Dr Ron Ehrlich [00:00:05] Hello and welcome to Unstress. My name is Dr. Ron Ehrlich. Before we start, I’d like to acknowledge to the traditional owners of the land on which I am recording this podcast, the Gadigal people of the Eora Nation, and recognize their continuing connection to land, waters, and culture. I pay my respects to their elders of the past, present, and emerging.
Dr Ron Ehrlich [00:00:29] Well, today we are going to be talking about Sleep Wrecked Kids: Helping Parents Raise Happy, Healthy Kids, One Sleep At A Time. We’re going to be talking about myofunctional therapy, which is a term some of you may not be familiar with. But after this podcast, you will be and you’ll realize its relevance to each and every one of you. My guest today is Sharon Moore, speech pathologist, oral myologist, and author of Sleep Wrecked Kids. I hope you enjoy this conversation I had with Sharon Moore.
Dr Ron Ehrlich [00:01:08] Welcome to the show, Sharon.
Sharon Moore [00:01:11] Thank you for having me. It’s lovely to be here.
Dr Ron Ehrlich [00:01:14] Sharon, you’ve written this tremendous book, Sleep Wrecked Kids, and we’re going to get into that. But I wondered if you might share with our listener your journey, your professional journey, which brought you to this point in this book.
Sharon Moore [00:01:28] Yeah, it’s actually a great question. And I think it is that journey that brought me to this point and the reason that I wrote the book and I was always interested in studying medicine and retain that interest in medicine to this very day. But at the eleventh hour, I simply changed my mind and decided to study speech pathology because I thought, oh, it intersects so well with human behavior. And I was very fascinated with those concepts of behavior change and modification and also the linguistics, because speech pathology is such a broad profession anyway. So I studied this and in my career over the last four decades, I had my career has definitely intersected all the way with medicine in one form or another. But I think in the beginning I was very lucky because four decades ago when I studied at Flinders University at that stage in speech pathology training courses, they still did a lot of lectures from medical specialists like ENT, craniofacial surgeons, maxillofacial surgeons, ENTs, and orthodontists.
Dr Ron Ehrlich [00:02:52] Wow.
Sharon Moore [00:02:53] Yeah. And so I was very, very lucky in the beginning to hear from dentists and orthodontists who really believed that the way our muscles systems work in the mouth and the face could affect the way the teeth form or sit and also our bite our occlusion. So that was right there. And subsequently, actually, a lot of the orthodontics was removed from our courses. That’s a whole other story.
Dr Ron Ehrlich [00:03:25] Well, South Australia. You were in South Australia?
Sharon Moore [00:03:28] Correct? Yes.
Dr Ron Ehrlich [00:03:29] Which was the home of a type of orthodontics called Begg, B, E, Double G, which was all about extraction of teeth to get nice esthetics for ignoring the fact that there was a whole human.
Dr Ron Ehrlich [00:03:42] Being attached.
Dr Ron Ehrlich [00:03:43] We’re going to go down that path. I get distracted, keep going. I love what you’re talking about here, because that is a great intro, isn’t it, into speech pathology being lectured by those people?
Sharon Moore [00:03:53] Yeah.
Sharon Moore [00:03:53] And, you know, I think it was lucky because I think right in the very beginning, it really sowed the seeds. You know, it sowed seeds that many subsequently when I’ve worked with other students and other early-career speech pathologists, they’ll say, why didn’t anybody tell me this? You know, so I don’t really consider myself lucky, and really the first 10 years of my career, once I graduated, I really did go down the kind of behavioral emotional path, way of working with patients who actually worked in child psychiatry for 10 years, actually a bit longer. And I consider that as well. Just a gift in a way, because I was working every day with psychologists and social workers and psychiatrists and I really had solid grounding in human behavior and how to talk to people, how to counsel. And I think as a very young speechie, that was something that many people don’t get and I think is a foundation for me today.
Dr Ron Ehrlich [00:05:02] Hmm.
Sharon Moore [00:05:05] Yeah. So then after that, I would drifted on into private practice and I was being mentored by one of the speech pathologists that had taught me at Flinders. And it just seemed that everything that I was doing from then just crossed over somehow had to do with the anatomy and physiology of the mouth and the face and the throat, you know. So I was working with swallowing and with voice and with pronunciation problems that were caused by the way the tongue moved or its ability to move or a problem with the soft palate. And I just loved that work. And I loved diagnosing what was wrong, you know, what was underneath all that and how could we manage it. And so in that work, I was pretty much always working with ENTs. And then as time went on, I seemed to be working a lot with respiratory physicians. And now I’m on the transdisciplinary team for the Canberra Sleep Clinic. We’ll get on to that later. But I think all that early work allowed me to really explore and use these concepts of sorry, I was working with dentists and orthodontists. All these referrals would just keep coming in and saying, can you please fix this tongue thrust and swallow? And I think at the time, even I was surprised how quickly you could correct, for example, and open by.
Dr Ron Ehrlich [00:06:50] Well, you can if you understand the cause of it.
Sharon Moore [00:06:54] Correct!.
Dr Ron Ehrlich [00:06:57] No, no, but if you don’t understand the cause of it, you could be going through surgery in years and years of orthodontics, only to find that at all.
Dr Ron Ehrlich [00:07:04] Relapses.
Sharon Moore [00:07:06] Exactly. That’s got a, I’m not going to call it a rabbit hole.
Dr Ron Ehrlich [00:07:13] You know.
Dr Ron Ehrlich [00:07:14] Yeah, that’s a whole other story.
Sharon Moore [00:07:16] Yeah, but honestly, I think that also underpinned in the last 10 to 12 years, I really pursued avidly a lot more of continuing education. I really wanted to dig deep into myofunctional science and really understand what was happening with the teeth and with jaw development and with facial development. And where did function fit in with that? What was it? What was that relationship? So I really did a lot of study and I think I did five basic courses, advanced courses, intensives, internships, and these were all with people overseas because it wasn’t happening in Australia. So I traveled a lot, learned a lot. But still, I had come back to my clinic and I think. But how does all this fit into speech pathology? You know, how do I get this to work with my patients and with my profession? And you know, what is acceptable within my profession? That makes sense. And so over these years, I literally develop protocols and a new paradigm.
Dr Ron Ehrlich [00:08:37] Yes.
Sharon Moore [00:08:38] And sorry.
Dr Ron Ehrlich [00:08:40] No, no, no, it’s music to my ear, I mean, I think we’ve had a similar professional experience in that the more we learn, the more we realize we don’t know. And we find that rather empowering. And that’s what is exciting and drives this on. And I’m sure you’ve come up with similarly many professionals who don’t take that approach, who really want the certainty of knowing that what they learned is correct and what they don’t know isn’t worth knowing. I think they’re the two kind of professional journeys many people are on.
Dr Ron Ehrlich [00:09:10] But this is music to my ears. Sharon, you keep going. I love it.
Sharon Moore [00:09:15] Well, I look and I cannot resist making a comment about human behavior here. I think what we’re talking about is to a poll of very polarized views within our professions. But it’s everywhere, across all the medical specialties, dentistry, orthodontics, allied health. And I think, you know, if you have been schooled in traditional thinking and ways of practicing, that way you want to stay.
Sharon Moore [00:09:45] And it’s actually human behavior to resist change.
Dr Ron Ehrlich [00:09:51] Yes.
Sharon Moore [00:09:52] Because change is harder than change. Nothing changed. Energy and effort and in clinical practices like we run, that takes time and money anyway. [00:10:06] [0.0s]
Dr Ron Ehrlich [00:10:07] No, no, no, it is actually worth just reflecting on there because a lot of people will go, well, gee, my speech pathologist has never mentioned this or my dentist has never mentioned this. Will my doctors never mention this? And I often say, well, probably the reason they haven’t is because either they don’t know it or they don’t prioritize it in their own lives and would rather dismiss it as irrelevant. It’s actually a more appealing way of approaching in many, in some ways. It’s an easier path to follow one of certainty. There’s one wonderful thing about certainty, isn’t it? It’s so much easier to deal with certainty than uncertainty or change.
Sharon Moore [00:10:48] Correct?
Sharon Moore [00:10:49] Yeah, and I think that is what drives a lot of people’s thinking and their behavior that, you know, this professional journey that I seem to be going on with myofunctional science and building my knowledge and understanding what all of the implications for that are and for my professional, for my profession and all the people that I was working with, both professionals and also the public, my patients. And I think one of the defining moments that led to the book and writing Sleep Wrecked Kids was about six years ago I went to a conference in Sydney, actually, and it was run by the American Academy of Craniofacial Pain, the Australian Chapter.
Sharon Moore [00:11:42] It is a really fantastic group.
Sharon Moore [00:11:46] And at that time, they presented a conference called Breathe, Sleep, Grow, and there were nothing short of seminal speakers at this conference. There was no way I wasn’t going to back to that event. We had Dr. Christian Gimeno, one of the fathers of sleep medicine. We had Dr. Colin Sullivan, who invented CPAP. We had Dr. Bill Hang, who’s, you know, an orthodontist who’s stretching those boundaries of orthodontics. We had Dr. Jim Papadopoulos, a pediatric sleep specialist, and the list goes on. I’m really sorry about other people I’m not mentioning everyone who might think. But, you know, and I realized at that point that the work that I was doing in the upper airway to fix function, that we were focused, focusing on what was happening during the day. And by doing that, we were ignoring in kids half of the day because half the time they’re asleep. And in adults, it’s a third of the time where it should be. So if it’s not, you should be asleep for a third of the time. And I started to realize that if I wasn’t addressing kids sleep problems in one way or another, I was banging my head against the proverbial clinical treatment goals because poor sleep, whatever causes it, undermines every single aspect of a child’s development, every system in the body and the brain. And I think that was like a bomb going off in my head. And I thought, but there’s a lot we can do about this. Why don’t people know about this? Why don’t people know?
Dr Ron Ehrlich [00:13:40] Yes. Well, it’s interesting. And we are going to dove into the book, but I think it’d be good to lay some foundation here because, you know, you and I could go on and talk about this for hours and we would know exactly what we’re talking about in many ways.
Dr Ron Ehrlich [00:13:54] But let’s start with some basics. Firstly, what is myofunctional therapy? And you alluded to the fact that the mouth is an important part of how we breathe. And you might, it be interesting to hear from you why and how big a problem this is. So let’s start with what myofunctional therapy is.
Sharon Moore [00:14:14] OK, all right. Well, I’ll talk about myofunctional science, and that is the study of the muscles in the mouth and the face and the throat and how that impacts the functions that have to happen in there every day. The ones we never think about but are super important, like lifesaving functions, breathing, eating, and drinking. And also there’s a lot of sensory functions that happen in that system that are critical lifesaving functions. As well, like coughing if something goes down the wrong way and then we have life maintaining functions like speaking and voice, which are key parts of communication. And so myofunctional science look at how he looks at how those systems work and not only how they work, but how they also might affect craniofacial growth. And in this study, they are looking at, for example, how tongue posture affects the way the upper jaw grows. And her tongue movement, for example, during a swallow can impact the way the teeth sit at the front of the mouth, how many on this podcast would understand things like malocclusion?
Dr Ron Ehrlich [00:15:51] Oh, look, I think we’ve got a very intelligent community listening to this and malocclusion. Everyone will probably think it’s got something to do with the way the teeth fit together and whether it fits together well or in a malo way and not so well.
Dr Ron Ehrlich [00:16:08] So yeah go on let’s make that assumption.
Sharon Moore [00:16:10] So we’ll make an assumption that everybody knows that. So we’ve got crossovers there with speech pathology, speech pathologist, work on what we call communication and alimentation, the way we eat and drink. And so if we look at how the muscle systems are working inside this, I’m going to call it the upper airway because it’s really starting at the front of the face and it’s coming just below the vocal cords before we enter that lower part of the airway or the lungs.
Sharon Moore [00:16:45] And so a speech pathologist’s work is looking at what is happening with all of those functions in there and how does that affect the way we eat and how does that affect the way we speak and breathe?
Sharon Moore [00:16:59] And so that would be a speech pathologist focus, but a dental hygienist, for example, that also many of them now are studying myofunctional science to do this work very specifically within a dental clinic context. And they look at as we do as well, where the muscles rest.
Sharon Moore [00:17:25] And how they work and how that impacts where the teeth sit and the occlusion, and so that’s probably the simplest way that I can describe it, is how am I going any other than.
Dr Ron Ehrlich [00:17:38] Going
Dr Ron Ehrlich [00:17:39] Well, because, I mean, you know, I think we should identify what is ideal because just as we’ve evolved to have five fingers on each hand and various, we could work our way through our body parts. But we’ve got numbers of things. We have evolved to have 32 teeth as well. So I guess we could say an ideal occlusion would be having all 32 of those teeth through and in perfect alignment with just a little bit of overlap to allow freedom of movement. But from a myofunctional perspective, I mean, we swallow hundreds, thousands. What do we do twelve hundred times a day or something like that?
Sharon Moore [00:18:20] You hear different to somewhere between seven hundred and two thousand times.
Dr Ron Ehrlich [00:18:26] That’s alright. But what is an ideal swallow and where should we be resting our tongue ideally before we delve into some of the problems that can occur. What’s ideal. I mean 32 teeth through an imperfect alignment. That’s an ideal occlusion.
Sharon Moore [00:18:41] Exactly.
Dr Ron Ehrlich [00:18:42] Talk.
Sharon Moore [00:18:44] What you’re doing is talking about the anatomy, which is a key piece of the puzzle because the anatomy determines to a large degree how the muscles can move within the system. And it’s definitely what we would call bidirectional because we know when the muscle systems are working properly, they can influence growth and vice versa. And so anatomy or restrictions in anatomy can restrict the anatomy. But if we’re talking about the things that like a swallow, the ideal swallow is where the tip of the tongue can come up and rest on the alveolar ridge behind the teeth, and it presses and stays the anchors at that point. And then the rest of the tunnel does a wavelike motion to push the food or the drink down into the pharynx.
Dr Ron Ehrlich [00:19:41] The tongue on that palate is a very important part of that process.
Sharon Moore [00:19:46] The tongue on the palate is critical. And what we find is that when there’s an atypical swallow, we’re not talking about dysphagia here, a diagnosable swallowing problem. We’re just talking about an atypical swallow is when the tip of the tongue will push against the back of the teeth or completely through the teeth for the smaller. And so you’ve got this pressure of the tongue pushing there against the back of the teeth or through the teeth. And that’s like you said, if we’re swallowing seven hundred to two thousand times a day, that’s a lot of pressure. But interestingly, in the early research, by profit et al, who said that even swallowing was important. But the more important thing is where the tongue rests so when we’ve got nothing else to do, we’re not eating and we’re not talking. Where is that tongue sitting?
Sharon Moore [00:20:58] And the body of the tongue resting up inside the maxilla or the upper jaw is the thing that shapes the upper jaw, particularly in early childhood.
Dr Ron Ehrlich [00:21:11] Hmm. So that position if I was making your clucking noise.
Sharon Moore [00:21:16] Yep.
Dr Ron Ehrlich [00:21:17] Would that be where my tongue should be resting?
Sharon Moore [00:21:21] That is.
Sharon Moore [00:21:22] Yeah, that’s a fantastic in fact, that’s one of the key exercises we do to help kids to learn to use their tongue that way.
Sharon Moore [00:21:29] And adults that if you did a slow-motion cluck, like that, and feel the suction between the tongue and the roof of the mouth before you release the tongue and hold it there. OK, hold there, can you feel all of the tongue, the full body of the tongue resting right up inside the palate?
Sharon Moore [00:21:55] Yes, you can.
Dr Ron Ehrlich [00:21:57] Yes, I can.
Sharon Moore [00:21:57] Yeah, exactly. That’s a great example. That is where the tongue should be resting, right? Daytime and nighttime.
Dr Ron Ehrlich [00:22:08] With the mouth closed.
Sharon Moore [00:22:10] With the lips closed and nose breathing. So there’s you know, we’ve alluded a couple of times to how functions might influence the way the jaws in the face grow. And we know that breastfeeding is a key function that needs to happen with babies. That is, in fact, the sucking motion for efficient breastfeeding is the first thing that starts to develop a child’s upper jaw.
Sharon Moore [00:22:43] And the sutures inside the maxilla are really soft and malleable. And that strong sucking motion and the vacuums that are created in a child’s mouth during breastfeeding are the things that are helped to broaden and shape that upper jaw in very, very early development. So there’s chewing, sorry, sucking, and breastfeeding.
Sharon Moore [00:23:07] Breathing through the nose is super, super important. The oral rest posture. Tongue resting up in the upper jaw and chewing.
Dr Ron Ehrlich [00:23:19] Hmm. And when we are resting, the teeth should be slightly apart, lightly touching, clenching, what should we be doing?
Sharon Moore [00:23:28] Slightly apart.
Dr Ron Ehrlich [00:23:28] Slightly apart. So lips together, tongue resting on the roof of the mouth, breathing through the nose with all 32 teeth through an imperfect alignment. That is ideal. And that is perfect. That is perfect. OK, well, thank you so much for joining us, Sharon. That’s been true.
Dr Ron Ehrlich [00:23:45] No, no, that’s not it. What I was going to say was, that’s not often achieved, is it? How big is this problem of dysfunctional or malocclusion or dysfunctional resting and breathing position in your clinical experience?
Sharon Moore [00:24:01] Yeah, I mean, well, in my clinical experience, nearly all my patients have more functional disorders of some kind. And I think the Foundation for Airway Health quotes a statistic of around 85 percent of adults have some kind of breathing issue. And the general statistics, if we just talked about mouth breathing, for example, is around about 50 percent of the population.
Sharon Moore [00:24:28] And it’s almost considered normal, you know, to mouth breathing.
Sharon Moore [00:24:34] In fact, a lot of people don’t realize that we’re meant to breathe through our nose. So but yet it is one of the key functions for keeping a healthy airway. And it’s one of the things in a myofunctional context that we look really, really closely at and that actually now then harks back to something you were talking about. You were talking about the anatomy, the shape, and the size of things. And we were talking about an upper jaw that can and a lower jaw that can accommodate all 32 teeth. And that is absolutely ideal.
Sharon Moore [00:25:14] But it doesn’t happen very often these days. Actually, I don’t know the statistic to this. You probably know this as a dentist, that, you know how many adults have their wisdom teeth out.
Dr Ron Ehrlich [00:25:26] Well, I mean, I would estimate in my clinic, just my clinical experience that 95 percent of people do not have enough room for all 32 of their teeth. I mean, you know, whether they’ve had their wisdom teeth removed or not, they might be impacted. They’re not through. Wisdom teeth are the third molars for those that aren’t aware, but it’s a very, very common problem. I mean, not if we often draw the analogy. If we didn’t have enough room for all five fingers on our hands and everybody had their fourth finger removed at 18, would we be as blasé about it?
Sharon Moore [00:26:01] Oh, exactly, exactly. And so this actually leads onto that really super interesting discussion about the intersection between anthropology and dentistry, and there are some, there’s a dentist and an orthodontist that I know in the U.S. who are currently doing research at Penn University on ancient skulls.
Dr Ron Ehrlich [00:26:28] Right.
Sharon Moore [00:26:29] And what they found is that in ancient skulls, adults died with all 32 teeth intact, beautiful, broad upper jaws, upper and lower jaw, beautiful broad base to the nose. And they had all their teeth and there was no malocclusion and there was no tooth decay.
Dr Ron Ehrlich [00:26:53] Well, you know, you mentioned about the anatomy and having enough room for all 32 of the teeth in the mouth. But we’ve also got a tongue in there as well, which needs to have room. And the problem there, of course, is that if it doesn’t, you either walk around with your mouth open and your tongue sticking out, which isn’t a great look, or you just walk around with your mouth open and your tongue on the floor of the mouth, or you might even walk around with your tongue at the back of your throat blocking your airway. So they kind of the three alternatives we’ve got to tongue to house in this mouth as well.
Sharon Moore [00:27:25] Yeah. So if we segway into, you know, what’s what on earth has this got to do with sleep?
Dr Ron Ehrlich [00:27:35] Well, this is exactly the perfect segway because, you know, you’ve written about this and let’s talk about it.
Sharon Moore [00:27:43] The air.
Sharon Moore [00:27:44] Well, I’m just going to come back to the airway again and say that the upper airway starts at the front of the face and finishes just below the larynx. And we know it’s a collapsible tube in the pharyngeal section and there’s different parts of the pharynx. And so because our faces and our jaws are smaller, our airways impacted. And so this is where this intersection, anthropology and dentistry is so fascinating because we see, you know, early faces and jaws. There was plenty of room for a nice big airway.
Sharon Moore [00:28:24] And now many humans simply have a smaller airway that is leading to problems with breathing during sleep. And so, of course, it’s never that simple.
Sharon Moore [00:28:40] We really have to look at three things. So if we’re talking about just the size of the airway, we’re talking about structure. But then we have to understand what is going on inside of the airway. Then we look at the tissues because the tissues line the airway. And so in our modern world of pollution and stress and allergy and goodness knows what, you can have a lot of inflammation and changes in the tissues inside the airway that can also interfere with the way the efficiency of our airway. And then, of course, we’ve got function. What are those muscles doing inside the airway? And of course, that’s mainly within the mouth and the face, but also within the pharynx.
Sharon Moore [00:29:31] Because it’s a collapsible tube and there’s been some very fantastic research that came out of Brazil, I think it was 2008, and these studies showed that if we could work with the muscles of the mouth and the face and the throat and improve the patency of those muscles in there, that you can improve obstructive sleep apnea in children by about 60 percent and about 50 percent in adults. And you know who was doing this work? Speech pathologists.
Dr Ron Ehrlich [00:30:11] Fantastic. Well, yeah, it doesn’t come as a surprise to me, but it’s great to hear you say that.
Sharon Moore [00:30:19] Yeah.
Sharon Moore [00:30:19] So I think, you know, you say, well, why you know, why did I end up as a speech pathologist going down this pathway? Well, I think there was the bomb went off at this conference at the AACP. And I’d already been kind of really digging into the myofunctional science. But then it took me down, you know, this whole other journey through other worlds of science and medicine and human evolution. So I remember being captivated by the sleep medicine science itself and glymphatics.
Sharon Moore [00:30:54] Have you heard about that?
Dr Ron Ehrlich [00:30:56] Yes. Glymphatic? Go on. Tell us about glymphatics.
Sharon Moore [00:30:57] Well, glymphatics is the lymph drainage system in the brain that nobody knew was there. It was literally a new anatomical system. It wasn’t new, but it was discovered only in around 2015. And the only reason they didn’t discover it was because it’s only visible at night time when we’re asleep. And so it’s a whole lymph drainage system that opens up at night during sleep.
Sharon Moore [00:31:24] And this, the fluid that flows through there and gets rid of all the toxins and it helps regenerate cells. And what, and it has to happen completely every night for you to be ready for the next day. So if you’re gypping yourself on sleep hours or your sleep quality is not great, then your glymphatics doesn’t have a chance to do what it has to do that you will pay the price. And so I think the glymphatics that set me on fire and then there was all of this anthropology and dentistry and airways changing. And then there was epigenetics.
Dr Ron Ehrlich [00:32:07] Well the glymphatics just before we move off that I mean, people may not have heard the word glymphatics before, but they will have heard the word dementia before. And that is a growing problem affecting younger and younger people. And it’s often related to waste build up within the brain and damage to cells. And the glymphatic system is about draining that waste. So just let’s link those two words, glymphatics and dementia together because they’re very important. You know, we’ve focused on sleep many times on our program here. But I must say, I’ve not specifically focused on sleep for kids, which makes your book just such a wonderful addition to this very, very important subject. What are some of that, how big is this problem in sleep disorders with amongst kids?
Sharon Moore [00:33:03] Well, if we look at the sheer statistics, we know that 40 percent of 4 to 10-year-olds have a sleep problem.
Dr Ron Ehrlich [00:33:12] Wow. Wow. Say that again, 40 percent.
Sharon Moore [00:33:16] 40 percent of kids in the 4 to 10-year-old age range have a sleep problem.
Dr Ron Ehrlich [00:33:21] Wow. Diagnosed. That’s diagnosed.
Sharon Moore [00:33:25] That they know of.
Dr Ron Ehrlich [00:33:26] That they know of. Because it’s been awful lot of people out there that just my kids really difficult. I don’t know. I’m having, it’s just the way she is, he is, you know. 40 percent. Incredible. Go on.
Sharon Moore [00:33:39] Yeah, look, it’s a big statistic. And you’re actually raising a really good point around what just the general public, but also professionals understand about sleep and taking sleep seriously. I don’t. Because we still have so many myths and misperceptions. And I still to this day in my clinic, hear things like, oh, yes, Johnny snores loudly. That means he gets really great deep sleep.
Dr Ron Ehrlich [00:34:10] Yes.
Sharon Moore [00:34:10] Or I can train my kids to need less sleep, you know, and I can train myself to need less sleep. And of course, all these, I mean, and there are many more statements, but all of those things mean that sleep health is not honored, it’s ignored and it’s dismissed, and I think that is one of our first and biggest issues is that’s a public health issue.
Sharon Moore [00:34:39] And we know that the Sleep Health Foundation in Australia is working proactively around dispelling a lot of those myths and misperceptions, not specifically for kids, but in general. So it’s public education. And they were heavily involved in a sleep health awareness inquiry last year.
Sharon Moore [00:35:01] Have you heard about that?
Dr Ron Ehrlich [00:35:02] No, no, no.
Sharon Moore [00:35:03] They.
Dr Ron Ehrlich [00:35:05] Tell us about it. Sleep health inquiry.
Sharon Moore [00:35:08] The Sleep Health Foundation and Australasian Sleep Association.
Dr Ron Ehrlich [00:35:11] Oh, yes, I’ve heard of the foundation, but they did an inquiry on sleep quality.
Sharon Moore [00:35:17] Well, they banded, the Australasian Sleep Association and Sleep Health Foundation, they banded together and approached the government through an advocacy group to say, hey, you know, sleep health is a big problem. In fact, if you’ve read Matt Walker’s, Professor Matt Walker’s.
Dr Ron Ehrlich [00:35:39] Yes, brilliant, hold on, for our listener.
Dr Ron Ehrlich [00:35:43] We were referring to Why We Sleep by Prof. Matt Walker, who I often quoted as saying, Sleep is your built-in non-negotiable life support system.
Sharon Moore [00:35:53] Correct. Biological necessity. And so. And I can’t remember if he wrote this in his book or I’ve heard it on one of his interviews, but pretty much two and a half percent of GDP is what it costs to manage the associated costs of the problems that go with sleep. So if we fix sleep purely, we would have the health costs and double the money that we have available for education.
Sharon Moore [00:36:23] So just simply at that level, you know, sleep problems cost us an awful lot. I got distracted then it was nice.
Dr Ron Ehrlich [00:36:35] Well, it’s a huge problem. It’s an interesting one, though, Sharon, because we touched on this earlier about how practitioners approach education. And I’m often surprised, often surprised when I take a history of the patient who’s been on anti-depressants for years and their doctor has never once suggested to them that they have a sleep study done.
Dr Ron Ehrlich [00:37:00] And my answer to that is either the doctor does not know about sleep or where’s the lack of sleep is a badge of honor and thinks, come on, man up, you don’t need that much sleep. It’s not that important. And so that’s why your doctor may not be prioritizing them as well. It’s about prioritizing.
Sharon Moore [00:37:19] Correct. And you’re absolutely right because education around sleep health is lacking across medicine, across all of the health professions.
Sharon Moore [00:37:28] And so when these two organizations approached the government, the government said, yes, let’s do a sleep health inquiry. And there was a lot of work that went into this, which I won’t go into the details, but I think that for those two organizations, it was an absolute coup because then there were three, there were hearings around the country, I think, four capital cities. And they concluded in Canberra, and I was lucky enough on February the 19th to go with Dr. Stewart Miller to represent the Canberra sleep clinic there at that government hearing.
Dr Ron Ehrlich [00:38:06] This year?
Sharon Moore [00:38:07] And that was in February last year.
Sharon Moore [00:38:10] And then in April, following the conclusion of all of those hearings, we, the government released a document called Bedtime Reading that talks about 11 recommendations that the government has to act upon to improve sleep health in Australians. And so once the government releases a document like that, they then are required three months later to start responding. And this is, of course, under the banner of the public health, the Department of Health. And so we had a change of government.
Sharon Moore [00:38:56] We had the bushfires we had covered, so suffice to say, I think the government has, well not been sidetracked, but very busy with other issues. So these organizations are now ready to step back and start saying to the government, what are we doing? Because there hasn’t been a formal response yet and it is required. And so we’re now hoping 2021 is the year when some of the funding that’s been requested will be there to start propelling some of these very critical public health awareness initiatives.
Sharon Moore [00:39:33] And according to Dr. Dorothy Bruck, there’s not specifically yet something that is targeted in children.
Sharon Moore [00:39:43] But that is where I am the most passionate because I think we can change a child’s life trajectory literally by improving their sleep. And so if we look broadly at sleep health, we know that there’s probably around about 40 percent of those problems are easily fixable just by tweaking things at home with the environment, with behavior, with routines. We know that we can improve kids’ sleep health so they get the right number of hours and so they get the right quality. But secondly, if you know, aside from just those basic sleep health practices, we then need to look at what are the underlying sleep disorders that get in the way. And this is where medicine and dentistry and allied health are so important. So if, you know, if parents have done everything they can to fix the environment and behavior and routines, you can literally do that within two to four weeks. And if there’s still something there.
Sharon Moore [00:40:54] Or, you know, that’s when you need expert help. So one of the things that I’m very, very passionate about is helping parents take them on a journey to understand what is it that they can do to help their kids. And when do I need expert help? And that was really about what the book was about. The book, Sleep Wrecked Kids is about the very big why. Why do I need to do something? And now then they need to know, well, what exactly can I do, you know.
Dr Ron Ehrlich [00:41:30] Well, what are some of the red flags?
Dr Ron Ehrlich [00:41:32] What are some of the things that parents could or should be looking out for?
Sharon Moore [00:41:36] OK, so let’s start with this. What is the good sleep?
Sharon Moore [00:41:41] What is it? I think a very simple formula is according to a kid’s age, you need the right quality and the right quantity. The quantity of sleep varies with age.
Sharon Moore [00:41:56] So you need to understand what that is and you need to create sleep opportunity. So that a child can get the right amount of sleep. And that’s what doesn’t happen a lot, and there’s lots of things in modern society getting in the way of that, and then a parent needs to say, well, ok, actually my kids are getting 11 or 12 hours a night and they’re around the early primary preschool age.
Sharon Moore [00:42:26] They’re getting the right number of hours. But every morning that they wake up and they’re grumpy and they’re still tired, their bed looks like a hurricane hit it in the middle of the night. So, you know, then even though they’re getting the right quantity or the number of hours, something is disrupting their sleep.
Sharon Moore [00:42:47] And that’s where you would probably need an expert to help you unravel it. And that is also with kids where sleep-disordered breathing, airway the shape and size of everything, the way everything is working in the airway can really impact the quality of sleep.
Dr Ron Ehrlich [00:43:10] Yeah.
Sharon Moore [00:43:11] Red flags, red flags, ok. Most parents put their kids to sleep and then the kids are asleep, they don’t listen to them and they don’t watch them. Right. But there needs to be a little bit of a period of observation to really see, you know. Is my child’s breathing quiet? As in silent, the sleep of the dead. Is my child’s sleep uninterrupted? So if you went in and you heard noisy breathing or snoring, audible breathing, that’s a signal that the airway is collapsed or narrow in some way or the breathing is happening a little bit too fast. If you noticed that a child appeared to be holding their breath or stopping breathing. If they would gasp and wake with a start, or if they’re waking up for some inexplicable reason and you can’t explain why or there’s a question mark, what is waking that child? And we need to get to the bottom of that. If you watched your child and they were moving a lot, their chest was moving a lot, or it looked like it was hard work to breathe, that’s a sign that breathing isn’t quite right at night. Or if they get their body into odd positions. Very often, kids that whose airway isn’t really perfect for breathing at night, they’ll throw the chin back like this.
Sharon Moore [00:44:41] They extend their chin and that’s their body’s way of opening the airway.
Dr Ron Ehrlich [00:44:47] Hmm. Yeah.
Sharon Moore [00:44:50] I hear people giggling at photos of a child in the snail position. Have you ever seen a kid in the snail position asleep?
Dr Ron Ehrlich [00:44:59] When their bottom is up in the air?
Dr Ron Ehrlich [00:45:01] And yes.
Sharon Moore [00:45:03] They’re opening their airway.
Dr Ron Ehrlich [00:45:04] Well.
Sharon Moore [00:45:06] Yeah.
Sharon Moore [00:45:06] So there are all these little signs. You know, if a child is moving a lot during bed, bedtime, sleep time, you say what is making them move?
Sharon Moore [00:45:17] Because normal sleep is quiet, uninterrupted. They will have brief awakenings, but virtually all of the time they won’t be aware of those. And they usually happen between sleep phases and stages, between sleep phases. We don’t need to go into all this to do.
Dr Ron Ehrlich [00:45:42] No, no, we don’t. But I mean, the rough, the hurricane-looking bid is another example of that, I guess. I guess whether their mouth is open during sleep, you know, like mouth breathing is a huge one. And I guess the other one that comes to my mind is when you look at your child and they look as this looks on your book, that looks like a very tired child, doesn’t it, with sort of bags under and or blood venous pooling it’s called, I think. And looking very bleary-eyed. So these are just not normal.
Dr Ron Ehrlich [00:46:16] Sharon, what about bedwetting? People don’t often make that connection. What function does the speech pathologist doing myofunctional therapy? What role do you have to bedwetting?
Sharon Moore [00:46:31] Well, I think recognizing when it’s happening is super important as part of that profiling of what is happening at night, because really after about three years of age, it shouldn’t be happening. But we know when there’s interruptions to sleep and fragmentation and, you know, breathing issues that interfere with the phases and stages of sleep and causes waking, it’s the same process that interferes with those hormones that stop kids bedwetting at night.
Sharon Moore [00:47:06] So it’s one of those red flags.
Dr Ron Ehrlich [00:47:10] And it’s also when that balance in the lungs goes out of balance and pH and alkalinity, it also affects smooth muscle throughout the body and the bladder is smooth muscle and I often have observed with adults as well, while they don’t wet the bed, they certainly get up at night to go to the bathroom. And sometimes it surprises me and them that they might wake up once or twice or even three times to do that. And that’s out of sleep-disordered breathing issues often as well, isn’t it?
Sharon Moore [00:47:43] Absolutely. It is one of the classic signs, especially in adults, in fact, and well, in adults you could talk about alcohol and how if it’s okay if we go down there.
Dr Ron Ehrlich [00:47:57] Yeah, yeah, of course.
Sharon Moore [00:47:58] But, you know, alcohol is one of the things in modern society that disrupts sleep. And it’s often thought of as it’s great to have a drink because it’ll help me go to sleep. Well, it will, but you won’t get normal sleep. It will be whether you’re aware of it or not, it will be highly fragmented and you will toss and turn whether you’re aware of it or not, you will not get good quality sleep. And that then as I said again, it disrupts the hormones that are normally at play that suppress bedwetting, not bedwetting, sorry.
Dr Ron Ehrlich [00:48:37] Urination.
Sharon Moore [00:48:37] Urination or the urge to urinate at night.
Dr Ron Ehrlich [00:48:41] Mm hmm.
Dr Ron Ehrlich [00:48:43] And you mentioned Jim Papadopoulos, actually, who is a respiratory pediatrician. And I remember talking to Jim and I’ve got to get him back on the program as well. But I remember him once saying to me that 50 percent of kids diagnosed with ADHD have an undiagnosed sleep-disordered breathing condition and 1 in 10 kids are being diagnosed with ADHD in Australia. So that’s pretty sobering.
Dr Ron Ehrlich [00:49:09] So apart from prioritizing it and arranging the environment in which our children sleep, and they are two very big things and routine, what else can now listen and do with a kid that is having sleep problems?
Sharon Moore [00:49:29] Ok, I’m just going to trackback, actually, because people would say, well, how will I know I’m not going to stay up all night.
Dr Ron Ehrlich [00:49:35] I am. Ok. No. Good
Sharon Moore [00:49:38] That just doesn’t make sense, because usually when sleep-wrecked kids that sleep-wrecked parents, and we just don’t want that. It doesn’t need to be that way. But things, there are apps that can capture nighttime breathing, things like snore lab app. I think it’s free for about four nights. And you would, after a child was asleep, you would put that at next to the bed and then you just check it in the morning and say, you know, it gives quite a clear indication on the audibility of breathing and how long breathing is noisy during the night.
Sharon Moore [00:50:17] There are all sorts of measures and activity actigraphy measures and watches and things. And, you know, that they’re not standardized measures. They’re just an indication, but I think can be quite helpful alongside photos and videos. So if you decided that you think that your child’s breathing could be better during night, as in it’s not silent, you would take a little video to capture that, take a little video to show how your child is moving a lot during the night. You would take a photo of their mouth breathing. And then if you go to your GP or your ENT and say, look, I’m worried about this because little Johnny’s getting 12 hours sleep, but his breathing is not right during the night. And this is how I know. Can you help me with this? Who is going to help me with this? And then I think you’ve got to be like a dog with a bone and find the ENT or find the GP who’s going to listen to you and help you. And it can be as simple as clearing the nose. It can be as simple as changing a diet. Because what we eat and when we eat and food intolerances absolutely can have an impact on those tissues in the upper airway and breathing at night, and a lot of people don’t sort of make that connection. And in fact, one of the most common reasons for sinus and middle ear effusion or fluid in the middle ears and block nose is a bit of reflux, undiagnosed reflux, which, you know, food intolerances, it doesn’t even have to be an allergy can lead to that. And I see that all the time. And harking back to Dr. Papadopoulos, he is really good at this. He really looks at the way the justice system impacts the airway at night. It’s a really important connection. And in fact, Dr. Papadopoulos came up with a fantastic acronym for Allied Health.
Sharon Moore [00:52:37] People like myself. It was the SSS Disturbed Rest System. And I asked his permission to go ahead and develop that as a questionnaire for my clinic. And he said, yes, and I’ve done it and he’s approved it.
Sharon Moore [00:52:53] And it’s a questionnaire that I use with every single patient because after that bomb went off in my head about six years ago, I thought, how am I going to capture this in the clinic? How do I know what’s going on at night? How am I going to help parents know what to look for? So I developed this form and use it to this day alongside a validated sleep questionnaire.
Sharon Moore [00:53:18] And the one that I like to use is the sleep disturbances scale for children that was developed in Italy by Dr. Oliviero Bruni and his team. And look, the reason I like it is because.
Sharon Moore [00:53:34] It digs into a lot of the different things that you’re looking for during sleep. And there are other very good, very validated, highly validated questionnaires like the BEARS and the PSQ and they’re fantastic, but they’re designed to pick up obstructive sleep apnea. But you know what, a child’s sleep and breathing problem doesn’t stop at sleep apnea. Any noisy breathing at night, including snoring, that’s not apnea, is something that we need to address and we need to address it early and we need to work out why. Is it the anatomy? Is it the structure? Is it the tissues? Are they reacting to something? Is it the function? Is it these floppy, sloppy muscles in the mouth, face and the throat that are getting in the way of the airway during sleep at night? And really it is being like a forensic scientist and working out what are all the pieces of that puzzle. And I love thinking about it that way. It really is a puzzle and one to solve. And it’s not one person that can do it. It really is teamwork between the family, the primary practitioner, and all of the other professionals who might be called in to help, you know, it could be ENT it could be dentist, orthodontist, respiratory physician, pediatrician, gastroenterology. And the list absolutely goes on. In fact, one of the, I’ve recently done a presentation for the International Pediatric Sleep Association, IPSA, and it’s a public health focused symposium with Dr. Judith Owens, who’s the director of pediatric sleep at Boston Children’s Harvard. And she talks about. Ignoring sleep at your own peril, and she says that one of the most exciting things for her as a pediatrician working with sleep medicine is the fact that you don’t and can’t work alone. You have to work with a team. You have to. And she said that’s what she loves because when she goes to conferences, it’s all these different disciplines that truly have to come together to help kids sleep better and breathe better.
Dr Ron Ehrlich [00:56:17] Hmm. Well, you know, you cover so much of this so beautifully in this book, Sleep Wrecked Kids. And I actually, and those forms that you’ve mentioned they’re in that book. And there are a whole lot of other strategies. And I would recommend this book really to everybody. And you could have actually put up a byline there, I think sleep wrecked Kids and the impact they have on a sleep wrecked family and relationships, you know, because I think one of the things that people who have children for the first time realizes what sleep deprivation is all about and how it can impact on your mental and physical well-being and on the well-being of your relationships. So getting this right is not just getting the kids’ sleep right. It’s putting the family on a much more resilient footing. I think it’s a beautiful book, Sharon. It really is. And we’re going to have links to it. Listen, we’ve covered some great territory here today, and I just wanted to finish up because taking a step back from your role as a speech pathologist, as a myofunctional therapist is as an orphan now and as a teacher because we are all on a health journey through our lives. And taking a step back from your professional role, what do you think the biggest challenges for individuals on that health journey through life in this modern world?
Sharon Moore [00:57:43] What is the biggest challenge? I think it’s the knowledge. I think understanding, you know, what it means to be healthy and what’s in our control and what’s not in our control and understanding those key areas of our life as humans, that we do have control over exercise, nutrition, stress management, sleep. We actually, many of us do have control over these, and I think to understand that, we truly can empower ourselves and our families. You brought such an important point about talking about families. And, you know, sleep deprivation is almost considered a rite of passage in parenting like expected. You must have this. It doesn’t have to be that way. It doesn’t have to be as bad as it is. And you’re right, because families are the fabric of community. And so I think finding health professionals, if you can’t find the information that you need to put yourself on the right health trajectory yourself as an adult and your kids and your patients in your care, then find the health experts that can help you that think holistically. And just start. Just start somewhere.
Dr Ron Ehrlich [00:59:18] Yeah, well, what a great note to finish on, because this book is a great place to start and we’ll share the links to that. And I’ve been looking forward to this conversation since we first met a few months back. Sharon, thank you so much for the book. Thank you so much for joining us today.
Sharon Moore [00:59:34] Thank you so much, Ron. It’s been an absolute pleasure.
Dr Ron Ehrlich [00:59:38] Well, I met Sharon a few months back and I was introduced to her through another guest on this podcast, Dr. Howard Hindin, who is a holistic dentist with 45 or 50 years of experience. And I am so looking forward to the episode that I do with Howie Hinden. Every one of us needs a mentor. And if I was looking for a mentor, I could ask for no greater one than Howie. But Sharon was such a joy and a pleasure to meet, and I really wanted to share her with you. So many great things. They’re about collaboration, about an open-mindedness to education, about, you know, we’ve all come into contact with health practitioners who don’t think holistically, who are very set in their ways. And in many ways, I understand that because it’s a certainty. There’s something wonderful about certainty. It makes us sleep better at night, perhaps because we’re so certain that everything that we do is right and everything that we’ve learned is right. And anybody that’s proposing an alternate view is just a nutter. And if I don’t know about it, it’s not worth knowing. And we know lots of health practitioners like that. But I like to talk to health practitioners like Sharon, who has got such an open mind and after herself being in clinical practice for 35 plus years, is still learning more and more. And as I said, the more I learn, the more I realize I don’t know. And I find that incredibly empowering and stimulating and enjoyable. It makes what it makes learning about health care enjoyable. And I’m sure that’s the case with every other health, with every other profession, too. But health is a particularly interesting one because it affects all of us. And that’s why I encourage people to go into the area of health care. Very rewarding. And she mentioned about airway, about size. The size and shape of the mouth affect the size and shape of the upper airway, which includes everything above the lungs and below, I guess the eyes. That’s the upper airway. That’s the sinuses, the nasal passages, the mouth, the pharynx, the larynx, right down to the entrance to the lungs. That is upper airway. And if you’ve got a narrow jaw and crowded teeth, as in not enough room for all 32 of your teeth, then you have by definition, a narrower airway. How important is that? Well, fortunately, the human being, we humans are very adaptable and very resilient. So a lot of people can live a very healthy and happy life with only a small number of teeth. But for many people, that is an issue which needs to be addressed. And the issue of Sleep Wrecked Kids, I mean, to anybody that has had children, that has had sleep deprivation, you know how important it is. And you will have learned sometimes to the detriment of a long-term relationship, how sleep deprivation brings out the very worst in people and in relationships. So getting this right is a great way of getting family dynamics and relationships right as well, not to mention the health of all of those people involved. It’s a fabulous book. We’ll have links to it in the show notes. I hope you’ve had a good break. I hope you are looking forward to 2021 as much as I am. I think we needed that break and I hope 2021 brings us a happier and healthier year. I’ve often said that the pandemic has given us an opportunity to reflect on health care, on our health in a global way, hopefully in a holistic way, and to prepare us for this and future pandemics because they’re going to come. And the best protection of that is immune function. To not have comorbidities, to not have chronic diseases that are entirely preventable. And sleeping and breathing are two things that are incredibly cheap but can have an incredible impact on your health and well-being. So I hope you found that interesting until next time. This is Dr. Ron Ehrlich be well.
Dr Ron Ehrlich [01:04:00] This podcast provides general information and discussion about medicine, health and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.