Episode 48 and Part 2 in our Series with Dr. Dave McCarty of the Airway First podcast is now out! You can catch this and all other episodes on Apple, SoundCloud, Podbean, RSS, Spotify, or wherever you listen to your favorite podcasts. And don't forget to check us out on YouTube!
We continue with part two of our conversation with my guest, Dr. David McCarty. Dr. McCarty is a board-certified specialist in Sleep Medicine and a pioneer in the practice of patient-centered care for those who suffer from sleep disorders. An award-winning educator, he is passionate about empowering individuals with knowledge that restores confidence and personal agency, as each patient navigates the landscape of disease and wellness, within an increasingly fragmented healthcare system.
He is the co-creator of Empowered Sleep Apnea, an innovative cross-platform educational project combining storytelling, cartooning, scientific rigor, and quite a bit of fun, all in the name of helping individuals (and providers) navigate the fascinating but complex disorder known as “Sleep Apnea.” In 2023, the project comprises a website, a book (Empowered Sleep Apnea: A Handbook for Patients and the People Who Care About Them, co-authored with Ellen Stothard, PhD), a blog, and a podcast.
You can find out more about Dr. McCarty at empoweredsleepapnea.com.
If the child isn't sleeping well, it's usually the parent that suffers. ~ Dr. David McCarty
AIRWAY FIRST Show Notes:
Empowered Sleep Apnea: www.empoweredsleepapnea.com
Sleep Heart Health Study (SHHS): https://sleepdata.org/datasets/shhs
Wisconsin Sleep Cohort (WSC): https://pophealth.wisc.edu/research/the-wisconsin-sleep-cohort/
American Academy of Sleep Medicine: https://aasm.org/
Beyond Ockham's Razor: Redefining Problem-Solving in Clinical Sleep Medicine Using a "Five-Finger Approach": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883043/pdf/jcsm.6.3.292.pdf
Circadian Rhythmo-Wheel: https://drive.google.com/file/d/1LuwXQgnmmcemxFFVafT5X8No0PAGIqzY/view?usp=share_link
American Academy of Sleep Medicine (AASM) Two Week Sleep Diary: http://sleepeducation.org/docs/default-document-library/sleep-diary.pdf
Common Substances that Can Affect Sleep and Wake: https://drive.google.com/file/d/1-GXLPvd3KzzCfAcukTtAU2TP_77VV_SX/view?usp=drive_link
HOW MUCH SLEEP DOES A CHILD REQUIRE?
Each one of us operates on a circadian rhythm (a 24-hour cycle that communicates to our bodies when to sleep and when to wake). While all kids are different, there is a standard guideline for how much sleep a child needs.
This sleep guideline is based on your child's age:
Newborns (0-3 months): 14-17 hours of sleep per day
Infants (4-12 months): 12-16 hours of sleep per day
Toddlers (1-2 years): 11-14 hours of sleep per day
Preschoolers (3-5 years): 10-13 hours of sleep per day
School Agers (6-12 years): 9-12 hours of sleep per day
Teens (13-18 years): 8-10 hours of sleep per day
WHAT IS A SLEEP STUDY?
A sleep study can be performed at home or in a lab and is available for both children and adults. During the overnight test, the patient's brain activity, breathing, and movements are monitored and evaluated.
When performed in a lab environment, about 30 small electrodes are placed on the patient to record their sleep activities. Typically, when the study is performed on a child, a parent or legal guardian is required to stay overnight in the lab with the child.
WHAT ARE SOME SYMPTOMS OF SLEEP-DISORDERED BREATHING IN CHILDREN?
Sleep apnea in children differs from sleep apnea in adults. Daytime sleepiness tends to be more prevalent among adults, whereas behavioral problems are more prevalent among children.
According to the American Academy of Sleep Medicine, a child with sleep apnea may:
Experience prolonged pauses in their breathing lasting 20 seconds or longer at a time
Experience patterns of repeated pauses in their breathing lasting less than 20 seconds at a time
Experience related issues such as a slow heartbeat or low oxygen levels
While not all children exhibit these symptoms, the most common signs of a sleep-related breathing issue or dysfunction in children include:
Extended pauses in breathing (lasting longer than 20 seconds)
Restless sleeping
Snorting, coughing, or choking while sleeping (often causing a child to tilt their head back to breathe)
Chronic mouth breathing when awake or asleep
Nighttime sweating
Late age/stage bed wetting
Chronic sleep terrors
Poor weight gain in infants
Daytime sleepiness or trouble waking up in the evening after being in bed all night
Difficulty paying attention or ADHD diagnosis
Exhibiting behavioral problems
Depression or moodiness
The oxygen level in a child's blood may be lower due to sleep-disordered breathing. This is because the condition can make it difficult for air and oxygen to flow into and out of the lungs. Children's lungs and hearts may be permanently damaged if this pattern continues.
Chronic sleep apnea can also lead to poor growth, lowering of the IQ by as much as 10 points, and facial development abnormalities.
WHAT IS THE FIVE-FINGER APPROACH (EMPOWERED SLEEP APNEA)?
In simplest terms, the Five-Finger Approach is an expert-level Sleep Medicine clinical problem-solving tool for providers to use with patients to help determine the best course of treatment. When used collaboratively, as demonstrated via the conversation in Season 1, Episode 5 of the Empowered Sleep Apnea Podcast, it is truly a game changer that helps to empower both patients and providers.
In the sleep medicine Five-Finger approach, each digit of the hand represents a potential source of disturbance to the quality of a patient’s sleeping or waking experience. The task of the clinician, therefore, is to thoroughly evaluate the patient to determine the potential factors within each domain that may adversely affect sleep or wake.
In the simplest of terms, the five fingers represent:
The Thumb: Circadian Misalignment - Reviewing the careful history of a patient's sleep/wake schedule, including weekends.
The Index Finger: Pharmacologic Factors - Reviewing a patient's current medication or pharmacological intake
The Middle Finger: Medical Factors - Review a patient's medical symptoms, issues, or previous diagnosis
The Ring Finger: Psychiatric and Psychosocial Factors - Review a patient's history of anxiety, depression, ADHD, and other social and behavioral patterns
The Pinky: Primary Sleep Diagnosis - Review a patient's traditional sleep diagnosis and analyze how other factors may be impacting or contributing to the diagnosis
DID YOU MISS IT? THEN CHECK OUT PART 1 OF OUR PODCAST CONVERSATION WITH
DR. DAVE MCCARTY!
SPOTLIGHT BOOK RESOURCE FOR PARENTS
This is a handbook for patients and the people who care about them.
The curriculum from Dr. David McCarty and Dr. Ellen Stothard is presented in a style understandable without a medical degree …to provide unique teaching tools suitable not only for patients, but will also benefit sleep trainees and others interested in expanding their own teaching knowledge and tools. It has benefits for patients as well as sleep disorders healthcare workers who want an entertaining, in-depth understanding of sleep medicine, especially the evolving area of sleep apnea.
No doubt you will find Empowered Sleep Apnea: A Handbook for Patients and the People Who Care About Them a much more entertaining read than the typical sleep textbook and yet will finish with additional educational tools to use for teaching, in addition to an expanded knowledge about sleep apnea.”
