Maggie McKay (Host): Back to school time means getting kids back on schedule, but what if your child has a sleep disorder? What can you do to get them back on track? Today we'll find out with Dr. Monita Mendiratta, Pediatric Pulmonologist and Sleep Specialist at Maimonides Children's Hospital.

 Welcome to Maimo MedTalk, a podcast from Maimonides Health. I'm Maggie McKay. Thank you so much for being here today, Dr. Mendiratta. It's so good to have you.

Monita Mendiratta, MD: Hello. Thank you for inviting me, Maggie. I'm excited to be here today.

Host: Well, you know what? I think when most of us think of sleep disorders, we think of adults, but you are a Pediatric Sleep Specialist. So what kinds of problems when it comes to sleep, do children have?

Monita Mendiratta, MD: So when people actually ask me what I do for a living and I tell them I'm a Pediatric Pulmonologist and Sleep S pecialist, I often get the reaction, oh, I didn't even realize that anyone in pediatrics would have a sleep issue and that kids actually have sleep disorders. And you'd be surprised that up to 50 percent of children will experience some difficulty or issue with sleep somewhere during their development. And up to 25 percent of children will actually have a sleep disorder. So the most common disorders that I see referred to my office that people seek consultation for are sleep related breathing disorders, such as obstructive sleep apnea syndrome. And I think the next most common is insomnia, which encompasses issues with children having difficulty falling asleep, or staying asleep, or maybe even just getting up too early in the morning.

But I find that most parents don't necessarily seek consultation with a sleep specialist, or even reach out to their pediatricians about sleep issues, unless their sleep is actually disrupted, which is pretty funny. So if there's not a happy sleepy child, then there isn't a happy sleepy household. And then that's when I usually hear about it.

Host: So you mentioned parents usually just don't address it, but if a parent does notice, what can they do to prevent sleep issues or solve them, should they crop up in their children?

Monita Mendiratta, MD: Sure, so I think the most important thing is just developing and maintaining a relaxing and a consistent sleep or bedtime routine for your child. And although I call it a bedtime routine, it really does start well before your desired bedtime. So it begins with just keeping a consistent schedule, starting dinner, having a consistent dinner time, avoiding certain things at dinner time, such as sugary foods and drinks and avoiding caffeine, which some parents don't realize iced tea and certain sodas and these power drinks that children and teenagers drink actually contain caffeine and a high amount of sugar that can disrupt sleep. And then after dinner, start to dial the day down, and so this would mean disconnecting from our electronics, which include tablets, smartphones, video games, anything electronic; ideally an hour to two hours before bedtime. And replace it with doing something more relaxing like taking a bath, getting into a routine of brushing your teeth, and then maybe reading a book.

 And just keeping a consistent routine can help prevent a lot of sleep issues. And if you, for some reason, feel that your child is not getting enough sleep or their sleep is being disrupted, then talk to your pediatrician. And then they can help guide you as to whether your child may need to see or consult with a sleep physician or maybe even get a sleep study to evaluate for a sleep disorder.

Host: Dr. Mendiratta, when a parent does notice a problem, takes their child to the doctor and they're diagnosed with a sleep disorder, what then does the doctor do? How do they treat the child?

Monita Mendiratta, MD: So it really does depend on what the sleep disorder is. So the sleep study, for example, is a diagnostic test that we use where we monitor the brain, the heart, the breathing, movement during sleep. And then this helps us detect if there's something actually disrupting or interrupting sleep. So the sleep study is used to diagnose medical disorders that could be disrupting sleep.

And then that can often guide the appropriate intervention or treatment. Other disorders or issues that might come up in sleep, like I mentioned, insomnia is a very common reason for referral, doesn't always require a sleep study in order to help guide or treat that problem. So it really does depend on what the disorder is as to how we will intervene and treat the child.

Host: Okay, I know a lot of people, at least adults, use the CPAP machines. But I can't imagine a child having to use one, you know, going to a sleepover or school function or camp. Do they use those for kids?

Monita Mendiratta, MD: So a CPAP machine, just to educate everyone else on what it is, it's a device that's worn overnight, and you, through a mask that covers your nose or your nose and your face, and this mask is strapped on, and then this machine delivers pressure to sort of stent or keep your airway nice and open while you sleep, and can breathe with ease.

And so as you can imagine, it doesn't sound very comfortable and it's hard for an adult to wear it, much less to actually get a child to tolerate it well. So it is difficult and it is not the first line of treatment for sleep apnea in children.

So depending on the severity of the sleep apnea that the child has, I sort of reserve it as my last treatment. There are many other treatments that we look at before then in pediatrics, and like I said, it depends on the severity of the sleep apnea, so first we determine if the child has sleep apnea and then whether it is mild or moderate or severe.

And in the more mild cases, there are other options, for example, we may trial using a nasal steroid spray which could decrease some inflammation and actually help shrink the size of adenoids and tonsils which are often enlarged in children and a common reason for sleep apnea.

Other medications, another common one that we use is something called montelukast or Singular, which is a chewable tablet that's taken once daily that can also help with that upper airway inflammation. If the child has issues with a narrow palate, a palate widener often helps resolve a lot of issues with sleep apnea, will sometimes use certain mouth guards. So there are other therapies there, non surgical, and then our next step would be something more invasive or surgical, like removing the tonsils or adenoids. We'll often do that in pediatrics before we even entertain introducing CPAP. And there is another procedure that the ENT, Ear, Nose, and Throat specialists, do called a sleep endoscopy, where they look at various landmarks from the nose down to the vocal cords to see if there are any other points within the airway that they could surgically, reduce swelling or remove soft tissue to help keep the airway open and treat sleep apnea before we entertain introducing CPAP with children.

Host: You mentioned things that parents can implement to help their child get a better routine so they get a better sleep. But do nutrition and exercise play a part in getting a good sleep for children?

Monita Mendiratta, MD: Oh yes, for sure. So our sleep wake center in our brains take cues from our environment to guide our minds and bodies to sleep. And exposure to light is probably the most powerful cure, but what we eat, when we eat, and exercise, also play a big role. So, like I mentioned earlier, keeping a consistent dinnertime, not eating too late, because that can affect your sleep onset, avoiding certain things in our diet at dinnertime or in the evening, such as caffeine also found in iced tea and some of these power drinks and sodas that we don't even realize.

Avoiding sugary foods and snacks that may keep a child wired in the evening. The opposite of what you want to do to dial it down. And exercise is really important because it promotes sleep and it reduces stress. And so I always tell parents, encourage your kids to exercise regularly, aim for 30 minutes a day. It will really help them increase their drive to sleep at night and just improve mood and reduce stress.

Host: I've always read that it's better to exercise in the morning because if you exercise, like go to the gym late at night after work and you get home at like 10, it messes with your sleep. I wonder if kids who are on teams who don't get home to like eight or nine from like lacrosse or football, does that interfere with their sleep?

Monita Mendiratta, MD: It definitely does. the after school sports are great. We always like to encourage after school activity and exercise, but you do have to be careful to keep a healthy balance there because late exercise, late evening, nighttime exercise definitely does result in an adrenaline rush and you're going to keep your body and mind awake and it is going to be harder to shut it down later, for sure.

And then remember that kid coming off of the sports field still has to come home and do their homework and then they're connected to their laptops or their Chromebooks. That then also stimulates the brain and even like I said, light being the most powerful cue, to keep our wake centers bright and alert. The blue light just from our laptops and our smartphones is enough to decrease our melatonin, which is the most important hormone for sleep. And that's secreted naturally, but suppressed by light.

Host: What is a good amount of sleep for growing bodies?

Monita Mendiratta, MD: The younger we are, the more sleep we need. And to break it down for children, as they get older, they require less sleep. But for example, for preschoolers, around 3 to 5 years of age, they require ideally 10 to 13 hours of sleep. And some of them may get some of that sleep during the day with a nap or two.

By the time they're about 6 to 13, the school age children, require about 9 to 11 hours, ideally, overnight, with no daytime naps. And then teenagers, many of them don't get this much sleep, but ideally require about 8 to 10 hours of sleep in a perfect world.

Host: In closing, is there anything else you'd like to add or share that we didn't cover?

Monita Mendiratta, MD: Sure. I mean, I would say that sleep is vital to everyone's physical, mental, and emotional development. And children often look to their parents for guidance, you know, and their guardians. We're their models for developing healthy habits. sleep should not be an exception, and it's never too late to change and improve your sleep, what I call your sleep hygiene.

And this will also help your child develop healthy sleep habits, which will help them focus, and achieve more for the successful school year ahead.

Host: Thank you so much for your time today. This has been very informative and useful, and I'm sure helpful to parents.

Monita Mendiratta, MD: Thank you for having me.

Host: Absolutely. Thank you so much. Again, that's Dr. Monita Mendiratta, Pediatric Pulmonologist and Sleep Specialist. And for more information, you can visit maimo.org, that's M-A-I-M-O.org, or call 718-283-7500. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

I'm Maggie McKay. This is Maimo MedTalk from Maimonides Health. Thanks for listening.