132: Dr. Funke Afolabi-Brown, Pediatric Pulmonologist & Sleep Physician: Unlock the Key To Better Sleep For Your Child!

Welcome to the sleep as a skill podcast. My name is Mollie McGlocklin and I own a company that optimizes sleep through technology, accountability and behavioral change. Each week I'll be interviewing world class experts ranging from doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper.

Let's jump into your dose of practical sleep training.

Welcome to the sleep as a skill podcast. We have had a lot of episodes on the podcast over the years to talk about the various topics in the world of sleep. But one area that we have not touched on really with any real significance has been the world of kids and sleep. Whoa, big topic. And it's so big that I had purposely not discussed or not gone in that direction because it's not an area that I deal with on a day to day basis.

It's a big, big topic and didn't want to do it any disservice by not fully diving in with intentionality. However, as the years have gone by, it's become very, very evident that people are struggling in this arena. And I do want to put out content to support people in navigating this big world of. Sleep and children.

So we have our first guests to really help usher us through this topic. Dr. Funke Afolabi Brown, and she is a triple board certified sleep medicine physician, passionate about helping people discover the gift of sleep as a superpower. Dr. Brown is a speaker, coach, educator, writer, and founder of restful sleep MD, where she helps busy professional women and their children prioritize.

sleep to achieve their optimal health and thrive and live to their fullest potential as a physician in practice for over a decade and a mom of two who struggled with sleep issues. She fully understands the impact of sleep deprivation on our mental. physical and emotional health. As a result, she's dedicated her career to helping professional women be their best selves.

And she is a member of the American Academy of Sleep Medicine and the American Academy of Pediatrics. She's also on the medical advisory board of baby center and the expert advisory board of project sleep. Whew, that is a lot and we are going to get into the weeds on this episode. I hope you find this valuable.

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Now invest in better sleep and in turn in a better, more energized life. And welcome to the Sleep as a Skill podcast. This is going to be the first episode where we are really focusing in on children and sleep. Can you believe that we've gone this long without focusing in on this really important topic?

And who better to sherpa us through this topic than Dr. Brown. Dr. Brown, thank you so much for taking the time to be here. Thank you so much for having me, Molly. Oh, thank you. You know, I've been following you and your work on online and just when I see you speak, I just see the passion and the inspiration and just how how much you really believe in this topic and the information that we can get out to the masses.

So when we were prepping for this conversation we were like, okay, there's a couple directions we can go and I'm excited that we landed on this topic of children's sleep. So maybe you can just share a little bit about one about yourself, how you found yourself in this role, being such a fantastic expert here, and then help us bridge the gap in this topic of what do we need to know on children and sleep?

Big topic. Yeah, absolutely. So I started off really, I think my, my journey started from my own sleep deprivation, which is why I'm so passionate about the work you do. Um, and I had a combination of it, sleep deprivation and insomnia, right? As a physician, I was telling everybody else to get their own sleep.

in check. Yes. But I was struggling. I know. Right. Until I eventually hit a wall, right? Anxiety and all that. And my kids also showed up and they were not sleeping and I had a loss. My dad passed away. And so that just really culminated into this really dark time for me. Yeah. And eventually, you know, coming out of that, I saw.

How big a role sleep played, right? So I already had all those, you know, precipitate predisposing factors because I achieve her. I had a mom with no sleep and, and then I now had lost, I had a newborn and I had work. And so I got into this. But eventually I wrote through it and that really spiked my interest in pursuing sleep medicine as a fellowship as, you know, as part of my career.

And so I did that. And after my year training at Penn, I started my, you know, clinical practice and was seeing patients. And one of the things that just really resonated with me was, um, how parents would bring their kids. And the whole family was in disarray because the kid wasn't sleeping. And I'm like, Hmm, it took you six months or four months to get to see me.

And you guys have been struggling with this for the last hour long. And, and then that motivated me to step out and say, okay, you know what? Let's at least start to empower people even before they make it to the, to a sleep specialist. Cause not everybody's eventually going to see a sleep specialist. And not everybody needs to see a sleep specialist.

So let's start with. What are the basics? Why is sleep important? Why is sleep in kids important? And so it's, it's been an incredible journey. So I do a lot of work with consulting. I do coaching and you know, and it's all around sleep in moms, in their kids. Just really to optimize it in a way that everybody is well rested.

That is fantastic. And I so appreciate you sharing your own journey. I think that can just really help for the listener to understand that you understand what that is like. And I don't know if you know my backstory, but that's part of my passion for this topic too, was that kind of dark night of the soul and going through that journey.

You as well said that dark time, you know, the way you pointed to that, because, um, yeah. It could just be absolutely life changing, but particularly that we can meet this kind of fork in the road of which direction we're going to go. Are we going to really get up under this and find that support like yourself or continue a longer than necessary road of suffering?

So I'm grateful that you're here to help guide us so that we're not dealing with that suffering, but particularly as it relates to Children. So. Big topic. We really haven't discussed it in a dedicated way on this podcast at the beginning. How do we want to think about this large topic of children and sleep?

Um, and maybe any of your specialties as it relates to that. Absolutely. So I think the best place to start is understanding that sleep needs change, right? So the American Academy of Sleep Medicine, National Sleep Foundation have recommendations that varies by age. And so I think for setting those expectations and you know, what you will notice is that as kids get older, Right.

Their sleep needs sort of decrease the amount of sleep they need decreases. So you have a newborn who's sleeping anywhere from 14 to 17 hours, right? And then you have your school aged kids that would sleep anywhere from nine to 11, then our teenagers, about eight to 10, and then young adults, adults would be seven to nine hours.

So understanding that trajectory is really important to start. And then I think then the issue we start to face then is why sleep is important. At this stage, when kids brains are just developing, sleep is so critical, and initially that's one of the reasons why the way evolution has it is that you have kids having almost 50%, especially in that newborn period, they have about 50% of REM sleep.

And really, that's a problem. period of incredible rapid growth where they're learning, they're developing, and all those pieces are so important. And one of the things we start to notice when kids don't get enough sleep, one of the main things we see is hyperactivity. You may start to see learning difficulties.

You may start to see things like impulsivity. And then you might actually see growth failure or growth restriction, because growth hormone is produced in slow wave sleep. So if you have kids who are not getting enough sleep, um, that's something that you may see manifest. And then I think the other piece that we start to then talk, look into is what then affects kids sleep, right?

What gets in their way? And I think a lot of that, a lot of the issues that kids face when it comes to their sleep, majority are behavioral. Um, uh, but then there's also medical issues that affected sleep. And then there's a third category that I usually call those things that are present during the day that are also present at night.

Like if you have a child with anxiety or you have a child with ADHD or autism, though, they will have some sleep manifestations. So that's my sort of whirlwind of sleep. And then we can then dive into like. You know, specifics and things like that, if that works. Thank you. Yeah, thank you, because I know this is a big topic.

Thanks for spearheading this on this podcast. I'm wondering if we can double click a little on the hyperactivity piece, the ADHD. Unfortunately, I wasn't at the last Sleep Conference. I had a conflict, but the year before that, I loved how there was a number of sessions, I should say, when there was a focus on some new research coming out around.

Could this, certainly correlations between poor sleep and hyperactivity, but just new information, could it be even larger than we realize? How do you think about this topic for anyone that might be listening and have maybe previously thought that these were separate topics? Help us kind of bridge the gap and understand that piece more.

Yeah, yeah. You know, in kids especially, kids with ADHD, studies are showing that almost up to 70, if not 75 percent of them, actually have sleep issues and You know, there have been some postulations about why, um, some of that has been related to, is there abnormality in their melatonin secretion? Is it just that increased cognitive arousal and just that difficulty with self regulation that impacts their sleep?

And the way I see it, I feel, is that it's sort of a bi directional. Our relationship. Sure. And many times in schools or when kids are in school, which is when you really start to see those manifestations where they can't sit still. The first thing most, uh, you know, most recom, most people get, you know, most parents come to say is yeah, they said it needs to start a stimulant.

It needs to start Ritalin. It needs to start Adderall. It needs to start something. Many, many times, what I will do, of course, as a sleep specialist who sees every, who has a hammer and everything looks like a nail is, okay, what's going on with their sleep? Of course. Well, you just, even based on the research that's, you know, that's maxed this prevalence at about 70%, almost all these kids have some difficulty with sleep.

A lot of times it's more related to insomnia, but they also have medical sleep issues. They may have sort of a slightly delayed circadian phase, or they have restless leg syndrome, and things like that. So we end up having to parse this out. And then that really then helps to understand, Oh, maybe that's why they're, they have this behavioral issues.

Maybe they are overtired and really working on that. I'm going to be the first to tell you that if a child who has ADHD needs medications, absolutely, that's the right thing to do if your physician feels so. But I would implore people to say, how about you check out their sleep and we can work on this.

You know, the same way we talk about that bi directional relationship with sleep and mental health issues, you wouldn't just treat one and ignore the other, right? So you're still providing that support, but you're really making sure that these kids actually have their sleep issues addressed. Now, The reason why it gets confusing too is that if you have a child who doesn't, who has had, who's not had sufficient sleep, just like we as adults, right?

You're you feel exhausted, you feel that fog, that fatigue, inattention. That's pretty common even in a typically otherwise healthy child who just had a bad night of sleep. So I feel like I wonder if sometimes this is, you know, an area that we really need to look into more critically, because sometimes I feel like we are not fully controlling for their sleep impairments before we make that generalization about the 70 something percent.

So it's like how much of this is diluted out by their sleep, if you know what I mean. Oh, absolutely. I mean, I so appreciate you kind of parsing that out and for the listener if they have children that they were maybe navigating this separately of, okay, we got to improve their sleep. And of course, oh, they're having this hyperactivity, ADHD, or like symptoms, or maybe even being diagnosed and then how to navigate the medication piece.

I appreciate you sharing with us how we can think about this differently. And I'm wondering then if you can help guide for that parent, what are some of the steps? So instead of Potentially, because unfortunately, you can share your insight, but if we go to our primary care doctor, some things might get missed just systemically.

There's not a lot of training there. How do we make sure that parents are connecting with a sleep professional like yourself? That's that's that's an excellent question. I think the first place to start is as a parent to continue to be an advocate. If you feel like something is up, then something is up.

Don't wait and assume that they'll outgrow it. I think the sooner, the earlier you're able to start to address and find resources, the better. And you know, if the, depending on what is going on, especially if you notice, okay, this child, or if you have another child at home who seems a little calmer, less hyperactive, is to start and ask yourself what's going on with their sleep.

What are they getting sufficient sleep? Like we talked about, like age expectations. Is that appropriate? Uh, what's their sleep quality like? Like how long is it taking them to fall asleep? Are they having multiple awakenings? I think that's also important. Is their sleep restless? So those are things you want to start to...

Look out for. And the reason why I'm bringing this up is because you're unfortunately, like you said, your, your doctor may not know to ask that, right? They will just say, are they sleeping nine hours? Are they sleeping 10 hours? Okay, you're good. You know, so yeah, exactly. So what is going on? And that's one of the things that we do, especially with pediatric sleep is the devil is literally in the details.

What's going on with the routines? I see a lot of families have. Uh, pushback report that their kids are just really, really pushing back at bedtime, right? That's where we see that bedtime resistance. Your child wants another hug or your child wants to watch one more show, you know, that's normal. But if you're seeing that as a much higher level, then it's probably time to say, okay, maybe there's a behavioral component, especially if it's delaying their bedtime, right?

So that's. stuff that's happening at the beginning of the night. Does your child need a parent to be present all the time before they fall asleep? That's that bedtime co dependence, which also can delay sleep onset. So we want to pay really close attention to that. And then when your child falls asleep, like what is going on?

Do they wake up multiple times at night? Are they waking up to say, well, mommy, you were right next to me or daddy, you were right next to me. And now. You're gone, so I need you back here for me to resume sleep. So there's that component of sleep association. So that's another piece that then we have to kind of unearth and sort of help them to develop sleep confidence in that sense where they can sleep on their own.

And then at the end of the night, are they, or are they in the morning, are they waking up really, really early? And if they're waking up early, what are they doing? Are they just laying in bed, waiting for you to come in? Or are they running to your room or running downstairs to grab the TV remote, right?

Yes. Then we start to talk about that sort of that, um, you know, behavioral insomnia for all of this, right? Again, it's like we're really digging deep. And it's, it takes, it takes really paying attention to those details. Now, on top of that, how are they when they wake up in the morning? Is it hard to wake them up?

Right? Are they, most kids are like bright eyed, bushy tailed, right? But if you have a child who's exhausted too, that's a sign that something's up. And, and then during the day, what's their function like? Are they nodding off on car rides? Uh, are they, are they falling asleep in school? Or on the flip side, are they hyperactive?

They have inattention, they have difficulty sitting still, so you may start to see those manifestations. And, um, and so, yeah, so that's kind of how we just go through it. And that's the behavioral piece. And then, of course, we want to ask questions like, Is your child snoring? right, sleep disorder, breathing.

The prevalence in children may not be as high in, in, in children as it is in adults. It's depending on the literature you're looking at. It's anywhere from about, I guess, almost 2% to in some, I think some studies I've seen about 6%, right? So it's not really high, but I, I, I am very, very sure it's just underdiagnosed.

Because, you know, that's just something also to, you want to pay attention to. So kind of parsing those things out. When your child, if your child is having sleeping difficulties, what, what type is it? So it seems extremely stressful for you as a mom who's or dad who's exhausted, right? As a parent who's exhausted.

So you're just like, my child's sleep is crap. My sleep is crap. Help me. But we have to just kind of. Leaning a little to say, okay, let's do some detective work. You're tired. But for us to be able to tailor the care specifically, we got to know where the issue is. Oh, so good. And some of the questions that you put in there for us to be thinking about from the time, you know, leading up to sleep, during sleep, and then even going into the following day of how are they behaving, fatigue, inattention, all of those components.

Would you suggest that people kind of create almost a sleep diary or audit of their children before going in to see someone like you? to kind of be armed with some of those elements and then also including some of those pieces on maybe the mouth breathing or things that the snoring or things that people are noticing.

Yes. So absolutely. Yes. So I think that's really helpful, especially depending on where you're seeking care. Sometimes it may take months. It may take months. So use that time to get some data. And yes, a sleep diary is very helpful because sometimes our brains tell us everything is. Awful, the child does not sleep at all.

Exactly. So having, having objective data lets you see, oh, maybe there's a pattern, oh. And then, you know, with your sleep diary, you're logging in, did he have a cold? Did they take caffeine, right? Yeah. You know, giving them a whole lot of hot chocolate at bedtime where some kids are a little bit more sensitive or a little bit of soda or iced tea with dinner.

So all those things start to tell a story so that when you show up at a, at a, at a, at a sleep specialist office. You're armed with the details, you're seeing that there's a pattern, you're seeing that they're shifted and maybe on the weekends, for instance, they may be, you know, where they go to bed earlier, or sorry, on the weekend when they're going to bed later, oh, they're falling asleep sooner, or maybe there's a circadian component to this, you know what I mean?

So, it'll start to pop up. For you like patterns, and I think a sleep diary about two weeks worth is usually good. Okay, let's start. Um, and then, of course, the questions around sleep disorder, breathing questions around restless leg syndrome, you know, parasomnias are also something that's really, really common in kids sleepwalking, sleep talking or sleep terrors and things like that.

Older kids, narcolepsy is another big one. So those questions, you know, usually everybody kind of does this a little bit different. I, you know, I provide like kind of the whole spectrum, so I tend to focus on those things as well. Um, but I think, you know, Sleep Diary is an excellent place to start.

Absolutely. And you mentioned the concerns around potential under diagnosis of sleep disordered breathing. Could you just share some symptoms or things for people to be on the lookout since it sounds like so many people are just not aware of what to look for? Yeah. Oh my gosh. I think it starts with, you know, people, a lot of people hear kids snoring and think it's cute.

I don't think it's cute. Yes. Right? It's like, oh, they'll be cute. They snore, right? Because it's really, they're having fragmented sleep. They have impaired gas, gas exchange. It's going to, it's going to affect their growth, their learning, their focus. And eventually they do have those systemic manifestations as well that we see in adults.

And so most common things you would see would be snoring, uh, pauses in breathing, and rest, a lot of restless sleep. Sometimes you might also hear like gasping, choking, and then Another thing that you might see, especially in, you know, in kids who maybe, for instance, were already potty trained that are dry, is what we call, uh, secondary nocturnal enuresis, so bed wetting after they've been dry, so you might see that.

Uh, another thing that I see frequently is that some kids may really have really, really dry mouth, especially if they, if they're mouth breathing because they're snoring. And then, you know, I would say that and then. Let you know also, because most common reason why kids have sleep apnea is big tonsils and adenoids, right?

Adenotons around the age of two to about seven years is the peak age where their adenoids and their tonsils or the adenoids right behind the nose and the tonsils behind the throat. That's where it's growing the most, and that's really a common age where we diagnose sleep apnea, but then you also have other risk factors for sleep apnea in kids.

Obesity is one of them, unfortunately. Yeah. Yeah. what we call craniofacial abnormality. So sometimes kids have sort of a recessed jaw. Anatomical differences is a contributing factor. And then you have kids that might have genetic syndromes, too. So down syndrome, uh, some of the syndromes can also put them at risk for sleep apnea.

The reason why I mentioned hypotonia is sometimes you may not even hear much snoring. So this is where you really need to be very unheightened alert. Uh, so if you have a childhood, for instance, Down syndrome or trisomy 21 where their tone is low. Sometimes, in some cases, especially in the younger ones, they may not necessarily have your typical super loud snoring.

So you'll just have to be cued into all the other clues, like is the sleep very restless? Are they gasping? Are they pausing? So things like that may clue you in. And um, And then, you know, many of these kids also, you may see again, daytime manifestations, right? So you may see that they have a lot of, they get a lot of colds, they're more prone to, you know, allergies or things like that.

And then of course those daytime behavioral issues too, hyperactivity, inattention, daytime sleepiness, all those things are clues like, okay, something is wrong. And then especially if they've gotten enough sleep in terms of the number of hours of sleep and this. still exhausted or they still having issues, then you should have them have it checked out.

And if someone is listening and being like, well, my kid, there's no way they're going to wear a CPAP or so why bother if you can kind of unearth that, uh, concern for people. Yeah. Yeah. And even before that, I think we'll go, we'll park at a diagnosis, right? So in terms of, in terms of that, you know, we use a sleep study.

It's still in lab sleep studies for, uh, for kids. So for adults, usually you could do a home sleep apnea test. Now, a lot of this home sleep apnea testing devices are FDA approved. Some of them to children as young as two years of age, but commercially, commercial insurances and things like that. Mostly don't cover it because for now the ASM right hasn't really put out a recommendation for us to use home sleep apnea testing in kids.

So for now, the in lab studies are the gold standard and you know, it's multi channel. You're seeing a lot of detail. And so once that is done, usually you want to try to make sure that if you're bringing your child to get a sleep study done, it's done in a, in a, an accredited sleep lab. Okay. to take care of kids with sleepy sleep disorders.

So there needs to be some, a certain level of experience with the technicians and things like that, that are doing those studies. And then, you know, once that diagnosis is made, they're different treatment options because the most common cause of sleep apnea in children. Is the adenoid and tonsils been enlarged?

Then the gold standard right now for treatment is adenotonsillectomy. So removal of the tonsils and adenoids. And that's usually done by our ENT colleagues. So you'll go in, I mean, no procedure is. simple, but it's a relatively, it's relatively commonly done. Right. So there's still a few complications. I don't, not so much.

Um, and sometimes it's a day procedures for young kids, for kids with complexities and for kids with very severe sleep apnea, usually they need to be admitted in the hospital for monitoring. But usually within a week, kids are back to themselves. Parents are like, Oh my gosh, you gave me a whole different child.

Right. Um, because it's. pretty effective. In fact, there was a study that was done now several, several years ago now by one of my mentors, Dr. Carol Marcus, she's passed away now, where they looked at that and the curative rate of um, adenotone selectomy was about 79%. So that's phenomenal. Um, there are some patients that are risk for persistent sleep apnea.

And those would be kids, for instance, maybe with obesity, kids who may have, uh, craniofacial conditions and kids who may have like low tone hypotonia because their etiology or the cause of their sleep apnea is a little bit different from just big tonsils and adenoids. So that's Adenotonsillectomy. So a large majority of kids, uh, get that and, and that's it.

And their sleep apnea is done for other kids where either Adenotonsillectomy is not recommended either because they have some complications or it's just not recommended for some reason or the other. Or it's not curative, meaning that they did have adeno tonsillectomy, but um, you know, they still have persistent symptoms.

Then we start to talk about. CPAP. Yes. Now it's, it's a smaller proportion of children. But it is extremely effective. It does take a lot of some work by skilled. Sometimes we may need a behavioral sleep team to help. So you need to really work very closely with the family to say, this is something that's going to take getting used to.

And so one of the things we leverage is if you have a parent, or the other thing I should have mentioned, there's a familial tendency to sleep apnea. So there's some that kind of some, some. Patients either because of their, their facial features, right? Which you inherit, right? And so you just kind of work with them very closely.

We go through a process of desensitizing them to the CPAP devices. And eventually, I mean, I have kids who are like, I can't go anywhere without my CPAP. I love my CPAP. Wow, that's great. Okay. So thank you for walking us through that. One, there are multiple options, multiple things that might be at play. And two, just some of the what's on the other side, once we bring those things in, it can feel like a whole new child and just a real change in some of those symptoms that they were experiencing.

So with that, I'm curious too, if we think about this topic of Kids in sleep, we bring them through understanding their respiratory disorders, uh, any concerns around respiratory disorders. You mentioned the facial abnormalities that might be at play. Another popular thing that I hear people sending questions around is two things.

One, mouth taping for kids, and certainly it's a controversial topic even for adults, and I'm very curious how controversial that might get for kids, or thoughts you might have. And then the topic is of tongue ties, if you have any insights and if, uh, let me know how, how deep you want to get into that, those questions.

No, great, great. So the two common treatments I just talked about, adenotongue selectomy and, and, uh, and CPAP, and then there are other treatment options. So like you mentioned, Oral appliances, not so much in young kids, but in older children, there could be, there could be a role, but, um, more of, you know, maxillary expanders and things like that.

Palette expanders. That's definitely something. Orthodontic appliances. We work with our ENC colleagues, our orthodontists, to create um, devices that really helps and is very effective in this case, especially for those who are not tolerating CPAP. So that's one. So orthodontic appliances are good, um, and have been shown to be effective even in randomized, you know, in, in, in meta analysis and some randomized studies actually.

Another one that I see. Is actually for a certain cohort of kids are potentially medication options, but that's really, you know, the studies are a little bit mixed, and that's really looking at the role of things like there's a medication called montelukast or nose spray flonase, which are steroid nasal sprays, and what all that does is it shrinks that the nasal passages is.

So that the kids can breathe better. It kind of helps decrease the severity of their sleep apnea. That's just in a very small cohort of Children. He maybe, for instance, have really, really mild sleep apnea, you know, so that's another option. So we've talked about for now. Another one would be like you mentioned.

No, no, you didn't mention the just about taking that. We're not even going to go there. So that's not even an option. Thank you for walking us through the concerns on that. Yes. Yeah, yeah, certainly making its ways around social media. And so thank you for Yeah, at this point, it is unsafe. If you think about a child.

The same way even for even on if kids use CPAP, we usually, you know, the type of mask you use for a child with CPAP is so important. So for adults, it's okay to use a full face mask. For kids, we usually shy away from full face masks, except they're older kids. And the reason why is kids have reflux, they throw up.

Right. Imagine your child with a full face mask. I'm just going to paint that scenario and then we'll translate it to the mouth taping, right? A full face mask and the child throws up and there's pressure from the CPAP. That's an aspiration event, right? And that is not good. So we are, we usually shy away from full face masks as much as possible, unless they have someone really watching them closely.

Sure. And so think about the same thing, even for. For taping, right? If the child throws up, it's, we just don't have studies to show that that's a safe, um, or an effective way to treat sleep apnea. Unlike in, weight loss is also another one. Uh, the same way weight loss can help decrease severity of sleep apnea in adults, it actually can help for our kids, especially our obese adolescents.

So that's something we recommend, but of course that's a trajectory. So while we are waiting for them to lose enough, we also are treating them with some kind of adjunctive therapy as well. Positional treatment, you know, positional therapy, like we do in some adults, it's harder to get a kid to stay still because they're moving in bed.

In, for, again, for older, for like teenagers, that may be an option if they have positional sleep apnea. That's something to consider. Now, I wanted to bring up Inspire, the hypoglossal stimulator. Which is incredible as now it's become, it's becoming a treatment option, especially for children with Down syndrome who may have cognitive difficulties and they just cannot tolerate, um, wearing a CPAP or things like that.

And so there are lots of studies now that are going on to actually, uh, see, you know, really look at this on a larger scale, the efficacy. So far there've been studies published and it's, it's been life transforming for this children. Um, The final treatment, uh, I should have mentioned too, is for some children, they may need, um, facial surgery.

Just, uh, we call them mandibular distraction surgery, especially those kids that have really recessed chins, that's one. Another surgery, which we don't do as much anymore, when there were very limited options for treatment, was a tracheostomy. Where you actually are putting a hole in the neck and a piece of plastic to bypass that obstruction.

So that was actually a treatment option way back. Now they're a lot more effective and less, uh, aggressive and invasive treatment options that we don't do it as often, but we still have a handful of kids who end up needing a tracheostomy. So that's the, I think I touched on most of the. more common treatment options for sleep apnea.

Sure. Thank you. And just throwing out those things that have been circulating and getting a lot of press, the topics of like tongue tie removal for kids and potentially impacting that facial shape concern. Any thoughts on any of that? The studies on tongue tie release or frenulectomy, it's still mixed. I think theoretically what people have really been focusing on, and even in my practice, I don't necessarily go to that first as an option, unless of course when they're feeding.

Or their speech is impacted. I focus more on, on those two. There may potentially be a benefit with sleep. Now, there have been a few studies that I've looked at this and I honestly, I feel like the results are so mixed and I would not say that's necessarily a top of the line treatment. for sleep apnea.

Sure. And how about the myofunctional exercises or do you see any benefit or challenging to get kids to do that? What do you see there? You know, it's been, you know, it's been sort of more up and coming and we're starting to see that it's actually an, a potentially effective Concentration. And, you know, I think there have been a few studies that I've seen that I kind of looked at, glanced at and seen that, you know, they actually do look like the results are very compelling.

So that's something that I feel like it's, you know, it's definitely taking a lot more ground. Um, you know, when I have a child Okay. Just me personally, and with my own experience, if I have a child, depending on how significant their sleep apnea is, I may push more towards, you know, agnoton selectomy, if that's an option, or CPAP.

I mean, now, if they have more of the mild, sort of mild moderate range, where it's like, okay, you know what, it's not groundbreaking, then I am absolutely fine with them going ahead with the myofunctional therapy. But there are studies showing that it does have some efficacy. Great. Thank you so much for those and shifting gears a bit given your expertise and how deeply connected even in your own personal life, sleep has been for you.

I'm definitely curious to find out the answers to our four questions that we always ask everyone that comes on the podcast. So shifting gears a bit to how you're managing your sleep, and I'm sure it's evolving and changing and lots of different things, but for right now. Curious on the first question, which is what does your nightly sleep routine look like at the moment?

Yeah. So it starts with getting the kids to bed, right? And then usually what I do is take a hot shower. That's just been forever. Yeah. And then after that, usually I have a reclining chair in my bedroom. Oh, nice. I'm just like, I'm just beaming thinking about it. Right. I see that. I love it. We're not affiliated with this recliner people.

So I'm like, is it? Oh, it's 544. Hmm. I have just a couple more hours, right? Soon you'll be reunited. And so that's where I just process. You know, I spend some time just processing my day, right? So I do journaling and then I read, um, and one of the things I do in my journaling is just gratitude reflection.

And I think that's really been huge for me. So I do write what I'm thankful for. And then I read. And then I get into bed, I take a sip of water, I get into bed, I kiss my husband, and then that's it. I love it. You're actually one of the first people, I think, with all these episodes that has kind of pointed to that specific place that they go to, and clearly have good associations with, to kind of down regulate, reflect.

I really like that a lot, actually. So great. Okay. So then the next question would be, what might we see in your morning routine with the argument that that could play a role in your sleep? Yeah. Yeah. Yeah. That's, that's a big one. So one of the things I do once my eyes open up is first, just try to catch what the thoughts are that I start thinking of, right?

I, I've, I've become really conscious of that because there's usually a tendency to want to just run, but I stop and I process just for a moment, I whisper some gratitude and then I get up and usually what I'll do is I'll do some, some reading, I'll, I'll, I tend to. You know, open the windows right away, right?

Get some light in. Yeah. And then I'll do some reading. Um, I usually will then pray and then I go out for a walk. Everybody's still sleeping. I'm a morning person. So I go out for a walk. Uh, I mean, if it's winter, if it's cold, I still try as much as possible to get out and walk in the morning, even on a cold, if it's not snowing or raining.

Otherwise I just kind of sit by the window and just. So that's usually what I'll do. And then once, you know, folks wake up and things like that, I'll walk my way down to get some, um, workouts in. And then, and then I start my day. Amazing. I love that morning. And I like the kind of book ending of the gratitude from the evening and then pulling that into the morning as well.

And then. So good. The kind of looking and inspecting of your thoughts when you're first waking up and just kind of get an idea of where things are at. And, you know, maybe influence those with the gratitude and the prayer. Fantastic. And then, of course, the walking and getting that light. And have you found that that prayer has been an important piece and in your morning routine?

It's it's been the anchor, honestly, for me as a person who has. multiple passions. Yeah. I have a, usually I have a lot going on at the same time, because I'm raising, I'm raising human beings, right. All kind of important. Yeah. So I think that's been, uh, it's been a, it's been a big grounding for me. And so that's something that has just been, it's been leased through.

I see the different walks of life or different times in my life. And I've seen how that's just really gotten me through. And so, yeah, it's a, it's a big one. I love that. Yeah, I would like to do some more content around prayer and sleep and, you know, certainly a little hard to get, you know, a meta analysis on that topic, but I'd like to just go a little deep.

That would be phenomenal. Let me know. I would love to. I would love to I know. Oh, absolutely. Yes. Stay tuned. So good. I love that morning routine. And then the third question would be what might we visually see on your nightstand or if you're traveling, maybe proverbial nightstand and your environment, ambience, anything noteworthy?

Yeah. Yeah. It's my sleep mask. Yeah. A glass of water and a notepad and a pen. Yeah. Do you utilize that? Do you find certain times where you and suggest that for others? I do highly, highly, highly, highly, because even when I've had my night routine, at times there may be thoughts that I haven't captured quick enough.

Yeah. Yeah, sure. Totally. That didn't make their way to my journal. Right. And so as I get into bed, or sometimes if I just wake up, you know how you're just like, Oh man. I mean. Launch for the kids like come on. Are you serious? Or you know, like weird thoughts, right? It's like, okay, or like a great creative idea.

So I tell my beautiful brain, we're not going to be creating stuff right now because it's time to sleep. So we're going to write this beautiful thought down so that we could discuss and address it in the morning. You'll be okay. Oh, what a nice inner dialogue you have. But the goals, beautiful thoughts. I love that.

That is amazing. That takes training folks. That is so good. And I like that too, with the ability to be mindful of the timing for these thoughts, uh, and the importance of, so we, uh, in some of our programs, we're just looking at, you know, kind of habits and behaviors that we can help support people with on improving their, their health and their sleep.

And we'll talk about thought timing and just the importance of being mindful. And even if it's a eustress kind of derived thought pattern. So exciting things on the horizon, or like you said, just a great, beautiful idea or what have you training ourselves to not necessarily go down that. tunnel. No cheese down that tunnel at this moment.

Anytime. Anyway, I like that kind of bracketing approach that you're bringing in by putting that down and then you can pick that up later. Beautiful. And then the last question would be, what would you say for yourself has made the biggest change to your sleep game or said another way, maybe biggest aha moment in managing your sleep to date?

I would say, honestly, this sounds, maybe it sounds cliche. I don't know, but it's intentionality. Yeah. I just realized like good sleep just doesn't happen. Like you may be one of the lucky few where it just happens. Yes.

It really, and that's the thing. And that's why I smile about my routine because it's almost like. You know, it's, it's, it's like clockwork and one of the things I say is like, when I talk to people about this and it's the same for me, I think, think of your sleep as a multidisciplinary appointment because it is right.

You're seeing a neurologist for all the work it does with the glymphatic system. You're seeing an endocrinologist with your metabolism being regulated during sleep. Yes. Therapists with the REM and all the emotion regulation, right? You're seeing a nutritionist with your insulin, you know, you're seeing like all these specialists.

Every night for about eight hours, right? You probably wouldn't just skip a multidisciplinary appointment during the day and be like, Oh, yeah, sorry, guys. Sorry, all you team of doctors. I have I got to take a friend to watch a movie or go grocery shopping, right? You wouldn't. So you can't treat your sleep like that.

So you got to come with that. Like I am meeting like this whole team. Yeah. To work on my brain and my body so that the rest of the day is going to be phenomenal. And it really took me saying, huh? Hmm. Okay. That's what we're going to have to do. And I think that's really been a game changer for me. Um, in the way I approach my, my sleep, I, I, I really keep it very sacred, very, like, I don't play around with it because I think I have so much to give the world that.

I can't mess my sleep up in that sense. I mean, of course, I have rough patches. We all do, right? I have days where I have a hard time, but it's really coming back to those fundamentals. For me, that's been a big deal. Wow. I have never heard anyone describe it in that way, that multidisciplinary kind of approach or, uh, that respect for this thing that we do each night and that way to think about it of those appointments.

And you want to get to those appointments and we're going to be. chipping away at all those the later we stay up, or if we try to cut corners in the morning and cut into that, you know, that therapist appointment for REM or what have you, that's really such a great way to conceptualize that. Now for people that then will be like, Oh, well, I hear you're keeping it sacred, but What about flexibility and I want to be able to stay up late and that's too rigid or what have you, what do you say for those people that kind of might go to that, that thought process?

Yeah, you know, it's a, it's a mindset thing, right Molly? I'm like, what, how do you feel right now? Honestly, it's, that's where it boils down to like, how do you feel? How's your energy? How's your mood? How's your weight loss journey? How's your fitness journey? How are you achieving those goals? How's your productivity?

Like, Think about that. Like if it's perfect, then you're good. Like we don't even have a conversation, but if you could get just a little bit better, I would say, just be curious and try to just try it out. Try that out for like two weeks and see like, okay, I'm going to give this sleep thing a try and yeah.

And then see about it. So I really, that's what I say. Right. Because I know, of course, I'm not saying don't go out to parties. Don't go. No, of course not. Right. But yeah. I think just make sleep priority a lifestyle and give it a try, right? Be curious. Like, what would happen to this? I keep yelling. Hmm. I wonder.

Yes, I love that. No, a hundred percent. And for anyone that might be listening, like, oh, I don't do the nightly gratitude and the morning gratitude, the prayer and all the things for those people. I really resonate with your story of sharing that. You know, it hasn't always been like this for you. It hasn't always been like that for me.

And yet, sometimes there's seasons for all of us. So even if you're listening and you're in this whole other season where things are not working with your sleep, that this is a demonstration of what's possible that we can work through that. And then we can have this beautiful relationship with sleep versus like trying to force it or what have you.

It sounds like you really have created this wonderful connection with how you think about your sleep, how you manage it. So I just love that. So well said. And for anyone now listening that wants to follow you, learn more about what you're putting out there into the world. I'm very clear that we're going to be seeing a lot of you out there and on the internets, if you will.

But so how can people learn more? Because I know we only scratched the surface on this big topic of children in sleep. So what's the best way for that? Yeah, yeah. No, thank you so much, Molly, for having me. I've had a great conversation. I know, me too! It was great. So, I think you can, the best place to find me, I hang out on Instagram a fair amount.

Um, be gracious with my reels. I try to be, I'm a little goofy, but it's all good. No, definitely follow her people. So I'm on there at, um, restful sleep MD. And then I literally just announced today that my, I'm starting my own practice. Um, so that's going to be opening in October. Amazing. Congrats. I'm so excited about that.

And so the focus will be on kids and young adults with sleep issues. I also help moms with sleep issues as well. Um, so just sign up, you could grab a spot on my wait list. It's at, uh, restful sleep, md. com. And that way, once I start scheduling and all of that, I'll send out an email. So, you'll know. Amazing.

So awesome. Congratulations. That's super exciting. Love those new chapter moments. Happy to be here with you on that exciting day. So congrats, congrats for time in your life. So make sure to follow Dr. Brown. Fantastic content that's being put out. You can hear the passion, more coming and then just. Like, thank you so much for taking the time to be here and sharing your wisdom.

It really makes a difference. Thank you. You've been listening to the sleep as a skill podcast, the number one podcast for people who want to take their sleep skills to the next level. Every Monday, I send out something that I call Molly's Monday obsessions containing everything that I'm obsessing over in the world of sleep.

Head on over to sleep as a skill. com to sign up.

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