1 00:00:00,000 --> 00:00:21,120 Hi everybody and welcome to Airway First, a podcast from the Children's Airway First 2 00:00:21,120 --> 00:00:22,120 Foundation. 3 00:00:22,120 --> 00:00:24,920 I'm your host, Rebecca Downing. 4 00:00:24,920 --> 00:00:29,880 Today's episode is the first installment of a two-part series with my guest, Dr. David 5 00:00:29,880 --> 00:00:30,880 McIntosh. 6 00:00:30,880 --> 00:00:37,320 Dr. McIntosh is a pediatric ENT specialist with a particular interest in airway obstruction, 7 00:00:37,320 --> 00:00:43,560 facial and dental development, and its relationship to ENT airway problems and middle-year disease. 8 00:00:43,560 --> 00:00:49,320 Dr. McIntosh has undertaken advanced surgical training in ENT, head and neck surgery, and 9 00:00:49,320 --> 00:00:54,920 pediatric training at Starship Children's Hospital in Auckland, New Zealand. 10 00:00:54,920 --> 00:00:59,680 Dr. McIntosh has been published in peer-reviewed ENT journals throughout the world. 11 00:00:59,680 --> 00:01:04,840 He is also presented on ENT topics throughout Australia and overseas and is a fellow of 12 00:01:04,840 --> 00:01:08,520 the Royal Australian College of Surgeons. 13 00:01:08,520 --> 00:01:13,000 During the course of his career, Dr. McIntosh has held memberships with the Australian and 14 00:01:13,000 --> 00:01:20,320 New Zealand Society of Pediatric Order Laryngology, Australian Rhinological Society, and the Australian 15 00:01:20,320 --> 00:01:21,320 Sleep Association. 16 00:01:21,320 --> 00:01:24,880 He is also the author of Snored to Death. 17 00:01:24,880 --> 00:01:27,880 Are you dying in your sleep? 18 00:01:27,880 --> 00:01:35,880 You can find out more about Dr. McIntosh at entspecialists.com.au. 19 00:01:35,880 --> 00:01:40,080 And now, here is part one of my interview with Dr. David McIntosh. 20 00:01:40,080 --> 00:01:43,840 All right, thanks so much for being here today, Dr. McIntosh. 21 00:01:43,840 --> 00:01:45,960 I appreciate it. 22 00:01:45,960 --> 00:01:46,960 It's a pleasure. 23 00:01:46,960 --> 00:01:48,560 Thank you so much for the opportunity. 24 00:01:48,560 --> 00:01:49,560 Thank you. 25 00:01:49,560 --> 00:01:52,200 So, let's just dig right in. 26 00:01:52,200 --> 00:01:59,080 And I want to talk a little bit first, just kind of set ground set for everybody. 27 00:01:59,080 --> 00:02:04,000 What exactly it is that you do and your specialty as an ENT? 28 00:02:04,000 --> 00:02:05,000 Yeah. 29 00:02:05,000 --> 00:02:11,880 So, as people might jump on to board with my accent, I'm from Australia. 30 00:02:11,880 --> 00:02:17,400 And I did my basic ENT training as is the standard. 31 00:02:17,400 --> 00:02:23,120 And then when I did an extra year of pediatric fellowship training. 32 00:02:23,120 --> 00:02:28,200 And along the journey, I had an interest develop in upper airway obstruction, both in children 33 00:02:28,200 --> 00:02:30,040 and adults. 34 00:02:30,040 --> 00:02:36,680 And over time, that's become quite a strong part of my forte with respect to the types 35 00:02:36,680 --> 00:02:39,680 of cases and patients, therefore, that I see. 36 00:02:39,680 --> 00:02:46,200 So, the majority of my work these days is doing something that sounds remarkably simple. 37 00:02:46,200 --> 00:02:48,760 It's helping people breathe better. 38 00:02:48,760 --> 00:02:53,000 And that has an impact on their health and well-being. 39 00:02:53,000 --> 00:02:56,680 And also ties in strongly with their sleep and sleep quality. 40 00:02:56,680 --> 00:02:57,680 Right. 41 00:02:57,680 --> 00:03:00,560 And you made the comment that it sounds remarkably simple. 42 00:03:00,560 --> 00:03:02,560 Obviously, it's not. 43 00:03:02,560 --> 00:03:07,240 Well, it's something that we all take for granted with respect to breathing. 44 00:03:07,240 --> 00:03:14,240 It's not something that we necessarily consciously focused on or aware of in terms of how we're 45 00:03:14,240 --> 00:03:15,480 breathing. 46 00:03:15,480 --> 00:03:20,240 And then whatever pattern of breathing we develop over time, we accept that as just being the 47 00:03:20,240 --> 00:03:21,240 norm. 48 00:03:21,240 --> 00:03:27,640 So, if for example, someone is a mouth breather, then they grow up. 49 00:03:27,640 --> 00:03:30,400 They're a mouth breather. 50 00:03:30,400 --> 00:03:35,280 And just take that on board as being something that's normal for them. 51 00:03:35,280 --> 00:03:36,440 And it's no big deal. 52 00:03:36,440 --> 00:03:37,440 Right. 53 00:03:37,440 --> 00:03:41,160 And then when you start digging around the edges, then you can sometimes turn up all these 54 00:03:41,160 --> 00:03:46,120 problems that they've got around them that they just again think is just part of who 55 00:03:46,120 --> 00:03:47,760 they are. 56 00:03:47,760 --> 00:03:52,520 So part of the complexity is actually just addressing the fact that people are just so 57 00:03:52,520 --> 00:03:57,440 unaware of the importance of proper breathing in the first place. 58 00:03:57,440 --> 00:04:05,360 And then the next step is particularly with sleep is making parents in particular aware 59 00:04:05,360 --> 00:04:13,840 of the fact that snoring is not normal and that even noisy heavy breathing is not normal. 60 00:04:13,840 --> 00:04:19,160 So part of the challenge is actually just making people aware that there's a problem 61 00:04:19,160 --> 00:04:22,760 and that it's not normal. 62 00:04:22,760 --> 00:04:24,120 Just educating them. 63 00:04:24,120 --> 00:04:25,600 Yeah, absolutely. 64 00:04:25,600 --> 00:04:27,600 Right. 65 00:04:27,600 --> 00:04:34,160 And I can honestly say when I was a first time mom, I felt prey to that same, oh look, 66 00:04:34,160 --> 00:04:35,160 she's snoring. 67 00:04:35,160 --> 00:04:36,160 That's so cute. 68 00:04:36,160 --> 00:04:39,440 And now hindsight, you look back and she stopped obviously. 69 00:04:39,440 --> 00:04:44,440 But looking back, I wonder how many other parents have done that and their child doesn't 70 00:04:44,440 --> 00:04:46,080 grow out of it. 71 00:04:46,080 --> 00:04:51,760 And here's this underlying issue now that the child is contending with and parents don't 72 00:04:51,760 --> 00:04:53,760 realize that that's a problem. 73 00:04:53,760 --> 00:04:54,760 Yeah. 74 00:04:54,760 --> 00:04:55,760 And that's absolutely. 75 00:04:55,760 --> 00:04:58,320 And it's got a criticism of parents. 76 00:04:58,320 --> 00:05:00,040 It's not like there's an instruction book. 77 00:05:00,040 --> 00:05:01,040 Right. 78 00:05:01,040 --> 00:05:07,440 That comes sort of, you know, if this red light is on, then please go see ENT because breathing 79 00:05:07,440 --> 00:05:09,040 is a problem. 80 00:05:09,040 --> 00:05:12,080 So this is again, as you sort of alluded to is the education. 81 00:05:12,080 --> 00:05:17,720 But as we'll go ahead and obviously dig into the weeds as we discuss things, we've got to 82 00:05:17,720 --> 00:05:18,960 have a perspective here. 83 00:05:18,960 --> 00:05:24,480 So when we talk about, you know, snoring, mouth breathing, and then there's this thing 84 00:05:24,480 --> 00:05:25,480 called sleep apnea. 85 00:05:25,480 --> 00:05:31,000 If we're talking about it specifically in the pediatric population, we're talking about 86 00:05:31,000 --> 00:05:37,920 something that's affecting probably 20 to 25% of children in their developmental years. 87 00:05:37,920 --> 00:05:44,280 If you do the simple math on that, that makes this the most common chronic health condition 88 00:05:44,280 --> 00:05:45,280 of childhood. 89 00:05:45,280 --> 00:05:46,280 Right. 90 00:05:46,280 --> 00:05:50,200 And if it's far more common than asthma, far more common than diabetes, I'll guarantee 91 00:05:50,200 --> 00:05:55,560 you most parents have heard those two words and have some sense of what those words mean. 92 00:05:55,560 --> 00:05:56,560 Oh, of course. 93 00:05:56,560 --> 00:06:03,880 But if I was to mention the overarching description of this condition, which is sleep, disorder, 94 00:06:03,880 --> 00:06:09,160 breathing, I'll guarantee you that just get a blank stare for most parents and go sleep, 95 00:06:09,160 --> 00:06:11,440 disorder, breathing, what's that? 96 00:06:11,440 --> 00:06:12,440 Right. 97 00:06:12,440 --> 00:06:18,000 And if at a push, we might hit a mark on something called sleep apnea, and they might 98 00:06:18,000 --> 00:06:20,040 go, oh, yeah, no, about that. 99 00:06:20,040 --> 00:06:25,160 But that's the worst end of the spectrum of a condition that basically is founded on things 100 00:06:25,160 --> 00:06:27,160 that progress over time. 101 00:06:27,160 --> 00:06:32,360 You don't wake up, you know, no pun intended, one day with sleep apnea. 102 00:06:32,360 --> 00:06:37,960 You know, there's a process that leads to the evolution development of these conditions, 103 00:06:37,960 --> 00:06:44,520 and all these stepping stones along the way are opportunities and so forth to identify 104 00:06:44,520 --> 00:06:48,000 something earlier and actually nip it in the bud. 105 00:06:48,000 --> 00:06:54,400 And there's a whole lot of clues that in retrospect, when the child lands on my doorstep, you can 106 00:06:54,400 --> 00:06:57,240 start to sort of piece it all together. 107 00:06:57,240 --> 00:07:00,720 And then all of a sudden, it's like reading an Agatha Christie novel. 108 00:07:00,720 --> 00:07:06,280 And, you know, it's so obvious at the end of the day where those clues are just staring 109 00:07:06,280 --> 00:07:11,480 you in the face, that, you know, it all, it's all laid out and it makes so much sense. 110 00:07:11,480 --> 00:07:16,400 But again, it's all that in hindsight, you know, not knowing what you didn't know. 111 00:07:16,400 --> 00:07:20,040 And then when you do know it, and then it all just makes sense, and parents will go, 112 00:07:20,040 --> 00:07:22,560 oh, that makes so much sense now. 113 00:07:22,560 --> 00:07:30,240 Like the penny literally drops with respect to things that had been, you know, question 114 00:07:30,240 --> 00:07:35,680 marks in their head and concerns along the way that nobody really thought. 115 00:07:35,680 --> 00:07:39,360 And, you know, we've, you know, normalized this to some degree. 116 00:07:39,360 --> 00:07:43,040 You know, we have this term called the terrible twos, for example. 117 00:07:43,040 --> 00:07:44,040 Right. 118 00:07:44,040 --> 00:07:50,200 You know, that's a term that society uses to write off, you know, behavioral issues 119 00:07:50,200 --> 00:07:53,320 in young kids. 120 00:07:53,320 --> 00:07:57,040 That's one of the manifestations of sleep disorder breathing. 121 00:07:57,040 --> 00:08:02,320 So we've normalized things and snoring is a perfect example. 122 00:08:02,320 --> 00:08:08,160 There's plenty of movies that you can watch, you know, where they have kids snoring, you 123 00:08:08,160 --> 00:08:14,080 know, and it's all sort of just representative of the fact that that's part of what you expect 124 00:08:14,080 --> 00:08:17,840 to see when the child is asleep or expect to hear more particularly when the child is 125 00:08:17,840 --> 00:08:18,840 asleep. 126 00:08:18,840 --> 00:08:19,840 Right. 127 00:08:19,840 --> 00:08:23,040 And again, no second thought is given to it. 128 00:08:23,040 --> 00:08:28,120 But when you know what I know, and you see that in the movie, then you just face palm 129 00:08:28,120 --> 00:08:36,440 and just go, he's another time where as a society, we've demonstrated our ignorance 130 00:08:36,440 --> 00:08:42,720 and our acceptance of a condition that has such a deleterious effect on the development 131 00:08:42,720 --> 00:08:43,720 of children. 132 00:08:43,720 --> 00:08:44,720 It really does. 133 00:08:44,720 --> 00:08:45,720 Absolutely. 134 00:08:45,720 --> 00:08:55,480 And in doing so, we have created or manifested this pandemic, this huge issue that is global, 135 00:08:55,480 --> 00:08:59,800 that is 400 million children right now and these children are becoming adults. 136 00:08:59,800 --> 00:09:05,720 And so now we're impacting the medical systems across the board with a variety of chronic 137 00:09:05,720 --> 00:09:09,200 diseases, which we'll discuss that could have been prevented. 138 00:09:09,200 --> 00:09:10,200 Yeah. 139 00:09:10,200 --> 00:09:18,760 And that's what I posted way early on back when this this era of I don't even like using 140 00:09:18,760 --> 00:09:20,280 the term COVID anymore. 141 00:09:20,280 --> 00:09:23,280 So I think we've all got a bit fatigued with it. 142 00:09:23,280 --> 00:09:24,280 Right. 143 00:09:24,280 --> 00:09:29,360 So I posted something said, imagine there was if there was an infection that spread throughout 144 00:09:29,360 --> 00:09:36,400 children and it affected 20 to 25 percent of children and it caused brain damage. 145 00:09:36,400 --> 00:09:38,640 Imagine there was an infection that did that. 146 00:09:38,640 --> 00:09:49,800 How proactive and urgent would we act to address that problem? 147 00:09:49,800 --> 00:09:51,480 That's what sleep disorder breathing is. 148 00:09:51,480 --> 00:09:52,480 Exactly. 149 00:09:52,480 --> 00:09:54,520 So it's no different except the mindset. 150 00:09:54,520 --> 00:10:00,760 You know, if there was an infection that spread through children and resulted in them not 151 00:10:00,760 --> 00:10:05,200 being out of breath properly, which had the consequence of affecting their sleep quality 152 00:10:05,200 --> 00:10:10,480 and reducing the oxygen supply to the brain and disrupting their sleep patterns and then 153 00:10:10,480 --> 00:10:18,080 in turn affecting their school performance and behavior and so forth. 154 00:10:18,080 --> 00:10:26,640 And we had scans that proved it caused brain damage, like literal brain damage on scan 155 00:10:26,640 --> 00:10:28,800 images. 156 00:10:28,800 --> 00:10:38,160 We would have a massive health care crisis that would be front page of every news service 157 00:10:38,160 --> 00:10:40,600 you could think of. 158 00:10:40,600 --> 00:10:41,600 We've got that condition. 159 00:10:41,600 --> 00:10:42,600 It just happens. 160 00:10:42,600 --> 00:10:43,600 Exactly. 161 00:10:43,600 --> 00:10:45,600 It's just an infectious disease per se. 162 00:10:45,600 --> 00:10:46,600 Right. 163 00:10:46,600 --> 00:10:51,960 And it's already here upon us and we're all, again, no pun intended, we're all asleep at 164 00:10:51,960 --> 00:10:53,960 the wheel. 165 00:10:53,960 --> 00:10:54,960 That's true. 166 00:10:54,960 --> 00:10:55,960 That's true. 167 00:10:55,960 --> 00:11:01,320 And I'd like to talk a little bit more just so parents understand because we've mentioned 168 00:11:01,320 --> 00:11:05,040 it in a few blogs and I know it's mentioned on your site as well. 169 00:11:05,040 --> 00:11:10,640 Both mouth breathing and sleep disorder breathing impact the brain. 170 00:11:10,640 --> 00:11:14,600 I'd just like to dig into that a little bit more so parents understand because I think 171 00:11:14,600 --> 00:11:18,000 when you hear that, it sounds so surreal. 172 00:11:18,000 --> 00:11:19,000 How is that possible? 173 00:11:19,000 --> 00:11:21,680 Okay, so my child is a mouth breather. 174 00:11:21,680 --> 00:11:23,600 Aren't they getting more oxygen? 175 00:11:23,600 --> 00:11:25,600 That's a good thing. 176 00:11:25,600 --> 00:11:32,280 How do these two sleep apnea specifically and mouth breathing, chronic mouth breathing 177 00:11:32,280 --> 00:11:34,680 impact the brain? 178 00:11:34,680 --> 00:11:38,400 So we've used the term sleep disorder breathing. 179 00:11:38,400 --> 00:11:41,920 So just to clarify that in terms of what that encompasses. 180 00:11:41,920 --> 00:11:46,640 So that's the overarching term and what it basically describes is a spectrum. 181 00:11:46,640 --> 00:11:53,840 So if we go back historically, how we landed on this page initially is obviously with adults. 182 00:11:53,840 --> 00:11:58,120 So we identified way back in the day that there was a group of adults that are having 183 00:11:58,120 --> 00:12:03,320 a lot of car accidents and it turned out that they were snoring and stopping breathing 184 00:12:03,320 --> 00:12:06,720 at night and that was the obstructive sleep apnea. 185 00:12:06,720 --> 00:12:08,080 So they had disrupted sleep. 186 00:12:08,080 --> 00:12:13,960 They were tired, they had these little micro moments where they lost their concentration, 187 00:12:13,960 --> 00:12:17,120 lost their focus and as a result had a car accident. 188 00:12:17,120 --> 00:12:20,280 So that's how we tripped over it in adults and then we sort of noticed that there were 189 00:12:20,280 --> 00:12:23,400 kids that were snoring and stopping breathing too. 190 00:12:23,400 --> 00:12:28,800 So they had sleep apnea now, but there was a dichotomy because in the adults, the main 191 00:12:28,800 --> 00:12:33,720 state was that these were significantly overweight obese people. 192 00:12:33,720 --> 00:12:39,160 So that was the paradigm for obstructive sleep apnea that we developed. 193 00:12:39,160 --> 00:12:43,840 And as a consequence, as a by the by, there's a whole cohort of adults that we completely 194 00:12:43,840 --> 00:12:48,320 missed because they weren't obese, they weren't overweight, but they had other issues going 195 00:12:48,320 --> 00:12:51,800 on which actually sort of digs into the weeds as well. 196 00:12:51,800 --> 00:12:56,120 We end up with this as adults in terms of what's found at odd in childhood. 197 00:12:56,120 --> 00:12:58,800 So it knits together quite nicely. 198 00:12:58,800 --> 00:13:01,600 So anyway, but these children, they weren't overweight or obese. 199 00:13:01,600 --> 00:13:07,960 If anything, they weren't growing very well, they tend to be tiny and quite thin and scrawny. 200 00:13:07,960 --> 00:13:11,420 And we sort of noticed that in that group that the issue was that their tonsils and 201 00:13:11,420 --> 00:13:16,520 adenoids in particular, more than anything else, were a problem. 202 00:13:16,520 --> 00:13:21,400 And the ENT started getting involved and removing those tonsils and adenoids. 203 00:13:21,400 --> 00:13:26,840 And it was a little bit confronting because in those children, they didn't have tonsillitis, 204 00:13:26,840 --> 00:13:30,480 which was our historical focus for the procedure. 205 00:13:30,480 --> 00:13:34,080 But in the process of taking those tonsils and adenoids out, those children started doing 206 00:13:34,080 --> 00:13:36,920 better because it removed the obstruction, correct? 207 00:13:36,920 --> 00:13:38,880 It opens up relieving the obstruction. 208 00:13:38,880 --> 00:13:44,240 So all of a sudden there was a change in breathing and so forth. 209 00:13:44,240 --> 00:13:51,040 And the seminal article that that came from was David Gazale, who within the circle of 210 00:13:51,040 --> 00:13:56,360 airways is a well-known researcher and pediatrician in the USA. 211 00:13:56,360 --> 00:14:01,440 And what he did back in the late 90s is he went to his local school board and said, look, 212 00:14:01,440 --> 00:14:05,640 I just want to send this survey to the kids that are in the bottom 10% of your school 213 00:14:05,640 --> 00:14:06,640 grades. 214 00:14:06,640 --> 00:14:08,160 And the survey was very simple. 215 00:14:08,160 --> 00:14:09,640 Does your child stop breathing at night? 216 00:14:09,640 --> 00:14:11,440 Do they snore and stop breathing at night? 217 00:14:11,440 --> 00:14:17,840 It was a simple community screen for airway obstruction. 218 00:14:17,840 --> 00:14:21,280 And where the parents said, oh, yeah, that's my kid. 219 00:14:21,280 --> 00:14:25,560 Those children were then offered the opportunity to see an ENT and where appropriate had the 220 00:14:25,560 --> 00:14:27,960 tonsworn adenoid surgery. 221 00:14:27,960 --> 00:14:33,760 And then fast forward 12 months later of those children that were managed as per stated, 222 00:14:33,760 --> 00:14:36,920 none of them were in the bottom 10% of their class anymore. 223 00:14:36,920 --> 00:14:40,480 So the reason that we tripped over this in children obviously wasn't car accidents. 224 00:14:40,480 --> 00:14:44,760 It was academic performance. 225 00:14:44,760 --> 00:14:48,760 But we're still stuck in this paradigm of obstructive sleep apnea. 226 00:14:48,760 --> 00:14:55,520 But what we noticed along the way is that there was a group of children who they were 227 00:14:55,520 --> 00:14:59,400 snoring, struggling to breathe, but they weren't quite at the point where they were stopping 228 00:14:59,400 --> 00:15:00,400 to breathe. 229 00:15:00,400 --> 00:15:02,320 They didn't have the apneas. 230 00:15:02,320 --> 00:15:06,760 They had just enough basically to fight against it. 231 00:15:06,760 --> 00:15:10,960 But they were working really, really hard to do what should have just come normal and 232 00:15:10,960 --> 00:15:11,960 naturally. 233 00:15:11,960 --> 00:15:13,920 And then they weren't having the apneas. 234 00:15:13,920 --> 00:15:19,160 But again, they had this pattern, you know, again, historically in the mainstay of tonsworn 235 00:15:19,160 --> 00:15:20,800 adenoid problems. 236 00:15:20,800 --> 00:15:25,000 And again, the ENTs dipped their toe in the water and started fixing those kids. 237 00:15:25,000 --> 00:15:28,600 And they started getting better. 238 00:15:28,600 --> 00:15:36,240 And then we started finding that kids that were snoring, again, having breathing issues, 239 00:15:36,240 --> 00:15:39,960 snoring is a noise that is a sign of airway obstruction. 240 00:15:39,960 --> 00:15:44,640 And again, landed on the doorstep of the ENTs, again, behavior problems, school performance 241 00:15:44,640 --> 00:15:47,040 problems, started fixing them. 242 00:15:47,040 --> 00:15:49,200 They started getting better. 243 00:15:49,200 --> 00:15:54,400 And then we tripped over the mouth breathing group and started fixing them. 244 00:15:54,400 --> 00:15:57,080 And they started getting better. 245 00:15:57,080 --> 00:16:01,680 And then so that basically encompasses the overarching term that we call sleep-disorder 246 00:16:01,680 --> 00:16:09,320 breathing, which is a confluence of the fact that the aberrant breathing pattern, whatever 247 00:16:09,320 --> 00:16:16,680 it may be, and obviously varying in what we conceptualize as severity, has an impact on 248 00:16:16,680 --> 00:16:20,760 sleep and that then has an impact on health. 249 00:16:20,760 --> 00:16:25,960 And that health issue, as I said, historically is sort of focused on academic things, but 250 00:16:25,960 --> 00:16:28,960 we've realized now it's behavioral. 251 00:16:28,960 --> 00:16:31,400 And it's also, for example, ADHD. 252 00:16:31,400 --> 00:16:33,400 Right, that is diagnosis. 253 00:16:33,400 --> 00:16:41,040 Yeah, paper that came out in the early 2000s, where children were fronting up to an ENT 254 00:16:41,040 --> 00:16:47,320 clinic with, again, the paradigm at the time was just obstructive sleep apnea. 255 00:16:47,320 --> 00:16:52,160 And there was over 1,000 children and there was like, well, yeah, the ENTs saw them. 256 00:16:52,160 --> 00:16:54,600 It's like, yeah, your tonsillant adenoids. 257 00:16:54,600 --> 00:17:00,440 But before they did that, they presented these children to psychologists and psychiatrists 258 00:17:00,440 --> 00:17:04,640 and said, look, can you make an assessment of these children from your paradigm? 259 00:17:04,640 --> 00:17:06,920 How many of these kids have got ADHD? 260 00:17:06,920 --> 00:17:12,000 And it was a substantial portion of them, met the criteria of ADHD. 261 00:17:12,000 --> 00:17:13,280 And then the ETS get thanks. 262 00:17:13,280 --> 00:17:17,480 Julie noted went and fixed them because that was what was going to happen anyway. 263 00:17:17,480 --> 00:17:21,600 And then 12 months later, brought them back to the psychologist and the psychiatrist and 264 00:17:21,600 --> 00:17:24,960 said, how many more of these kids have still got ADHD? 265 00:17:24,960 --> 00:17:26,200 And a lot of them didn't. 266 00:17:26,200 --> 00:17:29,960 The so-called ADHD was gone. 267 00:17:29,960 --> 00:17:33,840 So they sort of, depending on whose doorstep they would have landed on, they either would 268 00:17:33,840 --> 00:17:37,440 have got an operation or they would have got medication. 269 00:17:37,440 --> 00:17:40,800 And that just highlights a huge problem. 270 00:17:40,800 --> 00:17:43,520 So how does this all evolve and how does this all eventually? 271 00:17:43,520 --> 00:17:47,840 Well, what we need to understand is in children, and this is, you know, one of these despondent 272 00:17:47,840 --> 00:17:54,720 facts that as adults, we need to come to accept the, the child's brain is far more active 273 00:17:54,720 --> 00:17:57,720 than an adult's far more active. 274 00:17:57,720 --> 00:18:02,520 And the reason for that is they're going through a massive amount of learning, whether it's 275 00:18:02,520 --> 00:18:09,160 the initial stages of learning to feed themselves and then learning to talk and learning to 276 00:18:09,160 --> 00:18:15,360 walk and then developing motor skills, learning to write and then hitting school and learning 277 00:18:15,360 --> 00:18:22,040 math and reading and sporting things and so on and so forth. 278 00:18:22,040 --> 00:18:23,200 Massive amount of learning. 279 00:18:23,200 --> 00:18:24,200 Right. 280 00:18:24,200 --> 00:18:29,400 What people may not be fully aware of is our learning happens when we sleep. 281 00:18:29,400 --> 00:18:36,840 So in terms of what happens is the brain functions by basically having this bucket where it's 282 00:18:36,840 --> 00:18:41,160 just everything that happens through the day gets thrown into that bucket. 283 00:18:41,160 --> 00:18:45,840 And then at nighttime, there's a sorting and filtering process that goes on where the brain 284 00:18:45,840 --> 00:18:51,280 looks at each piece of information and then decides whether that's a keep or a toss. 285 00:18:51,280 --> 00:18:58,200 So for example, you would have seen someone today and they would have been wearing something. 286 00:18:58,200 --> 00:18:59,200 Okay. 287 00:18:59,200 --> 00:19:00,960 Your brain doesn't, your brain doesn't care about that. 288 00:19:00,960 --> 00:19:05,840 That's not a useful piece of information unless you gave it some sort of importance. 289 00:19:05,840 --> 00:19:08,920 So for example, you're like, wow, I really like those shoes. 290 00:19:08,920 --> 00:19:09,920 Where do you get those from? 291 00:19:09,920 --> 00:19:13,560 And you make them, you know, what we call a mental note of it. 292 00:19:13,560 --> 00:19:16,280 But you know, then it becomes a key. 293 00:19:16,280 --> 00:19:21,040 And then the brain goes, oh, there was something about that that we want to retain. 294 00:19:21,040 --> 00:19:24,320 So we'll put that in the save file. 295 00:19:24,320 --> 00:19:28,920 So you think of it like, you know, essentially a computer, but imagine it's a computer that 296 00:19:28,920 --> 00:19:31,040 basically needs a clear run at things. 297 00:19:31,040 --> 00:19:34,280 It's got this massive amount of data that it needs to process. 298 00:19:34,280 --> 00:19:38,800 And it has a defined period of time and it has a defined way of that it needs to do. 299 00:19:38,800 --> 00:19:42,080 There's a sequence that it needs to follow. 300 00:19:42,080 --> 00:19:46,400 But then imagine that that computer is plugged into a power supply that is having a power 301 00:19:46,400 --> 00:19:50,640 interruption every 10 seconds or every 30 seconds. 302 00:19:50,640 --> 00:19:55,880 And the computer needs to shut down, reboot and start again. 303 00:19:55,880 --> 00:19:59,040 It's not going to do what it needs to do very well. 304 00:19:59,040 --> 00:20:02,120 And that's what's happening during sleep apnea. 305 00:20:02,120 --> 00:20:04,160 It doesn't get a clear run at it. 306 00:20:04,160 --> 00:20:10,080 And it's because of the sleep disruption, because if there's a disruption in breathing, 307 00:20:10,080 --> 00:20:16,880 then the brain needs to go into survival mode and go, oh, I've got to put my attention to 308 00:20:16,880 --> 00:20:17,880 something else. 309 00:20:17,880 --> 00:20:29,600 That's not where the brain wants to be. 310 00:20:29,600 --> 00:20:38,160 You can find out more about the Children's Airway First Foundation and our mission to 311 00:20:38,160 --> 00:20:43,360 ensure that every child has access to screening, evaluation and treatment of all children's 312 00:20:43,360 --> 00:20:50,920 airway disorders before the age of six on our website at childrensairwayfirst.org. 313 00:20:50,920 --> 00:20:55,800 You can also find a ton of great resources for parents on our website, including videos, 314 00:20:55,800 --> 00:21:01,560 blogs, recommended books, comprehensive medical research, and more. 315 00:21:01,560 --> 00:21:07,200 As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. 316 00:21:07,200 --> 00:21:12,160 If you suspect your child might have an airway issue, contact your pediatric airway dentist 317 00:21:12,160 --> 00:21:14,120 or pediatrician. 318 00:21:14,120 --> 00:21:28,960 And now, back to my interview with Dr. David McIntosh. 319 00:21:28,960 --> 00:21:32,200 You know, people think that when we're asleep, the brain switches off. 320 00:21:32,200 --> 00:21:36,400 The brain goes into a very specific mode and it's learning mode. 321 00:21:36,400 --> 00:21:39,920 It obviously needs to tick over in the background because it does all the things that we don't 322 00:21:39,920 --> 00:21:44,880 think about, you know, breathing, monitoring our heart rate, you know, monitoring, you 323 00:21:44,880 --> 00:21:49,720 know, all sorts of things that are going on within our system that's all just on automatic 324 00:21:49,720 --> 00:21:51,720 pilot. 325 00:21:51,720 --> 00:21:55,160 And we're lucky that we've got that because it allows the rest of our brain to do the 326 00:21:55,160 --> 00:21:57,480 other things that we are familiar with. 327 00:21:57,480 --> 00:21:59,960 But when we sleep is when we learn. 328 00:21:59,960 --> 00:22:05,000 So we have basically the perfect storm because if you're not breathing properly for whatever 329 00:22:05,000 --> 00:22:12,120 reason, then you've got the dis disrupted sleep architecture, which means that you're 330 00:22:12,120 --> 00:22:15,920 not building a house on solid foundations. 331 00:22:15,920 --> 00:22:20,520 And furthermore, if you have some form of airway obstruction, then you have an oxygen 332 00:22:20,520 --> 00:22:22,240 supply problem. 333 00:22:22,240 --> 00:22:29,040 And essentially, the brain to function optimally needs a constant reliable supply of two things. 334 00:22:29,040 --> 00:22:32,160 It needs oxygen and it needs sugar. 335 00:22:32,160 --> 00:22:35,640 That's it's two magic ingredients. 336 00:22:35,640 --> 00:22:42,320 And if there's anything going wrong in that context with the oxygen supply, well, again, 337 00:22:42,320 --> 00:22:44,880 that's another layer of problem. 338 00:22:44,880 --> 00:22:49,520 So we're we sort of run into this thing, I think, you know, in the main state obstructive 339 00:22:49,520 --> 00:22:52,600 sleep apnea is an easy one to explain to parents. 340 00:22:52,600 --> 00:22:53,600 You say, look, it's choking. 341 00:22:53,600 --> 00:22:57,720 You go, well, if you're getting tricked, of course, you're not getting oxygen. 342 00:22:57,720 --> 00:23:01,440 That's a really easy concept, you know, but we'll get lost. 343 00:23:01,440 --> 00:23:04,640 Just say, well, mouth breathing, so well, they're taking bigger breaths. 344 00:23:04,640 --> 00:23:05,640 So they're getting more air. 345 00:23:05,640 --> 00:23:07,960 So if they're getting more air, they're getting more oxygen. 346 00:23:07,960 --> 00:23:08,960 It must be good. 347 00:23:08,960 --> 00:23:09,960 Right. 348 00:23:09,960 --> 00:23:12,160 So so why why why can this possibly be an issue? 349 00:23:12,160 --> 00:23:17,960 So what we need to understand is how the air gets from the outside to the inside. 350 00:23:17,960 --> 00:23:23,040 And in very simple terms, when we breathe in the air goes into our lungs, and then within 351 00:23:23,040 --> 00:23:25,680 our lungs, the blood is flowing. 352 00:23:25,680 --> 00:23:31,640 And then there's an interface basically where the air and the blood are allowed to make an 353 00:23:31,640 --> 00:23:40,240 exchange and where basically the deal is that the air will donate oxygen to the blood. 354 00:23:40,240 --> 00:23:46,080 And in return, the blood will remove a byproduct of metabolism called carbon dioxide. 355 00:23:46,080 --> 00:23:51,320 And when we breathe out, we breathe out that carbon dioxide is actually the carbon dioxide 356 00:23:51,320 --> 00:23:56,880 that regulates our breathing because the carbon dioxide is a metabolic byproduct that has an 357 00:23:56,880 --> 00:24:01,960 impact on our body's fluid level. 358 00:24:01,960 --> 00:24:09,000 When we talk about acid and base, what we call pH, carbon dioxide level needs to be just 359 00:24:09,000 --> 00:24:10,000 right. 360 00:24:10,000 --> 00:24:14,720 So the way that that body and nature has hacked that forest is actually giving us a way of 361 00:24:14,720 --> 00:24:20,480 regulating the carbon dioxide and in turn regulating the acidic acidity level of our 362 00:24:20,480 --> 00:24:23,320 blood through breathing. 363 00:24:23,320 --> 00:24:26,120 So breathing is a twofold process. 364 00:24:26,120 --> 00:24:31,200 It's not just about getting the oxygen in, it's actually getting the carbon dioxide out. 365 00:24:31,200 --> 00:24:35,720 And when we breathe in, we only take a fraction of the oxygen that we actually breathe in. 366 00:24:35,720 --> 00:24:39,480 We don't take the whole amount, we take a portion of it. 367 00:24:39,480 --> 00:24:44,800 So what needs to happen is that we need to meet up in the middle. 368 00:24:44,800 --> 00:24:51,680 We need the air that we breathe to meet up with the blood that flows through the lungs. 369 00:24:51,680 --> 00:24:57,440 What happens though is that the blood flow through the lungs is not universally consistent. 370 00:24:57,440 --> 00:25:02,880 So there's more just to keep things simple just to understand how this matches up. 371 00:25:02,880 --> 00:25:07,840 In the mainstay, there's more blood that flows through the bottom of the lung relative to 372 00:25:07,840 --> 00:25:09,600 the top of the lung. 373 00:25:09,600 --> 00:25:16,040 And when we breathe through our nose, relatively speaking, the lower parts of the lung open 374 00:25:16,040 --> 00:25:18,520 up more than the upper parts of the lung. 375 00:25:18,520 --> 00:25:26,640 So when we breathe through our nose, the air that we take in, the balance of the volume 376 00:25:26,640 --> 00:25:32,000 that we breathe, most of it is distributed towards the lower parts of our lung, which 377 00:25:32,000 --> 00:25:37,200 is advantageous because that's where the majority of the blood is. 378 00:25:37,200 --> 00:25:41,960 So we have what we call ventilation, which is basically, all right, you know, we push 379 00:25:41,960 --> 00:25:44,000 air into a space, where does it go to? 380 00:25:44,000 --> 00:25:47,000 So we have that the ventilation of a space, right? 381 00:25:47,000 --> 00:25:49,480 We have perfusion, which is the blood flow. 382 00:25:49,480 --> 00:25:52,720 So we talk about what's called a ventilation perfusion match. 383 00:25:52,720 --> 00:25:58,200 And if they're matched up well, then the air and the blood are pretty much akin to being 384 00:25:58,200 --> 00:25:59,480 in balance. 385 00:25:59,480 --> 00:26:05,280 So we get an optimal system where we get the blood can say basically take the oxygen that 386 00:26:05,280 --> 00:26:07,880 it wants and needs. 387 00:26:07,880 --> 00:26:12,560 When we're a mouth breather, that involves taking bigger breaths. 388 00:26:12,560 --> 00:26:16,560 But in doing so, we're using different muscles. 389 00:26:16,560 --> 00:26:21,520 So when we breathe through our nose, we predominantly use what's called the diaphragm, which is the 390 00:26:21,520 --> 00:26:25,880 lower plunger of muscle. 391 00:26:25,880 --> 00:26:30,440 And in doing so, when it pulls down, it opens up the bottom parts of the lung. 392 00:26:30,440 --> 00:26:36,280 When we mouth breathe, we tend to use the ribs and the muscles around the upper part 393 00:26:36,280 --> 00:26:37,720 of our chest. 394 00:26:37,720 --> 00:26:41,880 And as a consequence, that tends to open up the upper part of our lung. 395 00:26:41,880 --> 00:26:48,240 So when we ventilate, we end up with proportionally more air going to the upper parts than the 396 00:26:48,240 --> 00:26:49,720 lower parts. 397 00:26:49,720 --> 00:26:55,960 And this is what we call a ventilation perfusion mismatch, because the air is going in, but 398 00:26:55,960 --> 00:26:57,640 the blood's not there to meet it. 399 00:26:57,640 --> 00:26:58,640 So there's no exchange. 400 00:26:58,640 --> 00:27:06,040 And as a consequence, there is a whole volume of blood that flows through the lung that 401 00:27:06,040 --> 00:27:08,880 completely misses out on oxygen. 402 00:27:08,880 --> 00:27:14,880 So as a result of that, we have this wasted effort. 403 00:27:14,880 --> 00:27:20,040 The heart has gone to this significant effort of pumping this blood through the lungs, and 404 00:27:20,040 --> 00:27:23,560 the blood basically comes through and turns up empty-handed. 405 00:27:23,560 --> 00:27:30,640 So that's why mouth breathing in its very simple physiology results in this very subtle 406 00:27:30,640 --> 00:27:32,080 oxygen deprivation. 407 00:27:32,080 --> 00:27:33,080 And it is subtle. 408 00:27:33,080 --> 00:27:39,120 It doesn't sound like it's a lot when we say it's 2% to 3%, but that's all it takes 409 00:27:39,120 --> 00:27:40,120 for the brain. 410 00:27:40,120 --> 00:27:47,560 The brain is sitting on this very fragile tipping point where just 3% or more is an 411 00:27:47,560 --> 00:27:48,560 issue. 412 00:27:48,560 --> 00:27:51,960 And if you're a mouth breather, you're already sitting at 2% to 3% deprivation. 413 00:27:51,960 --> 00:27:56,160 So you're sitting on the edge of the cliff. 414 00:27:56,160 --> 00:28:02,600 And then it just takes these subtle little nudges here and there where you're having 415 00:28:02,600 --> 00:28:05,160 to work a little bit harder with your breathing. 416 00:28:05,160 --> 00:28:09,560 So you're getting a little bit of a fatigue thing going on. 417 00:28:09,560 --> 00:28:14,120 And if you've got, you get a little bit of a cold, and you get just that little bit more 418 00:28:14,120 --> 00:28:16,640 blocked, and the parents go, oh, are they snoring? 419 00:28:16,640 --> 00:28:18,520 They go, oh, yeah, only when they've got a cold. 420 00:28:18,520 --> 00:28:22,480 I was like, well, they are mouth breathing, and they go, yeah, they mouth breathe all 421 00:28:22,480 --> 00:28:24,760 the time, and so forth. 422 00:28:24,760 --> 00:28:28,520 And then the little cold just makes everything worse. 423 00:28:28,520 --> 00:28:32,680 Well, that was that little thing that pushed them over the edge of the cliff. 424 00:28:32,680 --> 00:28:45,640 And that's the other counterbalance to this, is that we have the pernicious effect of things 425 00:28:45,640 --> 00:28:53,120 is basically the net balance of people's exposure to the irritant and their ability to cope with 426 00:28:53,120 --> 00:28:54,120 it. 427 00:28:54,120 --> 00:28:58,040 So, you know, this is the only analogy that I can think of. 428 00:28:58,040 --> 00:29:01,720 I use smoking as the example. 429 00:29:01,720 --> 00:29:05,840 We can identify people that picked up a cigarette at the age of six and lived to the age of 430 00:29:05,840 --> 00:29:10,760 110 and smoked a packet of cigarettes for their whole life. 431 00:29:10,760 --> 00:29:11,760 Okay. 432 00:29:11,760 --> 00:29:18,080 And they just had some really good genetics at the end of the day that gave them the resilience 433 00:29:18,080 --> 00:29:24,400 to basically survive against all the bad things that we know smoking does. 434 00:29:24,400 --> 00:29:28,240 But we don't use that as an example to say, see, smoking's okay. 435 00:29:28,240 --> 00:29:32,960 We just go, wow, that person got away with it. 436 00:29:32,960 --> 00:29:34,480 That's an outlier. 437 00:29:34,480 --> 00:29:39,360 And that's the same with this scenario, is that we have a vulnerability level and also 438 00:29:39,360 --> 00:29:42,600 therefore a resilience level. 439 00:29:42,600 --> 00:29:48,720 And it's for some children, they have such a remarkable resilience through their genetics 440 00:29:48,720 --> 00:29:52,480 that they can have these airway problems and it actually doesn't affect them. 441 00:29:52,480 --> 00:29:55,640 They basically got this ability to cope. 442 00:29:55,640 --> 00:29:58,640 They're an outlier. 443 00:29:58,640 --> 00:30:05,120 But that's the exception by far to the rule, just like smoking at the age of 110 is the 444 00:30:05,120 --> 00:30:07,080 exception to the rule. 445 00:30:07,080 --> 00:30:12,560 And for some children, they just need just a micro dose of airway obstruction. 446 00:30:12,560 --> 00:30:18,440 They've got no resilience or ability to cope and they're an absolute mess. 447 00:30:18,440 --> 00:30:22,680 But other children really need to get really quite blocked before they sort of land on 448 00:30:22,680 --> 00:30:26,120 our doorstep in terms of it becoming obvious. 449 00:30:26,120 --> 00:30:32,880 And when we're talking about a mess, it's not just their sleep quality that suddenly 450 00:30:32,880 --> 00:30:39,200 becomes impacted, it's a lower IQ as well as just in general school performance. 451 00:30:39,200 --> 00:30:41,840 It's the misdiagnosis of ADHD. 452 00:30:41,840 --> 00:30:44,880 It's mental and emotional. 453 00:30:44,880 --> 00:30:45,880 Yeah. 454 00:30:45,880 --> 00:30:46,880 So, you're absolutely right. 455 00:30:46,880 --> 00:30:49,720 I'm sort of going to say mess. 456 00:30:49,720 --> 00:30:53,960 I mean, what I'm talking about is just that landscape then of how we then from a medical 457 00:30:53,960 --> 00:30:56,920 point of view actually then trip over these kids. 458 00:30:56,920 --> 00:31:01,720 And by the time we're tripping over these kids, the horse has been bolting for a long 459 00:31:01,720 --> 00:31:07,440 time and has already weighed down the stable, out the paddock, jumped the fence and often 460 00:31:07,440 --> 00:31:08,840 to the distance. 461 00:31:08,840 --> 00:31:11,960 And now we're playing catch up to it all. 462 00:31:11,960 --> 00:31:19,520 So, you know, that's just a sort of in simple terms, just to try and explain how we land 463 00:31:19,520 --> 00:31:22,560 in the terms of a brain problem. 464 00:31:22,560 --> 00:31:25,800 But you know, you've sort of now opened the door, say, well, look, what are the health 465 00:31:25,800 --> 00:31:26,800 issues? 466 00:31:26,800 --> 00:31:33,960 And if we were to, you could nominate any body system, any body part that you want to 467 00:31:33,960 --> 00:31:34,960 nominate. 468 00:31:34,960 --> 00:31:38,360 I can tell you how that has an impact and a problem. 469 00:31:38,360 --> 00:31:41,520 But what's helpful is to just talk about big picture. 470 00:31:41,520 --> 00:31:47,760 Because the big picture is what we need parents to sort of just realize was that clue. 471 00:31:47,760 --> 00:31:52,600 It was that piece of the puzzle where, you know, all of a sudden, we can start to join 472 00:31:52,600 --> 00:31:56,680 these dots together and then make sense of things. 473 00:31:56,680 --> 00:32:04,640 What I talk about in terms of, you know, the big picture is two body systems, the neurological 474 00:32:04,640 --> 00:32:09,520 system, which is the brain and the nerves, and the cardiovascular system, which is the 475 00:32:09,520 --> 00:32:11,480 heart and the blood vessels. 476 00:32:11,480 --> 00:32:15,760 And there are two big systems, you know. 477 00:32:15,760 --> 00:32:23,160 So if we talk about the brain first, what we need to realize is that any, any, any, any 478 00:32:23,160 --> 00:32:27,360 behavioral issue is a manifestation of brain function. 479 00:32:27,360 --> 00:32:28,360 Anything. 480 00:32:28,360 --> 00:32:33,800 You know, right now, my words are a manifestation of my brain. 481 00:32:33,800 --> 00:32:34,800 Okay. 482 00:32:34,800 --> 00:32:41,040 The fact that I'm sitting here with in a certain body position is a manifestation of my brain. 483 00:32:41,040 --> 00:32:47,400 Everything we do in a physical way, in a mental way, is a manifestation of our brain. 484 00:32:47,400 --> 00:32:54,280 So with these children, what I sort of do is sort of have behavior, education, emotions, 485 00:32:54,280 --> 00:33:00,440 their education, sort of clues to, are we off on the wrong track? 486 00:33:00,440 --> 00:33:08,080 You know, is this a child that throws tantrums, that gets upset quite easily, has anger management 487 00:33:08,080 --> 00:33:16,280 issues, has concentration and focus problems, is disruptive, is can't keep to tasks. 488 00:33:16,280 --> 00:33:21,200 You know, is a sort of, you know, whether it's, you know, enough to call it the ADHD 489 00:33:21,200 --> 00:33:25,400 or whatever, you know, just sort of just putting them into a box. 490 00:33:25,400 --> 00:33:26,600 But there's that side of things. 491 00:33:26,600 --> 00:33:29,600 You know, I said, you know, that there are emotions. 492 00:33:29,600 --> 00:33:32,400 You know, do they get upset really easy? 493 00:33:32,400 --> 00:33:37,440 You know, that sort of, you know, crying at the drop of a hat type thing, the really 494 00:33:37,440 --> 00:33:41,760 quite fragile and delicate, and you got to sort of step around them because otherwise 495 00:33:41,760 --> 00:33:46,760 you're just going to have, you know, this thing, and like I said, you know, perfect manifestation 496 00:33:46,760 --> 00:33:48,240 of the so-called terrible tooth. 497 00:33:48,240 --> 00:33:49,240 Right. 498 00:33:49,240 --> 00:33:51,800 You know, perfect manifestation of it. 499 00:33:51,800 --> 00:33:56,160 And because as a side of society, we normalize that with that terminology, well, we don't 500 00:33:56,160 --> 00:34:01,960 go looking for, you know, is this really, you know, way off track? 501 00:34:01,960 --> 00:34:03,160 And then we had their education. 502 00:34:03,160 --> 00:34:07,840 Like I said, you know, this is how this first started, those bottom 10% of the kids. 503 00:34:07,840 --> 00:34:13,320 You know, there's a talk that was done many years ago by a sleep physician here in Australia. 504 00:34:13,320 --> 00:34:17,000 And the title was, can your ENT surgeon make your kid smarter? 505 00:34:17,000 --> 00:34:19,320 You know, and it's not so much about making your child smarter. 506 00:34:19,320 --> 00:34:21,480 It's about reaching their full potential. 507 00:34:21,480 --> 00:34:24,440 You know, and if they've got breathing and sleep problems, well, look, you've got a problem 508 00:34:24,440 --> 00:34:29,800 and their parents might spend, you know, hundreds, if not thousands of dollars on their child's 509 00:34:29,800 --> 00:34:34,960 education and tutoring and so forth to help them with their reading and their writing and 510 00:34:34,960 --> 00:34:35,960 their math. 511 00:34:35,960 --> 00:34:40,280 But they're the things that go off track if their child's got a breathing and sleep problem. 512 00:34:40,280 --> 00:34:45,160 So again, it's just sort of going, oh, there's actually something feeding this that's going 513 00:34:45,160 --> 00:34:46,920 on. 514 00:34:46,920 --> 00:34:50,800 And then, you know, we talk about brain again, we sort of actually then trip into mental 515 00:34:50,800 --> 00:34:53,880 health, you know, as its own category. 516 00:34:53,880 --> 00:34:57,200 And then when I sort of, you know, ADHD sort of, you know, we sort of put that under the 517 00:34:57,200 --> 00:34:59,320 banner of mental health. 518 00:34:59,320 --> 00:35:01,480 But we also put anxiety under there. 519 00:35:01,480 --> 00:35:07,640 And anxiety is significantly escalated by a factor of three to four times the background 520 00:35:07,640 --> 00:35:13,920 population rate in children, you know, in terms of the so-called child norms, if a child 521 00:35:13,920 --> 00:35:16,560 has sleep, a sort of breathing three to four times. 522 00:35:16,560 --> 00:35:17,560 Why? 523 00:35:17,560 --> 00:35:22,480 Well, in simple terms, again, you know, it's more complex than this, but in simple terms, 524 00:35:22,480 --> 00:35:25,960 their brain gets really good at what it gets taught to do. 525 00:35:25,960 --> 00:35:29,600 And if they're having breathing problems at night and the brain is having to go into panic 526 00:35:29,600 --> 00:35:36,960 mode and develops, you know, unnecessary, but obviously, you know, essential stress responses, 527 00:35:36,960 --> 00:35:39,360 well, guess what? 528 00:35:39,360 --> 00:35:41,560 That part of the brain got a good workout at night. 529 00:35:41,560 --> 00:35:42,560 And guess what? 530 00:35:42,560 --> 00:35:47,520 It's going to work really well during the day when it comes to anxiety type issues. 531 00:35:47,520 --> 00:35:49,320 But it doesn't stop at anxiety. 532 00:35:49,320 --> 00:35:53,920 We then start getting into really significant pathologies. 533 00:35:53,920 --> 00:35:56,800 So things such as depression. 534 00:35:56,800 --> 00:35:58,680 Things such as schizophrenia. 535 00:35:58,680 --> 00:35:59,680 Psychosis. 536 00:35:59,680 --> 00:36:03,800 You know, these things, bipolar effective disorder. 537 00:36:03,800 --> 00:36:08,960 These are, you know, psychiatric conditions that can affect children. 538 00:36:08,960 --> 00:36:13,200 And in the group of children with sleep disorder breathing, there's an overmanifestation. 539 00:36:13,200 --> 00:36:15,280 There's a higher rate of such conditions. 540 00:36:15,280 --> 00:36:21,080 And these are not insignificant diseases and affecting children. 541 00:36:21,080 --> 00:36:26,600 These are, you know, quite marked, you know, pathologies. 542 00:36:26,600 --> 00:36:31,760 And they're often again not explored and not asked for because the child turns up to 543 00:36:31,760 --> 00:36:35,480 the doorstep of the psychiatrist and the psychologist. 544 00:36:35,480 --> 00:36:41,360 And the paradigm comes with the tunnel vision of things. 545 00:36:41,360 --> 00:36:47,040 And no one's looking outside of their box to see, all right, what else is going on? 546 00:36:47,040 --> 00:36:53,880 You know, this is the frustration of healthcare is that we treat things in silos. 547 00:36:53,880 --> 00:36:55,320 And then it's all insulated. 548 00:36:55,320 --> 00:37:01,440 So despite the fact that we have the science, we have the research, we have the knowledge 549 00:37:01,440 --> 00:37:06,840 that, you know, we can point to and say, you know, a child with depression is more likely 550 00:37:06,840 --> 00:37:08,760 to have sleep disorder breathing. 551 00:37:08,760 --> 00:37:13,160 And therefore we recommend as psychiatrists that have done this research that this is 552 00:37:13,160 --> 00:37:18,000 a consideration that is made when such children present to clinics. 553 00:37:18,000 --> 00:37:24,240 Most most psychiatrists, as understandably, don't read ENT journals. 554 00:37:24,240 --> 00:37:29,880 It's not on their radar, you know, and again, most ENTs wouldn't be reading psychiatry 555 00:37:29,880 --> 00:37:31,000 literature. 556 00:37:31,000 --> 00:37:32,920 It's not on their radars. 557 00:37:32,920 --> 00:37:39,000 And then all of a sudden we have this silo effect where, you know, we have, you know, 558 00:37:39,000 --> 00:37:43,400 somebody that is yelling at the top of their lungs, but they're encased within the sound 559 00:37:43,400 --> 00:37:48,120 periphery and no one's ever going to hear the message until, you know, opportunities 560 00:37:48,120 --> 00:37:49,600 like this come along. 561 00:37:49,600 --> 00:37:55,520 And then all of a sudden it might be one, just one person will go, that's my kid. 562 00:37:55,520 --> 00:38:00,640 And then they'll go and then they'll say, I think we missed something. 563 00:38:00,640 --> 00:38:02,720 And then they'll go and get an intervention. 564 00:38:02,720 --> 00:38:05,840 And then from that intervention, they have a different trial. 565 00:38:05,840 --> 00:38:08,600 And then all of a sudden they get exactly what we need. 566 00:38:08,600 --> 00:38:09,720 We get an ambassador. 567 00:38:09,720 --> 00:38:10,720 We get an advocate. 568 00:38:10,720 --> 00:38:15,160 I was about to say we're advocating for ourselves and our children. 569 00:38:15,160 --> 00:38:17,160 That's kind of where we are at this point. 570 00:38:17,160 --> 00:38:22,680 All of a sudden we have a convert, we have someone whose eyes have been opened who goes, 571 00:38:22,680 --> 00:38:25,920 I don't want this to happen to another person's child. 572 00:38:25,920 --> 00:38:28,840 I had no, nobody told me about this. 573 00:38:28,840 --> 00:38:29,960 I didn't know about this. 574 00:38:29,960 --> 00:38:33,760 And then I just do not want this to happen again. 575 00:38:33,760 --> 00:38:37,160 And that's, you know, it's an unfortunate way for this to play out, but it's a necessary 576 00:38:37,160 --> 00:38:43,240 thing for people to, you know, spread this word, spread this message. 577 00:38:43,240 --> 00:38:47,440 So anyway, so we can have the, you know, the mental health side of things there. 578 00:38:47,440 --> 00:38:50,600 So you know, do you think about just what we've listed there? 579 00:38:50,600 --> 00:38:54,400 You know, how many kids are struggling at school and needing extra help? 580 00:38:54,400 --> 00:38:57,960 How many kids are going through anxiety things at the moment? 581 00:38:57,960 --> 00:39:02,760 And COVID didn't help that, you know, in terms of, you know, the environment that we created. 582 00:39:02,760 --> 00:39:07,840 So we've given more opportunity for anxiety to come to the surface. 583 00:39:07,840 --> 00:39:12,240 And if they've got a breathing and sleep problem in the background that was opening 584 00:39:12,240 --> 00:39:17,480 the door for that to flourish, well, we've just developed the perfect storm. 585 00:39:17,480 --> 00:39:19,280 So that's, that's the brain in the nutshell. 586 00:39:19,280 --> 00:39:21,560 But you know, what, what, what, what can we do? 587 00:39:21,560 --> 00:39:22,800 You know, that's subjective. 588 00:39:22,800 --> 00:39:25,880 Well, again, we have the research. 589 00:39:25,880 --> 00:39:32,440 People have gone and taken a cohort of children and put them through brain scanning protocols. 590 00:39:32,440 --> 00:39:37,520 It's not something we do, you know, on a clinical level, it's research based. 591 00:39:37,520 --> 00:39:38,520 But what did they find? 592 00:39:38,520 --> 00:39:46,320 Well, the parts of the brain that deal with concentration and behavior are not working properly. 593 00:39:46,320 --> 00:39:48,720 The parts of the brain that deal with memory. 594 00:39:48,720 --> 00:39:54,200 So there's a part of the brain, particularly called the hippocampus is our sort of memory centre. 595 00:39:54,200 --> 00:39:55,800 It's smaller. 596 00:39:55,800 --> 00:40:01,080 The parts of the brain, you know, what's called the frontal lobe that deals with, you know, 597 00:40:01,080 --> 00:40:03,960 behaviour, emotional regulation and so forth. 598 00:40:03,960 --> 00:40:05,640 It's not working properly. 599 00:40:05,640 --> 00:40:10,640 The parts of the brain that deal with learning and, you know, maths, for example, it's not 600 00:40:10,640 --> 00:40:12,000 working properly. 601 00:40:12,000 --> 00:40:16,440 The parts of the brain that deal with processing visual and auditory information. 602 00:40:16,440 --> 00:40:20,360 So what we see and what we hear is not working properly. 603 00:40:20,360 --> 00:40:29,120 You know, we can physically get a window of perspective by looking at brains through 604 00:40:29,120 --> 00:40:32,800 imaging of these children that are not sleeping properly. 605 00:40:32,800 --> 00:40:35,240 And those brains are not normal. 606 00:40:35,240 --> 00:40:37,880 This is brain damage. 607 00:41:05,240 --> 00:41:12,680 You can stay connected with the Children's Airway First Foundation by following us on 608 00:41:12,680 --> 00:41:16,520 Instagram, Facebook, Twitter and LinkedIn. 609 00:41:16,520 --> 00:41:20,560 If you'd like to be a guest on an upcoming episode, shoot us a note via the contacts 610 00:41:20,560 --> 00:41:29,000 page on our website or send us an email directly at info at children'sairwayfirst.org. 611 00:41:29,000 --> 00:41:33,360 And finally, thanks to all the parents and medical professionals out there that are working 612 00:41:33,360 --> 00:41:38,360 hard to help make the lives of kids around the globe just a little bit better. 613 00:41:38,360 --> 00:42:05,360 Take care, stay safe and happy breathing, everyone.