Hi everybody, and welcome back to another episode of Airway First, a podcast from the
Children's Airway First Foundation.
I'm your host, Rebecca Downing.
My guest today is Dr. Funke Afalabe Brown.
Dr. Brown is board certified in pediatric pulmonary medicine and pediatric sleep disorders.
As a double board certified pediatric respiratory sleep medicine physician, Dr. Brown helps
her patients breathe better and sleep better.
And by extension, she helps improve the sleep of her patients.
Dr. Brown is a speaker, an educator, a writer, and the founder of Restful Sleep MD, where
she helps busy professional women and their children prioritize sleep to not only achieve
their optimal health, but also thrive and to live to their fullest potential.
She does this through courses and programs focused on educating and empowering busy professional
women to make sleep a priority as a critical pillar of their health.
Dr. Brown is a member of the American Academy of Sleep Medicine, the American Academy of
Pediatrics, and the American Thoracic Society.
She has also served on several committees locally, regionally, and nationally.
Dr. Brown is passionate about mentoring the next generation of physician scholars and
is particularly vested in the training and development of minority scholars.
She also works with organizations and small businesses to improve employee health by incorporating
healthy sleep as part of their wellness journey.
She does this through seminars, workshops, and round table sessions.
You can find out more about Dr. Afalabi Brown on her website at restfulsleepmd.com.
And now here's my interview with Dr. Funke Afalabi Brown.
Good afternoon, Dr. Afalabi Brown.
Thank you so much for being on our show.
Thank you for having me.
I'm excited to be here.
Yeah, I'm super excited.
Lots of questions for you today.
So let's just go ahead and jump right in.
Let's talk a little bit about what are pediatric sleep disorders?
So pediatric sleep disorders are a wide range of sleep difficulties we see in children.
And so honestly, we see problems right from birth all the way through till adolescence
and young adulthood.
And this can comprise of medical sleep disorders, behavioral sleep disorders.
And then also there are issues that are going on as part of children's lives that can have
its implications when it comes to sleep.
So in that category, I would put things like autism, ADHD, anxiety, all those things tend
to have an impact on how kids sleep.
So really a broad range of issues can go on with kids sleep.
Right.
And you mentioned birth.
And I think for a lot of people, myself included.
It's a little surprising to hear the term sleep disorder and birth.
So you can just come out of the womb with something.
Yeah.
Well, pretty much.
So we usually will see those things as especially children with genetic syndromes.
So things like children that are born with maybe trisomy 21 or a condition called Pritawili
syndrome or neuromuscular disorders, and we'll also see problems that can occur when children
have sort of facial or cranial facial syndrome.
So children that may have like a small jaw or sort of a smaller midface.
And what that does is one, it changes the anatomy of their face.
And at times it makes that the airway that's already pretty tiny and narrow, even narrower.
So that's one way. And so most likely you may see them have snoring or difficulties
breathing or pauses in doing sleep.
And you can see that pretty quickly in children who have low tone.
So among those children with maybe neuromuscular diseases or children, like I mentioned with
Pritawili and some of these other genetic syndromes, what happens in that case is because
their tone is just overall low, then they may have more of a floppier airway.
And so because of that, they're more at risk for having sleep apnea.
And that's usually one of the more common disorders you'll see.
In some situations, super-duper rare, you can have a condition called central hypoventilation
syndrome.
And so what that is, is this children really just have, their brain is not able to sense
when carbon dioxide is rising in their blood.
And the way we breathe, right, we're breathing in oxygen, we're breathing out carbon dioxide.
So our brain sense, okay, now it's time to take a breath.
So we'll breathe in oxygen, get the carbon dioxide out.
And so for these children with central hypoventilation syndrome, their bodies just really, their brains
really don't have that response.
And we found some gene that's responsible.
It's called the Fox2V gene mutation.
So that's going a little bit far.
And just really letting you know that, yes, sleep problems kind of happen, even in that
newborn period.
It's not common, but it's just something parents should be aware of.
And you mentioned the phrase low tone.
So for parents, would you explain briefly what that is exactly?
So your tone, your muscle tone really tends to be, when you're awake, it tends to be,
you know, just like you and I, we have normal tone when we're awake, we're sitting upright,
we're able to breathe normally.
When we go to sleep, our muscles just relax.
So these children have super duper, super duper ultra relaxed muscles, muscles, if that helps.
So essentially your upper airway, that same tone is up, isn't your upper airway?
So if your upper airway is collapsing on itself, then you are at risk for snoring or having
a hard time breathing.
Okay, got it.
Thank you.
So let's talk a little bit about teens because anybody that visits your website, which we
have a link for in the show notes, you're going to see a lot about teens.
So let's just move over to that if we could.
One of the things we hear about teen behavior, right, is that it's normal or it's, you know,
just what teens do.
But some of these behaviors could actually be related to sleep issues.
So what are some of the signs that parents should look for when it comes to identifying
whether or not their teen is getting a restful night's sleep?
Yeah, that's a great question.
So when it comes to teens, I always say they're in this perfect storm for sleeping difficulties.
The first is that, you know, around puberty, there's a shift in the internal clocks.
And so their bodies naturally drift towards a later bedtime, which is why when your teen
is say, when you send them upstairs to sleep at 9 p.m. and they say they're not sleepy
and they're sneaking the phone into the room, they really are not able to generate sleep
that early.
So that really shifts things.
And so in our perfect world where they could choose their bedtime and choose their wake
up time, it really wouldn't be an issue because they're just sleeping according to their physiology.
But then we all know that most times we're dealing with early school start times, you
know, middle school and high schoolers.
So unfortunately, even though their bodies may want to go to bed at about 11 p.m. and
sometimes even as late as 12 midnight, they got to get up to catch the bus at the cracker
dawn or even before then.
And so they may need to wake up at 5.30.
Some kids as early as 5, it's really, really unfortunate.
And so with that, imagine that they're getting really, really decreased sleep.
And so with decreased sleep over time, even within the first few days of not getting enough
sleep, you start to see manifestations like, you know, difficulties getting out of bed.
So you're ringing multiple alarms to try to get them out.
Right.
And you try to see them just really exhausted and cranky and moody in the mornings.
And really, I always tell families that your teen is sometimes they're not just out to
make everybody miserable in the morning, they themselves are just, you know, they're so
sleep deprived.
And so that tends to become a big problem.
And so during the day, they may start really feeling sleepy.
We may start to see poor decision making.
We may start to see impact on their grades.
We may see, you know, sometimes behavioral issues and things.
So those are some of the, you know, the symptoms that you might notice that your teen is exhibiting
or they're falling asleep on car rides and falling asleep in class.
So that's something that we will see.
Another thing that I, so the first one is really that shift that's physiologic shift.
And then the early school start time.
And then another thing that, of course, naturally our teens do engage in behaviors that do not
support their sleep.
So you have your teenager on, you know, in the, in the, in the need for social, you know,
relations and interactions and things like that, which is a good thing, right?
They want to be thriving community about this age.
The only thing is the timing may be off.
So the, you know, the social media, the technology in their bedroom, drinking caffeine, all those
things make it even harder for their bodies to really, really get to sleep.
So those are sort of, there's the physiology part and then there's kind of the behavioral
part.
And then the third one I would say, even as a bonus, right, where in a time now where
anxiety and mental health is really at an all time high.
So some of our teens may be anxious.
They may, it may be a situation where they get into bed and their minds are racing.
They can't shut down and things like that.
And so that might get in their way of getting enough sleep.
So those are just a few reasons why.
And then also just what you might notice in your teen when they're having troubles with
sleep.
And that's quite, that's a lot.
And it's funny, I think, I think back from when I was a teenager and I don't remember
it being this bad.
Yeah.
I mean, is it just, is that just perception?
Or I mean, are you seeing there definitely has been this change that it really is becoming
this big of an issue?
It is.
It's definitely changed.
I mean, you know, there's some school districts, honestly, that have implemented early, later
school start times.
And we are seeing significant improvements in their grades, in mental health, in their
mood.
We're seeing such improvement when you compare it to those who are still, who are not getting
enough sleep because their school start times are earlier.
So there's that.
And then, you know, now, you know, the connectedness, the digital world is taking on a life of its
own, which was not as much as it was before where kids were outside and kids were really
physically active and were coming, spending time with family and going to bed.
So that's also a huge contributor.
And are you seeing this in other countries as well, I mean, to this extreme?
Or, you know, how is it manifesting in other countries?
Well, in some countries, but not all.
I mean, I think the issue again, really lies around where really forcing their sleep in
this really short window.
And also, you know, in a lot of more of the sort of first world countries where, again,
there's access to so many privileges.
There's a lot of competitiveness.
We're trying to get our things to the best goals.
And so we load them up with all kinds of activities.
And, you know, they're in, they're in the playing football and they're playing an instrument.
And oh, by the way, they're in Boy Scouts.
And, you know, there's so much more going on that that's also playing a big role in some
countries, you know, sort of first world countries, you may start to see, you may see
those issues, but definitely, you know, seeing a lot more of it here in the U.S.
So even as parents, we're trying to do, again, it's back, we're, we're trying to do what
we think is best and we're trying to help.
But perhaps we're also adding to this issue by stretching them to thin, overstimulating
them.
They are, they are absolutely over scheduled.
They are not one of the things I encourage sometimes, you know, even with my sleeping
team's course, one of the things I say is really check in with your parent and come
up with a plan, a game plan of maybe I don't need to do all this, like five activities,
including doing my homework, which may take two hours.
And I don't get to sit down and start my homework because I have all these other after school
activities.
And so then I can't get to sleep.
And then when I get into bed, I'm wired.
I'm so wound up that, you know, it's hard to fall asleep.
So I think really prioritizing the things that matter, getting them involved in activities
is helpful.
It's great, but I think we need to strike a balance.
Yep, I agree.
And that makes sense.
And again, you, you're just trying to do what you think is best for them.
And especially when you're looking at the competitive landscape for colleges right now.
Yes.
I mean, I've, I've fallen prey to that as well.
It's like, what all does my child need to make her application stand out?
Yeah.
And that's the thing.
It's so, it's such a competitive landscape.
And we're starting this journey younger and younger and younger and think about the anxiety
that is causing our children as well because of this need to complete, to perform.
And so they're stretched.
And so, you know, it's, it's this whole vicious cycle.
Absolutely.
Oh, we mean well, we mean, exactly.
We do.
We're trying this marriage, right?
Yes.
So, you know, when we're talking about anxiety with children, especially the ones that are
over achievers just naturally and then looking at ways that we can help them.
Okay.
So if we can streamline and maybe downsize some of their activities, controlling their
social media and the electronics in the bedroom.
What about things like meditation or tapping or other techniques that maybe we could teach
them to help them, especially at night when they're in bed and they can't fall asleep
and that anxiety is just building.
Yeah.
That's an excellent question.
And one of the things, one of the core tenets of what I do with a lot of my clients is really
focusing on having a bedtime routine.
You know, we have this beautiful elaborate bedtime routine for our little ones where
they, you know, have their bath and then we read a book and we cut a lot of things.
You know, we do all that.
And then they just go from, you know, in fact, they fall asleep in the midst of their schoolwork,
right?
They bring everything into the bedroom with them.
So just like even us parents, we all need to have that routine.
And what that routine really does is actually pretty powerful.
It's queuing your body in preparation for sleep.
And I like to kind of put those different, different elements of the bedtime routine.
It doesn't have to be something complicated.
It can be at least two or three activities that head in the direction of the bedroom.
So I usually will recommend some kind of hygiene, right?
So whether you're changing into PJs, brushing your teeth or having a bath, whatever that
looks like.
And then just really spending time sort of winding down over the course of the day.
So journaling is a powerful one meditation, breathing, you know, incorporating that as
part of your routine is so helpful.
Finding time for meaningful connections with our teenagers where, you know, if they have
things going on on their minds, they want to talk about, I think that's really helpful
as well again to help with unwinding.
And then also, you know, if you have a child that's really anxious, they may need to get
counseling.
They may need to see a therapist, you know, you would probably see those issues sort of
show up during the day as well and not just at bedtime.
But I think starting off with, you know, some kind of routine that really helps them to
unplug and to transition from the day to bedtime.
Another thing I always recommend, I see this a lot is our teens spend a lot of time even
in their bedrooms when it's not time for sleep, so they may be doing homework in bed, they
may be having dinner in bed, watching movies, games, talking with friends, and our brains
make associations, right?
So our brains really make very rapid associations.
And so one of the things we want to do is we want to connect our bed with sleep.
But then if our bed becomes our dining room, our movie theater, if it becomes our office
space, right, if it becomes our, you know, our gaming room, then when it's time to sleep,
it's really hard for us to make those connections.
You were listening to Airway First with today's guest, Dr. Funke Afalabe Brown.
You can find out more about the Children's Airway First Foundation and our mission to
fix before six on our website at children'sairwayfirst.org.
The CAF website offers tons of great resources for parents and medical professionals, including
videos, blogs, a recommended reading list, comprehensive medical research, podcasts, and
so much more.
Parents are encouraged to join the Airway Heddle, our Facebook support group, which was
created for parents of children with airway and sleep-related issues.
You can access the Airway Heddle support group at facebook.com backslashgroups backslashairwayheadle.
Are you a medical professional or parent that is interested in being a guest on our show,
or do you have an idea for an upcoming episode?
Then shoot us a note via our contacts page on our website or send us an email directly
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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. Afilave Brown.
That makes absolute sense.
So aside from some of these more psychological, physiological, let's talk a little bit more
about some of the health issues, specifically what could be some of the undiagnosed health
issues that could be sitting there in your teen.
And as a parent, you have no idea what kind of issues like that could be contributing
to sleep.
Yeah, that's a great question.
So again, I always come back to that, like the three categories.
So medical sleep problems can get in our way.
The habits can get in our way of good sleep routines.
And then also issues that are going on around the clock, like the anxiety or ADHD and things
like that, that can get in the way of sleep.
When we come to the medical, some of the common medical problems that children, teenagers
might have can be things like sleep apnea.
But they're also at risk for sleep apnea, especially those that may be overweight, or
if they have any structural differences with their face that makes their airway a little
bit narrower or things like that.
If they have, sometimes they might have what you call restless leg syndrome, which is that
very unpleasant discomfort that you have in your legs, mostly, that you need this constant
movement.
And a lot of women in pregnancy may experience it, but our kids also may have it.
Typically, it's relieved by motion, but then it does delay sleep onset.
And it might contribute to waking up at night.
Other sleep problems that you can think of, not as rare as people think, is things like
narcolepsy.
And that's actually diagnosed around the teen years.
Really?
And so, yeah, narcolepsy is that it's, you know, it's this just uncontrollable urge to
sleep.
Really, even in spite of having a full night of sleep, and you see it associated with other
things like loss of muscle tone with strong emotion, they may have hallucinations around
their time.
They may have, you know, what we call sleep paralysis.
So it's a combination of different symptoms.
But the key is they have profound sleepiness, and that's in spite of getting enough sleep.
So if your child is having those kind of symptoms, or any of the ones I just described, then you
definitely want to bring it up with your physician so that, you know, they can undergo
further evaluation.
Okay.
And for their evaluation, will they take a child into a sleep lab, you know, if they
deem it?
It's, if that's something, yes, absolutely.
If that's something that they, if there's concern for an underlying sleep disorder, then many
times the child might need a sleep study in a sleep lab, and that's to see if they have,
you know, either sleep apnea or something we call Periodic Limb Movement Disorder, which
is, you know, sort of in the same family as the restless leg syndrome.
Or for the narcolepsy as well, you get a sleep study, and then you get a daytime study.
And what that daytime study is called a multiple sleep latency test or a nap test.
And so what that test really is showing is what's the likelihood that your child will
fall asleep, giving the opportunity.
And so there's certain very specific criteria we use to diagnose that.
And when they give these tests to children, obviously that it's different than having
an adult come in and get suited up and stay for the night.
Obviously they make exceptions, you know, parents are parents close by, the parents
spend the night as well.
I mean, how does that work?
Oh, yeah, absolutely.
So typically they'll come into the sleep lab and a parent has to be there if the child
is below 18.
And so the parent is there and they have either a pullout couch or somewhere where they lay
next to the child and things like that in the same room.
Okay, perfect.
And I think we touched on this a little bit earlier, but I'd like to dig into a little
bit more about.
So you have a child that has this like sleep, specifically a teen.
I mean, in previous podcasts, we talk a lot about younger children, but let's talk about
teens, you know, how this manifests and how it presents itself behaviorally.
But also what are some of the health impacts that maybe we haven't talked about?
Yeah, absolutely.
And I think that's such a valid piece too.
So some of the things we see again is all your child has maybe daytime sleepiness or
mood problems.
We've seen anxiety and depression really correlate with insufficient sleep in teenagers.
And unfortunately, even increased suicidality, increased risk taking behaviors, you know,
such as, you know, drugs gambling, things like that.
You see that.
And also we see physical symptoms too.
So there's been studies that have shown if children have insufficient sleep, they are
at risk for obesity.
So really getting that excessive weight in some situations, they may be at risk for hypertension.
In adults, you may see things like, you know, that type on diabetes and strokes and things
like that.
We don't have as much robust data in children, but definitely in teens, we've seen that obesity
is a big one, as well as in some situations, hypertension as well.
In addition to all the learning difficulties, mental health problems that are there.
Wow.
Yeah.
Well, so as a parent, if you suspect this because you're seeing these behaviors or your
child's having trouble sleeping, or maybe you've heard them snoring, which we've discussed
is, you know, that's a sign of sleep apnea potentially.
But what point do you, as the parents say, I think there's enough here, you know, to
bring this up to your pediatric provider or your physician?
Yeah, no, I think the sooner the better.
You know, if now if they have snoring, but it's allergy season, right?
So that's right.
Right.
Yeah.
If they have snoring and they have a cold, you know, but if you're noticing there's habitual
snoring, say for instance.
And you are, and usually when we say habitual snoring, we're saying three or more nights
a week.
And then you're noticing either daytime issues as well.
Then you want to bring it up.
You know, I think that's just, it's better safe than sorry, it's better to over call it
than have your child struggle for long.
So you know, if there's things like insomnia, which is also something that we see in our
teenagers where they have difficulties falling asleep, staying asleep, or they're waking
up excessively early and because of that, they're having daytime effects.
Usually people will say insomnia should be going on for about three months when you're
having those symptoms.
I don't, I mean, that's what our, you know, our guide book, which is the International
Classification of Sleep Disorders, that's what it uses.
But you know, if you have a child who's really, really struggling at times just having a quick
check in with your, your physician to say, okay, are we missing anything here?
We don't have to wait three months if the child is already like falling apart and struggling
and things like that during the day.
But the standard definition says the symptoms should have gone on for three months.
Wow.
A lot can happen in three months too.
So.
Yeah, exactly.
And also, you know, we, that's sort of more of chronic insomnia.
There's also the entity of acute insomnia, which most, many of us experience, right?
You have a, the loss of a loved one, something happens and then, you know, for, you might
have a, you may have a hard time for a few days and then things kind of settle down or
a couple of weeks and then things settle down.
So I think usually they're using those guidelines so that, you know, some of these things just
naturally will improve depending on the season of life the child is going through, such that
if it's persistence by that three month mark, then definitely something else is going on.
Got it.
And that's where those check-ins can come in handy, right?
Because as the parent, you may or may not know what's going on at school from the personal
side that could be impacting it, right?
Yes.
Well, let's chat a little bit about restful sleep MD and some of the courses that you
provide because these courses are for parents, correct?
Yes.
So the, the course, the teens courses is actually for the teens.
It's really, it's a self-paced course that takes the teenager themselves through the
knowledge of sleep, right?
Because if we think about it, maybe at most they hear get, you know, eight to 10 hours
of sleep by sleep is good for you, you know, and nobody really gets that.
And even as a, as a, as a physician myself, I think I had all of maybe one, one hour of
lecture on sleep.
So I had to go ahead and get a full training to become certified to care for patients.
So this, and this, if we think about all these effects and the impacts of insufficient sleep
in our teens, it's not something we want to just live to the luck of the draw.
So I really, and I realized that a lot of parents just struggle.
Like you said, sometimes they don't even know their teens are having sleep issues, you know?
Right.
And sometimes, you know, no matter how much you tell them to, you know, get rid of them
for not bedtime, if they don't understand why and what's going on in their bodies, then
it becomes this uphill battle.
So how about we empower them, giving them that autonomy, they understand this things themselves.
They do so much self-reflection so that they know, okay, this is the reason why I shouldn't
be taking super long naps during the day.
This is what caffeine does to my body.
This is why trying to catch up on all the sleep on the weekend may not completely work.
You know, so they understand it themselves so that then it's easier to have a conversation
because that motivation to, to sleep well becomes more of an intrinsic motivation.
And they're, yeah, yeah.
And like you said, they're empowered, right?
So they're, they're, they're taking part in this decision.
It's not the parent going, go do this, go do this.
Here's why.
Yeah.
And what kind of outcomes are you seeing for the teens that have taken this course?
Those that are taking it have really enjoyed it because some of them had no idea.
And you know, I had one for instance who just had, you know, I used to see with dinner and
didn't know that was an issue and just couldn't sleep.
You know, so sometimes it becomes to things like that.
And so, you know, by himself caught back on caffeine and, you know, so I think it really
does make a difference when they understand it and it's broken down to their level without
too much fluff.
And then they can make choices because these sleep habits, it's not like an overnight thing,
right?
And that's when it starts to build healthy sleep habits that are sustainable versus,
oh, just the whole list of rules for them to follow.
And this knowledge that you're empowering them with not only helps them now, we're arming
them, I guess, for, for their health, for their health span, you know, preparing them
to have healthier lives as you were talking about earlier, maybe reducing some of these
other physical impacts.
Absolutely.
And honestly, the content is absolutely helpful even for the parents, right?
We as parents also need to be good role models.
Yeah.
These are very fundamental.
That impacts your own health as an adult, right?
You know, because our kids learn most from what we do rather than what we're saying.
Right.
So you, and also sometimes, of course, getting your child to be even motivated to sit and
the videos are really short as well, right?
So we had my, their attention span in mind, especially when they're not sleeping well,
their attention is also short, right?
So, right.
Really bite-sized videos.
So the parent, you can watch it together, talk about it, come up with action items to
take and then, you know, you move on from there.
So I definitely agree with establishing a great sleep foundation, not just for the short
term, but for the long haul.
I think that's great.
At the end of every episode, I always like to turn the floor over to our guests and just
any final thoughts that you want to leave with parents or anything that maybe we didn't
cover that you want to make sure, you know, parents and medical professionals hear from
you.
Yeah.
So I think, and thank you so much for this.
Thank you for having me.
Oh, absolutely.
I think one of the reasons why this has been my mission to help, you know, high achieving
professionals and their children with sleep is because we are a sleep-deprived generation,
right?
We are the CDC has declared that insufficient sleep is a global pandemic, you know?
So this is an issue that we're seeing across the board.
We're seeing it at work.
We're seeing it in our kids.
We're seeing kids diagnosed with ADHD and impulsivity and inattentiveness at a number
that's just ridiculously high.
Kids are being prescribed medications and it may be that they do need it, but sometimes
really drawing, coming down to is there anything else going on?
And you know, that may be sleep.
And so it could be that you start with increasing sleep, even just by 15 to 30 minutes, it will
make a world of difference.
It could be that you're becoming more intentional to pay attention to saying, okay, you know
what, we're going to have healthy sleep habits.
That's transformational.
And so we can start from that and then we can build from there.
So yeah.
Great.
Thank you again so much for being on the show today.
I really appreciate it.
You're welcome.
Thank you so much for having me, Rebecca.
Thanks again to today's guests, Dr. Funke Afalabe Brown for sharing her medical insight
and to each of you for listening to today's episode.
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