Hi everyone, and welcome to another video.
Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James.
Today I'm excited to welcome back one of our favorite guests, pediatric ENT specialist, Dr. David McIntosh.
This is part one of our two-part series, and it builds upon our initial conversations with Dr. McIntosh, which were episodes 13 and 14, and you can find those links in our show notes.
So, without further ado, let's get right to it and jump into our conversation with Dr. David McIntosh.
Thank you so much for joining us again on the show, Dr. McIntosh. I am so thrilled to have you back here.
It really is a great pleasure. It's a great foundation, and it's my privilege. Thank you.
Thanks, thanks. And I love our talks, and I will tell you, our parents have had a lot of questions.
So, I really appreciate you taking the time to come in and let's talk about some of these. So, let's go ahead and just dive right in because...
Sounds good.
ADHD, you and I were talking a little bit about this before, is a very big issue in America. I know it's a global thing, but in America, the numbers are staggering, the number of children that are diagnosed, something like one in four, diagnosed with ADHD, which is...
I can't even get my brain around that, but it makes sense to me because I look at my daughters when they were growing up, all of their friends, how many of them were diagnosed with ADHD?
That's just like you and I talked about arm bells, but what to me is most upsetting is most of these kids are getting prescriptions to regulate this.
When the reality is, that's probably not even the driving force behind it.
Look, I mean, those numbers are staggering. And I think this is one of those moments where you pause and go, all right, so this is what's going on in our part of the world.
Is this happening everywhere else? And the answer is no. In terms of that level of degree, it's not anything like that at all.
We do know that the diagnosis has become more common in time, partly because the condition has been defined and refined over time.
So ADHD is a diagnosis in terms of being in the books and so forth. That only came about in the late 80s and then got refined in the 90s and 2000s.
So it's sort of has been morphed and shaped over time.
And it's sort of, I remember when I went to school, there was no such thing, but it wasn't just in terms of it being a diagnosis, but there were certainly kids in the class that were having trouble concentrating,
that led to them being a little bit disruptive. They were the kids that got sat in the corner, you know, face the wall sort of stuff.
That was the tough love that we grew up with.
Yes, it was.
And in that respect, there was not even a thought that we'd be medicating kids in my school class back when I was a kid. Just slow them down.
So that was obviously the dynamic then, but you know, as we've emerged and we've come to understand there are some things we can do for these kids that are beneficial to them.
That's certainly perfectly reasonable. But it all comes into the context of have you made sure that there's nothing else going on that could be masquerading as ADHD, or that could be exacerbating symptoms that look like ADHD.
And I think in terms of, you know, obviously my focus and insights as an ear nose and throat surgeon comes down to breathing and sleep.
And there was a research paper that really was in my mind. There's all these little papers out there that I think the game changes and this is one of them.
And this was in 2006. And it came out of Chicago with the researcher was a shervin C H E R V I N was the surname.
And it was a really interesting study because we have to realize there's sort of a confluence of events going on. So we have ADHD been sort of defined and refined.
But starting from the late 70s, but really picking up in the 90s, and then progressing forwards into the 2000s is this whole thing about kids airway breathing sleep and in particular the starting point was sleep apnea.
And with the sleep apnea story in this Chicago study, what they did was that they had a cohort of children that were coming in for adenoid and tonsil surgery, because these children had obstructive sleep apnea due to big tonsils and
adenoids, which is, you know, kind of the vibe and the gist for a lot of the scenarios that play out in this context. But what they did is they tapped their colleagues next door on the shoulder.
Their colleagues were the psychologists and the psychiatrists and sort of, you know, present a little bit of a play story here.
They basically said, hey, we want you to come and look at these kids and the psychology and psychiatry department was dumbfounded. They're good. Oh my gosh, you got all these kids with ADHD.
And so these kids had fulfilled all the criteria basically of ADHD. So, you know, being disruptive, total concentrating, focusing, you know, just tick, tick, tick and tick.
And then, and then this and then the ENT said, yeah, hold my drink, come back in 12 months. So the kids had the surgery. 12 months later, the researchers come back again.
And they go, wow, what did you do? All this ADHD that you had, it's gone. And that's what happened.
And so you have to go, you know, there's nothing about having an anesthetic or an operation that cures ADHD. So the problem was the diagnosis.
It'd be like, you know, if you break your leg and I give you an antibiotic and your leg gets better, well, that antibiotic didn't make your leg better.
It was probably something else like maybe the orthopedic surgeon. Okay.
So you can't say antibiotics fix broken legs and you can't say surgery fixes ADHD.
The diagnosis was wrong. So the, if you know, so from that point of view onwards, there was a really significant awareness of the impact on children in terms of their learning and behavior, and the misdiagnosis of ADHD.
And the reason that this is such a red flag is apart from getting the diagnosis wrong is that the treatment, which the amphetamine based medications in particular, makes sleep a real problem.
They interfere with sleep. So you have a child that has one sleep problem and you medicate the symptoms of that sleep problem with something that also in its own right makes sleep worse.
You're actually making the child worse in the process. And the reason for this is the central theme of just how important sleep is.
And I can again recall going to medical school.
And we had probably if we were lucky, maybe four or five lectures on sleep in terms of our physiology coverage. So we learn about breathing, we learn about the cardiovascular system and the digestive system.
And we did do sleep.
But it was very basic, very primitive. But again, that was in the late 90s. Yes, I'm that old.
And sleep as a thing wasn't a thing then. So there was no sleep medicine.
You know, there was nothing nothing on the pathology radar significant enough at the time in my medical school education to even talk about something like sleep apnea.
You know, it's an adult's little, you know, it was sort of, it was just a little yes. Yeah, yeah, yeah, yeah, it was just starting to creep in to, you know, our awareness.
And when that happens, it takes a long time for a medical school curriculum to change.
You know, it's got to be something big and radical and so forth. And, you know, even to this day sleep is not a big component of medical school education.
It's not a big component.
Yeah, and it's not a big component of postgraduate education programs, unless you're doing the sleep medicine programs.
So, you know, when I did my training, I was kind of in the right place at the right time in Australia at the time because I was in the program where there was only one ENT surgeon in the whole country that had any idea about sleep apnea.
And the reason he had that idea is that he'd gone over to the US come come to your your place, but at Stanford and learn from the guys there and brought that back to our ENT program in Australia.
And that was in the late 90s, early 2000s.
So, that's the only reason that it hit my radar is because of that one person. So that was a really pivotal, you know, element of how it played out.
But that was fun.
And there's a huge delay, right, is we're even learning just on that airway side because we can remember 2016 talking about airway was still new.
And when we went to Australia this year, that was one of the first really big conferences there. So that's how long it has taken to get there.
Yeah, yeah, yeah.
There's usually somewhere between a 10 to 20 year delay from the science permeating into clinical medicine.
And, you know, and there's a reason for that is that, again, things are changing, you know, but again, I'm just showing my age.
We used to rely on these things called books.
That was it. All right. When I was at university, initially, there was no such thing as the internet.
And I can remember in 95.
I remember schlepping books and now kids have iPads.
I was like, we're all your books. What are you doing?
Yeah, you know, the reason that we were so trim and good looking back then is because we're carrying all these books.
We had to schlep all that, right?
Yeah, that's that. That was our exercise program right there.
You know, we'd be carrying around pounds and pounds of books, you know, 20, 30 pounds worth of books.
All of us.
It's just straight. And I'm sure everybody did this because we don't have our backpacks on one shoulder.
So you like a rib would move and you get these things and yeah, I remember all that.
Yeah, yeah. But good for the course.
Right. So yeah. So so that was sort of going on in the background.
So because we were relying on books, once a book's printed back, you know, back in the day, you wouldn't really print another five.
You wouldn't reprint for another five to seven years. And then whatever's in that book is basically been through the editorial process, which takes a year or two.
So by the time that book hits there, it's already two years out of date.
And then we're going to use it for the next five to seven years so that could easily rack up to 10 years that books, you know, there and bring out a new edition down the track.
But then, you know, the world's changed, you know, tenfold.
So that's actually the reality. And then the other thing is, which I found quite interesting, because I only learned this in the past week with your university medical curriculums.
They're all pretty much the same because there's a private organization in the US that actually sets the standards.
So as attractive as it might be to go to these big, you know, expensive universities, your actual medical curriculum is pretty much the same as a standard.
Yeah. So until the people sitting around that table decide to bring sleep into the university, it's not going to happen anywhere, you know, as a concept.
So and then and then it's forwards because it like I said in the postgraduate, it doesn't really get a mention.
And it's extraordinary because if we just pause for a moment, you think about what is the thing, the one thing that we do more of than anything else.
It's sleep, you know, throughout the day, I'm sitting, I'm standing, I'm walking, I'm talking, I'm moving, but I'm not doing that for eight to 10 hours without any, you know, and it should be without any interruption.
It's the thing that we do more than anything else on a consistent basis. There's nothing else that we sit down and do.
What was it like a third of your life is sleeping? Is that right?
Yeah, yeah, yeah. I mean, it's a simple math thing, right? Like 24 hours in a day, eight to 10 hours of sleep, depending on how old you are.
So when you're really old, like, like getting to my dinosaur age, you tend to need less sleep.
When we first kick off, you know, talking babies, like, they're like cats, you know, they feed and they sleep and then they sleep some more.
And there's a very good reason for that. And that is, I really hope we will come to this. And that is the, what we're coming to realise is the importance of sleep.
And the importance of sleep front and centre is about this thing we call the brain.
And it's a thing that we again kind of take for granted. But it's an extraordinary machine in terms of what it does.
And before we get too far down this, I want to ask a question and you can completely tell me that I'm off my rocker.
But you mentioned that ADHD really kind of came into mainstream, especially in schools, late 70s and in the 80s.
I mean, that's fine with you. That's my work.
The 70s and 80s, that was in reference to the breathing and sleep apnea in kids.
So the ADHD, as in terms of hitting the textbooks.
So it was called the DSM criteria, which is a sort of categorisation of mental health issues.
And that hit in the 80s, okay, in terms of there. But then it got sort of changed and chopped around and refined and so forth.
As time went by, so people got a little bit more sophisticated in terms of defining it.
So that's when it could start to be diagnosed as such, because you basically get a checklist and go, oh yeah, tick, tick, tick, tick, tick.
And all these things. Yeah, because where I was going was I was thinking, well, we were one of the first generation, like the full generation that started with retractive braces.
So to me, it's like, oh, look, that makes sense on the timeline that.
Yeah. Yeah, retractive braces is an interesting conversation in itself. And I make this fun link.
And, you know, retractive braces, you know, extraction, retraction is a interesting thing.
And I'm one of those kids that had it.
And from what I've understood from the history, it actually started in Australia. So, so really.
Oh, apparently. Thanks.
But it's not true. I don't care because when I'm not going to let the facts get in the way of the good story here.
You still have the Bee Gees. So you're fine. Right. Yeah. Well, you're not taking those from us.
So, let's say it. See, you've got great history. You're fed. Yeah. Yeah. Yeah, totally. Yeah.
So the, you know, the knock on follower on effect that it's sort of somewhat ironic in terms of trying to play this story out is Australia also invented CPAP.
So we worked out how to retract the jaws and then we worked out how to give them CPAP later on.
And we're also pretty prominent in creating mandibular advancement splints. So yeah, go Australia.
Yeah. Well, these things happen. Yeah. All right. So, so you kind of touched on it. So let's just.
Let's just go full throttle now on brain because we know that when kids don't sleep and they don't breathe correctly, you know, so we're talking mouth breathers and now they snore at night.
We know, and I don't think a lot of parents really understand though that it impacts your prefrontal cortex and it can actually lower a child's IQ by up to 10 points.
Yeah. Why aren't people talking about that? Why isn't that just like this big red blinking? Hey, close your mouth. I mean, that alone should be enough. I would think.
Yeah, look, it's extraordinary, isn't it? It's again, I think, you know, I talked about how it takes so long for information to permeate into the textbooks.
And then it takes even longer again to permeate into, you know, the mindset of people. So, you know, and we know it's doable, you know, we proved through that, you know, thing called COVID just how quickly people learn the word coronavirus.
It's just, you know, like that is spread like wildfire, you know, in terms of the disease and the knowledge of the same.
Right. And I guess partly that was because it was front and center and it did actually impact on people, you know, in a real way.
So that would go there. Whereas this thing, this is sort of tucked away and it's, you know, scenario is not unusual. Everyone's got home, you know, the parents have done the day.
They want to just settle the kids down and just have some, you know, quiet time to themselves. And, you know, we're in a situation where, you know, with some people's housing, not everyone's, the kids have, you know, one part of the house down one end and the parents are down the other.
So as soon as the kids are put away, there's no idea and no insight as to what that child is doing through the night with their breathing and the sleep.
So when the parent comes and tries to wake them up in the morning and the kid is tired and grumpy and I don't want to get up. I don't want to go to school.
And we've normalized that to where it's.
And you just go, oh, the kid doesn't want to go to school. You know, yeah, sorry, the kid just doesn't want to go to school.
And then it's the weekend. But, you know, on the weekend, they seem to be up and, you know, wanting to watch the cartoons on TV. That was sorry. That was my thing back in the day.
Yeah, I was going to say mine. Mine don't do that. They just sleep longer and then they get up and watch TV.
So, you know, so it was sort of like, oh, this is all just about school avoidance and so forth, but it wasn't.
And then like I said, the parents don't know. So, so this is, you're right, you know, we don't let children consume alcohol before a certain age.
In my country, it's 18 and yours is 21. There's a reason for that.
We don't let children play with mercury. There's a reason for that. We are concerned about children being exposed to us to lead because of the damage it does to the brain.
There's a reason for that. But if we pause for a moment and just look at how the brain works and functions, the brain is an evolving machine.
It's kind of, you know, they're talking about how AI can, you know, emerge and evolve and eventually, you know, we have that whole Terminator movie, you know, scenario playing out with Skynet that becomes self aware and then turns on the creators.
Well, the brain isn't ever evolving constant learning machine. And the most amount of brain development that happens is in the first few years of life.
Because that's when the brain is getting stuff sorted the the fact that you know we can communicate now, like you and I are is because you and I learned how to talk.
Now to do that, we needed a brain that worked connected to the ears and connected to the muscles and then coordinating it and refining it.
And so we're going from babble to words to sentences to war and peace. That's, you know, the movement of time. And what we've learned about sleep is that the learning part happens at nighttime.
It actually happens when we sleep. So the brain has a short term and then a long term memory system, you know, a bit like your computer.
And, you know, if I'm typing into a document, it will remember that but if unless I click the save button if I my computer crashes before I hit save, I've lost that whole document.
We've all lived those experiences. Maybe not the kids today. They don't know how lucky they've got it with auto save and cloud computing.
But, you know, just, you know, parents at least can relate to this. And, you know, you've lost that whole document and you got to start again because you didn't save it.
It's the same sleep is your save button in terms of your memory. That's when it happens. But it for it to happen, it needs to be good quality sleep because the brain is basically working through, you know, this is my list of things to do.
And if you have a list of things to do in your day, and something comes along and distracts you and interrupts you might not get around to doing what you were supposed to be doing and you just got to miss that opportunity.
It's the same for the brain. But the problem with this thing that we're talking about so mouth breathing, snoring sleep apnea that they're all part of what we call sleep disorder breathing.
And it really is a problem because the condition in simple terms impacts the brain in two ways. The first way is it knocks down the oxygen supply.
Now that's bad. The brain is so important to the body. It has a disproportionate amount of blood flow. So it by body weight, it is 2% of the weight of the body. Okay. 2%.
But it is 20% of the blood flow.
So it is has a disproportionate amount of blood flow. And that is because its activity is through the charts. It, you know, the, the, you know, there's no moment where the brain stops, you know, the gut will sort of be in a rested state until you eat and then it's then it sort of has it.
Oh, okay, we've got to do stuff. Your heart, you know, has its baseline, but it will be elevated when you go and do some exercise or physical activities of some sort.
Your brain is front and center controlling all of what I just told you about. And you don't even know about it. And then, you know, right now, wherever you're sitting, your brain knows exactly where your knee is it knows exactly where your big toe is it knows exactly if you know,
you know, the air is warmer cold. It knows if there's a car that just passed your house. And, you know, it knows whether to pay attention to those things or ignore those things and when they're important and when they're not.
It's extraordinary. And this is the problem is that the oxygen supplies compromise but the other thing is, is the sleep is disrupted.
So in the sleep nomenclature terminology, we talk about an arousal and arousal basically means something where you in a certain level of sleep, and we have different sort of, you know, we talk about like sleep and deep sleep to keep it simple.
And an arousal is where you bounce up higher in your level of sleep, then you should have, because something happened that interrupted it and that's again where the breathing comes in because the oxygen not only is that you know something that's deprived to the brain and in what it wants and needs.
But it gets to the point where the brain starts to worry about it in the background and starts to wake you up. So I don't know what's going on here but you need to breathe properly and whatever you're doing right now don't work in for me.
And that then mucks up the brain's, you know, system at night. And it's not just about learning. It's also, you know, the analogy that I use it's the street sweeper at night.
So, you know, you sort of, you know, wake up to your city and the streets are immaculate and pristine but then these humans come along and then by the end of the day it looks pretty terrible.
And then, you know, first thing in the morning, those street sweepers have been out and made it look glorious again.
That's actually the same story in the brain. There's a whole element of, you know, the street sweeper equivalent in the brain.
And that happens when we sleep. So not only is it important for learning, it's also important for basically, you know, clearing out the metabolic byproducts and the toxins and so forth that have accumulated in the brain.
And, you know, it's so active that it just cannot keep up with itself to clean out the metabolic byproducts of the day. So it created this system at night to do it for it. It's extraordinary.
You know, absolutely amazing. And people will know this as parents. Like, what do you like after a bad night's sleep? Anyone that has, you know, brought up a child, you know, in those early days, especially the mother, let's be honest,
the dads get off a bit, but the mums are front and center. You know, when we have these terms, you know, you know, I've got pregnancy brain, I've got baby brain, you know, I've got brain fog.
You know, what are all these terms sort of tie back to? Well, a lot of it ties back to I didn't really sleep really good last night.
I mean, I'm not sure what the tiny person. Yeah, they can. Yeah. And then they sleep on you. You wake up because they move you wake up. Just you don't sleep.
Exactly. So all those sort of dynamics, you know, play into it. So, and then you know what you like the next day, you know, you start forgetting things, you know, you and it's all you didn't sleep.
And this is in the context for an adult of a brain that is nowhere in the years developmentally in demand as a child.
So the impact, this is why the impact on children is significantly higher is that their brains are still going through a huge amount of growth and development.
And it needs that sleep. That's why children need much longer sleep time than they do as adolescents and adults. So, you know, we're talking like, you know, 10 plus hours for children, as opposed to, you know, the sort of more eighties hours for adults.
Yeah. And I was going to ask a quick question because you mentioned when we were talking just a moment ago about the impact on IQs.
And I post the question. I mean, I know you're not omnipotent. You don't know all this, but it just boggles my mind because, at least in the U.S., the average IQ is now under 100.
How is that not alarming? How is that not a big sign? Is it like this in other parts of the world? I mean, to me, that's that's a big red flag.
Yeah. All right. So I mean, and I'll joke you decide you mentioned the Terminator. I'm less fearful of computers because I'm very nice to my Siri and everything.
I tell her I love her and things like that just in case. But I'm more concerned of the movie Idiocracy because to me, if our IQs keep going down, that's where we're going.
Yeah. Look, the reason I'm pausing and taking deep breaths is that I know the answer, but I don't want to cause offense.
So let's just call it for what it is because sometimes you've got to do that. I love going to the U.S. OK.
But there are some very, very big problems that you've got over there. And one of your big problems is that your food, OK, one of these basic things, it ain't good.
It really, it really is. The American diet is a war. All right. Yeah.
It is not good. And but you are so immersed in it and it is so normalized. And it is. It's even weaponized now in terms of, you know, if you say something about, you know, you know, I heard the other day that, you know, there was pushback about having soft drinks on your food stamp program saying,
and then it was saying, well, if you take that off, that's racist.
Boy, that sounds like us. Yeah. Yeah. Yeah. That's what happens. And, you know, that's that's basically driven by a lot of the lobbying and stuff that's funded by the same companies that are selling these things.
So we've talked to people like, like, you know, Dr. Becky Andrews or we've read Stephen Lynn's book and some of the others that that impacts not only your job development, but that's impacting your brain as well.
What it really is. It really is, you know, the nutrition is so front and center to to health and well-being.
Yeah, that's the third or fourth pillar, isn't it? I mean, I've heard it. It's, you know, sleep and nutrition.
Yeah, yeah, absolutely. And, you know, so, so, you know, if we're going to, you know, go on that tangent and be honest about it, look, you got to call it for what it is.
You know, there's, you know, I mean, you know, there's only so long you can put your head in the sand, you know, as a sort of a defense mechanism.
And it don't work. That thing that you're hiding from it's still sitting there. As soon as you pull your head out of the sand and look around, it's there.
You know, and, you know, and we're not, we're not trying to shame people.
You know, and we should we should go back to you don't know what you don't know. And that's okay.
And it should never have been weaponized in terms of making it think about race or about culture or about economies. It really shouldn't have been.
It should have been, hey, we've created a problem here. We have basically allowed an industry which in your country is allowed to use things that are banned in food products elsewhere.
So, and you can just look over the border, just go over to Canada. Like some of your breakfast cereals, they're not the same.
That's the same box with the same picture. Go look at the ingredient list. It is not the same.
And you go, well, why is that? Well, that's because Canada bans those things. Okay.
And that is so so so you're right. You just like, wow, why aren't these red flags, you know, going around and so forth.
And I'll tell you what, I am one of those parents, by the way, that had my own brute awakening because I was diagnosed with cancer.
And I had to step back and go, I don't understand why. And I started doing this like I think a lot of people do this deep dive.
Yeah. And not only do I not go to drive throughs anymore. I mean, that's off the table.
But the things I buy are very different now. And I stay on the outside of our American stores.
Yeah, because all the crabs in the middle. Correct. Yep. But I wouldn't have known, you know, and I was a biology major and I had no idea.
I just, yeah. So parents don't know here. You just know what we were indoctrinated with.
Yeah. And look, let's be honest, you know, all this, all this stuff, it's heavily processed and it's cheap.
And that unfortunately does play into the economy of things.
And, you know, and I understand that I'm not judgmental. I'm a realist. But the reason it's cheap is because they took all the good stuff out of it.
Right. And they jammed it.
So they jammed it with the stuff that the brain's not really so, you know, it doesn't need it in anywhere near the amount that it's supplied in.
So you've got that dynamic, you know, that that's that, you know, if you're going to look at one thing, and one thing only that would be front and center.
That really needs to change. But the problem is we're back to permeating that does permeate everything because if you eat my crap.
Yeah, your body's going to behave sluggish. You're not even you're not optimal. So now your brain's not optimized.
And then when you sleep, you're not even going to get that.
Yeah. And you can look at this, you know, you look at something like a thoroughbred racehorse. Okay.
A horse that has the potential to, you know, win the Kentucky Derby and make you millions of dollars. And then you put it out to start afterwards where you make even more millions of dollars.
I guarantee you, you will not be giving that horse anything other than the best of the best of the best.
Right. And you go look at the owners of those horses. They are not giving themselves the best of the best of the best.
That's true story. Yeah.
Yeah, they're not. So, you know, it's not a financial thing. You know, when I can give you that example, you know, you go look at, you know, you're extremely wealthy people out there.
And, you know, it used to be about showing off the cars and the boats and the private planes.
Now you look at Jeff Bezos. What's it about showing off how physically fit and good he looks. Now admittedly he's already done all the other show up with everything else.
But that's now become the billionaire brag is about being, you know, trim, taught and terrific. So actually turning that around from, you know, just, just, you know, you go look at the movies.
You know, you look at those, you know, rich aristocratic, you know, dictatorial, they're all portrayed as heavily overweight people that just sit around and the gluttonous.
So, you know, we have these really interesting stereotypes that actually portray real life sometimes.
But anyway, that was a rabbit hole. You mentioned the prefrontal cortex just to circle back to the element because, like I said, with the brain being greedy and soaking up oxygen and so forth.
The other thing that soaks up, by the way, sugar, you know, that's its prime thing. And people have this sugar, sugar, sugar thing.
And well, that's all, you know, it's the dose that makes the poison. So sugar is good, you know, but the amount of sugar that we're having is extraordinary.
And again, that's part of why I brought up nutrition because you don't realize how much we're giving our kids. You think goldfish, there's not in there. Oh, put it over.
No, I think the statistic is that the amount of sugar that we now consumers in a week is what we use to consumers in a year.
In a year.
You know, in a week.
So again, it just shows you that, you know, our system works just fine with whatever we were doing a long time before.
So that's part of the dynamic there. And it does feed into airway problems because as you put on weight, that feeds into airway problems.
So, you know, all these things are intertwined. You know, so there is there is actually a very good reason for bringing these these things up.
But when it comes to the brain, you know, I said it gets, you know, 20% of the blood flow. Now when you have sleep disordered breathing, it actually bounces up to about 25 to 30% of the blood flow.
So the brain has a mechanism that says that, all right, I'm not getting enough oxygen. I'm not getting enough energy or whatever the like, but primarily the oxygen.
So give me more blood.
But it also has the ability to regulate which parts of the brain are getting the blood in proportions.
And the part of the brain that gets sacrificed relative to the others is the thing that you just mentioned is that prefrontal cortex.
Okay.
So just to give people, you know, an understanding of what we're talking about.
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Let's jump back into today's episode.
Our brains are divided up into sections, front, back, left, right, inside, outside.
This is sort of a generic thing.
And we generalize as to which parts of the brain do things.
So the frontal lobe is at the front of the brain.
Okay, that's its name.
And prefrontal is in front of that again.
Okay.
So also, it's just behind that.
Sorry.
So we've got, you know, those sorts of things.
But collectively, this frontal part of the brain is tied in with our emotional regulation and our sort of social norms.
Now, there was a movie that some people out there might have watched based on the book,
Jack Nicklaus, it's One Flew Over the Cuckoo's Nest.
Okay.
And it describes the journey of a person in a mental institution back in the day.
And then the conclusion of the movie, he's had a procedure where he's totally different.
And that procedure was a frontal lobotomy.
Okay.
And that was a treatment that was spooked and it was actually a, you know, traveling roadshow of sorts back in the US in the day,
where they were doing that to, you know, cure mental illness, but then they said, well, it cures everything.
And what you're doing is that they're physically dis-breaking the connection of that frontal region of the brain to the rest of the brain.
And that's associated with personality changes.
And in particular, the personality change that happens is that you lose your inhibitions of it.
So you're less restrained in your behaviors in some respects.
Well, hey, listen to what I just said.
The prefrontal region is underactive in these children with ADHD-like symptoms because of sleep-assorted breathing.
It's kind of like a frontal lobotomy in terms of its impact.
Why?
Because they're disinhibited.
And this is where people get confused because you go, well, hang on a sec.
You told me that if you don't sleep properly, you're tired.
I've got a kid that's got more energy than any of us know what to do with.
So I'm calling you out.
You don't know what you're talking about.
And I go, okay, let's just pause for a moment.
What could be going on here?
It's not that a child with ADHD has more energy.
They have unregulated energy.
And that is the problem.
So the comparison that I make is it's like a car.
Okay.
Your car has an accelerator and we're all the same model.
Obviously, one of us, we're all the same model just for the analogy.
And we've all got the same accelerating speed.
So if we all put our foot down, we're all going to go at the same speed relative to how much we're putting the accelerator down.
The children with ADHD, they don't have a break.
So that when we're speeding up to a corner, we will take our foot off the accelerator and start breaking to slow down to take that corner.
Those kids don't have a break.
So they just shoot forwards and then they're doing something that they shouldn't be doing.
That is why they manifest as having more energy.
It's not, they just can't contain and control what they've got.
So what happens when we take these kids that really don't have ADHD and we medicate them?
Yeah.
Well, like I said, the problem is in particular, as we muck up their sleep, you know, and they, you know, they sort of labeled as a, you know, poor responder to medications.
So then we find different medications.
So I hang on, you know, I've got a pill for this.
That pill didn't work.
Let me give you another pill.
And then we start using sedative medications in these kids and start, you know, to slow them down, we medicate them to slow them down.
The, you know, so it's all just this.
And again, you know, it's kind of like, you know, you've got this drug industry.
You've got it. You've got a food industry. You've got a sugar industry.
Like do the math on this one.
You know, so you know, so this is, this is, you know, the challenge.
So that's why when it comes to behavior, you know, what you've got to just pause for a moment is that what you saw happen just then is a reflection on how that brain works.
Okay, so the fact that you and I are sitting here and I'm still sitting and I haven't got up and walked around three times and so forth.
Well, my brain contained that, you know, you know, it wasn't even a thought to do that.
Whereas a child with, you know, troubles with, you know, concentration ago.
Well, what we're seeing is a symptom is a symptom of brain function.
Now, is that brain not functioning properly because there is some sort of neurodevelopmental issue, which ties in with the ADHD.
Or is it because they've had, you know, some really, really bad breathing and sleep, you know, as an alternative.
And I really, you know, even to sort of, you know, put this in the picture of things, there's no reason why you can't have both happening at the same time.
You know, people go, Oh, so if I get my child's breathing fixed, the ADHD will go away and go, Well, just pause on that for a moment.
You know, we don't know how much the breathing and sleep is impacting contributing to what we're seeing here.
It's possible your child does have both.
It's not like there's one or the other here.
You can have both.
But what we do know is when there is both, when we get the breathing and sleep better, there may still be a need for medication.
We're not going to deny that the role of that.
Right. Because there are some true actual ADHD.
It's not this many. It's like this.
Well, this is the problem is there's an over over diagnosis and over medication.
But in the context where it is a real thing.
A lot of those children when the breathing and sleep better, they still need the medication, but the dosages they need is a lot less.
So that's got to be a good thing.
Like, you know, anything with medication you want to the dose you take is the least amount possible to give you the benefit that you need without then also the trade off with the side effects that come from it.
So, you know, if we in a scenario where we can get some kids entirely off medication because the diagnosis is wrong, and another group of kids on lesser doses of medication because they have a second disease process that is contributing to their symptoms of ADHD.
You know, like every parent wants the best for their child is sort of, you know, the premise that we're programmed for, you know, so this is again, you know, we have all these sort of accidental jokes.
But you know, this has to be the wake up call right we're talking about sleep. This is the wake up call.
You know, and I think the simple thing that parents need and you know this can be a sound grab to promote this.
There's only in my mind is only three things a parent needs to know about sleep to cover 80 to 90% of this conversation.
The first thing is your kids mouth open at night. Do they snore? Are they tired in the morning? Three things mouth open snoring tired.
If your kids got those things combination 123 or above, you have an underlying medical problem.
Now I can't tell you exactly what that medical problem is going to be. I can give you the vibe of it.
It's an underlying medical problem that your child needs to seek professional care for but be warned. Your doctor may not know what we're talking about and be aware it is not their fault.
No, because they didn't learn it. Yeah, let's just get over the blame game right there. Okay.
But that's where things like this foundation can give the parents what they want and what they need so that they can go in there with awareness.
So that they can go, you know, so and they need to be the advocate and say, right, I have concerns about my child.
I spend more time with my child than you are in this three to 10 minute conversation piece.
And I have concerns about my child. I have noticed that they sleep with their mouth open at night.
And I have become aware that that is a normal that is not a normal breathing pattern and can be a sign that they airway their breathing channels are blocked.
And whilst it's good that they have the mouth to breathe through, it's the nose that they should be using instead.
And I want to know why I have learned that snoring is a noise that is made because there is a blockage in the airway.
I thought it was cute and humorous and funny. I've come now to realize it is actually a warning sign of some form of breathing and sleep problems.
We need to normalize. It's not cute. It's kind of terrifying. So as a parent, let's shift that.
Yeah. Yeah. And then the third thing is waking up tired. Now, waking up tired again doesn't point to the reason.
You know, it can be a sleep quality problem. It can be a sleep quantity problem.
It can actually be due to other underlying medical diseases that are not related to ear, nose and throat at all.
You know, so from that point of view, for adults and children alike, by the way, waking up tired.
That is actually a really serious red flag in the medical speak that needs to be reviewed and assessed and investigated for.
And we're going to have the tunnel vision in this talk with airway because that's what we're here for.
But I just want to broaden the horizons just to highlight it.
So like I said, there's your sound grab right there.
Mouth breathing, snoring, tired. Not normal.
Not normal. I want to ask about one of the questions that we received from parents was about.
And I see this a lot in my insta feed as well. So I know it's out there.
The term neurodivergent. And I want to tell you right now, Gen Z has grabbed this. They're making videos.
They're all excited because I'm neurodivergent in the world.
And parents are going, what is that? Is that a good thing? Is that a bad thing?
Yeah. So again, words have been weaponized in some respects.
And, you know, political correctness has its place.
There are certain things that, you know, we grew up with kids that we said that just abhorrent when we look back at it.
You know, what we said, but you know what, we were kids, we were innocent in the big scheme of things.
There was nothing overly malicious that, you know, and so forth.
So let's just be careful about where we draw some lines in the sand here.
So one of the things that has been weaponized is the word spectrum as part of the ASD,
acronym of autism spectrum disorder. You know, spectrum just means that there's a spread.
I mean, let's just use the word.
Because technically aren't we all on the spectrum? I mean, it's like a giant spectrum. We're all on it.
Everybody's on the spectrum. We're on the spectrum of height.
We're on the spectrum of hair color. We're on the spectrum of skin color.
You know, tell me, tell me where you want to stop. We're on the spectrum of food choices.
We're on the spectrum of religions. We're on the spectrum of countries of origin.
That's what a spectrum means.
Right.
And what it is, is basically, you know, it comes from, you know, the idea of white, you know, we split light out into its wavelengths.
And then we see rainbow. A rainbow is a spectrum of color.
Right.
And that's what the word means. So when you bring it back, it means that we are all, as a starting point, the same.
But then we can start to spread ourselves out to see how we're also not quite the same.
But inside we're all the same. We have to be all the same, you know, we make these pretend differences and so forth.
And it seems to be a human trait. It doesn't matter what we want to nominate.
Right. We have this somehow programmed desire to find differences.
And then sometimes we make those differences issues.
And now we use the words to make it. And it's like, you can't call me autistic. I'm neurodivergent.
And you know what, that's fine. If that's what, if that is important to you, I recognize that.
But let's not then assume that me using the word autistic is me somehow attacking you.
That's not what this is all about. So what is neurodivergent?
Well, it's no different. Neuro means brain. Okay. Divergent means different spectrum.
It's this, you know, it's just an identification thing. And that's fine.
You know, if somebody wants to, you know, use a particular term that they identify with more, that's okay.
You know, and then we have these things, you know, like when I grew up as a kid, I had asthma. Okay.
And, you know, so I said, I said, I'm asthmatic, you know, now you can't say I'm asthmatic.
You say I have asthma because I don't identify, you know, being asthmatic is not my identity.
Asthma is one of my clinical diagnosis. I'm sorry. So you can't say someone is autistic because you're basically saying that's them in a nutshell.
You know, it's no different. You know, it's like, let's, we're weaponizing words when we actually let's just get on with what we can probably put energy into better, which is understanding the condition, understanding the individual, and just get on with the fact that, you know,
whilst we're different, we're also the same. We just got to work out, you know, it's like when you meet someone from a different country, and they have different cultures, and different different belief systems.
And you come into it with respect and understanding. And some of it will be like, oh, okay, this is a bit strange, but you want to make them feel comfortable. So you accommodate them, they're doing the same.
You know, it's a two way street. So, you know, so I think we need to just, you know, just realize we don't need to weaponize words. What we do need to do is actually deal with the underlying issues.
So when it comes to being neuro divergent, I'm neuro divergent, your neuro divergent. Okay. And if people want to, you know, wear that as an identity for some reason that serves a purpose to them.
That's okay. All right. But again, it's really distraction from what we really need to be focusing on, which is to go, All right, we've talked about the sort of the ADHD side of it now we've got the autism side of it.
Let's go. All right. Well, where's autism come into the mix. Well, autism again wasn't a thing.
In fact, historically, the first cases of autism were linked in with schizophrenia. They thought it was a form of schizophrenia.
In terms of behaviors and so forth. And then it was sort of described separately so the autism word is actually historically embedded with schizophrenic autism.
And then the other word that came into being was actually the person that described it was aspergers.
And these things were described in a round about two or three years apart from each other in different parts of the world, and sort of co coexisted and co evolved, and then started to merge where aspergers was then recognized as what we would possibly now call high functioning autism.
And you know, as an example of things. And, you know, moving forwards with that being the case, the autism as a diagnosis again is sort of evolved and been refined and defined, so that we can again start ticking boxes and so forth.
So that we can, you know, put things into categories and so forth, not with a point point too much. And it shouldn't be that putting a label on it.
But it's really just a conduit. You know, the reason you said you said you had cancer. All right. So, you know, when you say you've had cancer that means one thing but also is pretty meaningless in the context of well, I don't know what sort of cancer you got which means I don't know how we're going to fix it.
But we can help you. You say I got cancer you go well look I got this whole range of cancer therapies. But you know was that a skin cancer, or a bowel cancer or a breast cancer because that conversations totally different.
So we do need to label your cancer to provide a treatment to provide a management plan that is best suited. And that's the whole point of having these categories and and so forth.
And it's like, you reason that we've categorized it and put it into this little box is not to put you in the box. It's to help us then understand what do we what belongs to that box that's going to help you as an individual with, you know, in
what medical condition doesn't matter what it is. There's a reason and a purpose. It's not a why we've seen it so much that that they talk about ADHD and our divergence together. I mean, is it possible that.
Yeah, yeah. No, no, again, there's no reason that things can't coexist. And one of the things that we would sort of coming to understand because people go, Why my child, why, you know, what happened.
The thing you got to do is we've got to eliminate how this, you know, especially with the ASD, the autism, how this started. It was that it was parental blame. You go back to the 50s and the 60s.
It was all blamed on the parents. It was the parents fault. That's just the nonsense right there. We need to just beds with that right there. It has got nothing to do with parenting.
It's got everything to do with brain development. And in particular, just how fragile that development is and how these things can come along.
That seemed quite innocuous. That can have a marked impact. And when it comes to ADHD and ASD, there's a lot of things in commonality that can affect brain development.
And it really just depends on which way it pushes you as to whether it has no impact at all, or if it has an ADHD impact or it has an ASD impact, or it has an ADHD and ASD impact, because again, there's commonality there.
It's why, for example, you know, someone that smokes can get lung cancer, or they can get throat cancer, or they can get both. It's the same deal. Okay, because cigarettes can do those things.
It's the same thing. So the, you know, and from an ear nose and throat point of view, breathing and sleep mucks up brain development in ways that it affects brain development that is consistent with.
The things that we see in the brain development of ADHD in the brain development of autism. So, you know, these things can have, you know, underlying contributing factors that can lead to the brain development to the point that there is enough of a divergence that we see you at the
extreme end of the spectrum. Okay, and when you're the extreme end of the spectrum, then we'll be drawing some lines in the sand to say, you know what you're actually at the point where this is dysfunctional from what it needs to be.
Let us then find ways that we can help help you with this. And when we look at things in terms of autism ADHD look at starts in pregnancy. Okay, like in utero, and actually starts one step before that it starts with your genetics.
And we know there are certain underlying genetic factors in play with both of these conditions more so. But we found with the autism side of things. We know there's pregnancy related issues, including by the way, the mum having obstructive sleep apnea herself during pregnancy.
Okay. Okay. We know that there are, you know, early things that happen in life so like getting infections, being premature, birth, getting infections young, these things all play into it.
And then we have other things that come along and then, you know, breathing and sleep is one of them, like even just ear infections is another, you know, just, you know, the innocuous on my child got a few ear infections. Yeah.
In most of the cases, it is innocuous a few ear infections. But if there is any in the programming that is an underlying. And you know, it's the word is tendency. If you have a possibility that you could end up with this.
Okay. Then it might happen. So again, if we go back to the cigarette smoking, for example, cigarette smoking bad, let's just cut up for what it is.
Otherwise, but if you've got some really bad genetics in your mix, that means that if you smoke, you're going to get lung cancer real bad real quick. Well, if you don't smoke, you may not get that lung cancer.
You might, you know, you might get away with it, but you're really bad genetics, but you got away with it.
But you're genetically disposed, but you trigger it basically. The trigger wasn't there to trip you over onto that. It's the same thing. You know, we can find these genetic changes in people that don't have the manifestations of the genetics and that's because it's not just genetics.
It's genetics, it's environment, all sort of blended together. And it's really just a matter of having those those things that come along.
Are we getting into epigenetics at this point or epigenetics? There's all those dynamics that come into play. And epigenetics is again, you know, when I went to university, that was just the rubbish part of DNA.
And now we're realizing, hang on a sec, maybe it's not rubbish after all. And so forth. That's sort of, you know, we're still trying to unravel that, you know, you can stay connected with the Children's Airway first foundation by following us on Instagram,
Facebook, X, LinkedIn, and YouTube. Don't forget to subscribe to the Airway First podcast on your favorite podcasting platform. So you won't miss an upcoming episode.
If you'd like to be a guest or have an idea for an upcoming show, shoot us a note via the contacts page on our website, or send us an email directly at info at children'sairwayfirst.org.
Today's episode was written and directed by Rebecca St. James, video editing and promotion by Ryan Draughan, and guest outreach by Christy Bojinkian.
And finally, thanks to all the parents and medical professionals out there that are working hard to help make the lives of kids around the globe just a little bit better.
Take care, stay safe, and happy breathing, everyone.
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