Children’s Sleep Apnea Treatment in Brookline, MA

How does airway disorder present in children? What you may observe in your child is an undeveloped jaw. They may have dark circles underneath their eyes. You may get reports from the school saying they're falling asleep at the desk, that they're not performing up to their potential. They can have behavioural issues - they're just tired. And it affects the whole family.

Again, you're not talking about one or two nights of not sleeping well; you're talking about years. There might be "musical beds" in the house - I think that's a term a lot of parents can understand: the kid comes into your room and then you go to that bed, and it's because they're not sleeping well.

There might also be problems with bedwetting. If you are in a deep sleep and you're having an episode of apnea where you have stopped breathing, as an adult you may wake up and have to go to the bathroom - your body wakes you up. As a kid, it's like an emergency crisis, and so they might urinate in bed to get the child to wake up and breathe.

Interviewer: Thomas, you've got an interesting story that I think backs up why you and your practice are now involved in sleep apnea - you encountered it personally with your son. Tell me a little bit about this story.

Thomas: A couple of years ago, before Covid hit, I started getting those phone calls from the school: your child's not performing up to his potential, he's being disruptive in school, he's not interacting appropriately with the other kids. And you're saying to yourself, that's not my kid. I know my kid - my kid is loving, he's sweet, he gets along with everybody. And then they say you should have your child evaluated, and you know what's coming next: your child has ADD, your child has ADHD. And you know what's coming after that - they want to put them on medications so that your child can perform up to their full potential.

Interviewer: Can I ask how old your son was when this started?

Thomas: My son's now eight. The phone calls started coming in at around age six. You want the best for them, so you follow the recommendations, but in the back of your head something's not right. What they've told you and what's happening is a disconnect from the child you know and love. But you don't know what to do, and of course you don't want your child on pharmaceuticals.

Interviewer: So that was an occurrence. What happened after that?

Thomas: About four months ago, Dr. Stock asked me to look at a video about airway and Vivos, and it was like a light went off in my head. They described my child. They talked about how children with ADD and ADHD are behaviourally identical to kids who are sleep-deprived - you put them in a room and you can't tell who's who. I went: that's my child. I wanted to talk to Dr. Stock afterwards - we've got to do this for my son.

We did the sleep test, and it was identified that he had mild sleep apnea. We digitally imaged him, so we actually see his bite in 3D. After going through the parent instructional video, it meant a couple of things. One is that his jaw was not developing, so there wasn't space for his tongue in his mouth. When he's sleeping, there's no space for the tongue, it's going backwards and he's not breathing. Because he's not getting enough oxygen, his mouth is gaping open and he's having apnea sessions - he stops breathing at night, and he's a heavy breather.

We decided to move forward with treatment, and step one was a trainer. Before you go to the sleep appliance they want you to get used to it, so your child's sleeping through the night. I told my son - I'm doing Invisalign, and prior to that for about a decade I had a night guard - "you're going to get a night guard like Daddy." He totally knew what that was, that's big-boy stuff, so he was all on board.

Interviewer: I get this picture of a football mouthpiece.

Thomas: No - it has to be big enough to help move and train the teeth, but small enough that you get your lips wrapped around it to get that seal, because you want them to be a nose breather. The first couple of nights it would go in, he'd fall asleep and it would pop out, and I'd check on him. By night seven he was sealing his lips and holding it the whole night. He adapted, in my opinion, very quickly.

On day nine he went back into the office and Dr. Stock and her team did another scan, and we were able to see the difference in the strike points of his teeth. Before treatment there were all these spots that were red - all I can tell you is red's bad. After nine days of treatment the number of red spots where the teeth were hitting was reduced by half. That's only nine days with a trainer. Trainers are usually about three months, and we're capping out at that point, so now he's getting ready for his first appliance.

Interviewer: Now that you're involved in dentistry and in sleep apnea, what are you hoping to achieve with your own son?

Thomas: One of the benefits I'm hoping for - it's not a guarantee, but I'm very optimistic - is that maybe he'll be able to come off the medication. That would be a personal win for him and for me. The big thing is, if you're having apnea and you're not sleeping deeply at night, you're not storing information, and if you're not storing information you're not learning. I want my son to flourish, to perform well, to be a superstar in school - friends, teachers, relationships, academically. None of that can be achieved without quality sleep.

Interviewer: If you're half asleep, you're not at your best anywhere in life.

Thomas: Sleep - airway, quality sleep - is a chronic problem in this country, and the good news is it's solvable.

Interviewer: Tell me about other symptoms. Say I'm a parent - what am I going to see?

Thomas: Obviously dark circles. Allergies. Adenoids and tonsils. You take your child to the pediatrician for the annual exam - ears, nose, throat - and they say little Jimmy's or little Sally's adenoids or tonsils are inflamed, we need to monitor that, or maybe they need to come out because they're impacting the airway. But why is that happening? It's because the mouth is open, the air is not being filtered, it's going down the throat and inflaming it, which also causes problems with allergies. Dry, cracked lips would be another indicator. Falling asleep during the day. School performance - not performing up to their potential.

Another one, which I find fascinating and is sort of the unspoken fact, is bedwetting. I'm not talking about two- or three-year-olds learning to manage themselves - I'm talking about eight-, nine-, ten-, eleven-, twelve-year-olds wetting the bed. While the child is sleeping they're having a sleep apnea event: they're not breathing, and the body's saying wake up, alarm bells are going off, but the child's not breathing. So what does the body do? It urinates as a way to stimulate them, to wake them up so they can get that breath of air. It's a survival tactic.

There's a whole slew of things - anxiety, depression - that all get triggered by airway: restorative sleep, deep sleep, quality sleep.

Interviewer: Even for us - how do you deal with life when you have insufficient sleep? You're more easily triggered, anxiety, stress, general tension. Everything you're saying makes sense.

Thomas: If you're not getting enough sleep, how do you manage and regulate your own emotions? You don't have the capacity, because you're struggling moment to moment just being awake. If you don't have that restorative sleep at night, you're not waking up refreshed with good control over all the elements of your body, including your emotions. So how can you deal with the world around you and be master and commander of your own life, if your life is controlling you?

Interviewer: Best wishes and luck on this treatment. It sounds like you've found some gold here. I'm very interested to hear the results - we'll have another discussion later on.

Thomas: I'm very excited about the results also.

Interviewer: Dr. Stock, you mentioned that this underdeveloped-jaw situation - resulting in a narrow jaw, resulting in sleep apnea because you're not getting enough air and there's not enough room for the tongue - that the cause goes back to a Western diet. Touch on this a bit.

Dr. Stock: Some of the first solid foods we give are strained peas and mush, and so the child isn't working their muscles the way they would if they were eating beef jerky or hard foods. It's the muscles that make the jaw grow, and the majority of that growth is happening before age eight. So it's a really important issue.

Interviewer: Because of that there's a lack of stimulation for natural development. So now we're stuck in a situation where we have a narrow jaw. Is Vivos treatment for kids, is it for adults - when do you do it, how do you do it?

Dr. Stock: There are two appliances. You have the DNA appliance, which is for adults, though you can use it for teens. Then you have the Guides, which are for children. The Guides are removable appliances that the child wears at night, and over time they're monitored, so they get a bigger and bigger appliance and we're able to guide their growth - so that either they don't need braces, or they need less time in braces. We're starting earlier: ideally you're starting at four or five and you're trying to guide this growth.

If a child has a really deep overbite, they may have large tonsils, they're breathing through their mouth, they're not sleeping well - they might have sleep-disordered breathing. A child who snores is an adult who snores. A child who grinds is an adult who grinds, and the grinding is your body fighting to breathe. That's one of the signs.