Hi everybody and welcome to Airway First, a podcast from the Children's Airway First
Foundation.
I'm your host, Rebecca Downing.
Today's episode is the first installment of a two-part series with my guest, Dr. David
McIntosh.
Dr. McIntosh is a pediatric ENT specialist with a particular interest in airway obstruction,
facial and dental development, and its relationship to ENT airway problems and middle-year disease.
Dr. McIntosh has undertaken advanced surgical training in ENT, head and neck surgery, and
pediatric training at Starship Children's Hospital in Auckland, New Zealand.
Dr. McIntosh has been published in peer-reviewed ENT journals throughout the world.
He is also presented on ENT topics throughout Australia and overseas and is a fellow of
the Royal Australian College of Surgeons.
During the course of his career, Dr. McIntosh has held memberships with the Australian and
New Zealand Society of Pediatric Order Laryngology, Australian Rhinological Society, and the Australian
Sleep Association.
He is also the author of Snored to Death.
Are you dying in your sleep?
You can find out more about Dr. McIntosh at entspecialists.com.au.
And now, here is part one of my interview with Dr. David McIntosh.
All right, thanks so much for being here today, Dr. McIntosh.
I appreciate it.
It's a pleasure.
Thank you so much for the opportunity.
Thank you.
So, let's just dig right in.
And I want to talk a little bit first, just kind of set ground set for everybody.
What exactly it is that you do and your specialty as an ENT?
Yeah.
So, as people might jump on to board with my accent, I'm from Australia.
And I did my basic ENT training as is the standard.
And then when I did an extra year of pediatric fellowship training.
And along the journey, I had an interest develop in upper airway obstruction, both in children
and adults.
And over time, that's become quite a strong part of my forte with respect to the types
of cases and patients, therefore, that I see.
So, the majority of my work these days is doing something that sounds remarkably simple.
It's helping people breathe better.
And that has an impact on their health and well-being.
And also ties in strongly with their sleep and sleep quality.
Right.
And you made the comment that it sounds remarkably simple.
Obviously, it's not.
Well, it's something that we all take for granted with respect to breathing.
It's not something that we necessarily consciously focused on or aware of in terms of how we're
breathing.
And then whatever pattern of breathing we develop over time, we accept that as just being the
norm.
So, if for example, someone is a mouth breather, then they grow up.
They're a mouth breather.
And just take that on board as being something that's normal for them.
And it's no big deal.
Right.
And then when you start digging around the edges, then you can sometimes turn up all these
problems that they've got around them that they just again think is just part of who
they are.
So part of the complexity is actually just addressing the fact that people are just so
unaware of the importance of proper breathing in the first place.
And then the next step is particularly with sleep is making parents in particular aware
of the fact that snoring is not normal and that even noisy heavy breathing is not normal.
So part of the challenge is actually just making people aware that there's a problem
and that it's not normal.
Just educating them.
Yeah, absolutely.
Right.
And I can honestly say when I was a first time mom, I felt prey to that same, oh look,
she's snoring.
That's so cute.
And now hindsight, you look back and she stopped obviously.
But looking back, I wonder how many other parents have done that and their child doesn't
grow out of it.
And here's this underlying issue now that the child is contending with and parents don't
realize that that's a problem.
Yeah.
And that's absolutely.
And it's got a criticism of parents.
It's not like there's an instruction book.
Right.
That comes sort of, you know, if this red light is on, then please go see ENT because breathing
is a problem.
So this is again, as you sort of alluded to is the education.
But as we'll go ahead and obviously dig into the weeds as we discuss things, we've got to
have a perspective here.
So when we talk about, you know, snoring, mouth breathing, and then there's this thing
called sleep apnea.
If we're talking about it specifically in the pediatric population, we're talking about
something that's affecting probably 20 to 25% of children in their developmental years.
If you do the simple math on that, that makes this the most common chronic health condition
of childhood.
Right.
And if it's far more common than asthma, far more common than diabetes, I'll guarantee
you most parents have heard those two words and have some sense of what those words mean.
Oh, of course.
But if I was to mention the overarching description of this condition, which is sleep, disorder,
breathing, I'll guarantee you that just get a blank stare for most parents and go sleep,
disorder, breathing, what's that?
Right.
And if at a push, we might hit a mark on something called sleep apnea, and they might
go, oh, yeah, no, about that.
But that's the worst end of the spectrum of a condition that basically is founded on things
that progress over time.
You don't wake up, you know, no pun intended, one day with sleep apnea.
You know, there's a process that leads to the evolution development of these conditions,
and all these stepping stones along the way are opportunities and so forth to identify
something earlier and actually nip it in the bud.
And there's a whole lot of clues that in retrospect, when the child lands on my doorstep, you can
start to sort of piece it all together.
And then all of a sudden, it's like reading an Agatha Christie novel.
And, you know, it's so obvious at the end of the day where those clues are just staring
you in the face, that, you know, it all, it's all laid out and it makes so much sense.
But again, it's all that in hindsight, you know, not knowing what you didn't know.
And then when you do know it, and then it all just makes sense, and parents will go,
oh, that makes so much sense now.
Like the penny literally drops with respect to things that had been, you know, question
marks in their head and concerns along the way that nobody really thought.
And, you know, we've, you know, normalized this to some degree.
You know, we have this term called the terrible twos, for example.
Right.
You know, that's a term that society uses to write off, you know, behavioral issues
in young kids.
That's one of the manifestations of sleep disorder breathing.
So we've normalized things and snoring is a perfect example.
There's plenty of movies that you can watch, you know, where they have kids snoring, you
know, and it's all sort of just representative of the fact that that's part of what you expect
to see when the child is asleep or expect to hear more particularly when the child is
asleep.
Right.
And again, no second thought is given to it.
But when you know what I know, and you see that in the movie, then you just face palm
and just go, he's another time where as a society, we've demonstrated our ignorance
and our acceptance of a condition that has such a deleterious effect on the development
of children.
It really does.
Absolutely.
And in doing so, we have created or manifested this pandemic, this huge issue that is global,
that is 400 million children right now and these children are becoming adults.
And so now we're impacting the medical systems across the board with a variety of chronic
diseases, which we'll discuss that could have been prevented.
Yeah.
And that's what I posted way early on back when this this era of I don't even like using
the term COVID anymore.
So I think we've all got a bit fatigued with it.
Right.
So I posted something said, imagine there was if there was an infection that spread throughout
children and it affected 20 to 25 percent of children and it caused brain damage.
Imagine there was an infection that did that.
How proactive and urgent would we act to address that problem?
That's what sleep disorder breathing is.
Exactly.
So it's no different except the mindset.
You know, if there was an infection that spread through children and resulted in them not
being out of breath properly, which had the consequence of affecting their sleep quality
and reducing the oxygen supply to the brain and disrupting their sleep patterns and then
in turn affecting their school performance and behavior and so forth.
And we had scans that proved it caused brain damage, like literal brain damage on scan
images.
We would have a massive health care crisis that would be front page of every news service
you could think of.
We've got that condition.
It just happens.
Exactly.
It's just an infectious disease per se.
Right.
And it's already here upon us and we're all, again, no pun intended, we're all asleep at
the wheel.
That's true.
And I'd like to talk a little bit more just so parents understand because we've mentioned
it in a few blogs and I know it's mentioned on your site as well.
Both mouth breathing and sleep disorder breathing impact the brain.
I'd just like to dig into that a little bit more so parents understand because I think
when you hear that, it sounds so surreal.
How is that possible?
Okay, so my child is a mouth breather.
Aren't they getting more oxygen?
That's a good thing.
How do these two sleep apnea specifically and mouth breathing, chronic mouth breathing
impact the brain?
So we've used the term sleep disorder breathing.
So just to clarify that in terms of what that encompasses.
So that's the overarching term and what it basically describes is a spectrum.
So if we go back historically, how we landed on this page initially is obviously with adults.
So we identified way back in the day that there was a group of adults that are having
a lot of car accidents and it turned out that they were snoring and stopping breathing
at night and that was the obstructive sleep apnea.
So they had disrupted sleep.
They were tired, they had these little micro moments where they lost their concentration,
lost their focus and as a result had a car accident.
So that's how we tripped over it in adults and then we sort of noticed that there were
kids that were snoring and stopping breathing too.
So they had sleep apnea now, but there was a dichotomy because in the adults, the main
state was that these were significantly overweight obese people.
So that was the paradigm for obstructive sleep apnea that we developed.
And as a consequence, as a by the by, there's a whole cohort of adults that we completely
missed because they weren't obese, they weren't overweight, but they had other issues going
on which actually sort of digs into the weeds as well.
We end up with this as adults in terms of what's found at odd in childhood.
So it knits together quite nicely.
So anyway, but these children, they weren't overweight or obese.
If anything, they weren't growing very well, they tend to be tiny and quite thin and scrawny.
And we sort of noticed that in that group that the issue was that their tonsils and
adenoids in particular, more than anything else, were a problem.
And the ENT started getting involved and removing those tonsils and adenoids.
And it was a little bit confronting because in those children, they didn't have tonsillitis,
which was our historical focus for the procedure.
But in the process of taking those tonsils and adenoids out, those children started doing
better because it removed the obstruction, correct?
It opens up relieving the obstruction.
So all of a sudden there was a change in breathing and so forth.
And the seminal article that that came from was David Gazale, who within the circle of
airways is a well-known researcher and pediatrician in the USA.
And what he did back in the late 90s is he went to his local school board and said, look,
I just want to send this survey to the kids that are in the bottom 10% of your school
grades.
And the survey was very simple.
Does your child stop breathing at night?
Do they snore and stop breathing at night?
It was a simple community screen for airway obstruction.
And where the parents said, oh, yeah, that's my kid.
Those children were then offered the opportunity to see an ENT and where appropriate had the
tonsworn adenoid surgery.
And then fast forward 12 months later of those children that were managed as per stated,
none of them were in the bottom 10% of their class anymore.
So the reason that we tripped over this in children obviously wasn't car accidents.
It was academic performance.
But we're still stuck in this paradigm of obstructive sleep apnea.
But what we noticed along the way is that there was a group of children who they were
snoring, struggling to breathe, but they weren't quite at the point where they were stopping
to breathe.
They didn't have the apneas.
They had just enough basically to fight against it.
But they were working really, really hard to do what should have just come normal and
naturally.
And then they weren't having the apneas.
But again, they had this pattern, you know, again, historically in the mainstay of tonsworn
adenoid problems.
And again, the ENTs dipped their toe in the water and started fixing those kids.
And they started getting better.
And then we started finding that kids that were snoring, again, having breathing issues,
snoring is a noise that is a sign of airway obstruction.
And again, landed on the doorstep of the ENTs, again, behavior problems, school performance
problems, started fixing them.
They started getting better.
And then we tripped over the mouth breathing group and started fixing them.
And they started getting better.
And then so that basically encompasses the overarching term that we call sleep-disorder
breathing, which is a confluence of the fact that the aberrant breathing pattern, whatever
it may be, and obviously varying in what we conceptualize as severity, has an impact on
sleep and that then has an impact on health.
And that health issue, as I said, historically is sort of focused on academic things, but
we've realized now it's behavioral.
And it's also, for example, ADHD.
Right, that is diagnosis.
Yeah, paper that came out in the early 2000s, where children were fronting up to an ENT
clinic with, again, the paradigm at the time was just obstructive sleep apnea.
And there was over 1,000 children and there was like, well, yeah, the ENTs saw them.
It's like, yeah, your tonsillant adenoids.
But before they did that, they presented these children to psychologists and psychiatrists
and said, look, can you make an assessment of these children from your paradigm?
How many of these kids have got ADHD?
And it was a substantial portion of them, met the criteria of ADHD.
And then the ETS get thanks.
Julie noted went and fixed them because that was what was going to happen anyway.
And then 12 months later, brought them back to the psychologist and the psychiatrist and
said, how many more of these kids have still got ADHD?
And a lot of them didn't.
The so-called ADHD was gone.
So they sort of, depending on whose doorstep they would have landed on, they either would
have got an operation or they would have got medication.
And that just highlights a huge problem.
So how does this all evolve and how does this all eventually?
Well, what we need to understand is in children, and this is, you know, one of these despondent
facts that as adults, we need to come to accept the, the child's brain is far more active
than an adult's far more active.
And the reason for that is they're going through a massive amount of learning, whether it's
the initial stages of learning to feed themselves and then learning to talk and learning to
walk and then developing motor skills, learning to write and then hitting school and learning
math and reading and sporting things and so on and so forth.
Massive amount of learning.
Right.
What people may not be fully aware of is our learning happens when we sleep.
So in terms of what happens is the brain functions by basically having this bucket where it's
just everything that happens through the day gets thrown into that bucket.
And then at nighttime, there's a sorting and filtering process that goes on where the brain
looks at each piece of information and then decides whether that's a keep or a toss.
So for example, you would have seen someone today and they would have been wearing something.
Okay.
Your brain doesn't, your brain doesn't care about that.
That's not a useful piece of information unless you gave it some sort of importance.
So for example, you're like, wow, I really like those shoes.
Where do you get those from?
And you make them, you know, what we call a mental note of it.
But you know, then it becomes a key.
And then the brain goes, oh, there was something about that that we want to retain.
So we'll put that in the save file.
So you think of it like, you know, essentially a computer, but imagine it's a computer that
basically needs a clear run at things.
It's got this massive amount of data that it needs to process.
And it has a defined period of time and it has a defined way of that it needs to do.
There's a sequence that it needs to follow.
But then imagine that that computer is plugged into a power supply that is having a power
interruption every 10 seconds or every 30 seconds.
And the computer needs to shut down, reboot and start again.
It's not going to do what it needs to do very well.
And that's what's happening during sleep apnea.
It doesn't get a clear run at it.
And it's because of the sleep disruption, because if there's a disruption in breathing,
then the brain needs to go into survival mode and go, oh, I've got to put my attention to
something else.
That's not where the brain wants to be.
You can find out more about the Children's Airway First Foundation and our mission to
ensure that every child has access to screening, evaluation and treatment of all children's
airway disorders before the age of six on our website at childrensairwayfirst.org.
You can also find a ton of great resources for parents on our website, including videos,
blogs, recommended books, comprehensive medical research, and more.
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue, contact your pediatric airway dentist
or pediatrician.
And now, back to my interview with Dr. David McIntosh.
You know, people think that when we're asleep, the brain switches off.
The brain goes into a very specific mode and it's learning mode.
It obviously needs to tick over in the background because it does all the things that we don't
think about, you know, breathing, monitoring our heart rate, you know, monitoring, you
know, all sorts of things that are going on within our system that's all just on automatic
pilot.
And we're lucky that we've got that because it allows the rest of our brain to do the
other things that we are familiar with.
But when we sleep is when we learn.
So we have basically the perfect storm because if you're not breathing properly for whatever
reason, then you've got the dis disrupted sleep architecture, which means that you're
not building a house on solid foundations.
And furthermore, if you have some form of airway obstruction, then you have an oxygen
supply problem.
And essentially, the brain to function optimally needs a constant reliable supply of two things.
It needs oxygen and it needs sugar.
That's it's two magic ingredients.
And if there's anything going wrong in that context with the oxygen supply, well, again,
that's another layer of problem.
So we're we sort of run into this thing, I think, you know, in the main state obstructive
sleep apnea is an easy one to explain to parents.
You say, look, it's choking.
You go, well, if you're getting tricked, of course, you're not getting oxygen.
That's a really easy concept, you know, but we'll get lost.
Just say, well, mouth breathing, so well, they're taking bigger breaths.
So they're getting more air.
So if they're getting more air, they're getting more oxygen.
It must be good.
Right.
So so why why why can this possibly be an issue?
So what we need to understand is how the air gets from the outside to the inside.
And in very simple terms, when we breathe in the air goes into our lungs, and then within
our lungs, the blood is flowing.
And then there's an interface basically where the air and the blood are allowed to make an
exchange and where basically the deal is that the air will donate oxygen to the blood.
And in return, the blood will remove a byproduct of metabolism called carbon dioxide.
And when we breathe out, we breathe out that carbon dioxide is actually the carbon dioxide
that regulates our breathing because the carbon dioxide is a metabolic byproduct that has an
impact on our body's fluid level.
When we talk about acid and base, what we call pH, carbon dioxide level needs to be just
right.
So the way that that body and nature has hacked that forest is actually giving us a way of
regulating the carbon dioxide and in turn regulating the acidic acidity level of our
blood through breathing.
So breathing is a twofold process.
It's not just about getting the oxygen in, it's actually getting the carbon dioxide out.
And when we breathe in, we only take a fraction of the oxygen that we actually breathe in.
We don't take the whole amount, we take a portion of it.
So what needs to happen is that we need to meet up in the middle.
We need the air that we breathe to meet up with the blood that flows through the lungs.
What happens though is that the blood flow through the lungs is not universally consistent.
So there's more just to keep things simple just to understand how this matches up.
In the mainstay, there's more blood that flows through the bottom of the lung relative to
the top of the lung.
And when we breathe through our nose, relatively speaking, the lower parts of the lung open
up more than the upper parts of the lung.
So when we breathe through our nose, the air that we take in, the balance of the volume
that we breathe, most of it is distributed towards the lower parts of our lung, which
is advantageous because that's where the majority of the blood is.
So we have what we call ventilation, which is basically, all right, you know, we push
air into a space, where does it go to?
So we have that the ventilation of a space, right?
We have perfusion, which is the blood flow.
So we talk about what's called a ventilation perfusion match.
And if they're matched up well, then the air and the blood are pretty much akin to being
in balance.
So we get an optimal system where we get the blood can say basically take the oxygen that
it wants and needs.
When we're a mouth breather, that involves taking bigger breaths.
But in doing so, we're using different muscles.
So when we breathe through our nose, we predominantly use what's called the diaphragm, which is the
lower plunger of muscle.
And in doing so, when it pulls down, it opens up the bottom parts of the lung.
When we mouth breathe, we tend to use the ribs and the muscles around the upper part
of our chest.
And as a consequence, that tends to open up the upper part of our lung.
So when we ventilate, we end up with proportionally more air going to the upper parts than the
lower parts.
And this is what we call a ventilation perfusion mismatch, because the air is going in, but
the blood's not there to meet it.
So there's no exchange.
And as a consequence, there is a whole volume of blood that flows through the lung that
completely misses out on oxygen.
So as a result of that, we have this wasted effort.
The heart has gone to this significant effort of pumping this blood through the lungs, and
the blood basically comes through and turns up empty-handed.
So that's why mouth breathing in its very simple physiology results in this very subtle
oxygen deprivation.
And it is subtle.
It doesn't sound like it's a lot when we say it's 2% to 3%, but that's all it takes
for the brain.
The brain is sitting on this very fragile tipping point where just 3% or more is an
issue.
And if you're a mouth breather, you're already sitting at 2% to 3% deprivation.
So you're sitting on the edge of the cliff.
And then it just takes these subtle little nudges here and there where you're having
to work a little bit harder with your breathing.
So you're getting a little bit of a fatigue thing going on.
And if you've got, you get a little bit of a cold, and you get just that little bit more
blocked, and the parents go, oh, are they snoring?
They go, oh, yeah, only when they've got a cold.
I was like, well, they are mouth breathing, and they go, yeah, they mouth breathe all
the time, and so forth.
And then the little cold just makes everything worse.
Well, that was that little thing that pushed them over the edge of the cliff.
And that's the other counterbalance to this, is that we have the pernicious effect of things
is basically the net balance of people's exposure to the irritant and their ability to cope with
it.
So, you know, this is the only analogy that I can think of.
I use smoking as the example.
We can identify people that picked up a cigarette at the age of six and lived to the age of
110 and smoked a packet of cigarettes for their whole life.
Okay.
And they just had some really good genetics at the end of the day that gave them the resilience
to basically survive against all the bad things that we know smoking does.
But we don't use that as an example to say, see, smoking's okay.
We just go, wow, that person got away with it.
That's an outlier.
And that's the same with this scenario, is that we have a vulnerability level and also
therefore a resilience level.
And it's for some children, they have such a remarkable resilience through their genetics
that they can have these airway problems and it actually doesn't affect them.
They basically got this ability to cope.
They're an outlier.
But that's the exception by far to the rule, just like smoking at the age of 110 is the
exception to the rule.
And for some children, they just need just a micro dose of airway obstruction.
They've got no resilience or ability to cope and they're an absolute mess.
But other children really need to get really quite blocked before they sort of land on
our doorstep in terms of it becoming obvious.
And when we're talking about a mess, it's not just their sleep quality that suddenly
becomes impacted, it's a lower IQ as well as just in general school performance.
It's the misdiagnosis of ADHD.
It's mental and emotional.
Yeah.
So, you're absolutely right.
I'm sort of going to say mess.
I mean, what I'm talking about is just that landscape then of how we then from a medical
point of view actually then trip over these kids.
And by the time we're tripping over these kids, the horse has been bolting for a long
time and has already weighed down the stable, out the paddock, jumped the fence and often
to the distance.
And now we're playing catch up to it all.
So, you know, that's just a sort of in simple terms, just to try and explain how we land
in the terms of a brain problem.
But you know, you've sort of now opened the door, say, well, look, what are the health
issues?
And if we were to, you could nominate any body system, any body part that you want to
nominate.
I can tell you how that has an impact and a problem.
But what's helpful is to just talk about big picture.
Because the big picture is what we need parents to sort of just realize was that clue.
It was that piece of the puzzle where, you know, all of a sudden, we can start to join
these dots together and then make sense of things.
What I talk about in terms of, you know, the big picture is two body systems, the neurological
system, which is the brain and the nerves, and the cardiovascular system, which is the
heart and the blood vessels.
And there are two big systems, you know.
So if we talk about the brain first, what we need to realize is that any, any, any, any
behavioral issue is a manifestation of brain function.
Anything.
You know, right now, my words are a manifestation of my brain.
Okay.
The fact that I'm sitting here with in a certain body position is a manifestation of my brain.
Everything we do in a physical way, in a mental way, is a manifestation of our brain.
So with these children, what I sort of do is sort of have behavior, education, emotions,
their education, sort of clues to, are we off on the wrong track?
You know, is this a child that throws tantrums, that gets upset quite easily, has anger management
issues, has concentration and focus problems, is disruptive, is can't keep to tasks.
You know, is a sort of, you know, whether it's, you know, enough to call it the ADHD
or whatever, you know, just sort of just putting them into a box.
But there's that side of things.
You know, I said, you know, that there are emotions.
You know, do they get upset really easy?
You know, that sort of, you know, crying at the drop of a hat type thing, the really
quite fragile and delicate, and you got to sort of step around them because otherwise
you're just going to have, you know, this thing, and like I said, you know, perfect manifestation
of the so-called terrible tooth.
Right.
You know, perfect manifestation of it.
And because as a side of society, we normalize that with that terminology, well, we don't
go looking for, you know, is this really, you know, way off track?
And then we had their education.
Like I said, you know, this is how this first started, those bottom 10% of the kids.
You know, there's a talk that was done many years ago by a sleep physician here in Australia.
And the title was, can your ENT surgeon make your kid smarter?
You know, and it's not so much about making your child smarter.
It's about reaching their full potential.
You know, and if they've got breathing and sleep problems, well, look, you've got a problem
and their parents might spend, you know, hundreds, if not thousands of dollars on their child's
education and tutoring and so forth to help them with their reading and their writing and
their math.
But they're the things that go off track if their child's got a breathing and sleep problem.
So again, it's just sort of going, oh, there's actually something feeding this that's going
on.
And then, you know, we talk about brain again, we sort of actually then trip into mental
health, you know, as its own category.
And then when I sort of, you know, ADHD sort of, you know, we sort of put that under the
banner of mental health.
But we also put anxiety under there.
And anxiety is significantly escalated by a factor of three to four times the background
population rate in children, you know, in terms of the so-called child norms, if a child
has sleep, a sort of breathing three to four times.
Why?
Well, in simple terms, again, you know, it's more complex than this, but in simple terms,
their brain gets really good at what it gets taught to do.
And if they're having breathing problems at night and the brain is having to go into panic
mode and develops, you know, unnecessary, but obviously, you know, essential stress responses,
well, guess what?
That part of the brain got a good workout at night.
And guess what?
It's going to work really well during the day when it comes to anxiety type issues.
But it doesn't stop at anxiety.
We then start getting into really significant pathologies.
So things such as depression.
Things such as schizophrenia.
Psychosis.
You know, these things, bipolar effective disorder.
These are, you know, psychiatric conditions that can affect children.
And in the group of children with sleep disorder breathing, there's an overmanifestation.
There's a higher rate of such conditions.
And these are not insignificant diseases and affecting children.
These are, you know, quite marked, you know, pathologies.
And they're often again not explored and not asked for because the child turns up to
the doorstep of the psychiatrist and the psychologist.
And the paradigm comes with the tunnel vision of things.
And no one's looking outside of their box to see, all right, what else is going on?
You know, this is the frustration of healthcare is that we treat things in silos.
And then it's all insulated.
So despite the fact that we have the science, we have the research, we have the knowledge
that, you know, we can point to and say, you know, a child with depression is more likely
to have sleep disorder breathing.
And therefore we recommend as psychiatrists that have done this research that this is
a consideration that is made when such children present to clinics.
Most most psychiatrists, as understandably, don't read ENT journals.
It's not on their radar, you know, and again, most ENTs wouldn't be reading psychiatry
literature.
It's not on their radars.
And then all of a sudden we have this silo effect where, you know, we have, you know,
somebody that is yelling at the top of their lungs, but they're encased within the sound
periphery and no one's ever going to hear the message until, you know, opportunities
like this come along.
And then all of a sudden it might be one, just one person will go, that's my kid.
And then they'll go and then they'll say, I think we missed something.
And then they'll go and get an intervention.
And then from that intervention, they have a different trial.
And then all of a sudden they get exactly what we need.
We get an ambassador.
We get an advocate.
I was about to say we're advocating for ourselves and our children.
That's kind of where we are at this point.
All of a sudden we have a convert, we have someone whose eyes have been opened who goes,
I don't want this to happen to another person's child.
I had no, nobody told me about this.
I didn't know about this.
And then I just do not want this to happen again.
And that's, you know, it's an unfortunate way for this to play out, but it's a necessary
thing for people to, you know, spread this word, spread this message.
So anyway, so we can have the, you know, the mental health side of things there.
So you know, do you think about just what we've listed there?
You know, how many kids are struggling at school and needing extra help?
How many kids are going through anxiety things at the moment?
And COVID didn't help that, you know, in terms of, you know, the environment that we created.
So we've given more opportunity for anxiety to come to the surface.
And if they've got a breathing and sleep problem in the background that was opening
the door for that to flourish, well, we've just developed the perfect storm.
So that's, that's the brain in the nutshell.
But you know, what, what, what, what can we do?
You know, that's subjective.
Well, again, we have the research.
People have gone and taken a cohort of children and put them through brain scanning protocols.
It's not something we do, you know, on a clinical level, it's research based.
But what did they find?
Well, the parts of the brain that deal with concentration and behavior are not working properly.
The parts of the brain that deal with memory.
So there's a part of the brain, particularly called the hippocampus is our sort of memory centre.
It's smaller.
The parts of the brain, you know, what's called the frontal lobe that deals with, you know,
behaviour, emotional regulation and so forth.
It's not working properly.
The parts of the brain that deal with learning and, you know, maths, for example, it's not
working properly.
The parts of the brain that deal with processing visual and auditory information.
So what we see and what we hear is not working properly.
You know, we can physically get a window of perspective by looking at brains through
imaging of these children that are not sleeping properly.
And those brains are not normal.
This is brain damage.
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