Hi everybody, and welcome back to Airway First, a podcast from the Children's Airway
First Foundation.
I'm your host, Rebecca Downing.
My guest today is Dr. Magna Dassani, a sleep apnea and airway dentist from Houston, Texas.
Dr. Dassani has practiced dentistry for over two decades, and she's passionate about the
role of the dentist in whole body health.
She frequently sees patients for whom the dentist is the only consistent medical provider.
By screening patients, connecting them with the appropriate specialist, and devising treatment
plans, Dr. Dassani changes lives.
In recent years, she's begun to identify and treat adults in pediatric sleep apnea in her
practice.
While many of her patients have reached adult home without ever being educated about how
the shape of their skull affects their breathing and sleep, Dr. Dassani's in-depth knowledge
of oral-facial anatomy allows her to help patients with underlying defects of the tongue,
jaw, and palate.
As a mentor, Dr. Dassani works to educate fellow dental professionals about sleep disorder
breathing so that these treatments can become more easily available to patients throughout
North America.
As a writer, as well as a clinician, Dr. Dassani has published two books on sleep apnea and
the dental practice.
You can find both books, Healthy Sleep Happy Kids and Sleep, Breathe, Dream on Amazon.com.
You can find out more about Dr. Dassani on her website at www.magnandassani.com.
And now, here's my interview with Dr. Bangda Dassani.
Thank you so much for being on our podcast this morning, Dr. Dassani.
Thank you so much for having me.
What a journey it has been to get here between mostly my schedule and the schedules, but we
made it, so I'm super excited.
Yes, thank you.
And I'm really very excited because you have a very unique message that I think parents
need to hear.
It's incredibly important.
Thank you for hanging in there and continuing to reschedule.
Let's just go ahead and just dive right in.
As a dentist, the approach you take is very different than a lot of dentists, and you're
really focused on the whole body, but specifically on sleep.
So I thought we could just start there and talk a little bit about where this focus comes
from, where your approach comes from.
Yeah, so I'm fond of saying dentists fix more than teeth or fix more than cavities.
And we are actually in the unique position of being able to follow our patients and a
lot of them for a huge part of their life.
I mean, it's not uncommon for us to see moms come in when they're pregnant, and then we
are usually the first providers to see those child from a dental perspective, of course,
because they tag along with the siblings and the parents all the way until a lot of times
adulthood.
They go away to college, come back because they come to visit parents, see us for their
cleanings, and they see us twice a year at least.
So we are in that position, but we're able to assess, evaluate, and impact whatever's
going on with their growth and development in the head, face, and neck, and guess where
our airway is.
So I can actually spot a problem before it becomes a problem.
If I can guide that family, that child, that parent into, hey, this might be our next best
step.
And it doesn't always have to be in the dental office.
And I'm fond of telling the doctors that I coach, too.
It's like, we are sometimes the quarterback as to where or what happens with a child's
or even a person's treatment.
And it's not uncommon for me to observe something and go, oh my gosh, go see the ENT.
Oh, make sure you talk to a pediatrician about this, to have that multidisciplinary team
of the cardiologists, the neurologists, the pediatrician, the ENTs.
And we all come together because what is the goal at the end of the day?
It is our patients' life.
And yes, if we can hone in, actually dial in, have this laser focus on the airway as well.
If I can address something while you are growing, oh my gosh, I don't have to put a
band-aid on you when you're grown up.
Right, absolutely.
And I've spared you so much heartache, trouble, and discomfort by way of your health, right?
I mean, we know how many kids, teens, adults struggle with their health.
And I'm going to segue this into how did this happen for me?
It's by losing a family member.
And for someone that was completely healthy, didn't have any known comorbidities for us
to lose them without any warning, made me determined that I, you know, when I got into
airway, I'm the first to admit I was selfish.
My only goal was I do not want my family to have to go through this ever again.
Because if sleep apnea was the issue, surely there's something I can do to impact this.
Surely there are solutions.
And this was 20 years ago.
Surely there's a way out.
I may not be able to impact it as a dentist.
I didn't know anything.
Then there's, we don't get this education in dental school.
Right.
We've heard.
I'm still very surprised about this.
I know.
Pediatricians as well.
Exactly.
It's shocking.
Exactly.
And it's like, well, at least I can get answers.
At least I know what questions to ask of my doctors when we do come across this.
I didn't ever want to go through it again.
But in the deeper I looked, I was like, oh my gosh, this is something right up my alley.
I can do this to where I can help my family.
Remember, I'm still focused just on my family because the loss was so great.
But then what I realized is as you get into this, it's like, once you see it, you cannot
not see it.
Can I do it?
Yeah.
And I found out that, I found out that, I found out that, I found out that my family
grew, it grew into my office manager's dad, who I could help.
It grew into the patient in the dental chair who talked about his grandson that was snoring.
It grew into, it's just one of those things that it keeps getting bigger and bigger and
bigger until you just can't ignore it.
You have to do something about it.
We were mainly talking to adults that could not use their CPAP and we were helping them.
And then I would get these questions, hey doc, my grandson snores.
Whatever you did, the appliance helps me.
Can you make my grandson this?
Just like, no, he's a child.
And I still didn't have answers then.
Until same thing, when you have something personal, hit you.
My office manager, Christina, has been with me 11 years and she was pregnant with Avery
when she started working with me.
Well Avery is your classic child with everything Avery that we see in a kid.
And at one point, her and I stopped and she looked at me and she goes, doc, do you think
this is Avery?
I was like, oh my gosh, we are missing an entire demographic of the population.
And same thing, nobody's talking about this.
I didn't learn this.
I didn't know what to do.
I didn't even know what questions to ask.
So that was another rabbit hole to go down.
And you know this once you go down this rabbit hole, it's like, you're in it, like it or
not.
You're in it.
Yeah.
And you see it everywhere.
That's the other thing.
Once you know what to look for, you see it everywhere.
You see it watching TV.
You see it standing in the line at the grocery store.
You see it when your children's friends come over.
I mean, you see it everywhere.
Exactly.
And I was just talking to somebody yesterday.
It gets so bad.
Like you talk about it so much.
I have two girls, they're teenagers, but when they were growing up, because you know, we've
been doing this for a while now, we'd be at Target and my kid would go like, mom, that
kid's now breathing.
So stop looking at people in Target.
But I understood you.
Yes.
So that was what got me going.
And you're really focused a lot on the sleep aspect of it specifically.
Correct.
So I'm still a general dentist.
Yeah.
I still drill, fill, do whatever a stentist do.
But a large focus of my practice is sleep because this is not something that you can
put into a box.
It is not something where I can isolate it and say, as an adult or as a child, sleep
is going to sit in this corner and everything dental is going to sit in this other side.
They're all interconnected because let's take a look.
You know, when we have a child in the chair, that's just coming for cleaning, nothing else.
But we see all these signs and symptoms and clues.
As a child, that is, for example, mouth breathing can have red, puffy and flame swollen gums
that bleed is prone to more decay.
And how do you separate that?
It all ties in together because then you got to figure out why.
Where's that mouth breathing coming from?
What can I do about it?
And it just turns into this big old cycle.
Right.
Absolutely.
And I think, I'll put a link to it on our website just for, or in the show notes, but
there's a link to on our website.
We've got signs as a parent to look for.
Yes.
But as a dentist and as well as I'm sure it's not just you at this point, it's you and your
staff.
What signs are you all looking for when they come in?
Specifically children.
Yeah, yeah, for sure.
There's so much.
You know, when we have an adult with sleep issues, I like to say I can fit them inside
a box.
Adults present with very specific signs and symptoms.
And you check those boxes, you know, for the snoring, the daytime sleepiness, the getting
up to use the bathroom multiple times a night, choking and gasping in your sleep.
I can fit typically you into a box.
But as a child, I could have seven children with nine different symptoms and they could
all be positive for sleep disorder breathing, which is why it's so important, you know,
parents play a big role in our team here because there's so much that they can observe at home
that we don't see the child asleep in our offices.
And this is where the parents come in.
So what do we look for and what can parents look for?
Mouth breathing is a big one.
Usually when, you know, and my team is trained to do the same, I walk into an arbitrary and
I immediately focus on the parent, not because I don't like the kid.
I love kids, which is also I could never become a pediatric dentist.
But in the reason I want to do that is in our office, we have TVs on the ceiling.
So the child is really laying back and they're watching TV or now, you know, today's day
and age, even if you don't, they're what are they doing?
Typically, they're on their phone.
Right.
What I want to see is because anytime you walk in and you you're talking to somebody,
we automatically come to attention.
Don't we?
We sit upright.
We adjust our posture, all of that.
Right.
That's not their normal resting posture.
Normal resting posture, remember, should be lips together, breathing through the nose
and the tongue resting in the roof of the mouth passively.
Well, when I walk in and introduce myself to the parent and completely ignore the child,
the child goes back to what it is that they're doing, which is, I don't know, watch Indora
on TV.
And I catch this child either sitting with their mouth open, breathing through their
mouth or whatever that posture looks like.
And I can immediately focus that attention to the parent and go, is this how she is or
he is at home as well?
And I'll get one of two responses.
Right.
I was like, oh my gosh, yes, I have to remind him or to close the mouth during, I don't know,
reading, playing puzzles, whatever it is that they're doing, watching TV.
And that's the connection.
Boom.
We start right there.
Or the parent's going to say, you know what, I haven't really noticed.
And for me, then it is, let's pay attention.
When you go home, now the parent is diodin into what is it that I need to look for?
So that is key number one.
As a dentist, I will look for my team will look for other telltale clues that tell us
that something is going on that's impacting their area.
And typically it will be growth and development, right?
We look for if this is a child that either has permanent teeth or has permanent teeth
coming in, is there any crowding?
Crowding tells me there's just not enough room.
There's a discrepancy between the size of the jaw and the size of the teeth.
Or a lot of times when those permanent teeth come in behind the baby teeth, right?
Shark teeth, as we call them.
Right.
They just aren't, there isn't enough space in the jaw for those teeth to be able to do
what they do.
The permanent teeth erupt, try to push themselves out and that's what causes the baby teeth
to get loose and fall out.
Well guess something is not working the way it needs to and which is why these teeth are
in all different kinds of positions.
So is there enough room for those permanent teeth to come in?
Yeah, there could be a discrepancy in the size of the teeth and the size of the jaw.
You got dad's teeth and mom's jaw, smaller jaw, bigger teeth, sure.
But at the end of the day, we still need the space.
Right.
So that is a big telltale clue.
If there is crowding, don't wait.
Talk to your doctors, talk to your dentists and make sure this is being at least evaluated.
They may not be the ones treating it, but at least they'll know where to send you out.
We want those full wide smiles in a chat.
I don't like seeing those dark corridors, as I call them, when they're smiling.
The key example is, look at Julia Roberts' smile, right?
You want those wide smiles.
Or keeping in tune with everything going on in the last few weeks.
William and Kate, when you look at their smiles, Kate has that wide, full smile, right?
And when you look at it, you can start that slightly more narrow smile.
What do I look for?
I want her smile.
So we want those teeth to fill up.
I don't want those dark corridors along the side.
Outside the mouth, if I'm just extra orally looking, what does the nose look like?
Is there a deviated septum?
Is one nostril bigger than the other?
Are there narrow pinched nostrils?
That's where our airway starts.
Let's start at the very beginning.
Is this something that you need to see the EMT to have evaluated and addressed?
Chapped lips, right?
Any story, my younger daughter, who's now 14, when she was young, every time, and I tell
my parents, anybody that feels guilty about not noticing this in their kids, like worst
mom right here, I didn't notice anything.
You know what?
The guilt has no place in what we do for our kids, right?
So I always try to tell parents, as a doctor, I miss things.
So there's no place for you to feel bad about it because I didn't know what I didn't know.
Exactly.
There's no way I could have addressed it, which is why I say that.
But when my younger daughter was growing up every year for birthdays, for Christmas, anytime
anybody asked her, it's like, baby, what do you want?
You know what she'd ask for?
She'd ask for a chapstick.
Because her lips were always chapped because that child was a mouth breather.
And I'm going, oh my God, how did I not see this?
So that is one thing we look for.
And I'm not talking about, you know, it's the season's changing or you're in a place
like the pole or whatever.
It's chronic.
But if you have a child that is constantly that has cracked lips or dry lips, that could
be a telltale sign.
Are they breathing through their mouth?
What's going on there?
We also look for the shape of the palate.
We want that palate to be a wide U shaped palate.
The roof of the mouth is also the floor of the nose.
So the shape of that palate, if you have a high arched V shaped deep narrow palate, the
other side of it, and I know you can see me because we're on video right now, but this
is what the upper airway looks like.
And that is narrow as well.
That is constricted as well.
So that tells me a story.
Look back in the back of the throat, what do the tonsils look like?
Are those tonsils enlarged?
Are they contributing to any obstruction, which can then possibly be play a role in obstructing
that airflow?
So, Doc, these kids need to see an ENT.
Just know two ways about it.
What does the tongue look like?
And true macroglossy, like truly where the tongue is super large, is not all that common.
When the tongue looks too big for the mouth, how about we think about is the jaw space,
the space there, the size of the jaws too little for the tongue?
Let's flip it over.
So when I have a child open their mouth wide, not even say, ah, not even stick your tongue,
just open your mouth, baby.
And when I see that tongue spilling over onto the chewing surfaces of those back molars
for those kids, we might have a problem.
That might need to be addressed.
Not like that does need to be addressed.
Because what happens, where's that tongue going to go when this child is going to lay
back?
It's going to fall backwards into the throat.
It's going to potentially create an obstruction, which means that the child is getting less
oxygen to the brain while they're asleep.
If the tongue has those scalloped edges, little markings on the tongue, which is just from
the teeth, right?
And they have the shape of those teeth show up.
That's the same thing.
The justice and enough room.
Clenching and grinding is a big one.
Children to have tooth wear in some cases that we see are, there's so much wear from
the child grinding so much.
And you know what?
A lot of parents will say this too.
It's like, I can hear my child grinding down the hallway.
And clenching and grinding is your body's reflex to open up the airway.
Oh, okay.
Yeah, you know, just let's look at it this way.
A muscle that is tense occupies less space than a muscle that is relaxed.
So for those of us that, and I know I do it, when we pose for pictures, what do we do?
We pop our arm up, do we not?
Because that makes that bicep look so much more toned and skinnier as opposed to not
posing it right.
When it's down.
Yeah.
Right.
And that's exactly what it does.
When we clenching and grinding, it tightens up all these muscles because we got to use
our muscles when we clench and grind.
That is your body's reflex to open up the airway.
So if you have a child that is constantly grinding at night, get this looked at.
And no, a night guard is not the answer for a child.
I'll even say that.
Because what is that?
It's a band-aid.
I don't want a band-aid.
Oh, right.
There's a problem there.
Yeah, that is growing.
And I can impact growth and development, and I want to get in as quickly as I can to help
this child breathe and grow to their best ability.
Having conversations with moms while they're in the office as well is huge.
When we started this, my team would be like, Doc, will you stop talking?
Because you have other patients waiting for you.
You have these moms really need to go places.
And I was like, I know, but I can't not get all the information from them.
A child that is struggling at school, that has trouble focusing, that has trouble getting
along with their peers, that has behavioral issues that can be related to sleep disorders,
that can be related to lack of oxygen to the brain.
So that's where sleep comes in now.
Why sleep is so important for children.
Correct.
So we use all of these signs and symptoms and what we see to start to connect the dots.
So when I see any of this, I will start asking mom questions.
Does your child snore?
Audible breathing in a child when they're asleep does count as snoring.
They don't have to snore like you and I.
Any audible breathing.
Correct.
Okay.
When I talk to the mom about what kind, like is this child a messy sleeper?
Are they a restless sleeper?
Do they start on one side of the bed and move over and they're all over the place?
So both my girls, my, one of my girls was has still been like, she literally never had
to make the bed in the morning because she'd get up, smooth the covers and she was fine.
She didn't toss and turn.
But the other one, you'd go into her room in the morning and be like, good Lord child,
who have you been fighting with?
Right.
The blankets are everywhere.
The pillows are on the floor and like she starts in one position, ends up in the other.
That can be a sign as well.
So these are questions that I then start to ask parents to be able to connect the dots
is to what is going on.
These are all my clues.
We talk about bedwetting as well.
We talk about breastfeeding as an infant.
Of course, I'm seeing a little one.
We ask about are they breastfed or bottlefed, but even the older ones, because when I look
at somebody that has a constricted palate that has the growth and development of a narrow,
long face that I'm seeing as opposed to those wider faces and very non-judgmental.
But I want to know, hey, is your baby or was this child breastfed or bottlefed?
Is that's going to give me a clue as to where they even able to nurse?
If mom chose not to nurse, I completely respect that decision, but were they able to nurse?
A lot of times it hurt.
It was painful.
My next question has to be why?
And that's what I tell my team.
They give you an answer.
Think why?
And you get the answer to that.
Ask it a second time.
Why?
What are we not seeing?
What are we missing?
So when I have a mom that says, oh, like bottlefed, okay, tell me more, what was going on with
that?
Well, it hurt too much or she had trouble latching on or it took her forever to eat.
It seemed like it was a full-time job.
Now I know to ask myself, why?
Why was that happening?
Then that leads me down the rabbit hole of, is there a tie?
Is there a tongue tie going on?
Because remember when I'm still evaluating the mouth, not only am I looking the shape
and the position of the tongue, is there a tie because that itself again, tongue needs
to be resting in the roof of the mouth.
If it's unable to, that is impacting growth and development.
My early blues are a child that was unable to breastfeed.
You are listening to Airway First with today's guest, Dr. Meghna Dasani.
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.
The CAF website offers tons of great resources for parents, including videos, blogs, recommended
books, comprehensive medical research, and so much more.
We've also recently launched the Airway Huddle, a Facebook support group for parents of children
with airway and sleep-related issues.
You can access the Airway Huddle support group at facebook.com backslash groups backslash
airway huddle.
Are you interested in becoming a guest or have an idea for an upcoming episode?
Shoot us a note via the contacts page on our website or send us an email directly at info
at childrensairwayfirst.org.
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, let's jump back into my interview with today's guest, Dr. Meghna Desani.
So it's a waterfall effect.
You look at one and you ask the questions.
You look at something, you ask the questions, and then no conversation is the same in the
office.
If you could have two parents and two operatories, it will not follow the same route because what
am I seeing to what why am I asking and what questions am I asking as follow-ups is what
is going to drive that conversation.
So there's so many.
Remember what I said earlier, seven kids can present with nine different symptoms and they
could all be positive.
And this is why, because we just don't know what's going on.
And it sounds so weird.
My team would be like, talk, why are you asking parents about bedwetting?
We, that's not up our wheelhouse, right?
But I will tell you this.
In our early days, when we started to have these conversations and talk to parents about
this, we had a 16-year-old coming with his mom.
And typically in our office, when it's a new patient, you know, the team gets all, you
know, whatever we need, all the information, the data I need first before I walk in to see
the patient.
And my assistant came to tell me and she's like, doc, you might want to see this one
first.
I was like, why, what's going on?
It's like, you know what you need to do, you know, get the history, like check whatever
medications if actually needed, blah, blah, blah.
And she's like, no, you want to come into this one first.
Okay.
So I walk in 16-year-old boy in the chair and mom's in the room and I was like, hey,
bud, what's up?
Like, you know, just my usual.
And like that child is sitting with his head bowed and just mumbles, can she not be here?
Like for the assistant.
And I said, no, we kind of need her here.
I need a team member just like your mom's here.
I need a team member here.
Now tell me what's going on.
And he still has his head bowed.
You could tell he's so embarrassed like he just does not want to be here.
And he goes, well, I still wet my bed.
Like literally he mumbled it out.
I was like, say what?
Say that again.
I still wet my bed.
That was a 16-year-old boy in my chair telling me he's here because he still wants the bed.
Let's back up here.
I am a dentist.
I deal with teeth.
You know that when this family has found themselves in my practice for their teenage
boy that is still wetting the bed, you know I am probably their last option.
And sure enough, they had done everything they could, everything.
They'd been to numerous pediatricians.
They checked off all the boxes, made sure he wasn't drinking on gallon of water before
going to bed, cleaned up his diet, saw whoever they needed to.
Everything was fine.
Thank God.
Everything was fine.
And sure enough with whatever clues we noticed within the practice and I told mom, I said,
I don't know if this is going to help, but I think it is.
Are you willing?
I mean, she's like, you know, I've done everything.
What I've exhausted all my options.
What can it hurt?
Because it's non-invasive, right?
Whatever we're doing.
And sure enough, the child comes in for a three-month follow-up.
Our office is, we have eight operatories down a long hallway.
He was walking in and I was just walking out of the break room with my coffee.
And he runs, 16-hour boy running up to me, not a good idea.
Right?
There's like teenage boys, never.
He runs down that hallway, makes me put my coffee down and gives me the biggest hug.
And he whispers in my ear, he's like, I haven't had an accident since I saw you last.
I tell you why.
I was done that day.
I was done.
I was like, I'm going home.
My day, week, month, year cannot get better.
I was done.
Wow.
So ask the questions.
And for moms that may be the listening parents, educators, ask the questions.
Because you never know who has the answer.
Because if we don't have the answer, we might know somebody that might have the answer.
I always share this story because I want parents to know, I know you're going to be thinking,
so weird.
Like why would I talk about, what are they going to do?
Somy diapers?
Like, you know?
Right.
But you never...
But it is a sign.
It's a sign that parents don't know.
I mean, until I started my work with Children's Airway, I would never, ever have put those
two together, that that's a sign of an airway issue.
Never.
Yeah.
So there's a lot.
There's a lot, sure.
And on your website, you also talk about how anxiety can impact a child's sleep.
And I thought maybe we could talk a little bit about that.
How does that happen, first of all, and what can parents do to help with that?
Yeah, yeah, for sure.
So anxiety has, you know, there's so many reasons that can happen, right?
And again, it's a big group that we want to make sure we're looking at.
Kids could have anxiety from whatever's going on at school.
We do big things in school.
Our kids, you know, we expect them to go to school with a great attitude.
We expect them to learn, be respectful to their teachers, to their peers, to do whatever
it is, you know, that they're asked to do.
And come home with that great attitude, do their homework, be respectful at home, go
to all their classes that we send them to, go to bed.
There's a lot that goes on in their day.
We never know what part of that day contributes, did not end well, or did not go the way they
wanted it to.
For us as adults that have learned to deal with things, a lot of times it's not a big
deal.
Right.
But for that child, it might be a big deal.
And there may be anxiety surrounding it.
So sometimes the anxiety comes from that, where they're getting into bed and they're still
ruminating over the day, what didn't go right, but it impacts their sleep.
It can't fall asleep because they're constantly thinking about it because that loop has not
been closed in their head.
So that is one way in which, yes, that sleep is being impacted, but let's look at it from
an airway perspective.
If this is a child that has sleep disorder breathing, you know, they're stopping breathing,
oxygen levels are dropping, whatever is happening at night time.
The brain is now perceiving this as our brain is smart, right?
It's only job is to keep us alive when we're asleep.
And the brain is perceiving this as a threat, right?
The brain goes, dude, like you stop breathing and I don't get oxygen and I have to work
harder to wake you up to make sure the oxygenated blood comes to me.
The brain is going through its loop and that can contribute to anxiety surrounding sleep.
For kids that are used to running around, acting up, not wanting to fall asleep, whatever
it is, with relation to sleep, that might be something that's playing into it.
So the brain is telling you, it's a bad thing that you're trying to fall asleep.
And what does that show up as, as anxiety in these kids, because it's not safe?
How do you and I feel when it's not safe someplace?
Right?
When you walk down a dark alley at 11 p.m. and there are shadows, what do we perceive
it at?
There's anxiety going in there.
You don't feel safe.
Well, if this child is stopping breathing, isn't getting oxygen, you know, and I say this
in air quotes, bad things, the brain is perceiving are happening at night.
Well, how is it going to react or respond as anxiety, which is why it's so important
to have these and moms, parents don't always have the answers, but it helps to talk about
this, but also make sure you talk to your kids about this.
Where is this coming from?
Because once we know what's causing it, it's when you can address it.
Is it from, I don't know, getting an 82 on your Mac when you knew all the answers yesterday
that is making you feel bad about it?
Then a lot of hugs and cuddles and talking it out with mom and knowing that you can do
better next time is the answer.
But if it's because your brain feels like you're choking in your sleep, then something else
might be the answer.
So it's very important to figure out where this is coming from.
And how might a child, when you're having these conversations, because obviously they're
not going to be able to say, I'm choking in my sleep, could they present it in more of
a manner of I just can't sleep or I try, but I can't sleep or as a parent, what are we
listening for?
How would it present from them?
In this case is when we would tie in the other signs and symptoms that we looked at.
Does your child have those dark circles under their eyes?
Is your child's moving?
Are these other signs and symptoms tying in for us to connect the dots?
Yes, the child may not be able to see this, but here's another thing.
If you have a child that has this anxiety, this chronic insomnia, maybe take in on them
at night.
And I tell moms, our phones are a powerful tool.
Yes, we use them to capture all these amazing memories of our kids, but go in and record
your child's sleeping because sometimes mom's like, I don't know what's right or what's
not.
And I don't want to be the mom that's presenting with little concerns where it really may not
be because we don't want to come across that crazy parent also.
I've been there.
I do worry about little things.
Go take your phone and record your child's sleeping.
If you think that, I'm not sure if they're snoring, but whatever it may be, record it
and show it to your doctor, to your pediatrician, to your dentist and say, this is her at night,
every night for, I don't know, the last three, four, five nights.
Is this a concern?
Ask your healthcare provider.
Get expert eyes on it.
And then it's a yes or a no.
I think that ties into one of the things.
There's so much on your website and I'm definitely going to put a link in the show notes because
I absolutely strongly advise any parent listening to go to your website.
There's so much amazing information there.
I can say this is one of the few times putting the show notes together that there was so
much to cover.
I just really wasn't sure where to start.
One of the other things that's on your website and you talk about is the link between sleep
and healthy hearts.
Oh my gosh, yes.
Yeah.
And as parents, again, you're seeing your child, they're running around, they're acting
normal.
You don't think about these things.
So I thought maybe we could take some time.
Let's just talk about that.
And that's critically important.
And it's something when we talk about airway, we don't often talk about.
Absolutely.
So just backing up a few big steps.
When we talk about sleep disorder breathing, one of the main things that we do, we do
we focus on our like to address is sleep apnea, right?
Sleep apnea is when a person and I say person because it applies to adults as well as kids
stops breathing for multiple times throughout the night.
Typically what happens is when we sleep, no, always this happens when we sleep, our muscles
relax, right?
That's how our body feels, rests, rejuvenates, all of that.
When these muscles relax, the tongue, which is also a muscle also relaxes and that tongue
can fall backwards into the airway.
That creates an obstruction, obstructed sleep apnea, which closes up the airway.
So now in kids, let's tie in a child that may have enlarged tonsils or adenoids as well,
right?
So that compounds the problem.
Just one little side note there.
So now we have this tongue that's falling back.
It's obstructed the airway.
There's no oxygen going in.
The brain, which needs oxygenated blood, the heart slows down.
The heart doesn't have much to do because it's like, dude, there's no oxygenated blood.
I'm just going to sit here and chill.
And at some point the brain goes like, dude, wake up.
I need air.
I need oxygen.
So these impulses are sent to the heart and the heart has to speed up to be able to carry
oxygen enough oxygenated blood to the brain.
And this cycle happens all continuously multiple times throughout the night.
What did I just say earlier?
What happens at night?
At night is when we are sleeping, we are healing, we are resting, we are rejuvenating all of
our muscles, you know, the different parts of our body that have worked so hard during
the day.
So for an adult, it may be walking the dog, it may be CrossFit for our children.
It's playing lacrosse.
It's on the football field learning whatever needs to happen with them.
The heart is also a muscle.
Nighttime is when all of this healing, repairing, rejuvenating needs to happen.
But instead what is happening when this obstruction, obstructive sleep apnea is happening, the heart
is working overtime.
Is it not?
It is re-eated insults and injury that is happening because it's the stop, start, stop,
start, stop, start that's going on.
And instead of this heart now healing, it has more of this insult happening to it.
This is what puts us, puts our kids, puts our communities at a higher risk for these
are people that present with high blood pressure.
How many children are we seeing?
High blood pressure, right?
This is what puts us at a high, just cardiac enlargement, cardiac disease, heart attacks,
everything that goes in the realm of an adult's higher risk for strokes.
That's where the whole let's make sure the healing actually happens as opposed to thinking.
And I tell parents this, you know, most parents go like, well, my kid sleeps enough.
I'm sure your kid gets the seven, eight, nine, 10 hours of sleep, whatever it is that they
need based on their age, but are they getting enough quality sleep?
That's right.
Is it restful?
Yeah.
That's where the disconnect is because I may think my kids slept for 12 hours, but if
they woke up five times on the hour every hour and not get up, eat, sleep, watch TV and
go to bed kind of thing, but these kind of arousals, that's not truly restful sleep,
is it?
No, no, it's not.
So as a parent, I know, you know, you mentioned monitoring them because I think we've all
done it as parents when they're babies, we're in there all night, we're watching them and
then they get a little older and you put them down and you go in the other room and you
relax and you have your tea and you read and that's it.
So periodically go in, spend five, 10 minutes at different times of the night, monitor your
child.
So as a parent, now I'm seeing these symptoms, you know, I've watched them at night.
I'm seeing some of the others, maybe the dark circles, maybe, you know, they have this kind
of ADHD hyperactivity that's not really, I'm seeing some of the symptoms, but when I look
in their mouth, everything that looks normal to me as a parent, you know, there's no tongue
tie, the tonsils look fine.
Now what do you do as a parent?
You ask questions, you still bring up these concerns to your doctors.
Be a dear pediatrician that you may be seeing every year, twice a year, whatever it is that
you need to see them.
If your child is one, I know you see your dentist twice a year, at least every six months.
Ask questions.
Bring up these concerns to your dentist.
It does not matter.
I promise you were not going to think like, well, why are you telling me this?
Not once have I said that to a parent, and I know nobody I know is going to say this.
What we will do is if it is outside the realm of our practices guide you towards somebody
else, but it will help us connect the dots for you.
So ask questions, bring it up to your providers, whoever it is that you may be seeing, to at
least get some more clarity.
You never know who is going to be able to help your child.
It is the advocacy aspect.
We hear this time and time again.
Another thing that we hear about, or is mentioned from time to time, is migraines.
That is something most of us as parents deal with in children, but this airway issue can
also present itself in that way, is that correct?
Correct.
It all comes down to the lack of oxygen.
In a lot of times for migraines, it is the insomnia that can set up.
The correlation with migraines ties directly into the insomnia.
Based on what article you read, some will tell you it is the migraines that set this
off and the insomnia and then the other way around, either way, they are all connected.
So getting that sleep addressed can help a great deal.
And how as a parent do we get the sleep addressed?
I know there is sleep labs, there is telemedicine.
Let's talk a little bit about that, what the process is to get in, what it is like.
So telemedicine, I am assuming you are asking that in regards to having these conversations,
consultations?
Yes.
Is that an option to start with?
Because I know it is such a big thing now.
It could be, especially with COVID and everything, when things were shut down, when we had so
many more restrictions in place, that was a great tool.
So for parents, a lot of times the initial conversation consult, yes, absolutely, can
happen over telemedicine.
But for us to be able to actually assess, evaluate, peek our heads in, look what is
going on, and in person visit does make more sense to get that conversation on the consult
going.
As far as sleep labs, for kids, I always, anytime there is a sleep concern, be it whoever
you are talking to, your dentist, your pediatric dentist, your pediatrician, whoever, I always
recommend seeing an ENT, get those tonsils and adenoids evaluated.
That should always be a first line of evaluation.
Again, they have their own guidelines as the dental world has its guidelines for what can
and cannot be done at what stages.
But I always, parents, let them get their eyes on it.
I work with a fabulous ENT and we have a great working relationship where I'm like, you know,
I'd rather worry more than not worry enough about my patients.
I'd rather have you get your eyes on it and you say they're good or good catch.
I'd rather have that.
Working with the sleep lab, if a sleep study is warranted, again, I live and practice in
Houston, so we have a lot of bigger hospitals and a lot more access to all of this.
But it can be a challenge sometimes.
There's not enough that have pediatric testing.
Pediatric, our patients have to be screened and scored a specific way as opposed to adults.
So I tell parents, make sure that they do have that.
Or they have somebody that is trained and knows how to score a pediatric patient.
So take the referral from your ENT or your MDs or whoever before you go to have that
done.
Typically, it's in a lab that's attached to a hospital.
And if they're doing in-lab sleep study or PSG, which is what we need for children, it
can be a bit overwhelming for kids at times.
Sure.
Because the PSG is those sleep studies, they're attached to all these leads that give us the
information that we need and want.
But it can be a lot for a kid.
So just make sure you're talking to your child about what to expect, what's going to come.
It does not hurt.
That's the good point.
It does not hurt.
But there's a lot of data that's being gathered.
And it can be funny to have everything attached to you.
I usually tell the kids, we turn it into a game.
You're going to be an alien for the night or whatever.
You're going to have all these wires coming out of you.
Parents are typically allowed to spend the night there with their kids.
So that's very reassuring for the children.
But just preparing them for...
There's a lot of people putting all of this.
Not going to hurt.
You just sleep with it as best as you can.
And then they take it all out in the morning and you go home.
It doesn't hurt.
And it'll tell us what we need to do to help you.
So just like anything else explaining to the kids that it's going to be okay.
I'm going to be right there with you.
But knowing that there's a lot that's going to happen.
Right.
How early could a child go in for something like this?
Honestly, I defer to my specialists for that.
They get to make the call on what they're seeing and what is going on.
I have seen two-year-olds get a sleep study because the ENT thought that was what was
needed.
But again, you have to understand not all two-year-olds are going to be compliant to
allow them to do everything.
And then there are some older kids too that get anxious about it.
So it just...
I say it comes down to what the specialist thinks is needed based on the child and everything
else that's going on.
Absolutely makes sense.
So for a parent that is looking for a dentist like you, one that's actually looking for
Airway and when we go on our insurance company websites to find a provider, are there specific
terms we're looking for?
How do we know?
Yeah.
Unfortunately, insurance is not going to list any of that.
Just ask your dentist.
It's like most are screening now.
There's a lot of awareness in the dental world.
And just, you know, hey, do you look for airway issues?
Or I have a concern, is this something you can help address or do you know somebody that
can?
In our practice, it's the same thing.
There are plenty of patients that get sent by other docs that don't see this or treat
this.
They come to us just for the airway issues and see their regular dentist for their cleanings
and fillings and everything else that may be needed.
So yeah, like I said, it takes a team and just ask, just talk to your dentist.
Got it.
One of the last things that I always do in our interviews is open the floor to our guests.
So anything that maybe we didn't cover or anything specifically that you wouldn't like,
a message you'd like to leave with parents.
Thank you for that.
But no, I think we covered a lot.
The only thing I would say to parents is don't be afraid or embarrassed or ashamed to ask
questions.
If there's one thing I can tell moms because I see a lot of these parents every day.
First off, it's not your fault.
It truly isn't because as moms, we tend to be ourselves up thinking we might have done
or not done something.
It's not your fault.
A lot of it is genetics, growth and development, the world that we live in.
You know, everything's changing.
It is what it is.
You, I say kudos for at least addressing it, noticing it and ask questions.
If you are not happy, satisfied or you think it is not the answer because nobody knows
your child like you do, ask again or ask somebody else.
Get a second, third, and opinion.
It does not matter.
But nobody, be your child's advocate is all I would say.
Ask questions.
Perfect.
Thank you so much for being here, Dr. Dasani.
I really appreciate it.
Thank you for having me.
It's been a pleasure.
Thanks again to today's guest, Dr. Magnet Dasani, for sharing her medical insight into each
of you for listening to today's episode.
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If you suspect your child might have an airway issue or related sleep disorder, contact your
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And finally, thanks to all the parents and medical professionals out there that are
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Take care, stay safe, and happy breeding everyone.