The Tucson Children’s Assessment of Sleep Apnea Study was published this year in the journal SLEEP [1]. In this study of 263 youth, sleep study and neurobehavioral data was collected twice, five years apart. Twenty-one of the children had persistent sleep apnea throughout the entire study. These children were six times more likely to have behavioral problems when compared to children with no sleep issues. Parent-reported behavioral problems were significantly higher for the children with sleep apnea; these observed problems included hyperactivity, attention deficits, aggressiveness, poorer communication, lower social competency, diminished self-care, and compromised adaptive skills. The study also reported an association between sleep apnea and lower academic function. The children with persistent sleep apnea were three times more likely to have learning problems and seven times more likely to have grades of C or lower than youth who never had sleep apnea. This study and others [2] conclude that children with sleeping issues may develop learning problems, disruptive behaviors, and other ADHD symptoms if sleeping issues are left untreated.

The National Association for Child Development has known that sleeping issues affect the global development of a child, due largely to a lack of adequate oxygen being delivered to the brain during sleep. Sleep apnea is a breathing problem in which the airflow is limited and obstructed during sleep, resulting in less oxygen to the brain [3]. The importance of oxygen for the brain cannot be overstated. The brain uses about three times as much oxygen as muscles in the body do, and brain function and performance are directly linked to oxygen availability [4]. NACD highly recommends that parents with a child experiencing any symptoms of sleep apnea, such as snoring, take the child to a doctor to be evaluated. It is also a good idea to frequently check the child’s oxygen saturation level. A quick, easy, inexpensive way to track oxygen saturation levels at home is with a pulse oximeter.

To find out more about sleep apnea, including common symptoms and treatments used by doctors, please read our article here.


To find out more about the importance of oxygen for the brain, please read our article here.

To find out more about pulse oximeters, please read our article here.

Sources

1. Perfect, M.M., et al. (2013). Risk of behavioral and adaptive functioning difficulties in youth with previous and current sleep disordered breathing. SLEEP, 36(4), 517-525.
2. Beebe, D.W., et al. (2010). The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. SLEEP, 33, 1447-1456.
3. Riggs, S. (2012). Sleeping and breathing problems. NACD Journal, 25(3).
4. Joo, E.Y. (2010). Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome. SLEEP, 33, 235-41.

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The very best way to work with your doctor is to educate yourself so that you can ask informed questions. Doctors are usually more at ease answering a question if they feel like the person asking the question has already done some of their homework. This way it is more of a discussion, and your doctor won’t feel like they have so much to explain that their answers will be overwhelming. Also if you know what you want to ask you can phrase your question in an “I need your help with this” format. (Dr. Smith, I was reading up on hot compresses and I would like your thoughts about why they are so effective.) Doctors by nature are educators, although they may have lost some of that in the world of health “business.”

If you have a good article on something related to your child’s condition, make them a copy of it. They may not get around to reading it, but they will appreciate your dedication and good will.

Medical doctors’ time is really at a premium in today’s rapid paced society. The week or night before your appointment make a list of things you want to ask and take it with you. Tell them you have some questions written down that you would like to discuss with them.

You are in charge of your child’s care. The doctor is your resource person. If there is something that you are not comfortable with, let them know. For example, they may want to order a vaccination or medication that you are uncomfortable with. It is fine to let them know you are uncomfortable with it at that time. Give them your reasons, and make sure you have done some homework. Don’t dismiss their thoughts and education, but introduce yours. You might say, “I really am not comfortable with that right now; why don’t we wait until our next appointment and reconsider?” If you find your doctor is not willing to work with you, then it is time to find another doctor.

If you are shopping around for a doctor, on your first visit let them know how you feel about certain treatments or medications and any other concerns you have. Ask them if they will be willing to work with you on your child’s care. You are the consumer; if you are not satisfied with the answers to your questions or feel that you can’t build a rapport with a particular doctor, keep shopping.

If you are working with medication and prescriptions, your pharmacist may be a good partner. Ask for counseling even before you fill a prescription, and if there are issues the pharmacist will often call your doctor on your behalf for clarifications, thoughts, or concerns.

Reprinted by permission of The NACD Foundation, Volume 25 No. 4, 2012 ©NACD

Please note: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.

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Sleep is so important to our health, healing, and learning processes. It affects the way we feel during the day and most aspects of how we function. Our sleep can be compromised or interrupted for a number of reasons. One of the big factors contributing to sleep problems is related to breathing. Breathing problems at night range from things we think of as normal, such as snoring, to a range of other breathing problems. Children have many more problems with breathing at night then we might think. Children have smaller anatomical structures than larger people, so it is easier for them to have breathing obstructions and reduced breathing or blocked breathing for periods of time.

Let’s look at these problems and see them for what they really are. Snoring in children is not uncommon and not often thought of as something needing treatment. When they snore it is often thought of as cute. However if the snoring is very loud, there are probably three things happening. First, they are undoubtedly mouth breathing, leaving them dried out and obstructing airflow to some degree. Second, the noise of snoring tends to keep the brain from going into a deeply restorative sleep. It would be like any other sound in the room. Watching it on brain wave equipment, one can easily observe that it keeps the brain from going in deep realms of restorative sleep. And third, the body is using more oxygen just to breathe a little harder, while at the same time possibly limiting or obstructing airflow enough to create low oxygen levels in the blood. That means less oxygen to the brain. The American Academy of Pediatrics recommends evaluating all children that snore.

Even more serious than just snoring, though, is the issue of obstructive sleep apnea. About 10% of children snore, and of that 10%, 20 to 30% of them will have obstructive sleep apnea. It is estimated there are about 18 million people in America that have sleep apnea and 95% of them are undiagnosed and untreated. It is estimated that 2 million of these people are children.

So what is obstructive sleep apnea? Obstructive sleep apnea is diagnosed when the child literally obstructs their own airway enough to stop air from entering and exiting the lungs until they gasp for air. This obstruction results in oxygen levels decreasing, which in turn results in compromised brain function and irritable, sleepy children during the day. Most obstruction comes from low tone in the base of the tongue where the tongue tends to fall back into the airway and create an obstruction to airflow. Less common is obstruction by other structures, such as the soft palate or the tongue against the hard palate. But in most cases of obstructive sleep apnea, the tongue base is the culprit.

There is one more form of apnea that is far less common. It is usually uncovered when the obstructive component of sleep apnea is resolved. It is an absence of breathing that occurs for reasons other than obstruction. Basically the brain fails to continue the breathing commands when we are asleep. Because this form of apnea is related to the central nervous system, it is referred to as central sleep apnea. For the purposes of this article, we use the term “sleep apnea” to refer to obstructive sleep apnea.

There are some features of air flow obstruction that can be addressed with oral or dental appliances. Dentists have a part to play in resolving issues that create airflow obstructions by assessing oral structures, jaw positions, oral cavity formation, and tongue positioning. After a dental assessment the dentist may provide different appliances that keep the jaw forward or expand the hard palate. There are many different appliances that can be used for positioning, correction, and resolution of snoring and airflow problems. This not only addresses the immediate problem, but can correct structural problems as the child grows, as well as facilitate air flow, eating functions, and proper facial structure.

Some of the features of children who tend to be predisposed to sleep apnea include: small jaws, large tongues, obesity, structural characteristics related to Down syndrome, enlarged tonsils or adenoids, nasal septum deviations, allergies and sinus problems that are chronic, and general low muscle tone.

Symptoms of sleep apnea include: snoring, irritability, daytime sleepiness, morning headaches, hyperactivity, poor cognitive performance, poor school performance, weight gain due to metabolic sluggishness from low oxygen, sleep that is not refreshing, and feeling tired all the time. These are symptoms you can report to your doctor.

The simplest way for your doctor to check for sleep apnea is to do an overnight sleep study in the home. You will find your child will probably prefer this to going to a lab. If your doctor feels it is indicated, they may want to perform a full overnight sleep study in a sleep center. Most of these centers are much more comfortable than you might think.

There are many ways to treat sleep apneas. The resolution for each child is different and will be managed by your doctor. The treatments range from using a positive pressure device, called a CPAP machine, to removal of tonsils or adenoids if they are a problem, and weight loss. The benefits from the treatment of sleep apnea include better cognitive function, feeling less tired and irritable, better metabolism, increase in physically restorative sleep, and greater immune system function for better overall health. The treatment plan will vary from doctor to doctor and will be different for each child. Treating sleep apnea will help avoid other health issues such as diabetes, heart disease, obesity, and high blood pressure.

It is recommended that you request evaluation and treatment by a board certified sleep doctor. Family practice physicians are usually very helpful in referring you to a qualified sleep doctor.

Reprinted by permission of The NACD Foundation, Volume 25 No. 3, 2012 ©NACD

Please note: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.

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The use of pulse oximeters has been growing throughout acute healthcare for years but has been slow to catch on in home health and long term care. It has been even slower to catch on for the use of monitoring oxygen trends in the general and special needs populations. NACD has been a spearheading group in recognizing the importance of oxygen levels in special needs groups and people healing from many types of brain injuries and developmental delays.

The pulse oximeter is inexpensive and very easy to use as a trending tool for families at home. Since the rehabilitation and learning in the brain is heavily dependent on oxygen being available, it is crucial we do everything we can to maximize oxygen delivery to the brain. The pulse oximeter can give us information about whether we are oxygenating as well as we need to. It also easily picks up on decreases in oxygenation during our daily living activities, learning, and sleep; decreases that can alter brain and body function or create problems that need to be corrected.

What does a pulse oximeter do? It uses an infrared light source to calculate or measure how much of the hemoglobin in our red blood cells is saturated with oxygen. Our blood contains red blood cells that have what is called hemoglobin in each cell. The hemoglobin has four sites where it can retain an oxygen molecule. Using a pulse oximeter we can check how much hemoglobin is saturated with oxygen and get a number referred to as saturation percentages. Normal oxygen saturation for most of us is 98 to 100%. In healthcare we usually consider 94% and above normal. When we go to see our doctors the majority of them will check our oxygen saturation routinely now and will refer to it as our “fifth vital sign.” Our doctor will determine what is normal for us and if it is in acceptable ranges. If it is not, they will determine why and establish if it is okay or else create a plan to bring our saturations to within normal ranges.

Most of us have a thermometer, blood pressure cuff, or glucometer at home to track specific health concerns. We are just learning how helpful pulse oximeters are at home. Technology can be slow and initially expensive, so the use of pulse oximeters at home is just getting started. But if we have a need for a pulse oximeter, they are now easy to obtain and reasonably priced. If you are buying one on your own, you need to look at the specifications and what it will measure. If you have a heart condition and you know your oxygen saturation is usually 85%, you don’t want to get a pulse oximeter that only measures 90 to 100% accurately. A good home pulse oximeter should measure 70% and above with good accuracy.

Having a monitor at home can be important for many people. Why is this? Having your oxygen saturation taken once is like having your picture taken once and expecting that the way you look will never change. The way we look changes all the time and so do our oxygen saturations. If saturations vary within the normal range, that is typical and okay. But if, for example saturations are in the range of 94% and your child takes a brisk walk and returns short of breath with saturation readings at 86%, then we need a doctor to assess those numbers and decide if an action or treatment is necessary or if there is a problem that needs addressed medically. We can only track this over time if we have a home pulse oximeter.

In summary, using a pulse oximeter at home is a quick, easy, inexpensive way to track oxygen saturation. Because brain function depends on good oxygenation, we can use pulse oximetry as an indicator of how our bodies are using oxygen.

Purchase a Finger Pulse Oximeter at the NACD Store

Reprinted by permission of The NACD Foundation, Volume 25 No. 3, 2012 ©NACD

Please note: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.

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Vital capacity may not sound like a very exciting subject. However it is a very important subject and one that we address frequently at NACD. So it’s worth your time to learn a little about what it is and why it is significant.

There is a lot of talk about vital capacity (VC) when we talk about what assists good oxygenation. What is vital capacity? When we talk about how much air our lungs can hold, we can say that the entire lung has a total capacity. Total Lung Capacity (TLC) is the amount of air our lungs can hold when completely full. If we blow all the air out of our lungs that we can, then we have some amount still there because our lungs are made never to be totally empty. We call the amount still left residual volume (RV) and the amount that we blew out vital capacity (VC). So our total lung capacity (TLC) equals our vital capacity (VC) plus our residual volume (RV). TLC = VC + RV. That’s the scientific way it is written and talked about.

Why is this important to our health and the health of our children? If our lungs and chest are exercised and well inflated we can maintain our very important vital capacity. Keeping our vital capacity where it needs to be will maintain our oxygen levels; and improving our vital capacity certainly suggests that we can improve our oxygen levels. In most studies, athletes and mountain climbers have larger vital capacities than the average person. Larger vital capacities can help keep oxygen at levels where we have more oxygen available to the brain and body.

That all sounds good. But what does it mean for our health and in particular the health of people that have challenges? It definitely means two important things. First, that we can maintain and improve our oxygen availability to the brain, and second that we can keep our lungs open and functioning well enough to minimize the chances of having health problems. If we don’t keep our lungs open and clear we can develop pneumonia, and small areas of our lungs tend to collapse (called micro-atelectasis) from not being properly inflated. When either of these takes place oxygen availability will decrease!

Remember:

• We know having good supplies of oxygen available to the brain helps us heal, process thoughts, and utilize the brain in ways that help us become more functional mentally and physically.
• We know keeping our lungs open and fit are great ways to maintain and improve oxygenation to the brain. We all need to practice breathing correctly and improve lung and chest muscle fitness.
• We know we need to have our oxygen levels as stable and consistent as possible. Exercising our lungs, staying as mobile as possible, and belly breathing help normalize our lungs’ airflow.

For your convenience we stock breathing exercisers (Expand-A-Lung) in the NACD bookstore.  http://www.nacdbookstore.com/products/expand-a-lung

Reprinted by permission of The NACD Foundation, Volume 25 No. 5, 2012 ©NACD

Please note: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.

The post More on Brain Oxygen and Lung Health: Vital Capacity appeared first on NACD International | The National Association for Child Development.

How can I get more oxygen into my brain? We all know that our bodies need some attention in order to grow and be healthy. We know that we need a good diet and exercise. But what about our brain? What does it need to be able to grow, to heal, and to learn in the best way it can? What are the elements of balance that will affect brain function and recovery?

A good diet is a great beginning. Our brain has a lot of structure just like our other body parts, and it needs to be fed well too. But there are other things that our brain needs that are less talked about. If we are going to intentionally care for our brain, we need to know about body balance in ways that we don’t often hear about. Specifically, we need to do as many things as possible to get the best circulation of blood to the brain that we can. This is important because our blood carries the oxygen to our brain, and oxygen is vital to brain growth and healing. Oxygenating the brain well is required to promote brain healing and brain use. Proper brain function requires a critical balance of a) correct breathing for oxygenation b) correct carbon dioxide and nitric oxide levels for circulation and c) a program of brain activities or exercises for growth stimulation.

When we go to the doctor they often clip a piece of equipment on our finger called a pulse oximeter. It gives them a general idea of how much oxygen is in our blood. It is so important that it is often referred to as the fifth vital sign. (Vital signs are body temperature, heart rate, breathing rate, blood pressure, and now oxygen saturation.) The pulse oximeter tells them how well your blood cells are saturated with oxygen.

To really understand the importance of this fifth vital sign, consider this:

• The brain uses about three times as much oxygen as muscles in the body do.
• Brain cells are very sensitive to decreases in oxygen levels and don’t survive or function well very long without it.
• The brain is made up of very special cells called neurons, and each of them can do the job of any of the other neurons in the brain. That process gives us the ability to relearn most functions using different parts of the brain. So if we have an injury or a sick part of our brain, we can teach our brain to restructure and control body parts and function with other areas of the brain. That is called brain plasticity.

So how do we increase oxygen and circulation in the brain? One of the easiest ways to understand is how we physically breathe. We were truly meant to breathe easily and without thought; through our noses, mouth closed, and with what is called belly breathing, or diaphragmatic breathing. We have structures in our heads called sinuses, oral cavities, and the upper parts of our lung structure that hold a certain level of chemical control agents, such as carbon dioxide and nitric oxide, that help control blood vessel tone and circulation. When we breathe normally and deeply into our belly, we move air and oxygen down to areas of our lungs where most of the circulation of blood is. This is where most oxygen and carbon dioxide exchange takes place. If we don’t learn to breathe naturally with our diaphragm muscle, we do not get the proper amount of oxygen into our blood to be carried to our brain and body parts. If we breathe through our mouth, we do not rebreathe the stored carbon dioxide and nitric oxide that help circulate blood to the brain in order to oxygenate brain cells. Remember, the carbon dioxide and nitric oxide open up blood vessels in the brain so we can get proper oxygen levels in our brain. Nitric oxide helps dilate blood vessels in our lungs so that we can get good circulation there for exchange of oxygen and carbon dioxide.

Although some information on this subject does not seem to get taught in science or in medicine, there is a lot of literature that supports these thoughts 100%. There is also adequate information on the adverse effects of chronic or intermittent low levels of oxygen saturation on development, behavior, and academic achievement that has been reported in many well-designed and controlled studies.

Now what were those simple things that must be practiced for increasing oxygen to the brain? Here they are: 1) Breathe easily and normally with your belly in a relaxed way. 2) Breathe through your nose under normal conditions and not your mouth. 3) Take short walks throughout the day. Short walks will increase your circulation and increase oxygen to your brain, whereas while forced walks or runs may be good for you too, they also cause your muscles to absorb much of the oxygen in your system, and that hinders increasing the oxygen being carried to your brain.

Finger Pulse Oximeter available at NACD Store.

Reprinted by permission of The NACD Foundation, Volume 25 No. 5, 2012 ©NACD

Please note: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.

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Everyone needs good lung function in order to stay healthy, feel good, and oxygenate well. Many people in our society today have challenges that require specific attention in order to keep their lungs functioning adequately. But before we discuss how to create greater lung function and build lung strength, let’s review some structural considerations.

In our chest our lungs consist of different parts, or “lobes.” On the right side we have three lung lobes, and on the left side we have two. Our lungs are like large balloons, where oxygen and carbon dioxide exchange takes place. When we breathe, air from outside our bodies moves into our airway, travels through the trachea, and then into two tubes—one that supplies air to the lung on the right and one to the left. Our lungs are surrounded by what we call our chest wall. Our chest wall consists of our ribs and internal and external muscles that are important for inspiration (breathing in) and expiration (breathing out). At the bottom of our lungs there is a large, flat muscle called the diaphragm that extends from front to back and side to side and is our major muscle of breathing. When we take in a deep breath, the diaphragm moves downward, creating room for the lungs to expand.

Natural and normal breathing, especially deep breathing, is mostly done with the diaphragm and is often referred to as “belly breathing.” Other muscles, like the muscles around our ribs and up around our neck, are referred to as accessory muscles and play a large part in labored breathing, such as when we run or have shortness of breath. In order to have the best possible breathing both at rest and in situations where breathing is more difficult, we need to have a strong diaphragm and strong accessory muscles.

In order to improve lung function/lung capacity and to decrease mucus retention, we can work on good natural breathing, cough effectiveness, and deep breathing exercises. Get started by following the steps below:

• Obtain the best posture possible when working on breathing. Good posture provides the best chest space for a good volume of air and good airflow.
• Breathe through your nose when breathing normally. (Nose breathing is not for breathing if we are in labored breath or air hungry, such as during intense exercise.) Nose breathing ensures we have moist air getting to our lungs and uses carbon dioxide and nitric oxide store in our upper respiratory system to our advantage.
• Learn and practice belly breathing for normal breathing and relaxation. Lie down and put a book on your belly. Breathe in through your nose and use your diaphragm to breathe air down deep into your belly. Make the book go up as your belly expands. Breathe out slowly through your mouth, and make the book go down as you push the air out with your belly.
• Become aware as much as you can of when you are breathing through your nose and down into your belly.
• Do your lung exercises. If you have a lung exerciser use it to breathe out against if it is an expiratory resistance device; or use an incentive spirometer to breathe in as deeply as you can with a medium flow breath, hold your breath for 3 to 5 seconds, then breathe out slowly.
• Coughing: practice taking in a good deep breath as outlined above, hold it for a few seconds, and then make a good strong cough out from your belly to loosen any retained secretions or for coughing when you are sick.

Reprinted by permission of The NACD Foundation, Volume 25 No. 3, 2012 ©NACD

Please note: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.

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