Don’t Ignore the Snore: The Hidden Link Between Airway, Sleep, and ADHD

There are documented changes, my friends, in the brain regions, the hippocampus, the frontal cortex, areas that are responsible for learning, for memory, for executive function. And this matters even more in children because these are critical development years. Hello friends, and welcome back to the podcast. Today we are going to dive into a conversation on sleep and airway and mouth breathing and how this is all deeply intertwined with ADHD behaviors, learning, and neurocognitive function. Now, before we dive in, I just wanted to say I feel very appropriately positioned to talk about this because I'm ADHD. I actually believe it is a superpower of mine. And I know that everybody refers to it as being neurodivergent, but I think that can mean a lot of different things. And so I like to hang with the ADHD title because I think it really clearly defines me, or not defines me, but describes me in certain ways. Like I am not hyperactive. Per se, but I do have an attention deficit and I definitely have several. I have the other characteristics that fall under the ADHD umbrella. So let's jump into this a little bit further. Welcome to the Untethered Podcast.

I am your host, Hallie Bulkin. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up-to-date information in the orofacial myofunctional therapy, airway, tethered oral tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture: tongue up, lips closed, teeth apart, breathe through your nose.

Let's get started. So I want to start this episode a little differently by sharing this personal story of my own, because I said this isn't theoretical for me. So when I was about 5 years old, teachers started telling my mom that I should get tested for ADHD. Like, Hallie's got ADHD-like behaviors. They wanted her to get me assessed. She took me to multiple professionals and she had conversations, did her due diligence, and ultimately decided not to medicate me. Okay. Fast forward. And, and here's the thing, cuz you guys will really enjoy this part of it. One of them diagnosed me over the phone without ever meeting me. The other one said I didn't have it. So basically removed the possibility of diagnosis without ever meeting me. And the third one met me and I guess presented medication as an option, but it was also not like being pushed. And my mom was like, she's 5, like this doesn't seem appropriate. But not one person ever said, hey, maybe you should have a sleep study or whatever. We'll get there. Okay. So let's fast forward to age 19, my freshman year of college, suddenly studying was really hard, like really hard. The way my brain worked felt different. I had always done great academically, so everyone including myself kept being like, you're fine, you've always got good grades. But I wasn't fine. And so I went for testing. I was diagnosed with ADHD. She actually diagnosed me as ADD. I was told, you have a high IQ, so you don't really— we don't It wasn't that they, yeah, she was like, we don't really wanna give you the ADD label, but I'm gonna give it to you because you're a candidate for Ritalin. Basically, here's a prescription. And here's the part that still gets me, and I already said it, nobody asked about my sleep. No one suggested a sleep study. No one looked at my airway. No one looked in my mouth. And to be fair, I didn't know to ask for them to do that either, right? This was like 2003 to 2004. None of this was on my radar at that time. I didn't even know I was gonna become a speech pathologist yet, right? I was in, I was in business, the business program at the University of Maryland. So let alone specializing in feeding and airway and myofunctional therapy. But by looking back, back now, that was a massive missed opportunity, right? And this is why this conversation matters so much. So I wanna start with one of the biggest, most overlooked signs of airway dysfunction. And that, my friends, is audible breathing. Breathing should be quiet. If someone is truly nasal breathing with an unobstructed airway, meaning there is no obstruction, breathing is typically silent whether you're awake or you're asleep. If you can hear somebody breathe through their mouth or their nose, something is usually off. So that right there is a tell-all sign, right? And here's something else fascinating. When someone transitions from mouth breathing snoring or loud breathing to quiet nasal breathing, especially in kids, like the parents or partners, they panic. They're like, I kept checking to make sure they were still breathing because I couldn't hear them anymore. Like, they're not used to that. That tells us how normalized dysfunction has become, and it's a little bit scary, right? So here's what mouth breathing often looks like. Lips apart at rest, the tongue might be sitting low and forward in the mouth, might not be forward, it might be back, but it's still low. There may be a narrow or high or both palate. There's deficient midface growth over time. There's vertical facial growth, right? That longer, narrower face pattern. And so your tongue, my friends, is meant to live up on the palate. It helps us shape our maxilla and guide proper growth. When it can't do that, the whole system adapts and not in a way that's supportive to our airway health. So why does mouth breathing start, right? Here, let's talk about that. This is why mouth breathing happens, right? Sometimes it's structural, sometimes it's inflammatory, sometimes it's functional and restrictive. Let's dive into each of those, right? So structural, there could be a deviated septum, enlarged turbinates, enlarged adenoids or tonsils, narrow palate, restricted nasal cavity. Like I had a septoplasty back in April of 2022 to fix my deviated septum. It was deviated in the back left side. You couldn't really even visibly see it that well. So I had no idea until I had a scan that showed it. I had enlarged turbinates. I also had enlarged nasal swell bodies. So that's another structural thing that could be going on. And so those, those were— I had a high narrow palate as well. My nasal cavity was thus restricted, right? So I literally had everything but enlarged adenoids and tonsils. In this structural list. Sometimes it's inflammatory, right? There could be allergies, chronic congestion, sinus issues. Now here's the catch-22. A lot of people with structural issues tend to have inflammatory issues, right? So how do you piece those apart? What came first, the chicken or the egg, right? And sometimes it's functional and restrictive. So there could be tethered oral tissues. Hi, had that too. Low resting tongue posture.

Mm-hmm.

Yep. Inability to maintain nasal breathing consistently.

Yeah.

I mean, if you're blocked, hello, right? So, you know, even if you don't have a block, this can still happen. Just want to highlight that even if you don't have tethered oral tissues, if you don't have a tongue tie, you might still have a low resting tongue posture, right? So sometimes these things exist outside of the others, and I just want you to hear that. But here's the key thing I want you to also hear: many people don't complain because this is all they've ever known. And when I say people, I'm really talking more about like older kids and adults. So think about when you've had a bad cold and your nose is stuffed, you become an obligatory mouth breather. Now imagine living like that all the time. Also imagine never having really known what breathing through your nose feels like and not breathing through your mouth, so you don't know that there's anything different than that mouth breathing. So is this common? Yes. Is it normal? Absolutely not. Okay, now let's connect this to sleep. Let's go into like sleep disorder breathing so you can really have a better understanding of why snoring is something that we don't want to ignore. Like, don't ignore the snore, right? If you hear snoring, loud breathing, gasping for air, mouth open, you know, you see mouth open sleep, you see restless sleep, we have to consider sleep disorder breathing. And this is true for adults and children. Okay, this might include snoring, UARS, which is what I was diagnosed with because I had sleep studies and I did not get diagnosed with sleep apnea. I got diagnosed with upper airway resistance syndrome, or UARS. Right? Maybe you do get diagnosed with mild sleep apnea or obstructive sleep apnea. But let me say this clearly again. Snoring is not normal. It never has been. It never will be. Unfortunately, it's been normalized in culture, but physiologically, it usually means airway resistance. Okay? And no, my child sleeps 12 hours and never wakes up all night tells you absolutely nothing about sleep quality. The question is whether the brain and the body are getting restorative sleep or whether the nervous system is being repeatedly pushed into fight or flight all night long. Right? And so thus they might be asleep for 12 hours, but it's not restorative and their body is completely wrecked when they wake up. Not a great way to start the day. Right? So this is where my story connects to so many families that a lot of us see now, right? That I see, that I'm sure you all see. There are kids and adults walking around with brain fog, with fatigue, irritability, difficulty focusing, hyperactivity, poor productivity, not feeling rested ever, ever, right? And the default response is often ADHD diagnosis and medication. And I want to be very clear, ADHD is real, like it exists, and many incredible creative people have it. That's why I joke, but also I'm very serious, that it is my superpower. Without my ADHD, I'm like, I don't know that I would be where I am today because it allows me to really have a lot of creative thoughts and ideas and juggle a whole lot of things at the same time. Whether I'm doing it well is a whole different conversation. But here we are, right? Before we medicate though, especially in children and especially in young children, we must rule out sleep disorder breathing because a chronically sleep deprived or under oxygenated, oxygen oxygenated, I know I couldn't say that, brain can look like ADHD. It can look exactly like ADHD, but it doesn't mean the child has ADHD. They might just be sleep deprived with an underoxygenated brain. So if no one looks at the airway, at the tongue, at the palate, the breathing, the sleep, right? We risk treating symptoms instead of causes. And I believe in root medicine intervention, and that it's not root medicine intervention if you're just slapping a diagnosis on a child and giving them a stimulant. It's not. So here's the thing about research, right? Research has shown for decades that sleep-disordered breathing is linked to lower executive function, poorer memory, reduced attention, decreased academic performance. Hello, right? And so in more severe cases like obstructive sleep apnea, the studies have actually shown significant differences in IQ and neurocognitive performance compared to peers. So there are documented changes, my friends, in the brain regions, the hippocampus, the frontal cortex, areas that are responsible for learning. For memory, for executive function. And this matters even more in children because these are critical development years, right? These are, this is critical developmental years for them. And so repeated oxygen deprivation and fragmented sleep, it's not just gonna lead to cranky kids the next morning. It's actually affecting the children long-term. It's impacting their brain development. So you're like, okay, well great, what do I do? What do I do? So here's what I want you to take away. If you can hear breathing, awake or asleep, please do not dismiss it. Look at the lips at rest, tongue posture, palate size, breathing patterns, sleep quality, right? And this might be where you want to seek an evaluation with a myofunctional therapist. If the child is at least age 4 or 5 chronologically and they can follow directions that a 5-year-old would be able to follow, then a myofunctional therapist would be great. Under that age, you want an SLP or OT who's trained in like Feed the Peeds because we about feeding myotoss as it applies to the younger crowd, but totally different beast than your traditional myofunctional approach. So seeking an eval with a myofunctional therapist like an SLP, OT, RDH, dentist, PT potentially would be really, really valuable here. Okay. And this is often a team approach as well. Like there may be an ENT involved, airway-focused dental providers, sleep medicine, allergy support, plus therapy, right? Plus myofunctional therapy, or under the age of 5, cognitively you might be looking at a feeding therapist. If you're struggling to find somebody in your area, you can DM me on Instagram and I'll help point you in the right direction. I also have two directories, and if you go to the Untethered Podcast where we host all these episodes, there is a myo directory. If you click there, you can search by your area if you're looking for a traditional myofunctional therapist. If you're looking for a pediatric feeding therapist, go to pediatricfeedingtherapist.com and you can find them. Them on there, right? So two different directories. So this conversation is so, so important. It really matters. It matters for our kids. It matters for adults who were dismissed. Hi, it's me going through adult expansion. I've had the tongue tie releases. I've had the— I shouldn't say releases. I've had my tongue tie and yeah, my tongue tie release plus the septoplasty is what I was going for with the ENT, and some turbinates reduced and nasal swell bodies reduced and I went through DNA Vivos for expansion, but now I'm in a Marpi with clear aligners. So I have walked the walk. I've walked the walk, talked the talk, done all the things. My kids have gone through the expansion. My 10-year-old has been in expanders, different, 3 different expanders, 3 times, and is now in Invisalign. She's hopefully done. My almost 8-year-old is in her second round of expansion and probably will be done after this as well, and currently in Invisalign following her her rapid palate expander that she had. And so this all is really important. It matters for our kids, it matters for their development, it matters for their health. If your child is older and you're like, oh my gosh, did I miss the window? No, there are still things that can be done. So this is important for you whether you have a young child, a child in elementary, middle, high school, or you're an adult, right? Maybe you're an adult in your 20s, 30s, 40s, 50s, or 60s, 70s. 80s, there, there is help for you. Okay? That's why this conversation is so important. And it matters because breathing and sleep are foundational to everything else for all of us. All right. So just a big thank you for being here and for listening to this massive PSA. Hopefully you're able to find somebody to help you. But like I said, if you can't, DM me on Instagram and I will be sure to see if we can connect you to somebody in your area. All right, guys, talk soon.

Quick disclaimer: all information, content, and material of this podcast are the opinions, of the speakers and is for informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these myotats, airway, and feeding-related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer at halliebulkin.com or pop over to @halliebulkin on Instagram to get all the latest updates.