Sleep apnea and ADHD can greatly impact sleep, but are often not discussed when discussing a sleep quality evaluation. In this episode, I welcome back Dr. Shelby Harris, a licensed clinical psychologist who is board-certified and specializes in behavioral sleep medicine.

We discuss:

• How sleep apnea and ADHD affect your child’s sleep and behavior
• When to be concerned about your child’s sleep
• Is it parenting or something more?

Connect on Instagram @sleepdocshelby

00:00:01:02 – 00:00:24:09
Dr. Shelby Harris
First thing I’m always going to ask is, does your child swim? Do they have any pauses in their breathing? Consistently. Like not just whenever. Something. And if that’s happening, then I’m immediately going to send for a referral for a sleep evaluation or other sleep center. Because what we see happen a lot of times, especially in like the 4 to 6 age range, is that their tonsils and adenoids begin to crowd their airway.

00:00:24:10 – 00:00:37:28
Dr. Shelby Harris
Their airway doesn’t grow as fast as the tonsils and adenoids. And as a result that throughout the airway, there’s more sleep disruption, more sleep apnea happens. And if we actually sleep apnea, guess what happens. Behavioral issues.

00:00:38:01 – 00:00:55:04
Dr. Mona
Welcome back to the PedsDocTalk Podcast. This podcast continues to grow because of you. The fact that you return every week to listen to our conversations that I have with guests, the fact that you leave reviews. So thank you so much for joining me today. I get to chat with the most incredible people to help guide us in our parenting journey.

00:00:55:10 – 00:01:20:02
Dr. Mona
And today is a return guest doctor Shelby Harris. She’s a licensed clinical psychologist, board certified and specializing in behavioral sleep medicine. And she was on the show already talking about if children can outgrow not being an independent sleeper. It’s an amazing conversation. So make sure to check that out. But today we’re talking about is it sleep apnea, ADHD or is it a lack of sleep boundaries?

00:01:20:08 – 00:01:23:01
Dr. Mona
Thank you so much for joining me today, Doctor Shelby.

00:01:23:03 – 00:01:24:28
Dr. Shelby Harris
Thank you, Doctor Moon. I’m happy to be back.

00:01:25:04 – 00:01:31:04
Dr. Mona
Yeah. So if anyone has not listened to the other episode, tell us a little bit more about yourself and why you do the work that you do.

00:01:31:06 – 00:01:52:29
Dr. Shelby Harris
So I’m a clinical psychologist by training, and I have subspecialty board certification in behavioral sleep medicine. So what that means is I treat sleep issues in babies through older adults using evidence based non medication approaches. So I worked for a long while at a pretty big sleep center in New York City, where I ran the Insomnia and Be Able Sleep medicine clinic.

00:01:52:29 – 00:02:10:17
Dr. Shelby Harris
So I treated all different ages of kids, adults, older adults for insomnia, sleep issues without using medication, nightmares, all different sort of stuff. And I worked along with the MDS there. So we really try and sleep medicine to not use medication. Believe it or not, a lot of the times, and that’s where I fit in and have a private practice.

00:02:10:17 – 00:02:14:14
Dr. Shelby Harris
Now in Westchester, New York, where I see people online all the time from New York City.

00:02:14:16 – 00:02:35:03
Dr. Mona
I love that philosophy because I understand sometimes medication is needed for many different things, but we got to figure out what’s going on, and I think we’ll talk about that today. But, you know, in the other episode we talked about older children. Is it anxiety? Is there something else? We’ll talk about more medical things here. And so before we just throw medication, we have to kind of figure out and understand that big picture.

00:02:35:03 – 00:02:54:13
Dr. Mona
And I think that that’s an important philosophy. And I’m going to admit it, like with the current health care model, many times it’s quick to medicate and including children, right. Like I’ll have parents ask me like, hey, my child’s not sleeping. Can I give Benadryl or can I give melatonin? And I’m like, well, there’s a lot of deep conversation we have to have about this.

00:02:54:13 – 00:03:13:26
Dr. Mona
Like what is going on? I maybe sometimes have used melatonin, but there’s a reason, and it’s not just my first line. We have to figure out what is the core of the sleep issue. So love that. Yeah. And the conversation we’re having today, I think is a really important one because, you know, I get parents coming into the office with the child.

00:03:13:26 – 00:03:33:15
Dr. Mona
It’s a four year old, five year old, you know, they’ll come in and the child is still not sleeping. Quote unquote, on their own or waking up super tired, even if they slept the whole night. There’s just a lot of things. And parents are like, well, you know, I’m putting them to bed at ten. And is it not setting these boundaries or is there something else going on?

00:03:33:15 – 00:03:42:05
Dr. Mona
So that’s the conversation we’re having today. So where would you kind of want to start with this. Like what do people kind of have to look at when they’re looking at sleep as a whole for their child?

00:03:42:08 – 00:04:03:07
Dr. Shelby Harris
So I always first and foremost just think about age of the child, what’s considered quote unquote, normal sleep amounts, durations. And there’s a range, but not everyone falls in like the 11 to 13 hour rate. You know, some people are outliers, but I always try to make sure that they’re consistent in general with their sleep hygiene. They’re not having a lot of sugar right before bed.

00:04:03:07 – 00:04:21:19
Dr. Shelby Harris
They’re having a consistent bedtime wake time. Now, if the child is sleeping through the night and they’re waking up early and tired, one of the big things that we see a lot tell you about whether medicate or not, especially in ages like 4 to 6, 4 to 7, we see a lot of behavioral issues start to happen at this age range.

00:04:21:19 – 00:04:50:00
Dr. Shelby Harris
So there’s a sleepy child. This is the key is the sleepy child doesn’t always look sleepy. They don’t usually look they look hyperactive. And so what happens is in some of these kids or a lot of these kids, they’re getting mislabeled as having behavioral issues and having potential ADHD or other outbursts, kind of behavioral issues. If I think the kid is actually sleeping well at night or sleeping another night, but it’s having a lot of behavioral issues, first thing I’m always going to ask is, does your child’s.

00:04:50:01 – 00:05:11:11
Dr. Shelby Harris
Nor do they have any pauses in their breathing consistently, like not just when they have a cold or something. And if that’s happening, then I’m immediately going to send for a referral for a sleep evaluation, whether it be for the anti pediatric sleep center. Because what we see happen a lot of times, especially in like the 4 to 6 age range, is that their tonsils and adenoids begin to crowd their airway.

00:05:11:11 – 00:05:29:14
Dr. Shelby Harris
Their airway doesn’t grow as fast as it controls and adenoids do. And as a result, that crowded airway, there’s more sleep disruption, more sleep apnea happens. And if we actually treat the sleep apnea, guess what happens? The behavioral issues tend to get better. Now, that doesn’t mean you can’t have ADHD or behavioral issues as well as sleep apnea.

00:05:29:14 – 00:05:50:24
Dr. Shelby Harris
You can. But I think a lot of times were quick to diagnose a behavioral problem without seeing how the sleep is actually factoring in. So first and foremost, does your child snore any sort of pauses and breathing or anything like that using the bathroom a lot at night, that can be another symptom. Anything like that should make you immediately go for a sleep evaluation.

00:05:50:27 – 00:05:54:10
Dr. Shelby Harris
Now the other thing we start to think about too is right. It’s like a little bit of chicken egg.

00:05:54:15 – 00:05:56:27
Dr. Mona
Is going to bring that up, right? Yeah.

00:05:56:29 – 00:06:19:14
Dr. Shelby Harris
So if we’re starting to talk about not like sweep limits, right. Or just not getting enough sleep or your child is needs to sleep with you or just won’t fall asleep until a certain time limit setting at that time. Right. So your child’s stalling. So is there a lot of that going on that’s causing sleep deprivation, which can then lead to behavioral issues.

00:06:19:14 – 00:06:35:09
Dr. Shelby Harris
Right. So you want to try and treat whatever you can at night to get your child sleeping more. And then if that’s not working, is there actually a behavioral issue going on. So sometimes ADHD what we see a lot of times is there can be with ADHD there can be trouble with falling asleep at night.

00:06:35:09 – 00:06:35:25
Dr. Mona
Yeah.

00:06:35:25 – 00:06:52:25
Dr. Shelby Harris
So I always try to work on the sleep first, trying to get them at least. Even if you have to be there for sleep, try to get them on a better, just not sleep deprived anymore. And then you can slowly remove your presence and work with a practitioner if you need to to help you do that. But let’s try and get them enough sleeping daily.

00:06:53:02 – 00:07:01:17
Dr. Shelby Harris
And if the quality and the quantity is okay, but they’re still having behavioral issues during the day, then you want to start thinking about what’s causing the behavioral issues because you’re rolling sleep out.

00:07:01:19 – 00:07:10:04
Dr. Mona
What’s the youngest maybe you don’t know. Having had this experience, what was the youngest? You’ve seen sleep apnea in your practice because we’re talking about 4 to 6. Yeah.

00:07:10:06 – 00:07:26:07
Dr. Shelby Harris
Yeah. I don’t diagnose it to get it myself because it’s not my area. Right? I mean, even a little bit. I mean, sometimes babies were born prematurely, right? They have sleep apnea and they’re put on a little baby CPAp in the, in the hospital. So all different ages. Sometimes it can just be the way that their airway is designed.

00:07:26:07 – 00:07:46:16
Dr. Shelby Harris
I mean, we have babies with it too, but we see it very commonly in that 4 to 6 age range, to the point where I was lucky enough to be a part of this groundbreaking study by Susan. The red line, a lot of other people called the chat study, which was a study that was in like I was I was one of the sites at Montefiore in like 2005.

00:07:46:16 – 00:08:05:01
Dr. Shelby Harris
I was in your home in that for a few years. And we did neuropsychological testing on kids to see if we just watched and waited for a few years for them to grow so that their adenoids and tonsils are not as crowded anymore, if that helps, or if doing surgery to take out their tonsils really helped with the behavioral issues and learning during that time.

00:08:05:06 – 00:08:28:12
Dr. Shelby Harris
And we found that actually intervening at that age younger is better for the humoral outcomes, for learning to get more of school, instead of just waiting a few years for them to potentially outgrow it. And then the other thing to add on to that, that we’re seeing a lot of is we see a lot more obesity and kids and we’re seeing younger kids, but also especially in the pre-teen and teenager population.

00:08:28:15 – 00:08:35:03
Dr. Shelby Harris
And that can be something that can lead to sleep apnea. So we’re seeing a lot more of that in kids because of that reason as well.

00:08:35:05 – 00:08:55:06
Dr. Mona
Yeah. And you know, you talked about the whole chicken and the egg, right. And the big thing is the ADHD component, right? Because it’s you know, you’re like, okay, is the ADHD causing them not to be able to sleep and then the cycle goes where they’re, you know, having more kind of ADHD type symptoms. Or is it that the lack of sleep is causing the behavioral symptoms?

00:08:55:06 – 00:09:13:06
Dr. Mona
You know, it’s a it’s a very hard diagnosis sometimes. And it is a lot of question asking like what’s going on. And also just getting a true, you know, diagnoses of ADHD for everyone listening. We’re not going to get into the diagnoses into detail. But I have another episode that I did about eight and ten toddlers have ADHD.

00:09:13:13 – 00:09:43:12
Dr. Mona
The one thing I you know, what we see in like under four, you know, we talked about like that 4 to 6 noisy mouth breathing. You know, it doesn’t mean it’s sleep apnea per se, but it could be something we want to intervene. And it is kind of in that line of an airway issue. Right. So if you do see your infant that is like mouth breathing noisy and just constantly mouth breathing past that, especially past that initial newborn phase, sometimes I do see it in the newborn, but I’m talking like a four month old.

00:09:43:14 – 00:09:49:06
Dr. Mona
Five month old, like an infant toddler. Mouth is open all the time while they’re sleeping.

00:09:49:08 – 00:09:49:28
Dr. Shelby Harris
Yeah.

00:09:50:01 – 00:09:55:06
Dr. Mona
I would talk to your clinician about it because would you agree that that’s something that is kind of something that we want to monitor?

00:09:55:08 – 00:10:11:17
Dr. Shelby Harris
Yeah, 100%. And there’s like all these names and stuff that’ll go around on Instagram and online of like, oh, look at how cute this is. My child is like sitting with their like mouth open or watching TV and stuff. And I look at this okay, well that’s probably a sleep disorder issue or a mouth breathing issue that needs to get evaluated.

00:10:11:20 – 00:10:26:25
Dr. Shelby Harris
And the thing is, to a lot of people don’t think about this, but when they’re having their mouth open, a lot of times that can also change the way that their airway develops. It can change the way that their jaw develops, their face develops. So we really want to work on helping them to close the mouth for sure.

00:10:27:00 – 00:10:48:27
Dr. Shelby Harris
Right? To sleep at night. So all ages. That’s why I tried for so long. When people are quick to diagnose ADHD, I’m always like, does your child mouth this to their pauses and everything? Just ask these questions first and then it can give you a lot of information. So for example, like my daughter, she’s eight now, but when she was 4 or 5 years old, because I’m on top of it, I know the literature.

00:10:48:27 – 00:11:09:04
Dr. Shelby Harris
She would not read a lap and she would snore a little bit at night. And so I took her to our interview with mazing in my area, and she found out that she had a large adenoids. Now, did we need to do surgery immediately? No. So we watch and wait. She actually used medication to help because she was congested a lot of the time and had allergies, and the medication helped to reduce the adenoids.

00:11:09:09 – 00:11:19:27
Dr. Shelby Harris
So we did that. And that was one other thing. And that helped with the mouth breathing and helped with her snoring at night. And I know that she didn’t have to have surgery. So there are definitely options, but you don’t want to ignore it. Not at all.

00:11:19:29 – 00:11:25:28
Dr. Mona
So she had mouth breathing and snoring or just the mouth. Yes. Yeah, but but and did it affect her behavior.

00:11:26:01 – 00:11:37:12
Dr. Shelby Harris
She not so much. It was interesting. It didn’t really affect her behavior. But I was definitely concerned about her sleep and quality of sleep at night. So brought it up. And she also had large adenoids.

00:11:37:15 – 00:11:54:16
Dr. Mona
This is so I mean, again, it’s personally hitting home too, because our son is at the time of this recording, our son is almost four and he sleeps a lot. Okay. Like, and I told my, my husband’s like, wow, he’s such a good sleeper. And I’m like, yes, like, I love I love that you’re saying that. But I am like you watching for these things, right?

00:11:54:16 – 00:12:05:13
Dr. Mona
The sleeping, the sounds. And so when this happened with your daughter, was she sleeping in a separate room than you? Yes. So you just you would just hear it from outside the door, or you would just hear on the monitor.

00:12:05:13 – 00:12:25:22
Dr. Shelby Harris
Or something, while I would hear it on the monitor, which was younger. It wasn’t so bad until she really hit that kind of four year old age. I noticed it, honestly, when we would, all have to speak together when we were traveling, stuff like that. Okay? We’re like, she had to share a room with my son, and he’s older, six years old, and you’d be like, wow, she was snoring at night.

00:12:25:24 – 00:12:28:04
Dr. Shelby Harris
Yes. That’s when we picked up on it for sure.

00:12:28:06 – 00:12:30:09
Dr. Mona
Yeah, yeah, that’s it, I sure thing.

00:12:30:11 – 00:12:39:14
Dr. Shelby Harris
She would sit in front of the TV with her mouth, which apparently I did as a kid too, and then had to go to speech therapy for it, but she. So she’ll sit by the seat with their mouth wide open. Yeah. And just for you. Right.

00:12:39:14 – 00:12:55:19
Dr. Mona
So I think this is I mean, it obviously makes a lot of sense, especially with that open mouth breathing and not using the nose. I mean, the nose is there for a reason, right? Where proper breath taking should be in through the nose, up through the mouth, you know. And so I think it’s really an important area that you go often missed.

00:12:55:22 – 00:13:16:11
Dr. Mona
And yeah, especially in that infant toddler age group where I’m going to be honest, even pediatricians will dismiss it sometimes and say, okay, oh, that’s normal. But no, I, I agree with you. I have become very in tune with that because like I said, I think we often miss sleep issues and, you know, chalk it up to behavior or like even not sleeping can lead to anxiety.

00:13:16:11 – 00:13:37:19
Dr. Mona
You know, talking about anxiety too, right? We know that sleep is very impactful. And again, it doesn’t mean you need to like your example of your daughter that you need to get your adenoids out tomorrow. But it is an important, you know, holistic approach, if you will, to sleep. And you know, is there anything else you’d want to add that we may have missed upon in terms of the sleep apnea, ADHD and, you know, parenting with sleep?

00:13:37:23 – 00:13:54:00
Dr. Shelby Harris
I think when it comes to the app or the ADHD stuff as well. Is that right? It’s you’ve done whatever you can to help your child, even if you have to be there with them and they still can’t fall asleep easily. They’re needing a lot of like it feels like it’s taking a lot of efforts to help them sleep.

00:13:54:02 – 00:14:15:00
Dr. Shelby Harris
If you know that there’s ADHD going on that has been diagnosed. What we do see is sometimes when we were talking about melatonin at the beginning, right? Sometimes there is a role for melatonin, for melatonin, having more of a role with kids who have autism and kids who have ADHD. So then it’s really if you’ve tried the behavioral stuff and it just is not working or not working well enough, right?

00:14:15:06 – 00:14:35:14
Dr. Shelby Harris
The goal is to get them sleeping. And like I said, we always want to do behavioral first. But sometimes there is a issue with some of these kids where we do need to use melatonin so that when we think about using the smallest dose possible, right. I can’t tell you how many kids I have or taking five ten milligrams just because it’s in a gummy form.

00:14:35:14 – 00:14:51:09
Dr. Shelby Harris
That’s way too much. So we’re talking like a milligram, half a milligram. If you have melatonin and taking it a half hour to an hour before bed to help with that doesn’t mean they’re gonna have to be on it long term. But sometimes it can help to settle the sleep a little bit more and then help with the behavioral issues during the day.

00:14:51:09 – 00:14:54:06
Dr. Shelby Harris
So it’s definitely something you can consider with your doctor’s approval.

00:14:54:13 – 00:15:19:20
Dr. Mona
And as a physician, I could not agree more because what I see, like I said at the beginning, is that I often see parents, even on my social media like Instagram, say, hey, my child’s not speaking. I want to give them melatonin. And like I said, I’m not against it because I have in those exact examples, I have a good amount of children who have ADHD and autism who need it, and it’s fine, but we’ve made that diagnosis as we’ve worked on other things sleep hygiene.

00:15:19:24 – 00:15:39:05
Dr. Mona
We’ve worked on the fact that we’ve excluded things like sleep apnea. Had that diagnosis of is your autism. And that’s the underlying message is that we’ve done our due diligence and not just medicated and potentially masks an underlying other condition that we could treat. And so that’s a huge thing that I see as well.

00:15:39:08 – 00:15:40:25
Dr. Shelby Harris
Exactly. There you go.

00:15:40:27 – 00:15:57:00
Dr. Mona
Oh man. So this is great I love this because like I mentioned, I think a lot of times parents put a lot of guilt on themselves. Like, you know, the topic was about, you know, is am I just not doing enough? Like, am I not strict enough with boundaries? But there is a reality that sometimes there is something medical going on.

00:15:57:00 – 00:16:19:19
Dr. Mona
And so the mouth breathing, the snoring and not the noisiness like, and I want to be clear, because I have talked about this on my social, that newborns are noisy, there’s no denying that a newborn under the age of, I would say, 12 weeks is noisy, but it should get better. Like it should not be that they’re always noisy, they’re always making these sounds like it should improve and we should see sleep start to stretch a little bit.

00:16:19:19 – 00:16:28:14
Dr. Mona
And if you’re not and they’re noisy and they’re making these snoring sounds, oh, we gotta evaluate that. What would be your final message for everyone listening today?

00:16:28:16 – 00:16:42:21
Dr. Shelby Harris
Sleep is the bedrock with which everything else is built on, so don’t ignore it. And if you think something is off and someone’s telling you I don’t worry about it, it’s fine. Keep getting another opinion. Yeah. You don’t. Don’t just ignore it if you notice something’s off.

00:16:42:24 – 00:16:54:28
Dr. Mona
So in your opinion would you start with, pediatrician or clinician? Yeah. And if yeah, obviously from there it would be, using people like a behavioral sleep specialist or a sleep study or if you need it. Right.

00:16:55:00 – 00:17:11:16
Dr. Shelby Harris
Yeah. It depends on what it is that you’re trying to treat. Like if someone’s coming to me and they think they have AP, I’m better referred to write pedes. I mean, like we went to a yenta into does a lot of tonsils and adenoid surgery, you know, but you could go to a pediatric sleep center. There are a lot of different places where you could go.

00:17:11:19 – 00:17:39:09
Dr. Mona
Yeah. And for anyone who’s unsure about what to do, and I like to talk about this because a lot of our listeners are like, yeah, but I don’t know where to start. So I agree. I would start with your clinician. If your clinician is dismissing you like Doctor Shelby said, I understand that this has happened. If you’re being dismissed, ask your clinician if they have somebody else that they recommend or on your own, get another opinion or you could, if your insurance allows it, self-refer yourself to, you know, a center or C specialist.

00:17:39:09 – 00:18:08:26
Dr. Mona
But having a sleep study usually that can be done through an EMT office in my area. I think maybe where you live as well, where they are going to do an evaluation before just saying, we got to take out your tonsils or adenoids. I want to be clear and get that evaluation to see what’s going on. And if you think it’s ADHD and your clinician is, again, not pursuing that behavioral therapy psychologist, those are your avenues to kind of deal with the sleep apnea, the ADHD.

00:18:08:26 – 00:18:25:20
Dr. Mona
But you should not have to struggle or suffer. I agree with that. Yeah. Oh for sure. Well, I love chatting with you. You are an inspiration to me because of your media presence as well. I just love everything that you share. Where can everyone stay in touch with you and get more information about your resources.

00:18:25:23 – 00:18:37:28
Dr. Shelby Harris
So you can find me easily on Instagram at sleep doc Shelby I’m on Tik Tok, but not as frequently, so same thing as Sleep Doc Shelby and go to my website Dr.. Like doctor. So Dr. Shelby harris.com.

00:18:38:01 – 00:18:46:04
Dr. Mona
I love it. I will be attaching all of this information to the show notes. And again thank you for joining me today to have this amazing conversation.

00:18:46:06 – 00:18:46:25
Dr. Shelby Harris
Thanks for having.

00:18:46:25 – 00:19:03:14
Dr. Mona
Me and for everyone listening. If you love the episode, make sure you leave a review. The reviews really help this podcast to reach more people and also just call out Doctor Shelby on her amazing information. I love showing our guests all the love, and I’ll probably have her back on for more conversations surrounding sleep.

00:19:03:17 – 00:19:04:06
Dr. Shelby Harris
Thank you!

00:19:04:07 – 00:19:19:29
Dr. Mona
Thank you for tuning in for this week’s episode. As always, please leave a review. Share this episode with a friend. Share it on your social media. Make sure to follow me at Peds Doc Talk on Instagram and subscribe to my YouTube channel, Peds Doc Talk TV. We’ll talk to you soon.