Dr. Funke (00:00):

ADHD, like symptoms, sleep deprivation, they look exactly alike. And the way I just approach it clinically is this: when someone is impulsive and they’re really having a hard time sitting slow and they’re having a lot of emotion dysregulation at the forefront, of course by the time parents come to either see their pediatrician, they’re like, nothing’s working. It’s all over the place. Everything night, bedtime is chaos. Mealtimes are chaos. So it’s really important that we drill down to see where and what are the issues. And that’s where I just really say let’s figure out what’s going on with the sleep.

Dr. Sarah (00:47):

Sleep isn’t just about feeling rested. It is a cornerstone of our health impacting everything from brain development and emotional regulation to physical wellbeing and family dynamics. When our children struggle with sleep or when we do as parents, the effects can ripple through almost every part of our lives. That is why I am so excited to be joined today by Dr. Funke Afolabi-Brown. Dr. Afolabi-Brown is a triple board certified sleep medicine physician and the author of the transformative book, Beyond Tired: A Sleep Physician’s Guide to Solving Your Child’s Sleep Problems For Good. In this episode, we will dive into the science of sleep. Its profound impact on the brain and body, and we’ll cover some of the unique challenges that neurodiverse children face when it comes to rest. Dr. Funke will shed light on the connection between ADHD and sleep difficulties and highlight, often overlook treatment strategies that can have a major impact on symptoms. Plus, she’ll walk us through the rise up protocol, which is a practical tool for anyone struggling to wake up and start the day without hitting snooze. I took a lot of takeaways from this conversation for my own life. I hope you will too. Here we go.

(02:07):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(02:36):

Hello, welcome back to the securely attached podcast. Today we’ve got Dr. Funke Afolabi-Brown here. Thank you so much for being here.

Dr. Funke (02:50):

Thank you so much for having me. I’m really looking forward to this conversation.

Dr. Sarah (02:55):

Me too. I’m ready to kind of geek out on some neuroscience with you. So okay. You are like a triple board certified sleep physician, a lot about sleep. How did you get into this specific area? Why are you interested in the impact of sleep on our health and in families and in children?

Dr. Funke (03:22):

Yeah, I mean, I think it’s a combination of reasons. It was my own personal journey as a mom who a health professional, a pediatrician for that matter, who actually didn’t know what I was doing. So I think that really I came to that awareness after experiencing burnout from both my own choices and also from the issues that my kids had with their own sleep.

(03:50):

I realized how little we know about sleep and its impact on our functioning. And also I realized how much this was affecting families in every area. So the child is struggling with sleep and then the parents’ relationships and the parents are struggling at work and productivity. So it just impacts across the entire families unit. And so I think that was one of the things that motivated me to really get into this space.

Dr. Sarah (04:24):

And so knowing what you know about the science of sleep, how did you bring that into supporting your child’s sleep as a parent?

Dr. Funke (04:37):

So I mean, I had to go back to, for me, a lot of these things I learned because it turns out, even in medical school for physicians, you get through your entire training, less than two hours of sleep education, that’s max. So a lot of these things were not things I knew because I was a clinician, it was things I had to learn. Now, I had to go through a whole year of training to get a sleep fellowship. So what I did at that time was start first to set boundaries with me because I was just like there was no, I didn’t know where I started and my son ended, or my son ended. And with people, boundaries with me, people with myself, with my family, it was just all over the place. So it wasn’t just around sleep. And when I talk about sleep, I usually will say that your sleep doesn’t start off at night.

(05:31):

Your child’s sleep doesn’t start off at night. It all literally starts off the moment you wake up. So looking at what are they eating, what are their, at that time, how long is he staying awake? We call him those wake windows, what are his cues, hunger cues versus sleepy cues? And then what medical issues he was spitting up and back arching. And I would be like, he’s crying. He just fed up, maybe he’s hungry again, I would feed him. And so I had started to make those changes, I would say, on multiple layers. And that was really what did it. And then in terms of things I know now, especially within those first three months of life, our kids go through initially when they’re newborn, they go through active sleep and quiet sleep. So as they get older, we start to talk about light sleep, deep sleep, rem sleep.

(06:30):

So in that first period, that active sleep is actually their own version of REM sleep and they’re moving, smacking their lips. Maybe they’ll cry out, they’ll yawn, maybe they’ll, they’re just really active. And so I was hyper alert and so would interpret any movement at all as, oh my God, waking up, he’s hungry again. So I was also perpetuating his sleep issues, worsening his reflux, and we’re in this vicious cycle. So now I know I’m like, oh, I was REM sleep, I should just have paused. But by the time we kind of got the reflux under control, I kind of started to not make him waking up or him having sleep issues about my parenting failure or whatever. Then we really started to see things improve.

Dr. Sarah (07:17):

Oh wow. So I’m hearing too, that last thing you said seems super important and might not have gotten caught the ears. I want to bring our attention back to that you being able to say, oh, my child’s sleep is separate from my capacity as a parent. That is an important distinction to make. I think when parents can cross that threshold of awareness and separate themselves a little bit from it, we have so much internalized stories around that. I could see that being a very important pivotal shift. Obviously knowing the stuff to do and being able to identify these cues accurately. If your kid is moving around and doing these things, even crying out, it’s really hard. It’s really hard to not intervene in that moment. If you don’t know that that’s a phase of sleep that’s typical of children, I wouldn’t have known that. And then that’s going to cue us telling ourselves the story, right? Like, Ugh, I’m failing at this again.

Dr. Funke (08:32):

Yeah, exactly. That is right. Really on point because you constantly feel the need to rescue them, rescue them, what we’re meant to do, just rescue them. And so I think making that separation is so important.

Dr. Sarah (08:48):

And I imagine too, maybe you could talk a little bit about just some of the science of sleep, why it’s important, what it does in terms of setting a child’s development and just regulation for all these systems, why it’s such a foundational, I always say when I’m working with adults or kids or baby, anybody like mother infant, it’s like we had to go back to the basics. And the first thing on that list for me is sleep, followed by hydration, nourishment, moving your body and fresh air and sunshine and connection. Those are my six big basics that I feel like are critical. But sleep is number one. That’s the first thing I check in with people about. Why is it so important and how does it affect the brain and the body?

Dr. Funke (09:45):

Yeah. Oh, so good. So I think you think about it, even from that newborn period, they’re sleeping sometimes as many as 17 hours within the first three months of life. And there’s a reason why during that period, they’re going through ultra rapid brain development. And one of the stages that is needed for learning and development is that REM sleep. So they have predominant REM sleep. Almost 50% of their sleep is occupied by REM sleep during that time, learning, development, growth, emotion regulation, all of those things are occurring. And so I think that’s the first thing, that ability for their brain to start to form the structure, the neural connections, the memory, all of that is taking place during sleep. And then the other thing we know is that sleep is important for their growth. So not just their learning and development, but actual their physical or what we call somatic growth.

(10:59):

Growth hormone, which is critical, is produced during sleep. It’s produced really majorly during slow wave sleep or deep sleep that is when this hormone, they literally get toler overnight. And growth hormone does not just doesn’t just get secreted in young kids, even in adults. It is what is responsible for tissue repair, protein synthesis, all those things that we need to get our muscles to expand. And also our immune system is another big one. So there are certain immune fighting or what we call natural killer cells that literally help you to fight infections or fight foreign agents that may come into your body that is regulated during sleep. This is why we know that when our kids don’t get enough sleep, they’re more likely to get sick, they’re more likely to catch the common cold. And actually now they’ve actually even done studies where they had two cohorts of patients, one that had short sleep and one that had sufficient sleep, and they immunized them and the response was different based on those who had good sleep and those didn’t also almost 50%.

(12:21):

So those that had poor sleep had probably about 50% response compared to those who had enough sleep. So very, very critical for that immune regulation. And cancers, even when we talk about adults and cancers are associated with post sleep and then emotions. So that’s another function where we get with REM sleep, you have, I almost described it like a filing cabinet. So negative emotions are processed through and then the positive emotions are retained. And so all of that takes place during sleep, such that if kids don’t get enough sleep just like us, we are more irritable. Emotions are more labile, you are more likely to be inattentive, impulsive, and really almost have those ADHD like symptoms all around very positive. Which is why for patients and for clients that I work with before, while you’re getting that evaluation for ADHD or whatever, neuropsych evaluations, you want to make sure it’s done on as good sleep as possible because it might make a big difference in terms of what the outcomes look like. And then metabolism. So there’s certain hormones like insulin, there’s some what we call satiety hormones, leptin and ghrelin, all of this that regulate our appetite is produced during sleep. So if we don’t get good sleep, you’re more likely to, especially for our older children, crave on healthy foods, feel more hungry, which will eventually lead to weight gain issues, diabetes, hypertension. Now we even see that even in our teenagers,

(14:15):

They have a higher risk of hypertension, obesity and things like that. So I would say from top all the way to bottom, there’s really no part of our system that doesn’t get impacted by sleep.

Dr. Sarah (14:29):

Yeah. Oh my god, I have so many questions that go in so many different directions. I want to ask you about, oh, the impact of sleep deprivation on postpartum moms because of all that, but might have to come back to that. I really want to go back to this idea you were saying, if you have a kid, maybe the hypothesis that we’re working on is like there’s some neurodiversity here. Maybe we’re going to get a neuropsych eval. Maybe we have a diagnosis of ADHD. Maybe we’re just getting feedback from our environment that something is an indicator that this might be a differential diagnosis that we’re exploring. I would imagine that kids who do not have ADHD for example, or maybe don’t meet the diagnostic criteria for it, that if we really dial in on sleep, we might see a shift. Because what you’re saying is that the lack of sleep or difficulty getting good sleep could actually make a kid who isn’t neurodiverse or doesn’t have ADHD look like they do, but that also a kid who genuinely does this is the brain they have, this is the machinery we’re working with. It could amplify the expression of those symptoms. How do you think about neurodiverse brains and sleep?

Dr. Funke (15:56):

Everything you said is just really on point, right? Like ADHD, like symptoms, sleep deprivation, they look exactly alike. They’re a mirror image of each other. And we do know that neurodiverse children with neuro, in fact, at some point, I can’t remember where I read this, there was a point where there were considerations around making ADHD almost like a subsection of a sleep disorder at some point to show how prevalent sleep issues are in children with autism, ADHD, dyslexia, learning differences, all of those things. And I think it might be a little bit of a bidirectional relationship.

(16:42):

Because almost if you think of a Venn diagram, you have those two, you have sleep issues, and then you have ADHD. There’s such an overlap. Honestly, the way I look at it, the way I just approach it clinically is this, when someone is having, usually they’re in school, they may be in school and they’re impulsive and they’re really having a hard time sitting still, and they’re having a lot of emotion dysregulation at the forefront. Of course, by the time parents come to either see their pediatrician, they’re like, nothing’s working. It’s all over the place. Everything night, bedtime is chaos, mealtimes are chaos. So it’s really important that we drill down to see where and what are the issues. And that’s where I just really say, let’s figure out what’s going on with the sleep. If you tell me this child is only sleeping six hours, I don’t know. I just have, personally, I think it’s challenging for me to say to just label this ADHD, I just don’t know that it’s fair. I mean, it’s prevalent. ADHD is extremely common. I’m not saying they don’t have it, but the picture is so muddied, which is why we’re not waiting for the child to get on medication or to start therapy specific to ADHD without working on the sleep. The sleep piece has to be priority.

(18:10):

And so really I think that’s the way we look at it. I think to also make things a little bit more complex is there are sleep disorders. So not just the behavioral, they have a difficulty with settling down and sleeping. They have a lot of behavioral sleep issues. They’re also actually full-blown sleep disorders that are more common in children with ADHD. So sleep apnea, restless leg syndrome, delayed sleep face syndrome. So all those things are more common in our kiddos with ADHD. So those are things also that sort of make the picture even more challenging. And so I always just plead with parents, I’m like, you may need to have your child on this journey to being evaluated to get neuroscience testing, sleep evaluation should be a part of it as well. And maybe what that will take away is potentially actually a diagnosis of ADHD or one extra medication or better response to therapy. So it is always a win-win.

Dr. Sarah (19:18):

Yeah, I feel like sleep, it’s kind of like, I don’t want to say low hanging fruit in that it’s easy, not really. These are entrenched challenges, especially if we’re dealing with sleep disorders. But I do think, I can’t imagine any parent saying, well, let’s just go straight to the meds and the therapy and we don’t really need to worry about the sleep. It’s not a big deal. Any parent that I’m talking to that’s worrying about an ADHD diagnosis or just struggling with some of these symptoms like the inattentiveness, the impulsivity, the emotion dysregulation, those pieces, they’re definitely concerned about sleep.

(19:59):

And sometimes those kids actually look like they’re sleeping fine. They tire themselves out so much during the day that they just completely fall asleep at night and they’re not, they’re tired, they’re really exhausted by the end of the day. But I’m curious what the data says or the research says about the quality of that sleep. Because you were saying, obviously if a kid’s only sleeping six hours, we know that that’s going to be putting a lot of pressure on the function of that sleep system. But what if the kid is sleeping 10 hours, they’re getting the appropriate amount of sleep, but the quality of that sleep or their ability to dip into that restorative deep sleep or REM sleep isn’t happening? I don’t know. I feel like a lot of kids look like they’re sleeping, but it’s not doing what it needs to do.

Dr. Funke (20:50):

So true. So here’s what I usually see. Yes, their sleep architecture looks a little bit different. They tend to have more what we call, so they may have more weekends at night. And I like what you said about the sleep piece because a lot of times we pay a lot of attention on the sleep quantity. Like, oh no, oh yeah, they’re school age. They need to get nine to 11 hours of sleep and teenagers, they need to get eight to 10. Yeah, that’s true. But beyond that, I always will say, I would literally have your school age child get eight hours of deep restorative sleep, good quality, high quality sleep than 10 hours of crappy sleep. So the quality is so important. And then the timing of their sleep. So some of these children also have what we call circadian rhythm issues, which we’re learning that the brain melatonin production may be either slightly delayed or a little bit low before it peaks something of that sort.

(21:54):

So naturally their physiology tends towards a later bedtime. And so if you are trying to put your child who maybe naturally they want to sleep at 10:00 PM you’re trying to put them to bed at 8:00 PM you’re going to now have this two hour window of chaos where they’re running out of the bedroom nonstop and you are thinking they’re just being bad. They’re just misbehaving. No, they literally are not able to fall asleep because their sleep system is just not ready. So I think the timing is also important and there’s some strategies we do to try to shift that as best as we can as well. In terms of the quality, there are different things. I usually we’ll use three categories. So the first category are more like the medical sleep issues that could be playing a role. So this is where sleep apnea has actually been shown to be a bit more common in children with A DHD and neurodiverse complications, restless leg syndrome is a big one.

(22:53):

And also delayed sleep phase, like I said, some other sleep disorders as well. And then the behavioral sleep issues, which is more about the habits and things that they’re doing that’s really now causing or perpetrating their sleep disturbances. So if they’re drinking caffeine energy drinks, if they’re on their devices all through the night or they have a TV in their room or things like that, if they’re constantly requesting co-sleeping or they’re not able to sleep independently or there’s so many of those behavioral things, if they have bedtime fears, sleep related anxiety, all those things will impact your sleep quality. Now they’re almost hyper aroused, so every time they try to get into deep sleep, they get kicked down.

(23:43):

And then the last bucket or the last category would be those 24 hour factors. The ADHD is not going anywhere even though you fall asleep, it’s not like, okay, I’m just going to let your brain be chill and I’m just going to stay right here till morning. No. So it literally just does have its own manifestations during sleep, which is again that sort of higher, almost like a higher arousal where they may have just a real hard time with winding down increased cognitive arousal and things like that, which some of them will tell you directly. My mind is always, my brain is running, my brain is racing. I can’t shut my mind. I have had six year olds say that. Right. I can’t shut my mind down. So some of those things are just really as a result of the ADHD, and sometimes it could be anxiety, which also co-occur.

Dr. Sarah (24:34):

Which are comorbid, right. Kids with ADHD and kids who have anxiety, a lot of times you’re going to see both of those things together.

Dr. Funke (24:41):

Exactly, exactly. So you can see that there’s such a wide variety of things that could be going on which can impact quality.

Dr. Sarah (24:49):

Which is helpful, right? Because in a way, yes, it makes it more complex, but I also think there’s more points of entry. You were saying there’s a lot of strategies, even just what you were describing, we can do interventions on that behavioral level. We can do interventions on that environmental level. We could do interventions on the family systems level. I do a lot of stuff with helping parents kind of reduce accommodations in a way that helps reduce anxiety but also reduce these sort of behavioral interruptions at nighttime. But I’m curious, you were saying there’s some strategies that you can do to shift the circadian rhythm stuff, move that sleepiness up a little bit. What things have you seen families try that have been successful for that kid? They really don’t settle till 10:00 PM but it’s not like they can go to school two hours later. They have to still wake up in the morning and their circadian rhythm is just not matching that cycle of the family rhythm or the life schedule.

Dr. Funke (25:59):

Yeah, no, that’s a good one. And yes, I love that. I love that what you just said about the opportunities for intervention. These are not easy interventions, but they’re treatable like most times, many times without needing additional medication or whatever. A lot of the behavioral strategies, of course, the medical issues, they’re also very, very treatable. So for a child who might have a delayed circadian rhythm or what we call delayed sleep wake face syndrome, which is again more common, I usually want to rule out anything else. So if they have restless leg syndrome, if they have low ferritin magnesium deficiency, we want to take care of that. Sometimes that also makes it hard for them to wind down and pushes their clock even further. So with these kids, one thing we know with the circadian rhythm, there are many things that queue, and that’s our internal clock that helps us to know when we should be naturally sleepy and when we should be awake, we should be awake.

(26:54):

And it is aligned with the 24 hour hour cycle. So naturally you feel sleepy in the evening because it’s dark and impulses are sent to your brain or your child’s brain to produce melatonin. Melatonin is sort of that sleepy hormone that helps you to know it’s time to sleep. And so one of the biggest cues of the circadian rhythm is light. So we use light to our advantage in these kids many times, especially because there’s so much light pollution. Our brain doesn’t recognize if it’s artificial light or if it’s natural light, it’s 7:00 PM even though it’s dark outside, everywhere is brightly lit in the house, all the TVs are on, the iPad is on, the child is on the phone that’s right next to their faces. What that is registering to the brain is it is not yet bedtime. There’s so much light. Your brain does not perceive what is at facial hood natural.

(27:56):

So we’re really trying to create environments to start to cue the brain that it’s in. So whether it’s dimming the lights a little bit, if your child needs to be on a device, maybe putting the blue light filters or on there and things like that, really starting to help them to wind down. So there are also behavioral cues, and this is where bedtime routines also can cue the brain to say, okay, it’s time to start to wind down from the day. So you can start to use that to your advantage. And for a child who maybe has a DHD super, maybe impulsive and really, really shift it, you may start need to start that process a little bit earlier than a child who doesn’t. So maybe you may need an hour and a half or two hours start to dim those lights and things like that.

(28:47):

In some instances, we might also, this is where we’ve, melatonin is, I mean is like every kid’s gumming now. It’s so widely used and all that. So in children with a DHD in children with autism, in children with other neurodiverse conditions, this is where we’ve seen that melatonin can actually help with promoting sleep onset. And so in some situations we may not do a super low dose of melatonin and give it some hours before bedtime to cue their brain. Again, a lot of these kids who have this delayed sleep face syndrome to shift things a little bit earlier. And then what we now do on the back end is when they wake up, we want to set that as consistently as possible and almost do the direct opposite of what we did at bedtime. So in the morning, you want to expose them to as much light as possible because remember, the way their melatonin curve is may be that it’s a little bit shifted.

(29:45):

So literally you are using light to now almost trick the brain to say, okay, it’s time to wind down. It’s time to wake up. So bright light therapy, getting them outside, getting physically active, regular mealtime and things like that is what we use. Now here is the thing, our naturals, our circadian rhythm wants to always be later and later and later. So if you set a wake up time that you figured out works best for your child and your family situation and you’ve set a bedtime that works for your child and your family situation, you’re going to have to lock that in as best as you can because otherwise you’re going to start to shift again and you’re going to be back to square one. And so unfortunately, that means even on the weekends, you don’t want them sleeping until 12 noon. It’s going to throw them off completely. So even though you may want them to catch up on a little bit of sleep, you just have to do it very cautiously.

Dr. Sarah (30:38):

No, that’s super helpful. I’m wondering too, because it’s funny, I have a DHD and I have always had the hardest time. My mother who totally listens to this podcast, my mom has been such a saint in her efforts to wake me up since I was a little kid. I cannot wake up in the morning. It’s just like my brain doesn’t, apparently is probably not making the kind of chemicals that are needed at that point in the day. But I also am like could stay up super late, but I recently got an alarm clock that if I set it for, let’s say I have to get up at six 30 at six, it will turn on a light. It’s like a sunrise clock, and I put it right by my face and it’s a really bright light and I’ve noticed that it helps a lot in terms of getting me, I still struggle, but it definitely helps me to wake up more, snooze less. And I can see how, and even with my kids, I will, when I go into their room in the morning, I’ve got a neurodiverse brain. They probably will do too.

(31:59):

I’ve always feel guilty for telling my mom friends whose kids wake them up at 5:00 AM that my kids won’t wake up in the morning. I know it’s really hard to have the opposite problem too, but when I have to get them up for school and they’re like the G griest of grouches because I am pissing them off by being disturbing their sleep, I start opening their window shades, I get that light in and they hate it. They get so mad at me, but I do it anyway. Are there other little types of things that we could do to help whether your kid’s neurodiverse or not to just tweak these environmental cues? What are some creative strategies you’ve seen parents do or suggested to people?

Dr. Funke (32:45):

The sunrise clock is, I love it. I think it’s the best because it’s much more, it’s less jarring sometimes, especially for the teenagers. They need loud alarm clocks that walk all over and run. You have all kinds of boom alarm clock, the running alarm clock.

Dr. Sarah (33:04):

I’ve had an alarm clock. I used to in college, I had an alarm clock that was made for deaf people where you slid it under the mattress and it would shake the bed because that was the extent to which I struggled with waking up.

Dr. Funke (33:20):

Yeah, yeah, exactly. So the light is, I feel it’s more natural, it’s more physiologic. So I think that’s a big one. There’s also a protocol I use, I would say maybe for the older, but I mean you can clearly modify it even if you have your own kids. If you have a child who struggles with waking up in the morning either because they have that shift, it’s called the rise up protocol. And this is published a number of articles now it’s rise up, so R-I-S-E-U-P. So R stands for refrain from snoozing because when you hit snooze, you get into more vocal the sleep inertia, which is that horrible grogginess that you just don’t feel feel worse. And then I is increased physical activity, so that’s a good one. So you want to get up and start moving, maybe even if it’s just some stretches, some couple of jumping jacks just really gets in that.

Dr. Sarah (34:26):

Or a little dance party with little kids.

Dr. Funke (34:28):

Yes. Exactly.

Dr. Sarah (34:30):

Or assignments like being playful with little kids, their bodies moving could be helpful.

Dr. Funke (34:36):

Exactly. Exactly. And then S usually talks about, it’s not necessarily in that order, it just has to fit the protocol. So S really stands for shower or really just getting water on. So either you drink water or you take a shower. That just really helps, especially something more of cool. So that’s S. And then ease is exposure to light. So this is where making sure that within the first 30 minutes, absolutely you want to make sure that you’re getting that light as soon as possible, depending on where you are. If it’s still dark out, artificial light is fine, natural light is absolute best, getting outside, getting on the porch, whatever, and then moving while you’re there or just having the windows wide open is great. And then you is what we call kind of upbeat music. Well, it could be upbeat music or just something to cheer you on. So either you could talk about something, tell a joke, tell Alexa to tell a joke, just something again to kind of jar you and ginger you and just kind of help lighten the mood. And then the P is, I mean it’s more for adults, but it’s like phone a friend. So either have somebody in your life that can hold you accountable to make sure that you don’t sleep back into bed. So again, used more for adults, but I think there are clearly elements of that that you can use for your teenager or your older child and things like that.

Dr. Sarah (36:08):

And most parents, I mean if you have a neurodiverse kid, chances are there’s a relatively good chance that at least you or your partner are neurodiverse too. And so I think as parents, and we were talking before the family’s sleep, health is interconnected. So if your kids are struggling with sleep, chances are so you, and it might just be because you’re up all night with your kid and you’re exhausted, but it also might be because the family system, sleep health as a whole could be improved. And so I think these strategies are great for parents too.

Dr. Funke (36:42):

Oh yeah, absolutely. Absolutely.

Dr. Sarah (36:45):

So one thing, I’ve heard this and I curious about your, I want to hear your read on it because I’ve seen things about it and I just don’t know if it’s legit or not. And that is mouth breathing and its association with A DHD. And I’ve seen therapies that help, they’re almost like physical therapies or oral facial therapies that help retrain the mouth so that the kid can sleep, breathe through the nose. What’s the science behind that?

Dr. Funke (37:20):

So mouth breathing in many cases is a sign of what we call sleep disordered breathing. So that can include sleep apnea, it can include snoring. And we know that when children have habitual snoring, when children have sleep apnea, meaning they get a diagnosis, they do a sleep study that shows sleep apnea, it’s associated with poor outcomes, daytime issues, a learning and developmental issues, impulsivity, behavioral concerns and things like that. So again, kind of similar to poor quality sleep, it disrupts their sleep quality because you can imagine that your child is sleeping, has pauses in their breathing and snoring. It kind of wakes them up out of deep sleep. So they have very fragmented sleep. And the most common cause of sleep apnea, sleep disorder breathing may be related to either big tonsils, there’s other tissues at the back of the throat. Sometimes it gets bigger in kids as they get older and so many times.

(38:20):

And also they have the adenoids, which are tissues at the back of the nose. So many times they may not be able to breathe in through their nose properly. And so it leaves their mouth open and so now they’re breathing through their mouth. And so the nose is supposed to be the most natural way to breathe. Some of these kids when they were younger also may have facial abnormalities in the sense of maybe their face just didn’t develop well. Maybe their heart palettes maybe high arched either because they were on a bottle for way too long, they were on a pacifier for way too long. Some of those things kind of like our diets, that’s really, really soft versus hard diet. All those things impact the face, the shape of our faces and can contribute to low muscle tone. And if there’s low muscle tone, the likelihood that your mouth will be open while you’re sleeping when you’re nice and relaxed is higher. So the myofunctional therapy, which is what you talked about, the physical therapy, is literally physical therapy for the airway and the tongue. So the goal is for a who constantly is mouth breathing, teaching them to close their mouth to learn to breathe through their nose, and also teaching them to strengthen the muscles of that airway so that when they’re sleeping, they have less chance of all these issues happening.

Dr. Sarah (39:48):

So that seems like something that would be, again, none of these strategies, none of these interventions are free from time, energy, resources, but potentially a less invasive or less, I don’t know, sort of higher level intervention than medication or things that just they carry more side effects. And I’m actually a big proponent of medication when medication is necessary and really reducing that stigma of we failed. If we hit that level that we have to do medication, it can help so much, especially with neurodiverse conditions. I think I really want to encourage parents to feel like that’s an option, right.

Dr. Funke (40:35):

Absolutely.

Dr. Sarah (40:36):

But I also think a lot of parents, especially with younger kids, want to exhaust everything before they hit that point. And I don’t know that a lot of parents know to think about this piece of maybe myofascial therapy or a sleep evaluation or other types of just sleep related interventions. If parents are kind of listening to this and they’re like, this is the first time I have considered sleep in the context of my child’s other symptoms in attentiveness, difficulty with impulsivity, emotion regulation, challenges, learning disorders, anything at all in that sort of neurodivergent realm. And they’re thinking, okay, so what do I do now to add in this layer? What would you for them?

Dr. Funke (41:35):

So I would say lean in with curiosity first to figure out what’s up with their sleep. Again, given how prevalent sleep issues are in children with neurodiversity, most likely 80%, four out of five times, there’s something going on there. And so then the question becomes, well, what is going on? Is it more of a behavioral issue? And you’ll know that by, are we having issues with screen time? Are there ways we could set those limits? Are we having issues with boundary setting in and are there ways we could help them with self-regulation and incorporating routines and making sure we work on consistency and limiting caffeine, all that stuff we hear about all the time, the sleep hygiene stuff. So you make sure you work on that. And then if you are left with, well, it seems like we’re doing pretty good here, but he’s still struggling or they’re still struggling, then that’s time you want to speak with your doctor and ask to be seen as to be evaluated for their sleep.

(42:42):

And there’s some things like the general behavioral things that you are a pediatrician most people will know to do, but when you start to think, okay, there’s a new level where again, their mouth breathing, they have restless sleep, they’re tossing and turning, they’re having severe nightmares or their sleepwalking sleep terrors or I’m concerned about delayed sleep phase, I cannot get them up with all the sunrise alarm and the loudest alarm clocks. That is probably a time where you do need to see a sleep specialist. I would say that would be something to do because again, there’s a wide variety now we talked about myofunctional therapy, but sometimes it may be that they have ginormous tonsils, which is become a nuisance and we may need to do surgery. So I think being able to have someone walk you through what does an evaluation look like, what does that entail and how do we interpret the results of that, I think is really important.

Dr. Sarah (43:38):

And what would a sleep valve sometimes look like? Does it mean that the child has to go and sleep overnight in a lab? What do your parents expect?

Dr. Funke (43:48):

And it varies. So depending on what’s going on, if we’re concerned about, okay, there’s something organic that’s going on with their sleep, maybe they’re pausing and breathing during sleep or they have what we call periodically movement disorder where they’re having frequent movements during their sleep, we need to measure that objectively with what we call a sleep study. And a sleep study is just a multi-channel recording of sleep. We’re literally bringing them into usually a sleep lab. Sometimes we could do it at home, especially for a lot of kids who maybe have sensory issues. Not many pediatric practices do home sleep tests. Some do my practice, we do, and that’s really just observing their sleep, looking for, again, sleep apnea pauses and breathing or irregular breathing, looking at limb movements and their oxygen levels. So it’s a super comprehensive non-invasive test with different stickers and channels that we monitor. And then from there we can then make derivations around what exactly is going on with their sleep, their sleep quality, are they hitting all the right sleep stages? If not, why, and all of that. And so that would then help us to provide solutions based on what the findings are.

Dr. Sarah (44:59):

That’s so helpful to know. I think information then can guide us. And then I imagine there’s a ton of different types of interventions that you can go from there. Maybe it’s surgery, maybe it’s a supplement protocol.

Dr. Funke (45:14):

Exactly.

Dr. Sarah (45:15):

Are there other types of interventions that could be commonly recommended?

Dr. Funke (45:20):

Yeah, so again, all depending on what the issue is, if they have any comorbid conditions. So we’re working collaboratively. It’s not like an isolation if for instance, a sleep study show, sleep apnea, there are many treatments now, surgery is one myofunctional therapy. Sometimes getting my expanders or maxillary expanders especially, or braces or working with orthodontics is another treatment option. If they have super mild apnea and we think a lot of their mouth breathing is cause they’re congested and they have allergies, we’re doing allergy management. In some situations we might need the C Pap, so similar to the ones we use in adults, children also sometimes can need that. So again, a wide array. If it’s related to, for instance, we do comprehensive nutritional evaluation. A lot of these kids have maybe restricted eating too, and they might be iron deficient, they might be magnesium deficient, they might be vitamin D deficient.

(46:19):

So we’re checking all those profiles and replenishing with different supplements. And if they have insomnia, we have behavioral programs, very effective. Multiple studies have shown effectiveness in those behavioral strategies. So we’re incorporating that. If they need supplements, actual supplements, then we’re doing that from an informed, not just throwing spaghetti at the wall, using some of these evaluations to guide that therapy. And if they need medications, so like I mentioned melatonin, I prescribe that with behavioral strategies if they need actual sleep medications in some situations, well, it’s what we need really at that point. So there’s quite a number of options available.

Dr. Sarah (47:07):

That’s so hopeful. And I’m really excited actually to learn about a lot of this stuff because I have a lot of clients and patients in my practice that I work with for ADHD or other types of emotion regulation or behavioral challenges. And I feel now there’s, I think I’m going to be much more explicit on the need to evaluate sleep in a more methodological way and not just check, Hey, how’s the sleep? So this has been really helpful for me and just as a mom of kids who bedtime can be a bit of a nightmare. I can probably tighten that up too. This is so helpful. And this book that you wrote Beyond Tired: A Sleep Physician’s Guide to Solving Your Child’s Sleep Problems for Good, this is a book that I recommend everybody read what you are talking about. And there’s a lot of stuff out there on sleep that maybe aren’t as vetted of a resource. And so thank you so much for coming on here and sharing all this with us. I really appreciate it so much.

Dr. Funke (48:22):

Oh, thank you. This was a lot of fun. Thank you so much for having me.

Dr. Sarah (48:27):

I’m so glad. If people want to get your book, they want to follow your work. If they want to connect with you and seek out some clinical support for your practice, can you share a little bit about where people can connect with you?

Dr. Funke (48:42):

So my website would be the best place to go. It’s restfulsleepmd.com and so that you’ll have, depending on where you are, I do see patients in California, in Pennsylvania and New Jersey. I’m based in Pennsylvania, so I see patients in person in Pennsylvania. And if you’re New Jersey, California, I can see you virtually on there is also a link to my YouTube channel, which where I share nuggets of information as well and blogs that I try to be as active as possible on. And then I’m on social media as well as @restfulsleepmd. And then my book is on Amazon, so if you just put in Beyond Tired, it’ll pop up. And yeah, I think it’s a good resource. I have a chapter specifically for children with neurodiverse conditions. It’s so unique and I think we talked about just before we started that some of the interventions we just generically provide to a typically developing child, we usually we will need to modify for a child who has ADHD or autism or other learning differences.

Dr. Sarah (49:53):

Yeah. Yeah, that’s a really good point. And I think your book is also applicable to kids who are neurotypical as well. So you might have one kid who’s neurodiverse and you might have another kid who isn’t, and you’re going to still get a lot of really useful resources. So definitely go check out that book and please come back. I’ve gotten a million more questions for you.

Dr. Funke (50:17):

We’re more than happy to. Thank you so much for having me. This has been great.

Dr. Sarah (50:20):Thank you. Thanks for listening. I really hope that you feel more informed and prepared to navigate whatever sleep challenges come your way. And if you want additional strategies for helping create a more successful toddler sleep routine, check out my free toddler sleep workbook. It’s packed with seven things you can start doing tonight that will help you create a more peaceful and effective nighttime routine, plus some pro tips to help you take these techniques to the next level. You can go right to the episode description wherever you’re streaming this podcast to download this free guide. Or go to my website, drsarahbren.com and click the resources tab. That’s drsarahbren.com/resources and get started turning your child’s sleep struggles into solutions. I will see you back here for a brand new Beyond the session segment of the Securely attached podcast this Thursday. And until then, don’t be a stranger.