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>> Good evening.

Thank you for watching HealthLine here on PBS Fort Wayne, I'm your host Mark Evans.

It's great to have you watch the program tonight and certainly hope to have some involvement from you as well by calling us and asking questions and asking about your concerns or our topic tonight is sleep medicine for pediatrics and our very special guest is Dr. Aaron Roberts who is a sleep medicine physician.

>> And Dr. Roberts, it's great to have you back.

It's been a few years since you've been on the program pre pandemic actually.

>> Yes.

And Aspen and I was so excited to know that you were going to be on the show tonight because I know the last time you were here we had several phone calls from our viewers and we want to invite them to give us a call tonight.

The number is on the screen 866- (969) 27 two zero here locally it's just (969) 27 two zero call it any time during the program if not for yourself but for a friend or a relative, someone you love who has a sleep disorder and we're going to primarily focus that on pediatrics and I guess children do have sleep issues.

>> They do.

Yeah, just like adults except they're a little bit different than the adult problems and I want to congratulate you before we go further that you're a brand new dad here.

>> Yes.

Yes.

Six weeks old actually about six weeks and two hours.

Oh yeah.

A little girl.

Yep.

Evelyn Evelyn me she's probably at home sleeping right now but no no I'm sure she's watching her day.

>> OK, very good.

But we want to open up those phone lines and we'll take those calls as they come in.

But I want go ahead and and talk about I do want to ask right off the top of the head top of the top they had I guess that is a question stuck in my head but is there a huge difference between sleep problems, sleeping issues between adults and pediatrics?

>> Yeah, there is actually a lot the reason that pediatrics have different problems in adults is because sleep is actually structurally different than what adults usually when you're a kid have much more REM or rapid sleep hence why you'll have more night terrors or nightmares because you have remnants of sleep that you dream.

You also have a little bit more slow wave sleep where it goes down as you get older and flow with sleep which is a deep sleep is where you get the parasomnia is like sleepwalking and sleep talking and if you get older you have less of that so you have less of a chance to get sleepwalking as well too.

>> And I want to get into those later in the program.

But what is considered normal versus abnormal sleep for children?

>> Yeah.

So when you're a kid I mean pretty much your job is to eat and sleep and then make dirty diapers and that's from personal experience.

>> Yeah but if you get older you know from going to toddler to young child to school age to teenager the amount of sleep that you need goes down and then also the sleep structure also changes as well too.

So when the younger you really require a lot more sleep about like Eve when she's sleeping sixteen plus hours per day I mean actually more than that probably but then probably in a couple of months from now she'll be sleeping through the night every night well cross fingers sleeping through the night every night and getting much sleep and being more awake during the daytime and as you can see as you get older especially during school age your sleep you really still need a lot good eight to ten hours or even more than that.

But if an adult your sleep deteriorates a little bit, you don't need as much.

You only need about six, seven hours of sleep and can get by with that.

But when you're a kid you just you just require a lot of sleep mainly because sleep is so we're trying to do in that's the time that they're really developing and growing now is as far as an infant goes.

>> I mean I know it's important that they sleep and they're going to sleep pretty much whether you want to or not.

>> But can they actually endure a lot of noise and distractions and sleep right through that?

>> They can again from personal experience I've taken everyone out to restaurants.

Fireworks are going off this past weekend so sleep right through that.

It's really if you're in a deep sleep I mean it's almost hard to wake her up sometimes to to feed her but not all children like some children, they have a little bit more about ability to wake up a little easier and actually it's normal or completely normal for kids to sleep her to wake up during the nighttime four to six times.

I mean completely normal.

So if the child is waking up the multiple times throughout the night time that is one hundred percent normal.

The majority of times those will go right back to bed won't even realize that the parents won't even realize that they woke up to it becomes more problem if they wake up and they don't go back to bed.

>> That's kind of when parents get a little bit more concerned right now and I read during my research today preparing for the show something on the Internet.

>> So it must be true.

No, but I came across something where there was a controversy about children taking naps because they thought they took naps during the day.

>> It prevented them from getting a good night's sleep.

How important are naps?

Yeah, some naps.

They're pretty important actually.

It's completely normal for kids to nap all the way up to age five after age five if they're still taking a nap or needing a nap and it's kind of more pointing towards something maybe wrong they getting enough sleep at night time or they might have a sleep disorder that is disrupting their sleep but kids still kind of give up their nap anywhere from two to four.

It just kind of varies from child to child but they unlike adults where well adults they sometimes take naps as well too.

But I'm guilty of actually some countries that they take advantage of that you know, with the siesta in the afternoon just kind of taking advantage of that natural dip or circadian rhythm.

But now they're kind of very restorative.

You actually can get through a whole sleep cycle during that short nap, is that right?

Yeah, during that shortly after they take during the usually at preschool or during daycare they'll still attempt to take a nap and so that's perfectly normal if your kid has now been up to age five after age five you might think there might be something else going on.

Well, you made me reminisce when we were talking about this before the show started.

You know, and you mentioned about five years old.

>> I remember when I was in kindergarten we had this little map that we would roll out and we had no name tag on there and every day right after lunch we would lie down and take a nap.

>> I don't know if I ever slept but it was quiet time I think more for the teacher.

>> Yes, I think it's more relaxation for the teacher but I do know some of those kids did sleep.

>> Yeah, but let's talk about some stats if you happen to have those at the top of your head what percentages of children have or will have any sleep disorder?

Yeah, so probably the majority of kids at some point in their life will have some sort of sleep disorder whether it's sleepwalking or wetting the bed or insomnia or snoring.

I'm usually when it comes to like an actual organic sleep disorder it's much a much smaller percentage and a lot of it is behavioral snoring.

It's very common in kids.

About 10 to 12 percent of kids will be a habitual snore and then only about one to four percent of those kids will have actual sleep apnea similar to adults.

It's a little bit different cause of why they have sleep apnea and then also a different treatment for that if they do have sleep apnea usually when you're an adult it's because you're older so your muscles are more weak also you have a little extra weight on you usually when you're child you have sleep apnea which is just kind of periods where you stop breathing mainly because you have adenoids or tonsils blocked airway off they haven't grown you throw away yet and so the treatment for that would be to get rid of tonsils or get them surgically removed and that would actually give her the sleep apnea 80 percent of the time they'll from having sleep apnea after that.

Also people especially teenagers will have kind of circadian rhythm disorders or delayed sleep phase where they will see a very late whether it's because of playing video games or they have sports or academics have to do and then they have to get up early but in the weekends of sleeping until noon they're whole insurance schedule is kind of shifted forward a little bit to the opposite end of usually older individuals.

Sixty five plus will have at the opposite end where they'll eat dinner at four o'clock and go to bed at seven o'clock then wake up at three o'clock in the morning.

So it's kind of more of an advanced sleep phase but more delayed coming in teenagers and kids and you mentioned a couple of risk factors but what are more that could affect the sleep?

>> So a lot of risk factors also include obesity.

Just this is America so we do have a lot of kids who sort BMI or body mass index which is just calculated by their weight and they can compare that to kids their age what it should be it's kind of percentile I'm sorry if it's the fifth percentile or above compared to their other peers that kind of puts them at increased risk for not only sleep disorders like the Japanese but then also diabetes, high cholesterol, high blood pressure.

So that is certainly a risk factor.

A lot of it also is behavioral so it kind of depends on the environment that they're in if they are drinking like slamming pop before bed, I'm just kind of , you know, caffeine intake and then they're on their cell phone either playing a game or on social media that can certainly play a part into a big, big risk factor as well too.

>> All right.

And if you're just joining us, it is helpline line here on PBS Fort Wayne and we're talking about sleep medicine for pediatrics with Dr. Aaron Roberts and you give us a call at any time at 866- (969) 27 two zero.

In fact, we have a call coming in right now.

CEU prefers to be offline and we're getting that question loaded up.

>> Doesn't seem to be loaded up totally right now but we'll get back to it because I do want to ask this first what are the consequences mentally and physically if a child doesn't get enough sleep?

>> Yeah, so interestingly kids, you don't get enough sleep.

They present a little bit differently than the adult usually the adult will be very tired.

They'll be kind of dragging they're kind of just can't concentrate whereas on kids they'll be the opposite.

They'll be hyperactive.

The ADHD kids, the ones that inattentive inability to focus and will have mood problems, anxiety, depression.

So it's a little bit different when you're adult than when you were a kid just the way that presents actually anyone with ADHD should kind of be recommended to kind of get screened for sleep disorders just because that is a very common cause for ADHD symptoms.

>> Well, without proper sleep you're going to have a cranky kid know so they're not going to do this well in school, right?

>> Yeah.

Yeah, it will affect because sleep this is kind of when you restore yourself consolidate memories of your period, your body.

So I mean there'll be mood they'll be grumpy, they'll be able to poor school performance increased risk for accidents whether it's a car accident or just accidents at home.

You know it's just all around just not not good.

In addition, blood pressure issues and increased risk for diabetes and cholesterol issues and so it can affect physical and mental.

>> OK, well let's see that question is ready to go and Sue is asking is a later start time at school recommended so kids can get more sleep?

Yeah, good question.

So yeah so we the sleep community, the American Academy Sleep Medicine they kind of fought for later start times for school in addition to getting rid of daylight Saving Time but unsuccessful in doing so.

I mean we do have to fit a lot of the curriculum in and but it's just not natural for kids to kind of wake up at six o'clock and then be on the bus at seven o'clock to get to school especially if they're doing sports or homework up until 11:00 at night.

They really need about eight to ten hours for the older kids and younger kids.

They need nine eleven even more than that if you're going to bed at eleven o'clock at night and then waking up at six o'clock to get the day going, you're really kind of getting sleep deprivation or chronic sleep deprivation.

So relating to serious question well they need an earlier bedtime.

>> They do.

They do.

So that's where kind of the behavioral component comes into play where you know, you have to cut off electronics, you have to cut off TV just kind to make sure the homework assignments still daylight out.

>> So that's got to go to it is very difficult.

I know when I was a little kid my mom made me go to bed like 7:00 o'clock during the summer and that's true.

I mean literally we didn't have blackout curtains.

>> It was the sun was shining in your kids outside playing my mom aluminum foil up on the windows so oh yeah.

>> You got a little bit better than I did at work but I mean I could hear people out playing it very difficult.

>> Yeah, it really is.

OK, we're going to go ahead and ask the next series of questions here.

>> I wanted to talk about what the more common sleep disorders are if you can come over those you've mentioned a couple of them in previous dialog.

>> Yeah.

Yeah.

So I frequently see sleep apnea in the clinic also I see restless leg syndrome which kind of also presents itself a little bit differently than when you're an adult and then when you're a kid after kids to kind of describe their leg movements to you when they're two or can't even you can't even talk.

Also insomnia very common but more commonly seen in sleep compared to the adult or the parasomnia sleepwalking Nocturnal Endris is what you just said what in those are much more common to all to you but mainly the more common ones are sleep insomnia and then also kind of sleep followed by sleep apnea, restless legs and the parasomnia is right and you mentioned sleep apnea.

>> I find that kind of surprising for kids but I guess they do have obstruction problems like adenoids and tonsils and things like that or maybe even chronic colds and things like that allergies.

>> But I know that's a very common thing for adults especially overweight adults.

>> But do they still use the child you say sleep apnea.

Good question.

So usually if the child has been diagnosed with sleep apnea and then they have adenoids and tonsils taken out, they're still having symptoms like they're still snoring, they're still tired or are still hyperactive during the daytime then we'll do this kind of do another sleep study on them to kind of evaluate if they're part of that 20 percent of people still have residual sleep apnea and then if they do then I will kind of pursue treatment with a C Pap machine which is kind of more of a second line therapy.

So first line therapy is the DNA adenoids and tonsils, second line therapy usually for residual sleep is where it comes to play no different than the adult population although you do have to watch they are kind of growing during that time so you have to kind of watch from different maskin that and compliance is a factor too.

I mean it's hard enough for the adults to see Pap let alone a six year old or a seven year old.

Well, I'm going to tell you something I do sleep with a C pap and I am so glad it's a it's a miraculous thing.

I have slept so well since I've started using I'm glad to hear that.

>> I mean I mean we do see people every day that they either love or they hate it.

It's kind of out of 100 people in her clinic about seventy five we'll do perfectly fine.

Twenty five percent kind of a little bit more fighting or resistance to my brother fought it for years and he in fact I talked to him yesterday and he just started on his CPR therapy and he says Mark, I don't know what I've been missing.

He says it's too bad that I've gone so many years and not getting good quality.

>> Yeah, I hear that a lot of people they wish they would have done it earlier.

It can make a huge day and people don't even realize what they're missing until they actually get good sleep.

But thankfully the people that do not tell her mother and don't work it there are alternative treatments for the kids.

Usually we use lethal corticosteroids in addition to asthma medications that can for more mild cases we can treat sleep apnea for adults as a whole different alternative treatment oral appliances which are dental devices, the type of awful neurostimulator which is something that new relatively new came out.

So there are some alternatives if people really need it and they are struggling with her sleep at all right now you did mentioned earlier narcolepsy and sleepwalking and of course bed wetting and let's break those down.

>> Kids can have narcolepsy.

Yeah, actually kids usually narcolepsy which is a neurological disorder starts or presents itself when you're a teenager.

Unfortunately studies have shown that it takes about on average ten years for them to get diagnosed.

Usually it'll get chalked up to anxiety, depression or they're just lazy or some other disorder medication side effect.

>> But for those who don't know what that is.

Yeah, so narcolepsy is pretty much where you're missing neurotransmitter called Hypocretin and the Hypocretin is a thing that keeps you awake and also helps regulate your sleep wake cycles.

So if you're missing that can be tired all the time then also a very dysregulated sleep meaning sleep intrusion during the daytime and then very fragmented sleep during the nighttime.

So people typically present as falling asleep all the time falling asleep in class if you're driving you'll fall asleep off the road.

The typical type one narcolepsy is the one where you get cataplexy to you which is where you get excited emotional ones and you lose function of your body.

So those are the people in the movies.

They are eating a bowl of soup and they just faint or they are laughing at a joke and they just fall to the floor really a little bit more subtle than that that that's kind of war movie they make it out to be more but narcolepsy is very, very common usually around like pre-teen like twelve thirteen year olds it's kind of when it presents itself so a lot of times again if it's hard to gauge because there's a lot of sleepy kids out there and want to rule out other stuff the number one cause actually of excessive daytime sleepiness in kids is chronic sleep deprivation.

>> So you want to kind of rule that out first before too much video game.

Yeah, I mean exactly.

That's definitely much more common.

I mean narcolepsy actually is just one in two thousand people.

So it you know, out of high school there's like Carroll High School or I mean there's probably one or two of them which I know there are.

>> Yeah.

All right.

Well Kevin is called in and Kevin , go ahead and ask your question for Dr. Roberts, please.

>> Yeah, I have a three year old daughter.

She is not overweight but she she snores like she's a fifty year old man and I think she may stop breathing at night sometimes I haven't had that evaluated.

I talked to her pediatrician about tonsils and adenoids but the pediatrician the said that you know, not to worry about that until she's older.

Is that is that a proper recommendation or what are your thoughts?

>> Yeah, so it kind of depends.

Certainly if you have untreated sleep apnea, no matter how old you are, whether you're one, two , three or a toddler that can cause developmental problems, you want to probably get that looked into a little bit further.

Usually there's a higher risk for surgery like getting those adenoids and tonsils taken out when you're under the age of three, which is kind of why some pediatricians might hold off on pushing for further evaluation or treatment just infection bleeding and you have to go under anesthesia for that.

So there are certainly risks to surgery otherwise everyone would probably get their adenoids and tonsils taken out.

But if they're snoring in their displaying other symptoms, you might want to kind of further evaluate usually you can evaluate whether a teenager adenoids and tonsils getting taken out would be warranted to do a sleep study and kind of see if it's habitual snoring like that ten to 12 percent or actually the one to four percent that have sleep apnea.

OK, very good.

>> Thank you for your call, Kevin .

All right, let's go ahead and move on to sleepwalking.

I had a cousin who was a chronic sleepwalker and boy the parents had a heck of a time dealing with that.

>> Yeah, sleepwalking.

I do run into that quite a bit and so sleepwalking very common and kids usually there is a family history as well to see if mom or dad or both of them then the child is probably definitely going to have some sleepwalking is going to ask if I'm not ready to yeah.

Oh yeah.

There's definitely a hereditary component.

The good news is that usually sleepwalking kids will grow out of that kind of like certain kids will grow out of ADHD or grow to have asthma.

Same with the sleepwalking mainly because as you grow up your have little less propensity to have that slow wave sleep which is when the parasomnia occur and then also just other sleep changes occur too.

So sleepwalking usually for that you want to try and be very cautious with that.

I mean is very benign.

It's not going to affect your long term health .

It's not going to cause you to be more development developmentally delayed or anything like that.

But it can be kind of disturbing especially if you are going out and eating stuff they shouldn't eat or going out in the middle of winter doing something that playing fire or sharp objects so kind stressing safety kind of the first thing and then kind of even I have some parents lock the door, make sure that the child cannot get out right.

I'm just but you really do experience that usually you'll want to just kind of gently guide him back to bed.

We try and avoid aggressive measures like putting on medicines or anything like that.

It's really just something that kind of like bedwetting pretty benign that most kids will grow out of .

>> Well, and you mentioned that earlier and I didn't realize bedwetting can be a sleep disorder.

>> Oh, a problem.

So what what brings that on?

Yeah, so that's very common usually much more common in males and females and it can go up to even when you're double digit age like 11, 12, 13 and still be considered normal maybe a little bit abnormal if you had better then you stopped it then you started it up again then you may want to look into for a secondary cause whether it's infection or sleep apnea causing that.

But for most kids it's more of an embarrassment.

There are medicines that some individuals if they go to sleep a night of difference use just for social purposes.

But bedwetting is a very I mean usually bedwetting is not even seen or seen by sleep specialist usually handle or managed by the primary or pediatrician or primary care physician.

>> All right.

And typically how how are these sleep disorders diagnosed?

>> Yeah.

So a good history and physical kind of I kind of like what they teach in med school.

Eighty percent of the diagnosis can be kind of told by the patient and so or with the help of a parent when you were a kid .

So getting a good history and physical there are other tests that we use mainly the sleep study just kind of bringing the child into the sleep lab to a bunch of wires kind of head to toe and kind of just observing what happens with them during that normal night everything from their oxygen to their breathing to their leg movements to kind of what sleep or kind of sleep they're getting during the nighttime.

But do kids do OK in sleep labs ?

Yeah.

Yeah.

So I mean I had to do a sleep study and I personally had a horrible night's sleep that yeah.

>> And I did too and I said as an adult I hope I can do my next one at home.

Oh yeah.

Oh exactly yeah.

And so kids surprisingly I found that they tend to do a little bit better than the adult population.

>> Yeah yeah.

OK well we have a minute left and I think this is a very important question when should you seek medical advice for your child's sleep problem and where should you start.

Yeah so I'm usually again at some point this child will have a sleep disorder whether it's short term insomnia or parasomnia or bedwetting or snoring and it only becomes more problematic when it starts affecting or bleeding into the daytime like kids are having symptoms of trouble concentrating or mood disorder or their developmental delayed then you might want to start looking into other causes.

A lot of times I get referrals from other specialties such as psychology or cardiology or urology just because I know they're most of the kids who have sleep problems and they're pretty benign they'll just stay at home.

But when it starts becoming more symptomatic starts being noticed by the parent parents, they know their kids better than anybody.

They can kind of tell what is normal and what might be off a little and sleep is so important especially when you are a child.

All right.

Well, Dr. Aaron Roberts, sleep medicine physician specializing in the pediatrics area of that, we thank you so much for being on the program tonight as always.

Great to be here and great to be back and happy fatherhood.

Thank you.

Thank you to your wife as well .

>> Yes, thank you.

All right.

And we will see you next week here on HealthLine.

We thank you for watching.

Until then, good night and good