Episode 33: Sleep Apnea in Children: Snoring Is NEVER Normal

Hi and welcome to episode 33 of the Untethered Podcast. Today I am going to be discussing sleep apnea in children and I want to put the disclaimer out there that I am not a sleep expert, but as a speech language pathologist and certified orofacial myologist who specializes in feeding therapy, I. I work a lot with children who have open mouth posture, and this open mouth posture can actually lead to issues with sleep. So that's where I want to dive in a bit deeper today. And this will be a quick episode, but I think it's a very important PSA public service announcement, if you will, and we can talk more about this on future episodes and dive even further into this topic. But the reason why I am even talking about this is because I hear so many moms on Facebook. You know, I put out a post at one point that said, you know, snoring is never, is never normal. And so many people contacted me and said, oh, I never knew that. Nobody ever told me snoring is not normal. Well, if snoring is not normal, then, like, my child does it and my husband does it and I think I even do it. And, you know, it seems cute, I'll give you that. It might seem cute on a baby whose mouth is open, they're snoring because everything on a newborn and an infant seems cute. But it's actually a very dangerous symptom that we really want to attend to. Snoring is often indicative of in many cases. And again, I'm not the expert here, actually. I want you guys to go back and listen to the episode that I recorded with Ken Hooks. He talked about the airway and he does sleep diagnostic testing, like home sleep diagnostic testing. He's just phenomenal looking at the airway. And so we definitely dove pretty deep into this topic that day and he gave a lot of really great information beyond my scope of practice and beyond what we're going to talk about here. This is just sort of my public service announcement that, you know, I want to make sure that people are aware that if your child has sleep issues, your child is not sleeping through the night. I know there's a lot of sleep consultants out there. I'm not knocking them. However, they are not all trained in what to look for from a medical standpoint and just trying to come up with strategies and compensations to get your child to sleep through the night so that you can sleep through the night. I get it. I don't sleep much, not because of my kids, because we've sorted that Out. But because I'm just a night owl and I work best in the evenings and I really prefer to get my work done after my kids are in bed. And sometimes I just want to decompress for an hour or two and then I'll start till, you know, 10pm and then I'm up till 1 or 2 in the morning. That's kind of just my M.O. but that's very different, right, than a parent who is frustrated and exhausted and just wants to sleep and her child's waking them up all night. I get it, I get it. I have a 4 1/2 year old and a 22 month old. I get it. When something happens and they don't sleep and that's just one night, it's miserable, right? So I'm like, I go to sleep late anyways and then all of a sudden they wake up at two in the morning and then mama really get no sleep. And I believe me, I'm with you. So that night after night after night, that would just be completely horrible. But the potentially faster fix to this and healthiest fix to this is sometimes looking at various symptoms and ruling out certain symptoms to see if they're present. Right. So you know, if a child. And this is from The Sleep foundation, sleepfoundation.org I'm going to use them because while I can give you this information, I also want to give you a resource to go check out after you hop off of here. And you know they're an organization that does this, right? Like I've already given that disclaimer. I am not a sleep specialist. I am someone who refers out when I have concerns about these things. So sleep apnea symptoms in children during the night, a child with sleep apnea, we often will see that they snore pretty loudly and pretty regularly. Meaning it's not just like, oh, one night because they have a cold. But you know, they might snore regardless of a cold, you know, or independent of the cold, I should say they'll have maybe pauses or you'll hear them gasp for air, maybe they'll snort and actually stop breathing. And what this does is these snorts or gasps for air kind of sends their body into like, like it kind of just make it brings them awake, they wake up, it disrupts their sleep. And so some kids, depending on how deep the sleep is, it might just disrupt them and they might fall right back to sleep. Other children, it might bring them to full levels of being awake. And again, I'm using all the wrong terminology, but I just Want to get you guys this information so you can kind of start to find the right specialist if you know your children have these symptoms. We also see that children are pretty restless when they have sleep sleep apnea. They may sleep in abnormal positions with their head in unusual positions. They also might sleep sweat a lot when they sleep. So that's something to pay attention to. Another thing that we sometimes see is bedwetting. And with urinesis, basically we're seeing that these children in such a deep state of sleep that if they have a moment of sleep apnea that jolts their body awake, it actually just kind of. They lose control. They lose control of their systems because they're gasping for air. And so all of a sudden they go into fight or flight, they lose control of their body and they wet the be. And so when people tell me they have 5 year olds, 6 year olds, 7 year olds, 8 year olds, 9 year olds still wet the bed at night, and the pediatrician says that's normal, I beg to differ. I don't think that's normal. And I think that we need to look at the child's sleep to make sure that there is not something greater going on that's causing that to happen. Because this also can become a very social, emotional thing for a child, especially if they're a child who gets the age of wanting to go on sleepovers, you know, and they have to secretly wear like a diaper to bed or something so that if they have an accident in the middle of the night, they don't pee all over their friend's bed or the sleeping bag or whatever. This is a big issue. And so, you know, the sooner we deal with it and the sooner we look at these other symptoms, the sooner you can actually help your child. And it really does impact them social, their social emotional development. So something just to be aware of as well. And I'm not sharing this as a scare tactic. I share this with all of this, you know, from love. Deep down in my heart, I just want people to realize that it's not just bedbudding. There's something causing that to happen. Okay, so going back during the day, a child with sleep apnea might also have like behavioral issues. They actually have research out now that I'm trying to remember who I linked to that research article with which recording that was. Maybe it will come to me. But they have done research that shows that attention deficit hyperactivity disorder, ADHD can, there can be signs of that from having sleep issues. And you know, apnea can also be associated with like delayed growth and cardiovascular problems. And so other learning issues come out of all of this, out of the ADHD and other developmental issues. And, you know, think about it, when you're tired, how easy is it to pay attention? It's not. It's really, really not. So, you know, just some food for thought there. But anyways, going back to the, the daytime symptoms. During the day, a child with sleep apnea might be said, you know, have behavioral issues. There might be some issues at school or some social problems. They may be hard to wake up in the morning because they're just so exhausted. They might have headaches during the day, but especially in the morning, they might be irritable, agitated, aggressive, cranky. They might also be so sleepy during the day that they actually fall asleep or they daydream a lot. And they might also speak with a nasal voice or breathe regularly through their mouth. Right, we talked about that before with like mouth breathing. And they can have a very nasal sounding voice as well if their nose is blocked, which is kind of forcing that mouth breathing. And that could also be directly related to why they have these symptoms of sleep apnea and possibly sleep apnea. Now, just because your child has one of these symptoms or two of these symptoms does not mean that they necessarily have sleep apnea. However, if they do have one or two of these, I would want you to start paying attention to their sleep and take a peek at them. Watch if you can, for a little bit to see. Are they restless? Do they pause or gasp for air? Do they snore loudly? Do they, you know, do they, are they restless? Do they sleep with their head, you know, like we talked about before, like their head ended in abnormal or unusual. Not abnormal, but unusual positions, we should say. And do they sweat a lot when they sleep? You know, those are, those are definitely nighttime symptoms that we want to pay attention to. And the daytime ones that I mentioned as well. You know, you can also help a child, your child's school teacher, monitor those for you. Just have that open conversation to understand, you know, how they're doing in school. Because oftentimes teachers have been forbidden from telling you to go get your child evaluated for adhd. Basically, if they tell you that, then the county is like on the hook to pay for at least where I live. So they might allude to some attention concerns or they might say they think that there are some issues, but their hands are so tight these days and there's just so much litigation around this. We live in such a litigious society that, you know, if you have concerns, I would address them with the child's teacher and ask the teacher, what does school look like? What are they looking like during the day at school? Are they. Do they have a hard time attending? They have a hard time sitting in their chair? Are they really fidgety? You know, do they complain of headaches? Do they seem irritable or agitated? Are they having any social issues? Are they cranky? Do they seem really sleepy? Do they kind of daydream a lot at school? You know, is their mouth hanging open? And you know, in the classroom when they're at school with you, you'll probably not have to ask that because you'll be able to see that at home, too. But these are all things that a teacher can give you such great insight into, answering these questions during the day. So, you know, it's just something that I really want to put out there and help people understand that snoring is never normal. Never, ever, ever, ever normal. And in some people, it's actually the tongue is falling to the back of the mouth at times, blocking the airway. And that's where you get that gasping or that, you know, they stop breathing, kind of the pauses that you hear. So I want you to really pay attention to this. If you're not sure if you do it and you live alone, you can record yourself sleeping. You'll hear it. You will likely hear yourself snoring. And you'll also pro will hear if you stop and gasp, you know, for air, or if you choke in your sleep. And some people choke and cough themselves awake. That happens too. So, you know, then I've also. I will also put a disclaimer in there because I have had children where the parent says, oh, and they're a great sleeper. They sleep all night long. And then I've gone into their preschool setting and I've observed them or, you know, we've talked to the teachers. And this child snores really loud during nap time because they're in like, you know, let's say they're in a full day program, preschool or daycare program. They just snore all day, all day long. Sorry, all nap time, you know, the whole nap time. And it's loud. Their snoring is loud. And actually, I think it's. There was a recent study in chest, the official journal of the American College of Chest Physicians, and they said children who snore loudly were twice as likely to have learning problems. So that kind of ties into everything I was saying before. Right. Sleep is restorative sleep. Is necessary. We need sleep. How much sleep you need varies for different people. I'm not well versed in knowing, you know, how many hours each different age and person needs, per se. I know that my little ones really benefit, you know, Lily and mia benefit from 11 hours of sleep. I can get away with six hours of sleep. And sometimes I joke I'm lucky if I get five or six. But I know I feel my best when I get seven to eight hours of sleep. So, you know, sometimes it's also dependent on your body and it changes with age. But young children definitely need way more sleep. And going back to some of the patients that I've had, some of them do appear to sleep all night, but they snore. They're not always waking up or the parent. As a parent, you're not always aware that they're waking up because they're waking themselves up and then falling right back to sleep. That is possible. But the snoring and the open mouth when sleeping, those are two huge indicators and two things that you can absolutely hear and see. And so if you're listening to this, I want you to go and check your children tonight. Whether you're a provider who's new to this or you're a parent listening to this or you want to check yourself, ask your spouse, you know, tonight to listen to you or your significant other or record yourself on your phone and just listen to, is there snoring? Are there gasps for air? Do I wake up coughing or choking? You know, do I sound restless? You know, what are the. What's going on? And if that happens, go back and listen to the episode with Ken Hooks because he gives you great tools for home sleep studies. Or you can contact your local ENT or sleep study center. Sometimes you might need to go through the pediatrician first to request a referral, but not always. You might be able to go straight to the ent, voice your concerns and ask them to write you a script for a sleep study and help you set that up. So I hope that's helpful. Wanted to put a little bit of information out there on sleep apnea in children. And again, that resource I shared is sleepfoundation.org we're not going to do show notes for this episode so you can hop over there sleepfoundation.org or go back to the episode with Kenya Hooks to get all the good, juicy details that you need on sleep apnea and home sleep studies. And I hope everybody's having a great 2020 now that we're in the new year. Have a great day, everybody. This is Hallie Balkan signing.