out, we know that parents will listen for snoring

279
00:19:30,120 --> 00:19:33,880
and things like that sometimes because they can actually hear them.

280
00:19:33,880 --> 00:19:39,240
But I would say, pay attention to see if your child is Bruxy.

281
00:19:39,240 --> 00:19:46,800
And then if they are, then you go to your dentist and you say, my child is Bruxene.

282
00:19:46,800 --> 00:19:52,720
And when the dentist says to you, oh, that's normal, you then have to say, well, look here,

283
00:19:52,720 --> 00:19:56,680
I've heard from these doctors that it's really not normal.

284
00:19:56,680 --> 00:19:59,080
And let me show you where you can go look.

285
00:19:59,080 --> 00:20:08,320
And can you refer me to someone in your area that maybe there's an MD or someone who specializes

286
00:20:08,320 --> 00:20:13,160
in sleep that I can have my child evaluated because it's not normal.

287
00:20:13,160 --> 00:20:18,560
And here's the thing, consumers push the curve.

288
00:20:18,560 --> 00:20:25,480
You know, consume, it's what the, and as one of the things we talk about with collaborative

289
00:20:25,480 --> 00:20:28,920
care is how do we push this forward?

290
00:20:28,920 --> 00:20:34,640
And the one reason that I wanted to do this more than anything is I want to speak to you

291
00:20:34,640 --> 00:20:41,920
parents out there, have you helped us to push it forward because it's going to only happen

292
00:20:41,920 --> 00:20:44,280
when you start squawking.

293
00:20:44,280 --> 00:20:50,360
So okay, so as a physician, so physician, they get, they hear about going to a conference

294
00:20:50,360 --> 00:20:51,960
and they're going to say, I don't have time.

295
00:20:51,960 --> 00:20:52,960
I'm so busy.

296
00:20:52,960 --> 00:20:53,960
Why am I going to go to conference?

297
00:20:53,960 --> 00:21:00,000
You know, I work so hard day in, day out, and I don't want to take time off to go to

298
00:21:00,000 --> 00:21:03,400
some other conference for a topic that maybe I'm not all that thrilled about.

299
00:21:03,400 --> 00:21:04,840
It's not within my specialty.

300
00:21:04,840 --> 00:21:07,440
I just, I don't want to do it.

301
00:21:07,440 --> 00:21:14,000
You know, but when the parents are saying, here's a problem and obviously you don't know

302
00:21:14,000 --> 00:21:17,600
how to solve my problem with my child.

303
00:21:17,600 --> 00:21:23,600
And then the physician then said, finds out that there is a conference that they can go

304
00:21:23,600 --> 00:21:27,120
to to learn the answers.

305
00:21:27,120 --> 00:21:28,680
Then they're going to be more motivated.

306
00:21:28,680 --> 00:21:33,080
The more they're going to be challenged during the day by the patients coming to them with

307
00:21:33,080 --> 00:21:37,360
a problem and then they're presented with an opportunity to get the knowledge to deal

308
00:21:37,360 --> 00:21:38,360
with that problem.

309
00:21:38,360 --> 00:21:40,600
That's what it's going to connect it to.

310
00:21:40,600 --> 00:21:41,600
That's going to change.

311
00:21:41,600 --> 00:21:47,680
It's going to, and I will say, we'll put links in the show notes, but for example, the SEC

312
00:21:47,680 --> 00:21:52,760
conference and Airway Health Solutions, they both have a great video series that we can

313
00:21:52,760 --> 00:21:54,520
put out that you guys can obtain.

314
00:21:54,520 --> 00:21:57,240
So maybe you can't get away to go to some of these events.

315
00:21:57,240 --> 00:21:58,840
There are options.

316
00:21:58,840 --> 00:22:04,640
We also have an area of our website, the parents can send clinicians to all the clinicians

317
00:22:04,640 --> 00:22:08,160
corner and we are building on that to make that more robust.

318
00:22:08,160 --> 00:22:11,480
And it's because of people like you, it's your information we're putting there.

319
00:22:11,480 --> 00:22:17,040
So there are places you can at least send them to start looking.

320
00:22:17,040 --> 00:22:21,680
But I want to touch back with, with Bill for just a moment because in your podcast, one

321
00:22:21,680 --> 00:22:25,040
of the things we talked about was TMJ.

322
00:22:25,040 --> 00:22:28,400
And you know, we kind of made this connection and I just want to make sure that we address

323
00:22:28,400 --> 00:22:33,920
it here as well for anyone that didn't hear it about Brexitism and TMJ, but more specifically,

324
00:22:33,920 --> 00:22:38,240
kind of to Rob's point, you can hear them snoring.

325
00:22:38,240 --> 00:22:43,120
You can't always hear these other things, but there are signs and symptoms as parents

326
00:22:43,120 --> 00:22:45,120
that we can look for.

327
00:22:45,120 --> 00:22:47,080
And let's define it also a little bit.

328
00:22:47,080 --> 00:22:51,680
So TMJ, Temporal Mendibular Joint, but it really should, it's really TMD, Temporal

329
00:22:51,680 --> 00:22:56,120
Mendibular Dysfunction or TMJ Dysfunction.

330
00:22:56,120 --> 00:23:01,840
So everyone has a T, but Rebecca, you're just demonstrating what most, what the lingo

331
00:23:01,840 --> 00:23:02,840
how it's evolved.

332
00:23:02,840 --> 00:23:03,840
Yeah.

333
00:23:03,840 --> 00:23:04,840
How we hear it as parents.

334
00:23:04,840 --> 00:23:05,840
Yeah.

335
00:23:05,840 --> 00:23:07,560
TMJ, everyone has a Temporal Mendibular Joint.

336
00:23:07,560 --> 00:23:09,280
It's just, it's the dysfunction.

337
00:23:09,280 --> 00:23:12,560
So TMD is probably, but I go ahead.

338
00:23:12,560 --> 00:23:13,560
Sorry.

339
00:23:13,560 --> 00:23:14,560
What it should be.

340
00:23:14,560 --> 00:23:15,560
Yep.

341
00:23:15,560 --> 00:23:16,560
No, no, no, that's why you're here.

342
00:23:16,560 --> 00:23:17,560
It's a good clarification.

343
00:23:17,560 --> 00:23:19,560
And by the way, you have two of them.

344
00:23:19,560 --> 00:23:20,560
Right.

345
00:23:20,560 --> 00:23:21,560
Right.

346
00:23:21,560 --> 00:23:22,560
Not just one side.

347
00:23:22,560 --> 00:23:23,560
They're all.

348
00:23:23,560 --> 00:23:26,280
And they need to work together.

349
00:23:26,280 --> 00:23:27,280
Yeah.

350
00:23:27,280 --> 00:23:28,280
Exactly.

351
00:23:28,280 --> 00:23:29,280
So Bill.

352
00:23:29,280 --> 00:23:33,280
Can we talk a little bit about the, the signs and symptoms that parents can look for?

353
00:23:33,280 --> 00:23:34,280
Yeah.

354
00:23:34,280 --> 00:23:40,520
And, you know, in children, you know, maybe things don't show up because you think about

355
00:23:40,520 --> 00:23:46,640
TMJ disorders, you think about arthritis and some of the destruction that occurs in the

356
00:23:46,640 --> 00:23:47,640
joint.

357
00:23:47,640 --> 00:23:54,440
Inside the joint is a little cartilaginous cap that sits on top of the bone of the lower

358
00:23:54,440 --> 00:23:55,680
jaw.

359
00:23:55,680 --> 00:23:58,480
And that's called the articular disc.

360
00:23:58,480 --> 00:24:03,440
It moves as you open your mouth, your jaws just don't rotate.

361
00:24:03,440 --> 00:24:07,080
They actually, they actually come down a slope.

362
00:24:07,080 --> 00:24:13,040
So the jaw actually, as it, as it opens, it starts to rotate and then it actually translates

363
00:24:13,040 --> 00:24:19,640
down and what keeps it in congruency so to speak is that little piece of cartilage.

364
00:24:19,640 --> 00:24:24,600
I kind of tell parents it's like a piece of cartilage in a chicken leg.

365
00:24:24,600 --> 00:24:28,760
They can kind of, they can kind of, it's not exactly like that, but they at least know

366
00:24:28,760 --> 00:24:32,080
what that thing is.

367
00:24:32,080 --> 00:24:34,800
But that is interposed between the bones.

368
00:24:34,800 --> 00:24:40,040
And believe it or not, it can become displaced even in children.

369
00:24:40,040 --> 00:24:49,000
And I saw a seminar just last week where the orthodontist, he was taking MRIs on all his

370
00:24:49,000 --> 00:24:53,520
children and he was finding a fair number of them.

371
00:24:53,520 --> 00:24:55,080
Their discs were displaced.

372
00:24:55,080 --> 00:25:03,600
And I worked with, oops, I worked with Dr. Bill Farah, who was the, one of the pioneers

373
00:25:03,600 --> 00:25:08,120
in TMJ a long time ago, especially an adult.

374
00:25:08,120 --> 00:25:15,680
But, and we saw, we saw some kids, I see some as early as, you know, nine years old that

375
00:25:15,680 --> 00:25:22,080
maybe their bite is looking something like that and is trapping the lower jaw.

376
00:25:22,080 --> 00:25:29,920
And it actually, the jaw actually gets displaced posterior backwards and the disc comes forward.

377
00:25:29,920 --> 00:25:35,080
So if your child has clicking and popping, you can put, you know, you can actually put

378
00:25:35,080 --> 00:25:40,240
your fingers in front of the ears and have them open and close and go side to side.

379
00:25:40,240 --> 00:25:42,560
It should be smooth.

380
00:25:42,560 --> 00:25:44,400
They should be able to open.

381
00:25:44,400 --> 00:25:49,360
The normal opening is about three finger widths of your non-dominant hand.

382
00:25:49,360 --> 00:25:55,520
If you just kind of want a quick little biometric measurement, if you take their fingers, non-dominant

383
00:25:55,520 --> 00:26:01,160
hand, you should be able to put it easily between, between your teeth.

384
00:26:01,160 --> 00:26:04,320
And it, you should have no clicking, popping or locking.

385
00:26:04,320 --> 00:26:10,360
But if you have two finger widths, then something, it could be muscular, it could be that the

386
00:26:10,360 --> 00:26:14,280
internal part of the joint are actually not functioning properly.

387
00:26:14,280 --> 00:26:20,160
So a bite like this is terrible on a, on a jaw joint.

388
00:26:20,160 --> 00:26:24,840
Now parents will look at that and say, well, their teeth are crooked a little bit, but

389
00:26:24,840 --> 00:26:25,840
they really don't look.

390
00:26:25,840 --> 00:26:31,240
If you look at that case, you can see where you don't see any lower teeth at all.

391
00:26:31,240 --> 00:26:35,320
They're biting up number one in the roof of the mouth, which is not healthy.

392
00:26:35,320 --> 00:26:38,360
But think about them trying to move their jaw forward.

393
00:26:38,360 --> 00:26:39,360
What happened?

394
00:26:39,360 --> 00:26:41,080
They can't really, they're locked in.

395
00:26:41,080 --> 00:26:42,080
Right.

396
00:26:42,080 --> 00:26:46,920
TMJs are locked and sometimes they're sitting backwards and they're off these discs and

397
00:26:46,920 --> 00:26:47,920
they develop that way.

398
00:26:47,920 --> 00:26:54,760
Then all of a sudden they get to be at orthodontic age and then you put braces on these kids

399
00:26:54,760 --> 00:26:58,480
and, and line the teeth up and make them look pretty.

400
00:26:58,480 --> 00:27:03,080
But their discs may be totally out of place and it really, the problems don't show up

401
00:27:03,080 --> 00:27:08,880
until their 20s or 30s or 40s when they maybe starting getting locking, they end up having

402
00:27:08,880 --> 00:27:11,480
to have surgery and all sorts of other stuff.

403
00:27:11,480 --> 00:27:20,560
So between sleep disorders and children and then, you know, early signs of TMJ disorders,

404
00:27:20,560 --> 00:27:25,520
you know, those are really important as for a parent to understand that and try to look

405
00:27:25,520 --> 00:27:26,520
for things.

406
00:27:26,520 --> 00:27:31,720
And you go to the dentist and say, Hey, my kids, Jaws are clicking and popping or they're

407
00:27:31,720 --> 00:27:34,520
locking and they go, Ah, that's just normal.

408
00:27:34,520 --> 00:27:35,520
They'll grow out of it.

409
00:27:35,520 --> 00:27:36,520
No, they don't.

410
00:27:36,520 --> 00:27:37,520
All right.

411
00:27:37,520 --> 00:27:39,200
Just watch for waiting.

412
00:27:39,200 --> 00:27:46,160
Like Rob said, is sometimes very, it's not good because it leads to more serious things

413
00:27:46,160 --> 00:27:48,040
and more treatment.

414
00:27:48,040 --> 00:27:49,040
Right.

415
00:27:49,040 --> 00:27:50,040
Absolutely.

416
00:27:50,040 --> 00:27:53,080
And I also want to touch on something that was interesting that you said and I've heard

417
00:27:53,080 --> 00:27:58,640
it, uh, new Ben Moralia has said this Felix Liao.

418
00:27:58,640 --> 00:28:03,840
It y'all aren't teeth doctors, your mouth doctors.

419
00:28:03,840 --> 00:28:08,840
And that to me is another paradigm shift that needs to happen because straight teeth.

420
00:28:08,840 --> 00:28:09,840
That's awesome.

421
00:28:09,840 --> 00:28:12,760
But straight teeth with everything else messed up.

422
00:28:12,760 --> 00:28:13,760
There's no point.

423
00:28:13,760 --> 00:28:14,760
Yep.

424
00:28:14,760 --> 00:28:19,280
I wrote an article for the dental sleep practice journal called the breathing smile connection

425
00:28:19,280 --> 00:28:27,040
and it goes into the introduction is kind of how orthodontics kind of has pushed itself

426
00:28:27,040 --> 00:28:30,920
toward smile aesthetics and pretty smiles and pretty faces.

427
00:28:30,920 --> 00:28:38,880
And okay, we create healthy gums and we create those kinds of things and theoretically we've

428
00:28:38,880 --> 00:28:44,640
been taught that if we can get the bite into what's called class one or a normal relationship

429
00:28:44,640 --> 00:28:49,160
of the teeth, then they're not supposed to have TMJ problems and they're not supposed

430
00:28:49,160 --> 00:28:50,160
to have a way problem.

431
00:28:50,160 --> 00:28:51,160
Well, guess what?

432
00:28:51,160 --> 00:28:52,160
That's not true.

433
00:28:52,160 --> 00:28:53,160
Right.

434
00:28:53,160 --> 00:28:58,480
And that's kind of why I wrote that article because it's the breathing, the airway is

435
00:28:58,480 --> 00:29:03,440
critical and airway and jaw joint problems all go together.

436
00:29:03,440 --> 00:29:06,000
So Rebecca, I shared my screen.

437
00:29:06,000 --> 00:29:07,680
I don't know if you see it.

438
00:29:07,680 --> 00:29:08,960
Uh, nope.

439
00:29:08,960 --> 00:29:13,840
Right now we see says you are sure to division to.

440
00:29:13,840 --> 00:29:14,840
Yeah.

441
00:29:14,840 --> 00:29:15,840
Is that you?

442
00:29:15,840 --> 00:29:16,840
Oh, okay.

443
00:29:16,840 --> 00:29:17,840
That's you.

444
00:29:17,840 --> 00:29:18,840
I thought Dr. Harold did that.

445
00:29:18,840 --> 00:29:19,840
I didn't see that.

446
00:29:19,840 --> 00:29:25,040
So, you know, again, kind of showing what a parent might see.

447
00:29:25,040 --> 00:29:29,360
If you have a child who has it, what we would describe this as a very deep bite.

448
00:29:29,360 --> 00:29:32,080
You can't see the lower teeth at all.

449
00:29:32,080 --> 00:29:38,360
And if you can't see the lower teeth at all, that means that the manable is being held

450
00:29:38,360 --> 00:29:41,080
in a posterior position.

451
00:29:41,080 --> 00:29:47,640
It takes those con vials that Dr. Simmons talked about that TMJ and holds it up and

452
00:29:47,640 --> 00:29:48,880
back.

453
00:29:48,880 --> 00:29:53,320
And that's the beginning of the problem, you know, in a young kid.

454
00:29:53,320 --> 00:29:59,200
So for mom and dad, if you see your child and they have a deep bite like this, that's

455
00:29:59,200 --> 00:30:01,560
something you need to be concerned about.

456
00:30:01,560 --> 00:30:02,560
Okay.

457
00:30:02,560 --> 00:30:08,560
And, um, you know, that's one of the things that I would, I would tell you to see and,

458
00:30:08,560 --> 00:30:12,760
uh, see if I can just quickly go back here.

459
00:30:12,760 --> 00:30:15,320
Hopefully I can show you.

460
00:30:15,320 --> 00:30:16,960
I can't.

461
00:30:16,960 --> 00:30:24,240
I'll find it and pop it in for them to see it, uh, later on when they're looking at us.

462
00:30:24,240 --> 00:30:25,240
Okay.

463
00:30:25,240 --> 00:30:33,000
Cause I don't want to disrupt the talk, but I will include a couple of, uh, slides for

464
00:30:33,000 --> 00:30:38,720
the presentation for this so that they can pull it into your thing.

465
00:30:38,720 --> 00:30:42,080
But it basically is what does the face look like?

466
00:30:42,080 --> 00:30:43,080
Okay.

467
00:30:43,080 --> 00:30:45,040
That's, that's the key.

468
00:30:45,040 --> 00:30:47,040
Wow.

469
00:30:47,040 --> 00:30:50,280
What was the parents see in terms of their facial profile?

470
00:30:50,280 --> 00:30:52,840
What does it look with their dentition?

471
00:30:52,840 --> 00:30:54,320
What are some of the key things?

472
00:30:54,320 --> 00:30:56,400
Are they thumbs suckers?

473
00:30:56,400 --> 00:31:00,880
We'll show you some things that parents should really look at, which then go to one of the

474
00:31:00,880 --> 00:31:02,720
things that Jerry should address.

475
00:31:02,720 --> 00:31:08,520
Cause I see popped in here and it's like, how can we teach the parents to screen their

476
00:31:08,520 --> 00:31:09,520
own kids?

477
00:31:09,520 --> 00:31:10,520
Right.

478
00:31:10,520 --> 00:31:14,000
But I mean, there's so much in some of the detail that we've just conveyed here, maybe

479
00:31:14,000 --> 00:31:18,360
a little bit beyond what the parent may be able to pick up.

480
00:31:18,360 --> 00:31:20,080
But it's a big picture.

481
00:31:20,080 --> 00:31:22,920
There's a spectrum to the degree of the problem.

482
00:31:22,920 --> 00:31:28,200
And look, we, I don't know that it's appropriate for us to put out information with the expectation

483
00:31:28,200 --> 00:31:34,280
that the most subtlest kids that are the mildly, the ones that are most mildly affected are

484
00:31:34,280 --> 00:31:37,920
going to be captured by the information we can hear.

485
00:31:37,920 --> 00:31:43,520
I think let's go up to the bigger picture of those children that are more seriously

486
00:31:43,520 --> 00:31:44,520
affected.

487
00:31:44,520 --> 00:31:49,640
So if the child will say tosses and turns all night long, they're just not good or they're

488
00:31:49,640 --> 00:31:51,200
hard to wake up in the morning.

489
00:31:51,200 --> 00:31:55,240
You know, they're throwing the sheets off the bed.

490
00:31:55,240 --> 00:31:56,960
They can't focus in school.

491
00:31:56,960 --> 00:32:02,320
And, you know, they're always talking at a turn and they're hyperactive and they're

492
00:32:02,320 --> 00:32:03,560
a real problem.

493
00:32:03,560 --> 00:32:06,160
The behavior leader of a problem.

494
00:32:06,160 --> 00:32:09,960
And then you see that there's these issues with their teeth.

495
00:32:09,960 --> 00:32:11,760
They're clenching, they're grinding.

496
00:32:11,760 --> 00:32:13,680
Their mouth breathing.

497
00:32:13,680 --> 00:32:14,680
Okay.

498
00:32:14,680 --> 00:32:18,160
The pathway of least resistance should be through the nose.

499
00:32:18,160 --> 00:32:21,760
So if a child's not getting the air that they need through the nose, they're going to compensate

500
00:32:21,760 --> 00:32:23,280
and do what we call rescue breathing.

501
00:32:23,280 --> 00:32:25,520
They're going to open their mouth and they're going to start breathing through their mouth.

502
00:32:25,520 --> 00:32:28,080
They may be drooling on their pillow at night.

503
00:32:28,080 --> 00:32:32,800
When you see a child like that, if you have a child like that and you go to your, now,

504
00:32:32,800 --> 00:32:36,760
so now we're not talking about just a little problem that I'm noticing that their bite is

505
00:32:36,760 --> 00:32:37,760
deep.

506
00:32:37,760 --> 00:32:41,240
And if that's the only problem and your child sleeps really well and their behavior really

507
00:32:41,240 --> 00:32:45,080
is doing well and they're well rested and nothing else is a problem, you're not going

508
00:32:45,080 --> 00:32:48,720
to get too many people to take that too seriously.

509
00:32:48,720 --> 00:32:54,400
And yes, it may be a problem and maybe anatomically they are predisposed to other issues and maybe

510
00:32:54,400 --> 00:32:55,840
come to a problem later in life.

511
00:32:55,840 --> 00:33:01,520
But let's get to the bigger, more serious scenario when your child is having these other symptoms

512
00:33:01,520 --> 00:33:07,560
I've talked about and you go to your dentist or you go to your pediatrician and they disregard

513
00:33:07,560 --> 00:33:08,960
your concern.

514
00:33:08,960 --> 00:33:10,360
You've got to go somewhere else.

515
00:33:10,360 --> 00:33:11,360
Yeah.

516
00:33:11,360 --> 00:33:12,360
Yeah.

517
00:33:12,360 --> 00:33:17,800
And we'll put some links, by the way, within the show notes as well for you can find providers.

518
00:33:17,800 --> 00:33:22,160
And let me, though, I want to prepare the parents for the scenario here and then I'm

519
00:33:22,160 --> 00:33:27,080
going to segue here in a second because you actually get a clinician that's going to say,

520
00:33:27,080 --> 00:33:28,880
okay, I take you seriously.

521
00:33:28,880 --> 00:33:33,640
Let me order a sleep study and then they're going to send you to a lab and your child

522
00:33:33,640 --> 00:33:39,520
maybe let's say seven or eight years old and the lab will do the study and it comes back

523
00:33:39,520 --> 00:33:42,400
saying no significant problem.

524
00:33:42,400 --> 00:33:45,760
So I'm going to let Jaten now talk a little bit about that, about what goes on with these

525
00:33:45,760 --> 00:33:49,040
tests and how it could be all over the map.

526
00:33:49,040 --> 00:33:56,000
And do you trust a test that comes back normal when clinically you've got a gut feeling my

527
00:33:56,000 --> 00:33:57,760
child's got a problem?

528
00:33:57,760 --> 00:34:01,040
So Jaten, maybe you can talk a little bit more about the testing aspect.

529
00:34:01,040 --> 00:34:02,040
Sure.

530
00:34:02,040 --> 00:34:03,080
Thank you, Dr. Simmons.

531
00:34:03,080 --> 00:34:06,360
So we've heard a lot of discussion today about sleep disorders.

532
00:34:06,360 --> 00:34:10,600
In previous episodes, we heard from Dr. Simmons as well as Dr. McCarty about a few things

533
00:34:10,600 --> 00:34:14,600
like sleep staging, REM non-REM, deep sleep.

534
00:34:14,600 --> 00:34:17,480
We heard from Dr. McCarty about the AHI.

535
00:34:17,480 --> 00:34:21,400
It's very important that these numbers come from what Dr. Simmons just mentioned is a

536
00:34:21,400 --> 00:34:22,600
sleep study.

537
00:34:22,600 --> 00:34:23,840
So what is a sleep study?

538
00:34:23,840 --> 00:34:29,040
To get these things, you have to measure multiple things, measure brain activity, eye movement,

539
00:34:29,040 --> 00:34:32,880
airflow, effort, leg movements, and oximetry.

540
00:34:32,880 --> 00:34:37,120
When you gather all of these different things, these are multiple sleep graphs.

541
00:34:37,120 --> 00:34:40,160
Multiple sleep graphs translates to polysomnography.

542
00:34:40,160 --> 00:34:43,000
It's one of the most comprehensive medical tests you can do.

543
00:34:43,000 --> 00:34:48,160
It requires no blood, no radiation, and you spend overnight.

544
00:34:48,160 --> 00:34:50,880
Similar to a hotel stay, you will check in and check out.

545
00:34:50,880 --> 00:34:52,760
You will be given snacks and drinks.

546
00:34:52,760 --> 00:34:56,680
You will spend more time with the person performing that test, the sleep technologist, than you

547
00:34:56,680 --> 00:35:00,400
will ever spend with the physician for a period of time.

548
00:35:00,400 --> 00:35:03,920
And during the application of these sensors, we can take up to an hour, half hour to an

549
00:35:03,920 --> 00:35:07,840
hour depending on the experience level and the cooperation of the patient.

550
00:35:07,840 --> 00:35:11,120
You're going to get education educated by the technician.

551
00:35:11,120 --> 00:35:14,520
As each wire is applied, they're going to explain to you this wire is applied and what

552
00:35:14,520 --> 00:35:17,960
the reason is for it and how it relates to the end result and what we're going to do

553
00:35:17,960 --> 00:35:18,960
about it as well.

554
00:35:18,960 --> 00:35:24,000
Dr. Simmons also mentioned CPAP therapy, continuous positive air pressure.

555
00:35:24,000 --> 00:35:29,080
Whenever the doctor prescribed CPAP, it's based off what's called a CPAP titration, where

556
00:35:29,080 --> 00:35:33,520
the technician applies a small amount of pressure and then slowly increases and increases and

557
00:35:33,520 --> 00:35:36,600
increases it until we get an open airway.

558
00:35:36,600 --> 00:35:38,840
So we're talking about sleep.

559
00:35:38,840 --> 00:35:41,560
You can't manage sleep until you can measure sleep.

560
00:35:41,560 --> 00:35:44,520
If you haven't done a PSG, it's what it's called, then we should do one.

561
00:35:44,520 --> 00:35:50,040
And even if you have done one, it may be time to do another one because you can't really

562
00:35:50,040 --> 00:35:53,280
know if you're sleeping or if you're not, or if you're breathing or if you're not, unless

563
00:35:53,280 --> 00:35:54,560
you are measuring it.

564
00:35:54,560 --> 00:35:59,040
And for a pediatric population, there is no other alternative than an in lab PSG.

565
00:36:24,560 --> 00:36:39,560
You can find out more about the Children's Airway First Foundation and our mission to

566
00:36:39,560 --> 00:36:45,400
fix before six on our website at children'sairwayfirst.org.

567
00:36:45,400 --> 00:36:51,480
The CAF website offers tons of great resources for both parents and medical professionals.

568
00:36:51,480 --> 00:36:56,080
Visit our parents' portal, clinicians' corner, resource center, and video library to see

569
00:36:56,080 --> 00:36:58,120
for yourself.

570
00:36:58,120 --> 00:37:02,200
We also encourage parents to join the Airway Huddle, our Facebook support group, which

571
00:37:02,200 --> 00:37:07,600
was created for parents of children with airway and sleep-related issues.

572
00:37:07,600 --> 00:37:14,720
You can access the Airway Huddle support group at facebook.com.

573
00:37:14,720 --> 00:37:20,440
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.

574
00:37:20,440 --> 00:37:25,200
If you suspect your child might have an airway issue, contact your pediatric airway dentist

575
00:37:25,200 --> 00:37:27,760
or pediatrician.

576
00:37:27,760 --> 00:37:57,360
And now, let's jump back into today's episode.

577
00:37:57,360 --> 00:38:01,480
And how does that work, you know, as far as some of these kids are little, it's scary

578
00:38:01,480 --> 00:38:02,880
and totally get that.

579
00:38:02,880 --> 00:38:09,280
So just kind of so to level set it for parents, do they stay with the child, the child in

580
00:38:09,280 --> 00:38:10,280
a different room?

581
00:38:10,280 --> 00:38:12,320
How does this process work?

582
00:38:12,320 --> 00:38:14,720
So the parents will always be in the same room.

583
00:38:14,720 --> 00:38:16,640
They may or not be in the same bed.

584
00:38:16,640 --> 00:38:21,640
There will be rails to prevent the baby from falling off in some situations.

585
00:38:21,640 --> 00:38:22,920
They have to have cribs.

586
00:38:22,920 --> 00:38:26,960
So what you would do is you would confirm all of this when you schedule the test.

587
00:38:26,960 --> 00:38:30,960
You will schedule, you'll have the age, you'll have all the issues.

588
00:38:30,960 --> 00:38:35,000
There's also pediatric focused technologies.

589
00:38:35,000 --> 00:38:38,520
And there's even pediatric focused labs and even hospitals.

590
00:38:38,520 --> 00:38:42,920
We're going to have another guest on the podcast coming up soon, James Cardell of the Lucio

591
00:38:42,920 --> 00:38:44,520
Packard Children's Hospital.

592
00:38:44,520 --> 00:38:46,720
And they do nothing but pediatrics.

593
00:38:46,720 --> 00:38:51,560
So he'll be able to explain a lot more about the actual logistics of getting that test

594
00:38:51,560 --> 00:38:54,560
and getting the instructions for our parents.

595
00:38:54,560 --> 00:38:59,680
What James and I work on is another collaboration, just like Dr. Simmons is collaborating with

596
00:38:59,680 --> 00:39:02,560
a dentist and physicians.

597
00:39:02,560 --> 00:39:06,680
What we're doing is collaborating between the technologist and the engineers, because

598
00:39:06,680 --> 00:39:09,880
the engineers are developing the systems, but they may not understand quite how they're

599
00:39:09,880 --> 00:39:11,280
actually are put into practice.

600
00:39:11,280 --> 00:39:14,240
And the technologists are having issues with these problems, but they can communicate with

601
00:39:14,240 --> 00:39:15,240
engineers.

602
00:39:15,240 --> 00:39:18,400
So that's what we're going to try to focus on now is trying to get this collaborative

603
00:39:18,400 --> 00:39:23,280
idea from the SEC and translate it to this other aspect of the story.

604
00:39:23,280 --> 00:39:35,680
Yeah, and so, Jane, what would you say about a scenario where the child is already symptoms,

605
00:39:35,680 --> 00:39:38,720
but the lab comes back with the test being normal?

606
00:39:38,720 --> 00:39:46,440
I guess, let's talk about, you know, theoretically, every lab should do everything perfectly.

607
00:39:46,440 --> 00:39:57,040
The reality, my experience is that a lot of times the labs aren't up to par to where we

608
00:39:57,040 --> 00:39:58,960
would like them to be.

609
00:39:58,960 --> 00:40:03,800
They're going to pick up the clearly abnormal kids where their oxygen level is dropping down.

610
00:40:03,800 --> 00:40:11,200
Those are easy to find, but when you get these more subtle cases, how, you know, I mean,

611
00:40:11,200 --> 00:40:16,880
so you know, a lot of labs may not have as much experience with kids, but also they're

612
00:40:16,880 --> 00:40:19,120
going to do one here and there.

613
00:40:19,120 --> 00:40:23,800
And so, so it's important, remember that there's two technologies.

614
00:40:23,800 --> 00:40:26,640
One is the person that's applying the leads as the acquisitions knowledges.

615
00:40:26,640 --> 00:40:29,680
And what Dr. Simmons is talking about is the second person.

616
00:40:29,680 --> 00:40:31,960
The second person is called the scoring technologies.

617
00:40:31,960 --> 00:40:35,680
Whenever they look at the signals, we have to make a classification after you decide

618
00:40:35,680 --> 00:40:37,560
whether the patient's asleep or awake.

619
00:40:37,560 --> 00:40:43,920
If they're REM or not, you classify whether that event qualifies as a respiratory event.

620
00:40:43,920 --> 00:40:45,320
So there's clear cut criteria.

621
00:40:45,320 --> 00:40:49,280
And what we're talking about is a desaturation as one type.

622
00:40:49,280 --> 00:40:50,640
We call that the AASM.

623
00:40:50,640 --> 00:40:53,760
There's also one that causes an arousal.

624
00:40:53,760 --> 00:40:58,920
The D4% desaturation is the Medicare definition and the 3% or arousal is the American Academy

625
00:40:58,920 --> 00:41:00,120
of Sleep Medicine.

626
00:41:00,120 --> 00:41:06,400
So the technician on the daytime, the one scoring the study also has a very significant

627
00:41:06,400 --> 00:41:08,880
impact on the result.

628
00:41:08,880 --> 00:41:12,600
Because if they decide not to score that study or not to score that event, then the patient

629
00:41:12,600 --> 00:41:17,600
will test negative versus if they use a different criteria using a different sensor, they might

630
00:41:17,600 --> 00:41:19,280
test positive.

631
00:41:19,280 --> 00:41:23,040
And with a pediatric population, the difference is like, is one per hour.

632
00:41:23,040 --> 00:41:26,640
As long as you have one event per hour, they are now diagnosed.

633
00:41:26,640 --> 00:41:31,520
So if you fail to miss one of those events, now your AHI, the apnea apnea index is less

634
00:41:31,520 --> 00:41:35,720
than one, it's 0.9 or something lower, now you have a negative study.

635
00:41:35,720 --> 00:41:39,400
So what Dr. Simmons is saying is you can have a negative study and solve a problem just

636
00:41:39,400 --> 00:41:45,000
based off of how the study was conducted and how more importantly the study was scored.

637
00:41:45,000 --> 00:41:47,360
There are also different quality sensors.

638
00:41:47,360 --> 00:41:50,280
As the engineer putting these systems together, including the one in Dr. Simmons, we had to

639
00:41:50,280 --> 00:41:52,080
calibrate those sensors.

640
00:41:52,080 --> 00:41:56,360
If the calibration was off or the technician applied it incorrectly, the scoring technician

641
00:41:56,360 --> 00:41:58,960
wouldn't be able to even score these events.

642
00:41:58,960 --> 00:42:03,160
So the scoring technician and the acquisition technician have a severe impact on the end

643
00:42:03,160 --> 00:42:04,400
result of it.

644
00:42:04,400 --> 00:42:07,680
If you go on Tuesday versus Wednesday and the technician is a different person, you

645
00:42:07,680 --> 00:42:09,000
may have a different result.

646
00:42:09,000 --> 00:42:11,240
It does have that much of an impact.

647
00:42:11,240 --> 00:42:16,920
As well as managing the actual situation, pediatric patients are the most challenging.

648
00:42:16,920 --> 00:42:19,720
They're not cooperating because they don't know what's going on.

649
00:42:19,720 --> 00:42:25,880
So a skilled technician will make the patient feel comfortable and also the parent comfortable.

650
00:42:25,880 --> 00:42:30,640
And there are many times where we're testing the pediatric population, the children, and

651
00:42:30,640 --> 00:42:32,640
we uncover a sleep disorder with the parent.

652
00:42:32,640 --> 00:42:35,800
We see them snoring, gasping, having apnees.

653
00:42:35,800 --> 00:42:38,560
Like, actually, maybe you're the one who used to get this study.

654
00:42:38,560 --> 00:42:41,640
So we have to kind of navigate that situation as well.

655
00:42:41,640 --> 00:42:43,680
But the technician isn't a doctor.

656
00:42:43,680 --> 00:42:44,680
We can't diagnose.

657
00:42:44,680 --> 00:42:45,680
We can't recommend treatment.

658
00:42:45,680 --> 00:42:50,160
All we're there to do is just to apply the leads and generate these tables and generate

659
00:42:50,160 --> 00:42:52,640
these plots for the doctor to make a decision.

660
00:42:52,640 --> 00:42:56,720
But the doctor can only make a decision if the technician and the lab do the job correctly.

661
00:42:56,720 --> 00:43:01,240
That's what Dr. Simmons is saying, is that the technician could get this done wrong.

662
00:43:01,240 --> 00:43:02,880
It's very easy to miss an event.

663
00:43:02,880 --> 00:43:06,560
It's very easy to misapply a lead or just put it one, submit it to the left side and

664
00:43:06,560 --> 00:43:08,120
you won't pick up these arouses.

665
00:43:08,120 --> 00:43:13,120
And also, I guess what I'm saying is go with your gut and don't always feel that maybe

666
00:43:13,120 --> 00:43:17,920
you're crazy because the test didn't come up with the abnormal result.

667
00:43:17,920 --> 00:43:20,560
Not all sleep labs have been created equal.

668
00:43:20,560 --> 00:43:25,360
And I use an analogy asking women, are all beauticians the same?

669
00:43:25,360 --> 00:43:28,360
I'll say, are all dentists the same?

670
00:43:28,360 --> 00:43:31,440
Well, don't assume that all sleep labs are the same.

671
00:43:31,440 --> 00:43:32,440
Right.

672
00:43:32,440 --> 00:43:38,720
So if you clinically see your child has a problem and it seems to be related to sleep,

673
00:43:38,720 --> 00:43:40,560
you're looking for confirmation from the sleep lab.

674
00:43:40,560 --> 00:43:46,320
And if you don't get it, recognize the possibility that a lab just may have missed the diagnosis

675
00:43:46,320 --> 00:43:48,560
and you may want to go to some other facility.

676
00:43:48,560 --> 00:43:51,240
You might have traveled further away.

677
00:43:51,240 --> 00:43:58,280
Another way to look at this is that the AHA is a language that has evolved differently.

678
00:43:58,280 --> 00:44:01,320
And so every AHA must be unpacked.

679
00:44:01,320 --> 00:44:07,360
And I think if every parent sort of accepts that, that the AHA you get on your study,

680
00:44:07,360 --> 00:44:13,880
there is a lot of investigation that goes into what that metric is, how it was defined,

681
00:44:13,880 --> 00:44:17,640
you know, whether it was defined by dissaturations or arousals.

682
00:44:17,640 --> 00:44:23,160
And so every AHA must be unpacked is a good mantra for us to repeat.

683
00:44:23,160 --> 00:44:24,160
You know?

684
00:44:24,160 --> 00:44:25,160
Yeah.

685
00:44:25,160 --> 00:44:26,160
I like that.

686
00:44:26,160 --> 00:44:31,240
I think I saw this earlier podcast, which we'll put a link to also where you talk about

687
00:44:31,240 --> 00:44:33,560
also its perception.

688
00:44:33,560 --> 00:44:37,160
The story you tell as an adult, but I think it applies to children as well.

689
00:44:37,160 --> 00:44:38,160
Yeah.

690
00:44:38,160 --> 00:44:41,440
This person didn't understand why they were having to come see you and sleep study and

691
00:44:41,440 --> 00:44:42,440
I'm fine.

692
00:44:42,440 --> 00:44:43,440
I'm fine.

693
00:44:43,440 --> 00:44:45,600
Kids are the same way you think as a parent.

694
00:44:45,600 --> 00:44:46,600
Put them down.

695
00:44:46,600 --> 00:44:47,600
They were in there for eight hours.

696
00:44:47,600 --> 00:44:48,600
We're good.

697
00:44:48,600 --> 00:44:49,600
We slept.

698
00:44:49,600 --> 00:44:50,600
But how did they really sleep?

699
00:44:50,600 --> 00:44:51,600
Right.

700
00:44:51,600 --> 00:44:55,920
You got to get to that or what are they like when they wake up?

701
00:44:55,920 --> 00:44:58,520
There's a lot of things that as parents we can look for.

702
00:44:58,520 --> 00:45:07,800
So kind of, I guess, to build on that, what does good sleep hygiene or, or I'm trying

703
00:45:07,800 --> 00:45:11,800
to remember another phrase instead of sleep hygiene, but what does that look like for

704
00:45:11,800 --> 00:45:12,800
a child?

705
00:45:12,800 --> 00:45:15,200
What should it be the various stages?

706
00:45:15,200 --> 00:45:18,800
Toddler, that kind of middle group, five to 10 and then up.

707
00:45:18,800 --> 00:45:21,840
What should it look like?

708
00:45:21,840 --> 00:45:23,840
Oh.

709
00:45:23,840 --> 00:45:32,280
I can do that Dave also, you know, can pitch in, but basically your sleep need changes as

710
00:45:32,280 --> 00:45:33,280
you're growing.

711
00:45:33,280 --> 00:45:34,280
Right.

712
00:45:34,280 --> 00:45:37,640
And like a little infant is going to sleep.

713
00:45:37,640 --> 00:45:43,120
The newborn's going to sleep most of the day and then it's going to sleep requirement

714
00:45:43,120 --> 00:45:46,040
is going to get down lower and lower.

715
00:45:46,040 --> 00:45:50,440
But still, I think the biggest problem is probably in adolescence and when these children

716
00:45:50,440 --> 00:45:57,640
are needing to sleep, you know, maybe 10 hours, you know, they're probably maybe are getting

717
00:45:57,640 --> 00:46:02,880
seven because they're staying up late at night.

718
00:46:02,880 --> 00:46:08,160
You know, there's the after school activities and then they have homework and now in order

719
00:46:08,160 --> 00:46:12,720
to get to school on time, they're waking up early early because, you know, we're living

720
00:46:12,720 --> 00:46:14,840
their phones, their iPads, phones.

721
00:46:14,840 --> 00:46:22,480
And so there's, so, you know, so there are a lot of children that are sleep deprived.

722
00:46:22,480 --> 00:46:31,680
And you know, we're talking about airway as being a cause for ADHD in children, but just

723
00:46:31,680 --> 00:46:37,600
something more basic of being sleep deprived can cause ADHD symptoms in children.

724
00:46:37,600 --> 00:46:41,760
So if you're going to take your child to a clinician who's then going to say, oh, your

725
00:46:41,760 --> 00:46:45,720
child's got ADHD and they're ready to plot a prescription pad and write a prescription

726
00:46:45,720 --> 00:46:50,840
for a child and they don't even ask a history about sleep run.

727
00:46:50,840 --> 00:46:51,840
Go somewhere else.

728
00:46:51,840 --> 00:46:52,840
Yeah.

729
00:46:52,840 --> 00:47:00,880
If they don't ask, they need to ask these basic questions about, you know, normal hygiene

730
00:47:00,880 --> 00:47:06,120
that, you know, sleep hygiene and get a better understanding of the child's behaviors and

731
00:47:06,120 --> 00:47:08,080
how much sleep are they getting?

732
00:47:08,080 --> 00:47:12,000
What's the environment of their sleep, you know, their sleep environment?

733
00:47:12,000 --> 00:47:13,000
Is it loud?

734
00:47:13,000 --> 00:47:14,000
Yeah.

735
00:47:14,000 --> 00:47:17,000
You know, is their bedroom right next to the street light?

736
00:47:17,000 --> 00:47:18,000
Exactly.

737
00:47:18,000 --> 00:47:22,160
And they're going to get the light blaring in or do they have the, you know, the parents

738
00:47:22,160 --> 00:47:25,280
up in the next room with their TV blaring late at night?

739
00:47:25,280 --> 00:47:29,240
Well, what about inner city kids when they're hearing, I mean, this is a public health issue

740
00:47:29,240 --> 00:47:30,920
that I don't want to talk about.

741
00:47:30,920 --> 00:47:33,760
They're hearing all of these sounds outside.

742
00:47:33,760 --> 00:47:39,160
So it starts, sleep deprivation is going to result in difficulty with focus during the

743
00:47:39,160 --> 00:47:44,040
day and reactive hyperactivity.

744
00:47:44,040 --> 00:47:48,640
But then you can start looking at physiologic abnormalities and obstructive breathing would

745
00:47:48,640 --> 00:47:50,320
be number one.

746
00:47:50,320 --> 00:47:55,560
And another thing called restless leg syndrome or another thing called periodic leg movements

747
00:47:55,560 --> 00:47:59,920
of sleep, either with restless leg syndrome symptoms or even without just periodic leg

748
00:47:59,920 --> 00:48:01,680
movements of sleep.

749
00:48:01,680 --> 00:48:07,680
Less number two from a physiologic standpoint is the next most common cause of disrupted

750
00:48:07,680 --> 00:48:13,880
sleep that can lead to daytime disturbances of ADHD kind of behaviors and difficulty with

751
00:48:13,880 --> 00:48:15,640
that inattention.

752
00:48:15,640 --> 00:48:19,200
So if your child has these kicking movements while they're asleep and they're kicking

753
00:48:19,200 --> 00:48:22,080
the sheets off or if you've ever slept in bed with them and they're just having these

754
00:48:22,080 --> 00:48:25,040
kicking movements, that's an abnormality.

755
00:48:25,040 --> 00:48:30,760
And the child may actually have a low iron level as one of the contributing factors.

756
00:48:30,760 --> 00:48:32,160
I mean, there's a lot of discussion.

757
00:48:32,160 --> 00:48:34,400
I'm going to not to take up things.

758
00:48:34,400 --> 00:48:36,480
I know Dr. McCarty knows this stuff really well.

759
00:48:36,480 --> 00:48:40,680
I'm going to actually transition to give him a chance to speak on the topic as well and

760
00:48:40,680 --> 00:48:41,680
give him a little bit.

761
00:48:41,680 --> 00:48:44,880
Yeah, I want to make sure we talk about RLS because I will tell you, even with everything

762
00:48:44,880 --> 00:48:49,800
that I've done, I sat in that conference and when we started talking about it, I was stunned

763
00:48:49,800 --> 00:48:51,400
when somebody said something about children.

764
00:48:51,400 --> 00:48:52,400
I thought, seriously?

765
00:48:52,400 --> 00:48:53,400
Oh, yeah.

766
00:48:53,400 --> 00:48:54,920
I just never occurred to me.

767
00:48:54,920 --> 00:48:55,920
Oh, wait.

768
00:48:55,920 --> 00:48:58,320
So the little monkeys is what we used to call them because they would turn upside down

769
00:48:58,320 --> 00:49:01,000
in bed and their legs are going everywhere.

770
00:49:01,000 --> 00:49:02,280
It never occurred to me.

771
00:49:02,280 --> 00:49:04,240
Oh, that's a restless leg.

772
00:49:04,240 --> 00:49:05,960
So they actually have it as well.

773
00:49:05,960 --> 00:49:08,520
That's not again, not normal.

774
00:49:08,520 --> 00:49:09,920
Yeah.

775
00:49:09,920 --> 00:49:18,040
So it's a very common problem and it's got a it's got a bimodal population distribution.

776
00:49:18,040 --> 00:49:22,920
So it happens in young children and it happens in seniors.

777
00:49:22,920 --> 00:49:26,200
And the reason is because of the relationship with iron.

778
00:49:26,200 --> 00:49:31,440
And it happens that growth is an iron consumptive phenomenon.

779
00:49:31,440 --> 00:49:39,280
And when we consume iron, we can develop problems with iron transport to the brain.

780
00:49:39,280 --> 00:49:43,160
And when that happens, it leads to these physical symptoms.

781
00:49:43,160 --> 00:49:47,360
And in the old days, we used to call them growing pains, you know.

782
00:49:47,360 --> 00:49:53,520
And nowadays, we sort of recognize there's this relationship with this semi movement

783
00:49:53,520 --> 00:49:58,800
disorder that has to do with a physical sensation of discomfort.

784
00:49:58,800 --> 00:50:03,840
So it is, in a sense, a chronic pain sort of issue.

785
00:50:03,840 --> 00:50:09,280
If you think about it, it's a chronic discomfort syndrome that interrupts sleep.

786
00:50:09,280 --> 00:50:18,440
And when we realize that it's, it's something that has no physical signs or symptoms that

787
00:50:18,440 --> 00:50:23,000
you can actually demonstrate, you realize that this is something we have to have a high

788
00:50:23,000 --> 00:50:26,520
index of suspicion for, you know.

789
00:50:26,520 --> 00:50:28,880
So when kids, this is a very real phenomenon.

790
00:50:28,880 --> 00:50:34,160
And as Jerry says, we need to be thinking about this as a source of sleep disruption.

791
00:50:34,160 --> 00:50:40,320
And actually, there is a bi-directional relationship between restless leg syndrome and sleep apnea.

792
00:50:40,320 --> 00:50:49,320
So it turns out that oxygen transport in the central nervous system is iron dependent.

793
00:50:49,320 --> 00:50:55,400
And so if you have a regional iron transport efficiency, you cannot get oxygen to critical

794
00:50:55,400 --> 00:50:57,400
places in the brain.

795
00:50:57,400 --> 00:51:03,120
So the fact that you have restless leg syndrome indicates that you cannot transmit oxygen to

796
00:51:03,120 --> 00:51:04,120
the brain.

797
00:51:04,120 --> 00:51:11,800
And if you, if you cross that with rest, with, with a obstructive sleep apnea, you recognize

798
00:51:11,800 --> 00:51:12,800
there's a problem.

799
00:51:12,800 --> 00:51:19,160
You know, if you're having oxygen desaturating events in the setting of a problem that, you

800
00:51:19,160 --> 00:51:26,840
know, eliminates oxygen transports to the brain, you've got a problem that now is augmented

801
00:51:26,840 --> 00:51:28,280
by each other, you know.

802
00:51:28,280 --> 00:51:31,040
So these problems tend to coexist.

803
00:51:31,040 --> 00:51:35,760
And this complexity is something we should all be talking about, you know.

804
00:51:35,760 --> 00:51:37,920
Yeah, absolutely.

805
00:51:37,920 --> 00:51:42,680
Another thing that was mentioned along with RLS, and then we've talked a little bit about

806
00:51:42,680 --> 00:51:46,960
ADHD is parasomnia, as I would like to just kind of dig into what that is a little bit

807
00:51:46,960 --> 00:51:50,800
and how it applies to children, because again, that one surprised me.

808
00:51:50,800 --> 00:51:54,760
And then sleep related eating disorders.

809
00:51:54,760 --> 00:52:01,560
So can we can we touch a little bit on what these are and do you want to take on the parasomnias?

810
00:52:01,560 --> 00:52:05,480
Okay, I'll take on the person because we can go into the sleep related eating disorders

811
00:52:05,480 --> 00:52:10,240
with respect to, to restless legs as well, because that coexist as well.

812
00:52:10,240 --> 00:52:11,240
Yeah.

813
00:52:11,240 --> 00:52:16,600
So basically, pirisomnias are abnormal events during sleep behaviors.

814
00:52:16,600 --> 00:52:21,200
So it's it when you have some kind of abnormal behavior during sleep like sleepwalking, sleep

815
00:52:21,200 --> 00:52:23,640
talking would be the most, you know, most common.

816
00:52:23,640 --> 00:52:31,240
So if your child does that once, okay, put them back to bed, don't worry about it, don't

817
00:52:31,240 --> 00:52:33,240
lose sleep over it.

818
00:52:33,240 --> 00:52:35,600
No, but do it twice.

819
00:52:35,600 --> 00:52:39,520
Don't worry about it, put it back to bed, don't lose sleep over it.

820
00:52:39,520 --> 00:52:44,480
But when your child starts doing it regularly, and it's going on for at least six months

821
00:52:44,480 --> 00:52:48,120
now, you definitely want to seek out attention.

822
00:52:48,120 --> 00:52:53,080
So it's it's common, especially if people are getting hurt, right, Jerry?

823
00:52:53,080 --> 00:52:55,640
Well, yeah, there's an injury involved.

824
00:52:55,640 --> 00:52:58,000
That's the you should get involved earlier.

825
00:52:58,000 --> 00:53:04,880
But but the thing is, you know, it's common for a child to have a parasomniac event, you

826
00:53:04,880 --> 00:53:07,600
know, as an isolated event.

827
00:53:07,600 --> 00:53:14,320
And they sit up and talk to the company, you walk in and they walk in and they go back

828
00:53:14,320 --> 00:53:15,320
out.

829
00:53:15,320 --> 00:53:20,240
So they took they took a leak in the closet, right, thinking it was the bathroom with the

830
00:53:20,240 --> 00:53:21,240
bed.

831
00:53:21,240 --> 00:53:22,240
But it's an isolated event.

832
00:53:22,240 --> 00:53:24,640
It doesn't happen very other times.

833
00:53:24,640 --> 00:53:25,640
All right.

834
00:53:25,640 --> 00:53:30,000
So do you need to get, you know, go to the pediatrician and get a whole thing, a workup

835
00:53:30,000 --> 00:53:31,000
for it.

836
00:53:31,000 --> 00:53:35,800
It's, you know, if it's a single event, it happens, it's just grow up.

837
00:53:35,800 --> 00:53:36,800
All right.

838
00:53:36,800 --> 00:53:41,800
And typically what's happening is when a person is in what we call slow wave sleep, not REM

839
00:53:41,800 --> 00:53:42,800
sleep.

840
00:53:42,800 --> 00:53:48,480
It's it's where the there's these high slow waves phenomena going on in the brain waves

841
00:53:48,480 --> 00:53:50,080
that we measure.

842
00:53:50,080 --> 00:53:53,920
It's hard to fully awaken when you're in that stage of sleep.

843
00:53:53,920 --> 00:53:59,320
But if some kind of stimulus occurs that would otherwise have a woke you up, the brain doesn't

844
00:53:59,320 --> 00:54:00,960
want to wake up when it's in slow wave sleep.

845
00:54:00,960 --> 00:54:07,520
So it goes into this in between stage of this, you know, pseudo quasi state.

846
00:54:07,520 --> 00:54:10,320
So you're talking about sleep disruptive forces.

847
00:54:10,320 --> 00:54:13,080
And this could be sleep, destructive breathing.

848
00:54:13,080 --> 00:54:14,920
And so that's something to say.

849
00:54:14,920 --> 00:54:17,040
And it could be restless leg syndrome too.

850
00:54:17,040 --> 00:54:19,360
So if it happens, that's a nice event.

851
00:54:19,360 --> 00:54:25,560
It could just be, you know, whatever, could allow noise, a dog barked outside, right?

852
00:54:25,560 --> 00:54:30,560
Or the child's got a cold and they're congested and they do have obstructive breathing, but

853
00:54:30,560 --> 00:54:32,040
it's only on that one night.

854
00:54:32,040 --> 00:54:33,040
Right.

855
00:54:33,040 --> 00:54:38,320
But when it starts occurring on a regular basis, it may be a sign of obstructive breathing

856
00:54:38,320 --> 00:54:39,840
during sleep.

857
00:54:39,840 --> 00:54:44,000
It may be a sign of rest or periodic leg movements of sleep.

858
00:54:44,000 --> 00:54:48,360
So those leg movements, instead of causing a complete awakening when it occurs in slow

859
00:54:48,360 --> 00:54:51,400
wave sleep, the child's now in this quasi state.

860
00:54:51,400 --> 00:54:52,760
And this is not just for children.

861
00:54:52,760 --> 00:54:55,240
This could be for adults as well.

862
00:54:55,240 --> 00:54:59,600
But then they'll start carrying out some behavior and start doing some abnormalities.

863
00:54:59,600 --> 00:55:01,800
Now there's something called a night care.

864
00:55:01,800 --> 00:55:02,800
Okay.

865
00:55:02,800 --> 00:55:05,440
Now a night care is not the same as a nightmare.

866
00:55:05,440 --> 00:55:07,720
Nightmare is a bad dream and you're not moving.

867
00:55:07,720 --> 00:55:10,320
Someone's having a nightmare, you look at them, they're asleep.

868
00:55:10,320 --> 00:55:11,800
You don't know that they're having a nightmare.

869
00:55:11,800 --> 00:55:16,560
A night care with child's gonna be yelling and screaming and moving around.

870
00:55:16,560 --> 00:55:20,320
And the nightmare is in REM sleep, rapid eye movement sleep.

871
00:55:20,320 --> 00:55:23,840
A night care is usually in non REM sleep.

872
00:55:23,840 --> 00:55:24,840
Right.

873
00:55:24,840 --> 00:55:29,880
And the night care is going to be, could be a sign of another abnormality.

874
00:55:29,880 --> 00:55:34,720
Now it could also be a sign of post traumatic stress disorder.

875
00:55:34,720 --> 00:55:40,080
All these non REM parasomnias can be a sign of, and not to alarm you patients, but this

876
00:55:40,080 --> 00:55:44,760
is the way I, my approach to these is that I'm looking for a physiologic cause.

877
00:55:44,760 --> 00:55:50,000
And if I can't find a physiologic cause on a child that's having these parasomnias on

878
00:55:50,000 --> 00:55:54,600
a regular basis, then I gotta start looking at psychological causes.

879
00:55:54,600 --> 00:55:55,600
Right.

880
00:55:55,600 --> 00:55:59,640
And I think about most common would be abuse.

881
00:55:59,640 --> 00:56:03,520
And it could be part of a post traumatic stress phenomenon.

882
00:56:03,520 --> 00:56:04,760
But you don't lead with that.

883
00:56:04,760 --> 00:56:09,480
I'm not gonna right away start making accusations or start probing into, could this child be

884
00:56:09,480 --> 00:56:10,480
abused?

885
00:56:10,480 --> 00:56:14,200
My job is first exclude all the physiologic possibilities.

886
00:56:14,200 --> 00:56:19,040
And when I can't find any, and this child's still having it, then I need to now probe

887
00:56:19,040 --> 00:56:24,240
further with the parents about the possibility that maybe this child's being abused.

888
00:56:24,240 --> 00:56:26,520
And it happens.

889
00:56:26,520 --> 00:56:29,920
So, so that's sort of the topic.

890
00:56:29,920 --> 00:56:31,480
You know, that means a big topic.

891
00:56:31,480 --> 00:56:34,200
It's the next two hours talking about parasomnias.

892
00:56:34,200 --> 00:56:38,360
And then there's something called rem behavior disorder, but that's not common in children

893
00:56:38,360 --> 00:56:39,360
at all.

894
00:56:39,360 --> 00:56:41,480
It does occur very rarely.

895
00:56:41,480 --> 00:56:45,440
So I don't really want to go down the rem behavior disorder pathway of discussion.

896
00:56:45,440 --> 00:56:48,560
But the non rem pair of parasomnias are common.

897
00:56:48,560 --> 00:56:52,200
And the first thing we have to look at is obstructive breathing during sleep.

898
00:56:52,200 --> 00:56:56,160
If it's going to be a recurrence phenomenon, because that's the most likely cause.

899
00:56:56,160 --> 00:57:00,120
And the same child is grinding, clenching and, and you know, drooling other pillow,

900
00:57:00,120 --> 00:57:04,320
the mouth, either either their mouth breathing or the clenching and grinding.

901
00:57:04,320 --> 00:57:06,320
So, okay.

902
00:57:06,320 --> 00:57:07,320
Okay.

903
00:57:07,320 --> 00:57:09,200
Oh, everybody moved around.

904
00:57:09,200 --> 00:57:11,560
Jayton, do you want to talk?

905
00:57:11,560 --> 00:57:12,560
It was important.

906
00:57:12,560 --> 00:57:13,560
Right.

907
00:57:13,560 --> 00:57:16,760
So part of the sleep study, in addition to all the sensors we mentioned, the EEG, brain

908
00:57:16,760 --> 00:57:22,080
wave, respiratory, SPO2 were also full time measuring audio and video.

909
00:57:22,080 --> 00:57:26,360
So if there was a abnormal situation like a sleep terror or sleep blocking event, the

910
00:57:26,360 --> 00:57:30,120
technician would actually be able to zoom in, move the camera, capture the audio.

911
00:57:30,120 --> 00:57:34,840
In addition to having all of the observations from the data, the most important data set

912
00:57:34,840 --> 00:57:38,400
is going to be the actual observation of the technician.

913
00:57:38,400 --> 00:57:40,880
They are typing in whatever they're observing.

914
00:57:40,880 --> 00:57:46,080
So we can go back to that individual frame of that individual video, look at everything,

915
00:57:46,080 --> 00:57:49,320
including the EEG, because we're going to see on the EEG the patient was in slow

916
00:57:49,320 --> 00:57:52,000
wave sleep, like Dr. Simmons is suspecting.

917
00:57:52,000 --> 00:57:54,880
Or we might even see spikes, waves.

918
00:57:54,880 --> 00:57:57,520
This will indicate some kind of epilepsy.

919
00:57:57,520 --> 00:58:02,400
But this is all only able to be done by the doctor if the technician manages the study

920
00:58:02,400 --> 00:58:03,400
the right way.

921
00:58:03,400 --> 00:58:04,400
Okay.

922
00:58:04,400 --> 00:58:05,400
Got it.

923
00:58:05,400 --> 00:58:06,400
Got it.

924
00:58:06,400 --> 00:58:07,400
So.

925
00:58:07,400 --> 00:58:12,880
Well, I guess one other thing to add to that is that the ability to identify seizures

926
00:58:12,880 --> 00:58:21,840
during a sleep study is going to be more likely to occur if there is the addition to

927
00:58:21,840 --> 00:58:30,320
a full set of electrodes to perform a complete electroencephalogram throughout the night.

928
00:58:30,320 --> 00:58:35,360
Most sleep studies only consist of several different, maybe six different electrodes

929
00:58:35,360 --> 00:58:36,360
on the head.

930
00:58:36,360 --> 00:58:40,320
I'm looking at frontal, central, maybe occipital activity.

931
00:58:40,320 --> 00:58:45,840
And seizures are most commonly going to occur over the temporal lobe.

932
00:58:45,840 --> 00:58:46,840
All right.

933
00:58:46,840 --> 00:58:52,320
And then you'll miss temporal lobe seizures unless the study is ordered in a fashion to

934
00:58:52,320 --> 00:58:53,320
capture that.

935
00:58:53,320 --> 00:58:54,320
So clinically.

936
00:58:54,320 --> 00:58:58,960
So, you know, one thing that's different about our facility is we are not a testing

937
00:58:58,960 --> 00:59:00,960
facility.

938
00:59:00,960 --> 00:59:02,560
We do sleep studies all the time.

939
00:59:02,560 --> 00:59:07,000
We test all the time, but we don't just do the test.

940
00:59:07,000 --> 00:59:12,080
We don't take in referrals from other doctors that just, you know, like a primary care doctor

941
00:59:12,080 --> 00:59:14,440
is going to refer for us through the sleep study.

942
00:59:14,440 --> 00:59:15,440
And that's it.

943
00:59:15,440 --> 00:59:17,000
We're going to take the results and send them back.

944
00:59:17,000 --> 00:59:19,400
No, we want to see the patient clinically.

945
00:59:19,400 --> 00:59:20,880
We're going to take a history.

946
00:59:20,880 --> 00:59:24,800
We want to know what's going on with the patient so that way we order the right test.

947
00:59:24,800 --> 00:59:28,880
And we want to be responsible for the results of the test to be involved with the treatment

948
00:59:28,880 --> 00:59:29,880
plan.

949
00:59:29,880 --> 00:59:33,000
So we're a comprehensive entity.

950
00:59:33,000 --> 00:59:37,600
And you know, some doctors don't want, they just want to send just for the test.

951
00:59:37,600 --> 00:59:42,400
And if a doctor knows, but if a doctor knows sleep really well and they contact me, I'm

952
00:59:42,400 --> 00:59:43,880
fine with that.

953
00:59:43,880 --> 00:59:48,760
But what I'm not fine with was it would be the primary care doctor that wants to, doesn't

954
00:59:48,760 --> 00:59:53,960
know sleep very well and just looks at our facilities being nothing but a sleep test.

955
00:59:53,960 --> 00:59:56,360
And in their mind, they don't even understand sleep as a specialty.

956
00:59:56,360 --> 00:59:57,360
They understand it.

957
00:59:57,360 --> 01:00:00,160
Sleep medicine is just a test.

958
01:00:00,160 --> 01:00:03,560
And now that what's in the lab is now just with a home study.

959
01:00:03,560 --> 01:00:05,280
So now you don't even have to send them to the lab.

960
01:00:05,280 --> 01:00:06,520
All you have to do is do the home study.

961
01:00:06,520 --> 01:00:10,480
And if the home study comes back negative, you've excluded the problem.

962
01:00:10,480 --> 01:00:17,400
That is so far from the truth because the sensitivity of the home study is not as good

963
01:00:17,400 --> 01:00:21,080
as the sensitivity of an in lab study that's done properly.

964
01:00:21,080 --> 01:00:25,440
But unfortunately, the mentality has evolved within primary care.

965
01:00:25,440 --> 01:00:28,400
They think that all you need now is a home sleep testing device.

966
01:00:28,400 --> 01:00:31,320
And so they're just doing it and they're sending the results to some sleep specialist.

967
01:00:31,320 --> 01:00:33,560
It's going to review it and sign their name on it.

968
01:00:33,560 --> 01:00:36,520
And they think that they've done a good job because they had a sleep specialist reviewing

969
01:00:36,520 --> 01:00:37,520
it.

970
01:00:37,520 --> 01:00:43,960
And if the study comes back negative and they have a patient with clinical symptoms, there

971
01:00:43,960 --> 01:00:45,880
has to be a further investigation done.

972
01:00:45,880 --> 01:00:46,880
Yeah, for this service.

973
01:00:46,880 --> 01:00:47,880
It's not done.

974
01:00:47,880 --> 01:00:55,280
So, Jerry, could you just clarify for the parents out there the availability of home

975
01:00:55,280 --> 01:00:57,240
sleep studies for children?

976
01:00:57,240 --> 01:00:58,240
Okay.

977
01:00:58,240 --> 01:01:01,640
So that's a point that's in transition right now.

978
01:01:01,640 --> 01:01:09,640
It's been the standpoint of the American Academy of Sleep Medicine that there are pediatrics.

979
01:01:09,640 --> 01:01:13,040
For pediatrics, you have to do in lab studies.

980
01:01:13,040 --> 01:01:17,880
And most home studies have not been approved for pediatric use.

981
01:01:17,880 --> 01:01:24,080
There are a few devices now that have been approved, which is fine.

982
01:01:24,080 --> 01:01:30,200
I think it's totally okay to do a home study on a child.

983
01:01:30,200 --> 01:01:34,680
If it comes back positive, you've now established the diagnosis.

984
01:01:34,680 --> 01:01:40,160
The likelihood of having a false positive home study showing sleep apnea, false positive,

985
01:01:40,160 --> 01:01:42,160
is very low.

986
01:01:42,160 --> 01:01:47,280
The likelihood of it being false negative, meaning it's negative, but the child really

987
01:01:47,280 --> 01:01:49,640
does have sleep apnea, is pretty high.

988
01:01:49,640 --> 01:01:56,120
In other words, so if the study cannot provide what you need, you need to take a deeper dive.

989
01:01:56,120 --> 01:02:02,360
So I'm more concerned about the overall treatment pathway or assessment pathway than say, should

990
01:02:02,360 --> 01:02:04,840
you never do sleep studies in children?

991
01:02:04,840 --> 01:02:10,360
Well, if in your community, there's a six month waiting list and your child's not breathing

992
01:02:10,360 --> 01:02:13,680
at night and you see it night after night, you're going to wait six months or you're

993
01:02:13,680 --> 01:02:19,000
going to put them on a home study, which might even consist of just a ring.

994
01:02:19,000 --> 01:02:20,480
And it's going to come back positive.

995
01:02:20,480 --> 01:02:23,760
Boom, you've just stayed six months off of establishing the diagnosis.

996
01:02:23,760 --> 01:02:25,960
Now you talk about treating the child.

997
01:02:25,960 --> 01:02:30,560
So I don't want to take the dogma and say you should never do sleep home studies on

998
01:02:30,560 --> 01:02:31,560
children.

999
01:02:31,560 --> 01:02:36,360
You just have to know what kind of study you're doing and what's the limitation of the technology

1000
01:02:36,360 --> 01:02:41,920
that you're using, because if it cannot give you the answer you are looking for, you have

1001
01:02:41,920 --> 01:02:43,680
to take a deeper dive.

1002
01:02:43,680 --> 01:02:45,560
That to me is a bigger issue.

1003
01:02:45,560 --> 01:02:55,800
So I want to do a follow up because I've got one coming up with Jayton, where we're

1004
01:02:55,800 --> 01:02:58,520
going to talk a little bit more about sleep, but I want to make sure that we do one with

1005
01:02:58,520 --> 01:03:03,680
you as well, Dr. Simmons, because there's a whole lot to unpack here and I think parents

1006
01:03:03,680 --> 01:03:05,880
need to hear it.

1007
01:03:05,880 --> 01:03:11,120
But for the sake of time, I want to make sure that we cover our last couple of questions,

1008
01:03:11,120 --> 01:03:14,680
because I really want everyone to have the opportunity to weigh in on these.

1009
01:03:14,680 --> 01:03:22,440
Rebecca, there's one important point between PSG in lab versus in home testing.

1010
01:03:22,440 --> 01:03:29,120
Those in-home tests are not really true sleep tests, they're just sleep apnea tests.

1011
01:03:29,120 --> 01:03:33,160
We discussed REM behavior disorder, parasomnia, slow way of sleep, REM.

1012
01:03:33,160 --> 01:03:34,480
They won't pick any of those up.

1013
01:03:34,480 --> 01:03:35,480
They won't pick up anything.

1014
01:03:35,480 --> 01:03:39,800
They'll pick up only one thing that is either you're breathing or you're not.

1015
01:03:39,800 --> 01:03:40,800
That's it, right?

1016
01:03:40,800 --> 01:03:44,000
If you have a strong suspicion of sleep apnea, fine.

1017
01:03:44,000 --> 01:03:48,240
We'll get an AHI, the AHI will likely be okay if it's moderate to severe, but if it's too

1018
01:03:48,240 --> 01:03:49,400
mild we'll pick it up.

1019
01:03:49,400 --> 01:03:52,560
If it's anything other than sleep apnea and we'll pick it up because when you look at

1020
01:03:52,560 --> 01:03:58,120
home sleep testing, you say it this way, HSAT, home sleep apnea testing.

1021
01:03:58,120 --> 01:04:00,120
Only one indication to use this one.

1022
01:04:00,120 --> 01:04:01,120
That's an excellent clarification.

1023
01:04:01,120 --> 01:04:02,120
Thank you.

1024
01:04:02,120 --> 01:04:08,800
Again, we'll dive into that more when you and I have a chance to follow up.

1025
01:04:08,800 --> 01:04:14,920
One of the things that was discussed at the ASCC, and I know and I'll put links for any

1026
01:04:14,920 --> 01:04:19,960
physicians, medical, allied professionals that are listening that hasn't attended, the

1027
01:04:19,960 --> 01:04:24,320
APMD has something coming up called collaboration cures.

1028
01:04:24,320 --> 01:04:27,720
That word collaboration is huge.

1029
01:04:27,720 --> 01:04:34,960
I didn't realize how touchy it could be for some people, but I don't understand why it's

1030
01:04:34,960 --> 01:04:43,080
not quite as well received because when you're looking at a child, instead of siloing it,

1031
01:04:43,080 --> 01:04:47,760
if you're working collaboratively with a myofunctional therapist and the ENT and the pediatrician and

1032
01:04:47,760 --> 01:04:52,760
the dentist, there's so much more just this comprehensive health we can provide for this

1033
01:04:52,760 --> 01:04:54,760
child.

1034
01:04:54,760 --> 01:05:00,600
I realize this is a loaded question and it is opinion only question, but how do we make

1035
01:05:00,600 --> 01:05:01,600
this paradigm shift?

1036
01:05:01,600 --> 01:05:06,880
What is it going to take to go from siloed to collaborative approaches?

1037
01:05:06,880 --> 01:05:11,400
I'd like to address that.

1038
01:05:11,400 --> 01:05:14,360
We need a common language.

1039
01:05:14,360 --> 01:05:21,400
We need to be able to talk to each other in a language that favors the patient.

1040
01:05:21,400 --> 01:05:25,520
That's what I've been spending my career trying to do is to try to find a way to talk about

1041
01:05:25,520 --> 01:05:30,200
this problem in a way that involves everyone that doesn't.

1042
01:05:30,200 --> 01:05:38,560
Somehow this problem has evolved in a divergent evolution of language where the different

1043
01:05:38,560 --> 01:05:44,400
silos can no longer speak to each other and the patient who finds themselves between silos

1044
01:05:44,400 --> 01:05:48,720
will be to them.

1045
01:05:48,720 --> 01:05:56,520
If we can have a language that we all can share that somehow talks about the patient's

1046
01:05:56,520 --> 01:06:02,400
own experience in this phenomenon and all of us can share that, that's where we need

1047
01:06:02,400 --> 01:06:04,400
to go.

1048
01:06:04,400 --> 01:06:14,280
I would add as a practicing dentist that and someone who's been treating sleep patients

1049
01:06:14,280 --> 01:06:25,080
since the 90s, I have just found that I cannot be successful to the degree that I want to

1050
01:06:25,080 --> 01:06:31,000
be without collaborating.

1051
01:06:31,000 --> 01:06:39,520
What I have done is I just tell my patients that I can't really treat them unless they

1052
01:06:39,520 --> 01:06:48,480
are going to collaborate with my medical partner in this because I'm just not going to have

1053
01:06:48,480 --> 01:06:52,200
a chance to be successful.

1054
01:06:52,200 --> 01:06:55,480
It really just comes down to that.

1055
01:06:55,480 --> 01:07:01,160
What that means for me as a practitioner is some patients are not going to see me because

1056
01:07:01,160 --> 01:07:07,560
they want that quick fix, they want that dental appliance because they've convinced themselves

1057
01:07:07,560 --> 01:07:12,880
that they can't wear a seat pad or whatever it is that they've convinced themselves of.

1058
01:07:12,880 --> 01:07:20,000
They're looking for that person to fix them, but I can't be that person.

1059
01:07:20,000 --> 01:07:23,720
It doesn't mean that I won't refer to somebody else who might fulfill their need, but it's

1060
01:07:23,720 --> 01:07:30,120
not going to be me because I want to have a fighting chance to be successful at helping

1061
01:07:30,120 --> 01:07:32,280
them.

1062
01:07:32,280 --> 01:07:38,320
Part of the cure is education and experience.

1063
01:07:38,320 --> 01:07:45,000
I use myself as the example that over time, I hope that I'm getting better and better

1064
01:07:45,000 --> 01:07:48,200
at how I treat my patients.

1065
01:07:48,200 --> 01:07:51,240
It's changing how I treat my patients.

1066
01:07:51,240 --> 01:07:55,400
The other part of the cure are things that we're doing here, Rebecca, and I repeat what

1067
01:07:55,400 --> 01:08:05,520
I said at the beginning, which is the change really, in my opinion, come from being patient-driven,

1068
01:08:05,520 --> 01:08:10,160
parent-driven.

1069
01:08:10,160 --> 01:08:17,400
That's why any good product, whether it in the dental field like a liner's, do you think

1070
01:08:17,400 --> 01:08:21,280
that a liner therapy was driven by the dentist?

1071
01:08:21,280 --> 01:08:26,840
No, it's driven by patient needs, by these companies that went out to them and said,

1072
01:08:26,840 --> 01:08:30,800
hey, we can make your teeth straight and go find someone who can do that.

1073
01:08:30,800 --> 01:08:33,320
It's the same thing.

1074
01:08:33,320 --> 01:08:42,440
We need to educate the parents, educate the end user, and push them to push us to communicate

1075
01:08:42,440 --> 01:08:43,600
with each other.

1076
01:08:43,600 --> 01:08:49,200
I think they have to be demanding to want that cure.

1077
01:08:49,200 --> 01:08:52,400
Dave, you're muted.

1078
01:08:52,400 --> 01:09:02,440
We can't hear you.

1079
01:09:02,440 --> 01:09:05,720
I would say push us to communicate with each other.

1080
01:09:05,720 --> 01:09:06,720
That is so true.

1081
01:09:06,720 --> 01:09:13,640
One of the things, if you look on TV now, there's all these big ads about Inspire.

1082
01:09:13,640 --> 01:09:14,640
They have some great ads.

1083
01:09:14,640 --> 01:09:20,680
They got some of the other people wearing masks and then this one guy over there says, I have

1084
01:09:20,680 --> 01:09:21,680
Inspire.

1085
01:09:21,680 --> 01:09:28,760
Somehow, the American Academy of Dental and Sleep Medicine or something, we need to put

1086
01:09:28,760 --> 01:09:31,400
some ads out there like that.

1087
01:09:31,400 --> 01:09:36,360
Now, it's very expensive and that's how Inspire can do it because they're a big company and

1088
01:09:36,360 --> 01:09:39,360
they got a big budget.

1089
01:09:39,360 --> 01:09:40,360
That grabs their attention.

1090
01:09:40,360 --> 01:09:43,840
I guarantee you that gets people to say, I don't want to wear it.

1091
01:09:43,840 --> 01:09:48,880
I want to go see if I'm a candidate for Inspire.

1092
01:09:48,880 --> 01:09:53,680
Maybe some I'm more, but a lot I'm aren't because I got to get scoped and all this other

1093
01:09:53,680 --> 01:09:55,680
stuff.

1094
01:09:55,680 --> 01:10:03,760
If there was an ad campaign or something along with that to say, well, here's another alternative,

1095
01:10:03,760 --> 01:10:14,160
but I don't know if we have a big enough group to be able to go out there and afford some

1096
01:10:14,160 --> 01:10:16,160
ad campaign like that.

1097
01:10:16,160 --> 01:10:17,160
I wish we did.

1098
01:10:17,160 --> 01:10:21,640
I thought I just saw the ad on TV just an hour ago.

1099
01:10:21,640 --> 01:10:22,640
Oh yeah.

1100
01:10:22,640 --> 01:10:26,400
And you said Inspire and now the whole thing is going through my head.

1101
01:10:26,400 --> 01:10:27,400
It's Inspire Sheila.

1102
01:10:27,400 --> 01:10:29,120
I can do the whole commercial.

1103
01:10:29,120 --> 01:10:30,120
It works.

1104
01:10:30,120 --> 01:10:32,120
I don't even need it.

1105
01:10:32,120 --> 01:10:36,800
Yeah, but it's not as simple as the commercial patients think, oh, they don't even realize

1106
01:10:36,800 --> 01:10:38,120
it's a plan to a device.

1107
01:10:38,120 --> 01:10:40,800
I think there's something you just press right here.

1108
01:10:40,800 --> 01:10:42,880
I had to look it up to find out what it was.

1109
01:10:42,880 --> 01:10:46,960
But to his point, because it was there, I went and looked it up.

1110
01:10:46,960 --> 01:10:49,000
I'm thinking, what is she yelling at Sheila for?

1111
01:10:49,000 --> 01:10:50,000
What is she talking about?

1112
01:10:50,000 --> 01:10:52,320
And then I went and looked up what it was.

1113
01:10:52,320 --> 01:10:53,320
And now I know.

1114
01:10:53,320 --> 01:11:00,240
Just like Dr. V said, he can't function his best without having physicians.

1115
01:11:00,240 --> 01:11:05,760
I know that I need dentists to collaborate with.

1116
01:11:05,760 --> 01:11:10,720
When I first came relocated from California, I was in fact with the UCLA, and I came out

1117
01:11:10,720 --> 01:11:12,320
to Texas.

1118
01:11:12,320 --> 01:11:19,360
I was looking for a dentist, at least one that I could work with locally, because I

1119
01:11:19,360 --> 01:11:26,800
knew that I had to provide appliances for patients to stabilize the mandible.

1120
01:11:26,800 --> 01:11:30,920
Even though a lot of my patients that are on the CPAP, they'll do better if they're on

1121
01:11:30,920 --> 01:11:31,920
an appliance.

1122
01:11:31,920 --> 01:11:35,080
But I already recognized that it's part of the treatment pathway.

1123
01:11:35,080 --> 01:11:40,320
So I went on a my way to find someone to fit the niche.

1124
01:11:40,320 --> 01:11:43,960
And the person I've collaborated the most with was Dr. Ron Preen.

1125
01:11:43,960 --> 01:11:46,720
It was also one of the faculty members at the consortium.

1126
01:11:46,720 --> 01:11:47,720
He was there.

1127
01:11:47,720 --> 01:11:48,720
Yeah.

1128
01:11:48,720 --> 01:11:51,080
And he didn't know, when I first met him, he didn't know anything about sleep.

1129
01:11:51,080 --> 01:11:55,840
He was a TMJ dysfunction dentist.

1130
01:11:55,840 --> 01:11:58,440
But he was making appliances.

1131
01:11:58,440 --> 01:12:02,040
So I then taught him a little bit.

1132
01:12:02,040 --> 01:12:05,360
And he right away was like a sponge and learned a lot.

1133
01:12:05,360 --> 01:12:07,200
And he's a big educator now in the field.

1134
01:12:07,200 --> 01:12:12,040
But this was like back in 2001, 2002, when I first met him.

1135
01:12:12,040 --> 01:12:18,800
So part of the problem, though, with collaboration is where all these doctors are busy doing

1136
01:12:18,800 --> 01:12:23,560
their own thing, and they don't necessarily reach out.

1137
01:12:23,560 --> 01:12:28,320
And they're going to do what they, their pieces of the puzzle, and there's not a good

1138
01:12:28,320 --> 01:12:30,920
quarterback to really pull these patients together.

1139
01:12:30,920 --> 01:12:36,480
So if you look on a national level and see where things, where are things changing the

1140
01:12:36,480 --> 01:12:42,400
most, I think what you're going to find is that there's a new type of clinician called

1141
01:12:42,400 --> 01:12:45,280
a myofunctional therapist.

1142
01:12:45,280 --> 01:12:50,320
And the myofunctional therapists are basically physical therapists of the mouth, of the airway.

1143
01:12:50,320 --> 01:12:56,600
And they are either coming to the pathways being speech pathologists that then realize

1144
01:12:56,600 --> 01:13:01,760
what myofunctional therapy is, and they get on the board that way, or they're dental hygienists

1145
01:13:01,760 --> 01:13:03,760
and are looking at mouths all day long.

1146
01:13:03,760 --> 01:13:10,680
And they become empowered by learning what's going on with myofunctional therapy.

1147
01:13:10,680 --> 01:13:13,200
And then they get going to that professionally.

1148
01:13:13,200 --> 01:13:17,880
But these myofunctional therapists, in many instances, are functioning as the quarterbacks.

1149
01:13:17,880 --> 01:13:21,160
I was about to say that on the podcast, that's what I hear over and over.

1150
01:13:21,160 --> 01:13:22,160
Right.

1151
01:13:22,160 --> 01:13:24,560
And they are, and we're just coordinating and sending patients.

1152
01:13:24,560 --> 01:13:25,560
Right.

1153
01:13:25,560 --> 01:13:29,840
So they're almost like the care coordinator because they can't function on their own.

1154
01:13:29,840 --> 01:13:34,040
They need these different kind of clinicians and they're getting it and they're working

1155
01:13:34,040 --> 01:13:39,800
with the dentist and the sleep physician, you know, and, you know, the ENT doctor.

1156
01:13:39,800 --> 01:13:45,920
And so they're functioning and evolving to help fill this void.

1157
01:13:45,920 --> 01:13:50,040
Now in my practice, I mean, I have five nurse practitioners.

1158
01:13:50,040 --> 01:13:56,080
All my patients are seen by my nurse practitioners, otherwise I'd be the bottleneck of my practice.

1159
01:13:56,080 --> 01:14:00,320
And I'm behind the scenes working with my nurse practitioners and I see a lot of the

1160
01:14:00,320 --> 01:14:01,560
patients, but I don't see every patient.

1161
01:14:01,560 --> 01:14:02,560
I couldn't.

1162
01:14:02,560 --> 01:14:04,080
There's not enough time of the day.

1163
01:14:04,080 --> 01:14:08,560
We don't rely on the myofunctional therapist in my practice to be the quarterbacks because

1164
01:14:08,560 --> 01:14:14,040
we're at a level that we know how to do this and we don't need the quarterbacking.

1165
01:14:14,040 --> 01:14:20,400
We send a myofunctional therapist quite regularly to a month and not to one or two to many, depending

1166
01:14:20,400 --> 01:14:24,320
on the geographical area, or we're getting referrals from myofunctional therapists.

1167
01:14:24,320 --> 01:14:28,600
And then we're referring back.

1168
01:14:28,600 --> 01:14:31,880
But most practices aren't going to be like mine.

1169
01:14:31,880 --> 01:14:35,520
And these myofunctional therapists are great resources.

1170
01:14:35,520 --> 01:14:40,560
So I would encourage your parents that are on this, if they're in an area where they're

1171
01:14:40,560 --> 01:14:46,360
not sure who to go to, seek out a myofunctional therapist because they're going to be finding

1172
01:14:46,360 --> 01:14:48,680
someone that's already done the homework for you.

1173
01:14:48,680 --> 01:14:49,680
Yep.

1174
01:14:49,680 --> 01:14:50,680
Yep.

1175
01:14:50,680 --> 01:14:56,480
And we'll put links because Airway Circle, for example, has a great doctor finder, clinician

1176
01:14:56,480 --> 01:15:00,680
finder that has so many myofunctional therapists that are airway focused, by the way.

1177
01:15:00,680 --> 01:15:03,400
I mean, they're really walking the walk on that.

1178
01:15:03,400 --> 01:15:04,400
Right.

1179
01:15:04,400 --> 01:15:05,400
And they've done the due diligence.

1180
01:15:05,400 --> 01:15:09,640
A lot of my orthodontic referrals now, guess where they're coming from?

1181
01:15:09,640 --> 01:15:10,640
Myofunctional therapists.

1182
01:15:10,640 --> 01:15:11,640
Yep.

1183
01:15:11,640 --> 01:15:14,080
A lot of them are three, four, five, six year olds.

1184
01:15:14,080 --> 01:15:17,960
They're early, early, most orthodontics don't sleep.

1185
01:15:17,960 --> 01:15:21,600
But I'm sleeping three and four and five year olds that have sleep at me, that have been

1186
01:15:21,600 --> 01:15:23,080
diagnosed.

1187
01:15:23,080 --> 01:15:26,920
And the myofunctional therapist has picked it up and I've discussed it with the sleep

1188
01:15:26,920 --> 01:15:28,480
physician.

1189
01:15:28,480 --> 01:15:34,320
And we're doing different types of expansion early on.

1190
01:15:34,320 --> 01:15:37,680
It's worth mentioning real briefly that we were going to have a myofunctional therapist

1191
01:15:37,680 --> 01:15:38,680
on.

1192
01:15:38,680 --> 01:15:42,600
We've got Dana Christy Gatto, who is also one of the faculty members.

1193
01:15:42,600 --> 01:15:47,240
She unfortunately had an unfortunate event of a friend of her that passed away.

1194
01:15:47,240 --> 01:15:49,840
So she could have thought, thought, thought, thought.

1195
01:15:49,840 --> 01:15:51,440
But I will be following up with her.

1196
01:15:51,440 --> 01:15:53,160
So parents will get to hear from her.

1197
01:15:53,160 --> 01:15:54,160
So I will be.

1198
01:15:54,160 --> 01:15:55,160
Yeah.

1199
01:15:55,160 --> 01:16:00,040
So she couldn't join us tonight on short notice, but, but I want to make sure people recognize

1200
01:16:00,040 --> 01:16:02,600
the role that the myofunctional therapists play.

1201
01:16:02,600 --> 01:16:08,520
And again, if you're having a hard time finding who to go to, the myofunctional therapists

1202
01:16:08,520 --> 01:16:15,280
has probably already done the homework in your geographical area and should know who is,

1203
01:16:15,280 --> 01:16:16,840
you know, good.

1204
01:16:16,840 --> 01:16:20,560
But sometimes they're also frustrated because, you know, we're dealing with a specialty that

1205
01:16:20,560 --> 01:16:25,160
has just it's, it's in its infancy.

1206
01:16:25,160 --> 01:16:34,400
And there are just not a lot of highly trained clinicians yet throughout the country to,

1207
01:16:34,400 --> 01:16:37,040
but then again, telemedicine is growing.

1208
01:16:37,040 --> 01:16:42,520
I was about to say we have quite a few myofunctional therapists that will do telework.

1209
01:16:42,520 --> 01:16:45,760
So as clinicians to, I mean, we're doing a lot of telemedicine.

1210
01:16:45,760 --> 01:16:48,560
I see patients around the country.

1211
01:16:48,560 --> 01:16:54,320
Yeah, which I didn't realize until I talked to Dr. Liao, he works with patients all over

1212
01:16:54,320 --> 01:16:57,920
the world and it just, I love technology.

1213
01:16:57,920 --> 01:16:58,920
It's mind blowing.

1214
01:16:58,920 --> 01:17:01,720
Well, and we're using it to get this message out.

1215
01:17:01,720 --> 01:17:06,320
Obviously, that form is what we're using to get the message.

1216
01:17:06,320 --> 01:17:07,480
Yeah, to get the message out.

1217
01:17:07,480 --> 01:17:08,480
So, all right.

1218
01:17:08,480 --> 01:17:16,040
So the last question and usually I leave this more as an open question for whoever I'm speaking

1219
01:17:16,040 --> 01:17:21,360
with, but I want to kind of tailor a little bit this evening and give you all an opportunity,

1220
01:17:21,360 --> 01:17:24,760
although it may be the same answer, I'm not sure.

1221
01:17:24,760 --> 01:17:30,400
But parents that are looking for support for their children, you know, for their sleep

1222
01:17:30,400 --> 01:17:32,280
and their airway journey.

1223
01:17:32,280 --> 01:17:41,800
I'll turn it over to each of you for the last word of guidance, encouragement, anything.

1224
01:17:41,800 --> 01:17:45,080
And I guess, you know, Jaden, let's start with you.

1225
01:17:45,080 --> 01:17:49,320
So I found that with my patients, whenever they are having some difficulty, the difficulty

1226
01:17:49,320 --> 01:17:51,120
looking to them is that they feel alone.

1227
01:17:51,120 --> 01:17:55,120
They don't, they go to their physician, they explain them to have this and that and they

1228
01:17:55,120 --> 01:18:00,240
need to be diagnosed with anxiety or depression or iron anemia or something.

1229
01:18:00,240 --> 01:18:01,400
And it's none of those things, right?

1230
01:18:01,400 --> 01:18:05,480
They get sleep and then they get those procedures, they get on medication and their problem never

1231
01:18:05,480 --> 01:18:06,840
goes away.

1232
01:18:06,840 --> 01:18:08,960
They feel better once they join a community.

1233
01:18:08,960 --> 01:18:13,280
That's what I think we're doing here, you know, joining dentists, functional therapists,

1234
01:18:13,280 --> 01:18:16,160
technologists like myself, parents like yourself.

1235
01:18:16,160 --> 01:18:18,480
The patients should do the same thing.

1236
01:18:18,480 --> 01:18:19,760
Patients should join a community.

1237
01:18:19,760 --> 01:18:21,160
There are multiple Facebook groups.

1238
01:18:21,160 --> 01:18:22,160
There are LinkedIn groups.

1239
01:18:22,160 --> 01:18:26,280
There are just communities that you can actually meet in person at the community center just

1240
01:18:26,280 --> 01:18:30,960
to share your story about what doctor I went to, what live I went to, what results I did,

1241
01:18:30,960 --> 01:18:32,640
what therapy worked for me.

1242
01:18:32,640 --> 01:18:35,840
And just that, even if you don't follow any recommendations, at least you know that you're

1243
01:18:35,840 --> 01:18:37,360
not alone in the journey.

1244
01:18:37,360 --> 01:18:38,360
Yep.

1245
01:18:38,360 --> 01:18:39,360
Yep.

1246
01:18:39,360 --> 01:18:40,360
And that's great.

1247
01:18:40,360 --> 01:18:42,480
And I'll make sure that we have a couple like the airway huddle and there's a tooth pillow

1248
01:18:42,480 --> 01:18:43,480
one.

1249
01:18:43,480 --> 01:18:46,600
I'll make sure those are also in the show notes.

1250
01:18:46,600 --> 01:18:47,600
Rod?

1251
01:18:47,600 --> 01:18:58,880
Well, what I would say is the message I'd like to end with for the parents as well is to

1252
01:18:58,880 --> 01:19:06,720
say that every method of treatment that we have, they all work to some degree, but they

1253
01:19:06,720 --> 01:19:07,720
are band-aids.

1254
01:19:07,720 --> 01:19:11,640
They're not cures.

1255
01:19:11,640 --> 01:19:13,640
The cures prevention.

1256
01:19:13,640 --> 01:19:17,480
See, and we're talking about kids here.

1257
01:19:17,480 --> 01:19:22,320
So the reason I so desperately wanted to do this, Rebecca, is because I want to reach

1258
01:19:22,320 --> 01:19:27,560
out to these parents and say, you know, you need to pay attention.

1259
01:19:27,560 --> 01:19:30,880
You need to screen your children yourself.

1260
01:19:30,880 --> 01:19:34,960
And CSMA, go online.

1261
01:19:34,960 --> 01:19:39,680
They have great screening forms that we use in our offices.

1262
01:19:39,680 --> 01:19:45,720
There's a screening tool that a group of us are developing that will allow practitioners

1263
01:19:45,720 --> 01:19:47,520
to screen, but you can screen.

1264
01:19:47,520 --> 01:19:56,880
We can help you to look at your children to be the driving force to maybe prevent the

1265
01:19:56,880 --> 01:20:03,800
problem, to treat what's happening now, and then prevent them from growing into adults

1266
01:20:03,800 --> 01:20:13,240
that will only have band-aid therapy available for them unless it's a surgical approach,

1267
01:20:13,240 --> 01:20:16,320
which, you know, has its pros and cons.

1268
01:20:16,320 --> 01:20:24,520
So my message would be we're here to help educate you and help you and push you.

1269
01:20:24,520 --> 01:20:32,480
And what Jayden said is great to work in groups and start being the driving force yourself

1270
01:20:32,480 --> 01:20:38,560
to help your kids, your friends, kids to pay attention.

1271
01:20:38,560 --> 01:20:43,880
You know, that's that's my message and we'll do our best to help you do that.

1272
01:20:43,880 --> 01:20:45,280
Thank you.

1273
01:20:45,280 --> 01:20:46,280
Bill?

1274
01:20:46,280 --> 01:20:53,360
Yeah, I think one thing I would kind of build upon what Rob said is the prevention.

1275
01:20:53,360 --> 01:20:55,720
And that's where we've got to see these kids early.

1276
01:20:55,720 --> 01:20:59,960
And a lot of these things are structural because what happens is they start breathing

1277
01:20:59,960 --> 01:21:02,360
through the mouth, they can't breathe through the nose.

1278
01:21:02,360 --> 01:21:05,400
It changes the whole growth pattern of the face.

1279
01:21:05,400 --> 01:21:08,200
It makes the face narrower.

1280
01:21:08,200 --> 01:21:13,200
You have a narrow upper jaw and maybe a setback lower jaw.

1281
01:21:13,200 --> 01:21:18,400
Well that's a structural issue that orthodontists are supposed to deal with.

1282
01:21:18,400 --> 01:21:21,840
But a lot of treatment philosophies that we've done.

1283
01:21:21,840 --> 01:21:24,840
And I'm an orthodontist so I can complain about myself.

1284
01:21:24,840 --> 01:21:25,840
Okay.

1285
01:21:25,840 --> 01:21:33,600
And, and you know, we've had this idea that, hey, all we are just a bunch of estheticians

1286
01:21:33,600 --> 01:21:35,960
making the teeth pretty.

1287
01:21:35,960 --> 01:21:40,520
And we're giving them good pretty smiles and they can go to the prom and all this other

1288
01:21:40,520 --> 01:21:41,840
stuff.

1289
01:21:41,840 --> 01:21:48,840
But seek out an orthodontist or a dentist that understands about airway.

1290
01:21:48,840 --> 01:21:53,760
And yourself, you know, get some knowledge because you got to have, but a lot of times

1291
01:21:53,760 --> 01:21:58,800
you'll go, you know, and parent may go to the orthodontist and say, no, I don't want

1292
01:21:58,800 --> 01:22:04,840
these teeth taken out or no, I don't want these teeth moved back or whatever.

1293
01:22:04,840 --> 01:22:09,080
I mean, there are a lot of things we can do orthodontically to move teeth and bones around

1294
01:22:09,080 --> 01:22:10,400
all over the foot.

1295
01:22:10,400 --> 01:22:13,680
We can move them forward and we can move them out and we can move them back.

1296
01:22:13,680 --> 01:22:19,120
Well, when we start moving stuff back, you know, that tends to get involved with the

1297
01:22:19,120 --> 01:22:20,120
airway.

1298
01:22:20,120 --> 01:22:22,120
The airway is really nothing.

1299
01:22:22,120 --> 01:22:26,760
It's a structure that's left over after everything else takes its place.

1300
01:22:26,760 --> 01:22:30,880
Everything else gets put in position, the tongue, the teeth, the bones, everything.

1301
01:22:30,880 --> 01:22:35,040
And then the airways kind of what's left over, but it's like the most important part of the

1302
01:22:35,040 --> 01:22:37,680
whole thing.

1303
01:22:37,680 --> 01:22:42,520
Because if you can't, and it's not just that you can breathe, people go, well, I can breathe

1304
01:22:42,520 --> 01:22:43,520
okay.

1305
01:22:43,520 --> 01:22:46,400
It's the quality and quantity of breath.

1306
01:22:46,400 --> 01:22:52,800
And unfortunately, with some of the environmental stuff and the industrial revolution changed

1307
01:22:52,800 --> 01:22:54,520
a lot of things.

1308
01:22:54,520 --> 01:22:57,240
Women aren't breastfeeding like they're used to.

1309
01:22:57,240 --> 01:22:59,600
And that's a problem too.

1310
01:22:59,600 --> 01:23:03,560
And allergies and all this stuff is a big layer of onion.

1311
01:23:03,560 --> 01:23:09,160
But as Rob said, you know, the only way you can really cure and Dr. Christian Gemino, who

1312
01:23:09,160 --> 01:23:16,160
is the guy that discovered sleep apnea and spasitine children, he said specifically that,

1313
01:23:16,160 --> 01:23:21,680
you know, that sleep apnea in children is a craniofacial growth disorder.

1314
01:23:21,680 --> 01:23:28,440
And so the structural changes from an orthodontic standpoint, not the whole thing, but we need

1315
01:23:28,440 --> 01:23:35,240
to look at seek out or malfunction of therapists and doctors that understand airway.

1316
01:23:35,240 --> 01:23:41,040
And believe it or not, David McIngarves, who's a pediatric ENT, he's one of the co-editors

1317
01:23:41,040 --> 01:23:45,920
of the book we're writing, but he said, just because you're an ENT doesn't mean you know

1318
01:23:45,920 --> 01:23:49,680
it's not about airway.

1319
01:23:49,680 --> 01:23:53,840
You would think that all ENTs would, but they focus on different things.

1320
01:23:53,840 --> 01:23:54,840
It's just like dentistry.

1321
01:23:54,840 --> 01:23:59,240
If you got to end the dentist, they're going to do root canal or whatever.

1322
01:23:59,240 --> 01:24:06,280
So just, I would say, you know, be a little bit wary sometimes, you know, if you, when

1323
01:24:06,280 --> 01:24:09,880
you go to the orthodontist, it's not all just about straightening teeth and making them

1324
01:24:09,880 --> 01:24:11,360
look pretty.

1325
01:24:11,360 --> 01:24:17,840
You want the teeth and the jaws to fit in a certain way that it protects the airway.

1326
01:24:17,840 --> 01:24:19,440
So ask questions about that.

1327
01:24:19,440 --> 01:24:24,520
And if you don't get good answers, unfortunately find somebody else.

1328
01:24:24,520 --> 01:24:26,520
I like that.

1329
01:24:26,520 --> 01:24:31,280
And for parents that haven't heard it, I'll put the link for that as well.

1330
01:24:31,280 --> 01:24:35,880
Dr. McIntosh was on, gosh, I think it was 2022.

1331
01:24:35,880 --> 01:24:40,920
It's been a while, but it's a two part series and it is an absolute masterclass and airway

1332
01:24:40,920 --> 01:24:42,560
for any parent that hasn't heard that.

1333
01:24:42,560 --> 01:24:44,480
So I'll include that.

1334
01:24:44,480 --> 01:24:45,480
Dave?

1335
01:24:45,480 --> 01:24:51,480
Well, I'll just conclude by saying, I think everybody can see at this point that there

1336
01:24:51,480 --> 01:24:55,560
are many moving parts with sleep apnea, you know?

1337
01:24:55,560 --> 01:24:58,640
And so there is no one size fits all solution.

1338
01:24:58,640 --> 01:25:03,360
So I think everybody who's involved with this problem should educate themselves.

1339
01:25:03,360 --> 01:25:09,920
And I will conclude with once again saying that every AHA should be unpacked, you know,

1340
01:25:09,920 --> 01:25:14,640
before we draw conclusions about what should be done, we should ask why it should be done

1341
01:25:14,640 --> 01:25:18,840
and we should unpack the AHA in a responsible way.

1342
01:25:18,840 --> 01:25:20,840
It's a complex system.

1343
01:25:20,840 --> 01:25:21,840
So we should unpack it.

1344
01:25:21,840 --> 01:25:26,880
And I'll I'll do the shameless promotion for any parent that has not listened to empowered

1345
01:25:26,880 --> 01:25:28,280
sleep apnea.

1346
01:25:28,280 --> 01:25:32,840
The podcast, if you can't listen to anything, just listen to season one, because we're going

1347
01:25:32,840 --> 01:25:34,200
to talk about by being rid of.

1348
01:25:34,200 --> 01:25:35,200
Thank you.

1349
01:25:35,200 --> 01:25:38,680
Yeah, season season one gives you the vocabulary to navigate this.

1350
01:25:38,680 --> 01:25:39,680
That's true.

1351
01:25:39,680 --> 01:25:40,680
Thank you.

1352
01:25:40,680 --> 01:25:41,680
So start.

1353
01:25:41,680 --> 01:25:42,680
Start there.

1354
01:25:42,680 --> 01:25:43,680
Go get on the island and start.

1355
01:25:43,680 --> 01:25:44,680
So the islands.

1356
01:25:44,680 --> 01:25:45,680
Yeah, I'll sleep.

1357
01:25:45,680 --> 01:25:46,680
There you go.

1358
01:25:46,680 --> 01:25:49,720
So Dr. Simmons, if you would like to close us out.

1359
01:25:49,720 --> 01:25:52,880
Well, thank you.

1360
01:25:52,880 --> 01:25:58,920
So I guess, you know, in terms of words of encouragement, the fact that someone's watching

1361
01:25:58,920 --> 01:26:02,480
this and they're at this point where they're actually hearing my voice, that means they

1362
01:26:02,480 --> 01:26:06,400
watch this to its completion, you should be encouraged because you right now already

1363
01:26:06,400 --> 01:26:10,760
were exposed to more information than most parents know.

1364
01:26:10,760 --> 01:26:15,960
And you're already on the path to getting a solution and you're probably watching this

1365
01:26:15,960 --> 01:26:21,320
because you're concerned because you see your child or someone you know or whatever that's

1366
01:26:21,320 --> 01:26:27,800
impacted and you're trying to get more information to enable yourself to seek a solution.

1367
01:26:27,800 --> 01:26:34,120
And so, you know, we've all mentioned various sources, you know, and half, you know, Children's

1368
01:26:34,120 --> 01:26:39,640
Airway First Foundation is serving a purpose to get this kind of message out there.

1369
01:26:39,640 --> 01:26:45,440
And you're not alone because look, there are people that are giving you this information.

1370
01:26:45,440 --> 01:26:49,200
Because we know that these kind of problems are out there.

1371
01:26:49,200 --> 01:26:55,040
And we're trying to provide the solutions and to create the bridges for the patients

1372
01:26:55,040 --> 01:26:58,200
to get the care that they need.

1373
01:26:58,200 --> 01:27:05,120
And you may be geographically situated in an area where there are not many clinicians

1374
01:27:05,120 --> 01:27:08,800
right now that know very much.

1375
01:27:08,800 --> 01:27:13,240
Because of telemedicine, you could seek out help elsewhere.

1376
01:27:13,240 --> 01:27:23,480
You may have to transfer yourself, you know, mobilize yourself to get some kind of testing

1377
01:27:23,480 --> 01:27:27,680
or to see some people, you know, to see the dentist that's kind of understand.

1378
01:27:27,680 --> 01:27:34,040
So you may have to, depending on where you live, you may have to, you know, commute a

1379
01:27:34,040 --> 01:27:36,720
distance, but the care is out there.

1380
01:27:36,720 --> 01:27:46,440
And so don't give up until you finally feel comfortable with the clinician that can understand

1381
01:27:46,440 --> 01:27:52,840
your child's problem and can put together a pathway that will improve their health.

1382
01:27:52,840 --> 01:28:00,560
And you really need to be complimented for your perseverance to even, you know, watching

1383
01:28:00,560 --> 01:28:07,040
this, you know, podcast or this, you know, this webinar.

1384
01:28:07,040 --> 01:28:09,480
And there are others that I'm sure you're going to be watching as well.

1385
01:28:09,480 --> 01:28:13,000
So, you know, congratulations to you.

1386
01:28:13,000 --> 01:28:16,800
And hopefully you'll seek, you'll be successful in getting the care that you need for your

1387
01:28:16,800 --> 01:28:17,800
child.

1388
01:28:17,800 --> 01:28:19,240
And we're here to help.

1389
01:28:19,240 --> 01:28:20,240
Yep.

1390
01:28:20,240 --> 01:28:26,520
And I want to say, I'll close this out on a personal note, because you are all there

1391
01:28:26,520 --> 01:28:28,080
at the conference.

1392
01:28:28,080 --> 01:28:29,800
And I said this to all of you there.

1393
01:28:29,800 --> 01:28:34,320
And so now I will say this here as both a patient that is an airway person.

1394
01:28:34,320 --> 01:28:35,320
I'm an adult.

1395
01:28:35,320 --> 01:28:40,240
I'm the reason I'm an example of if you can fix it, they don't end up like me.

1396
01:28:40,240 --> 01:28:42,240
They don't end up like savvy.

1397
01:28:42,240 --> 01:28:45,080
So, and I'm also a parent.

1398
01:28:45,080 --> 01:28:47,960
I'm a parent that I didn't know.

1399
01:28:47,960 --> 01:28:51,760
And now I look back and think, oh, and I'm having to adjust these things in my, you know,

1400
01:28:51,760 --> 01:28:53,680
my grown children.

1401
01:28:53,680 --> 01:28:55,680
It's okay.

1402
01:28:55,680 --> 01:28:57,000
We've all made mistakes.

1403
01:28:57,000 --> 01:28:58,000
You guys made mistakes.

1404
01:28:58,000 --> 01:28:59,000
Parents have made mistakes.

1405
01:28:59,000 --> 01:29:00,000
I didn't know.

1406
01:29:00,000 --> 01:29:07,080
So start from where you are, but that guilt aside and trust your, your parental instincts,

1407
01:29:07,080 --> 01:29:09,320
because you know what to do.

1408
01:29:09,320 --> 01:29:12,280
Trust that mama gut, be that airway mama.

1409
01:29:12,280 --> 01:29:16,680
And on a personal note, I want to thank each one of you and every one of the luminaries

1410
01:29:16,680 --> 01:29:20,720
that I am so fortunate enough to talk to.

1411
01:29:20,720 --> 01:29:22,720
Your passion is infectious.

1412
01:29:22,720 --> 01:29:27,640
And I thank you so much for what you're doing because you guys are who are going to save

1413
01:29:27,640 --> 01:29:29,720
these 400 million children.

1414
01:29:29,720 --> 01:29:30,720
So thank you.

1415
01:29:30,720 --> 01:29:31,720
Well, thank you.

1416
01:29:31,720 --> 01:29:32,720
Thank you for giving us the opportunity.

1417
01:29:32,720 --> 01:29:33,720
It's great.

1418
01:29:33,720 --> 01:29:34,720
Thanks.

1419
01:29:34,720 --> 01:29:35,720
Thanks.

1420
01:29:35,720 --> 01:29:36,720
Thank you.

1421
01:29:36,720 --> 01:29:43,840
Thanks again to everyone on today's panel for joining us for this special episode of

1422
01:29:43,840 --> 01:29:44,840
Airway First.

1423
01:29:44,840 --> 01:29:48,880
And to each of you for listening.

1424
01:29:48,880 --> 01:29:52,680
You can stay connected with the Children's Airway First Foundation by following us on

1425
01:29:52,680 --> 01:29:58,160
Instagram, Facebook, X, LinkedIn and YouTube.

1426
01:29:58,160 --> 01:30:02,880
Don't forget to subscribe to the Airway First podcast on your favorite podcasting platform

1427
01:30:02,880 --> 01:30:06,560
so you won't miss an upcoming episode.

1428
01:30:06,560 --> 01:30:10,560
If you'd like to be a guest or have an idea for an upcoming show, shoot us a note via

1429
01:30:10,560 --> 01:30:19,240
the contact page on our website or send us an email directly at infoatchildrensairwayfirst.org.

1430
01:30:19,240 --> 01:30:24,080
Today's episode was written and directed by Rebecca St. James, video editing and promotion

1431
01:30:24,080 --> 01:30:30,280
by Ryan Dawn and guest outreach by Kristy Bojinkian.

1432
01:30:30,280 --> 01:30:33,880
And finally, thanks to all the parents and medical professionals out there that are

1433
01:30:33,880 --> 01:30:38,880
working hard to help make the lives of kids around the globe just a little bit better.

1434
01:30:38,880 --> 01:31:03,120
Take care and stay safe and happy breathing everyone.