Question & Answer - Oral Sensory-Motor, Myofunctional, Vocal Tract, & Airway Information
How do we get crucial sleep information onto professional and family radar?
Answer from Sharon Moore, author, speaker, speech pathologist, and founder of Well Spoken in Australia
Good sleep is a challenge for parents globally. Did you know up to 40% of kids have sleep problems (Owens, n.d.)? And, did you know these sleep problems interfere with a child’s physical, mental, emotional, and social development with ramifications that can be seen throughout their childhood and adolescence (Bonuck, Rao, & Xu, 2012; Bonuck, Chervin, & Howe, 2015; Rabiner, Godwin, & Dodge, 2016)?
Who am I?
My name is Sharon Moore, and I’m a speech pathologist in Australia (known as a speech-language pathologist in the USA, and speech therapist in the UK). I’m the founder of Well Spoken, a speech pathology practice that helps children with communication problems like voice, articulation, fluency, hearing, and language disorders. Over the last decade, I became aware of research in the emerging field of sleep medicine that changed my personal and professional world. That’s why I wrote the book Sleep-Wrecked Kids: Helping Parents Raise Happy, Healthy Kids One Sleep at a Time.
As a mother, I know there is nothing like lack of sleep or interrupted sleep to bring out the worst in children (and their parents). And, in my work with medical and dental specialists, I have seen first-hand how sleep problems interfere with kids’ growth, health, and family happiness.
You may be wondering how sleep relates to a speech pathologists’ core work of diagnosing and solving communication problems. Surprisingly, a lot. In fact, they fit together very neatly in two main ways. Firstly, sleep problems, no matter the type or severity, interfere with a child’s ability to think, behave, regulate emotions, as well as develop and use communication skills. Secondly, when looking closely at the developing facial bones and muscle systems of the mouth, face, and throat (the upper airway) – which are key to speech, eating, breathing, hearing, and voice – it turns out this system also supports healthy breathing during sleep. So, we need, as health practitioners, to consider what goes on in the night just as seriously as what goes on in the day when it comes to upper airway health and function.
As a speech pathologist, I started to wonder how on earth I could help children with their upper-airway and communication problems without also addressing their sleep problems which were undermining everything we did in therapy. I realised resolving this issue was going to be critical to the success of the kids and families asking me for help, and it needed a team approach. Not only that, I came to realise global collaboration between families, as well as health, education, and childcare professionals would be needed to truly change myths and misperceptions about sleep.
What’s the problem?
The World Health Organization has named poor sleep an epidemic because up to 40% of children have sleep problems, and most of them go undetected. These sleep problems undermine every domain of a child’s development: physical, mental, emotional, and social. While there are 100+ possible sleep disorders, one of the most common relates to breathing and the upper airway (i.e., sleep-disordered breathing).
Sleep disordered breathing deserves its very own blog, but in a nutshell, ranges from severe to mild (e.g., obstructive sleep apnoea where the airway collapses and interrupts breathing for up to 10 seconds multiple times an hour). Dr. Rosemary Horne at Monash University in Melbourne reported at the recent Australian Parliamentary Hearing into Sleep Health Awareness that 35% of children snore.
Snoring is one of those symptoms frequently dismissed as a mild form of sleep disordered breathing like upper airway resistance syndrome (resulting from varying degrees of collapse in the upper airway during sleep) and dysfunctional breathing like mouth breathing. Yet, the behavioural and learning consequences of so-called mild forms of sleep-disordered breathing can be as bad as that of obstructive sleep apnoea. Might I say, in my clinical experience, many kids who snore or have mild sleep apnoea, are not treated and left with a wait-and-see approach to management. We are proud to announce the Australian government has been pro-active about sleep health by releasing a document on April 5, 2019 with 11 recommendations to improve sleep health nationally.
Studies show undetected sleep problems like sleep-disordered breathing interfere with a child’s brain development (Bonuck, Parikh, & Bassila, 2006; Bonuck, Chervin, & Howe, 2015). Untreated sleep problems may be irreversible. No matter how mild, these shape each developmental turn throughout childhood, compounding over time. Unhalted, they also shape each developmental turn into adolescence and then adulthood. Sleep problems don’t resolve unless we take deliberate action as soon as possible (Well Spoken & Canberra Sleep Clinic, 2019). For further discussion of mouth and airway development, disorders, assessment, and treatment in children, please see Bahr and Gatto (2017).
What are the main challenges facing parents?
There are millions of children globally who have sleep problems, and most of them are missed, dismissed, or misdiagnosed. This leaves parents with three key challenges:
-Awareness: Many parents think poor sleep is normal. Even if parents notice symptoms like noisy breathing, snoring, and night-waking, they may think they are normal because no one told them they are not. In fact, they are frequently told these symptoms are normal. We need to help dispel myths about sleep.
-Having effective solutions: Parents may recognise a problem, but they are busy, stressed, and probably sleep deprived themselves. This leaves them looking for the quick fix like, “I can stop snoring by propping a bigger pillow under my child’s head,” or playing musical beds in the middle of the night to settle the child. Parents may even think, “I can train my children to need less sleep.” We need to help parents find effective solutions.
-Finding expert help: Parents looking for expert advice have trouble finding the right advice. Sleep medicine is a specialised area, and many doctors simply do not know how to resolve sleep issues. In fact, one of my patients had visited more than 23 top medical specialists in Australia and the USA. It was not until a dentist recognised an airway problem at a routine check-up that the problems started to resolve. We need to help parents find the right help when they need it.
Fortunately, there are simple ways to start addressing these problems:
-Learn the good sleep formula
-Understand the red flags of sleep problems and the consequences of doing nothing
-Find out what to do and who to see for help
I’m going to sign off by saying it’s been great talking with you. May you and all your loved ones have sweet dreams every night. At Well Spoken we say, “Every child and family have the right to get the sleep they need every single night to be healthy and happy.” Sharon Moore
About the Author
Sharon Moore is an author, speaker, speech pathologist, and founder of Well Spoken. She is on the transdisciplinary team for the Canberra Sleep Clinic and helps improve littlies' sleep by treating disorders of the upper airway with myofunctional therapy. Knowing the critical impact of sleep on a child's physical, mental, social, and emotional development, she is spreading the word to parents and professionals about the importance of sleep and the upper airway, as they prepare children for life inside and outside the family bubble. It all starts with a good night’s sleep.
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You can purchase Sleep-Wrecked Kids, Google Sleep-Wrecked Kids on Amazon and other online book stores.
Bahr, D., & Gatto, K. (2017, Nov.). Mouth and airway development, disorders, assessment, and treatment: Birth to age 7. Los Angeles, CA: ASHA Conference.
Bonuck, K., Chervin, R. D., & Howe, L. D. (2015). Sleep-disordered breathing, sleep duration, and childhood overweight: A longitudinal cohort study. The Journal of Pediatrics, 166(3), 632-639.
Bonuck, K., Parikh, S., & Bassila, M. (2006). Growth failure and sleep disordered breathing: A review of the literature. International journal of pediatric otorhinolaryngology, 70(5), 769-778.
Bonuck, K., Rao, T., & Xu, L. (2012). Pediatric sleep disorders and special educational need at 8 years: A population-based cohort study. Pediatrics, 130(4), 634.
Owens, J. A. (n.d.). Behavioral sleep problems in children. Retrieved from https://www.uptodate.com/contents/behavioral-sleep-problems-in-children#! April 30, 2019.
Rabiner, D. L., Godwin, J., & Dodge, K. A. (2016). Predicting academic achievement and attainment: The contribution of early academic skills, attention difficulties, and social competence. School Psychology Review, 45(2), 250-267.
Well Spoken and the Canberra Sleep Clinic (2019, April). Key point summary: Paediatric sleep health. Bedtime reading: Inquiry into sleep health awareness in Australia. Parliament of the Commonwealth of Australia Supplementary Submission; House of Representatives Standing Committee on Health, Aged Care and Sport, 129 (1).