Maida Lynn Chen, MD

Dr. Maida Lynn Chen

Dr. Chen is director of Sleep Medicine at Seattle Children’s.

What’s new at the Sleep Center?

In June we opened a bigger, better Sleep Center. Our new state-of-the-art facility has 12 sleep study suites and 6 exam rooms, up from 8 and 4, respectively. We’ve included the latest technology while still prioritizing families’ comfort. We also have significantly more staff now, which allows us to see a lot of children we couldn’t before.

What kinds of patients are you seeing?

The whole gamut! That’s our big news. For a long time, we focused on serving primarily medically complex patients with sleep disorders, like sleep-disordered breathing or obstructive sleep apnea. We’re still seeing those patients, but now we are able to also see more typically developing kids with the whole spectrum of sleep disorders, from very common ones to very rare. And we offer consultative visits and shorter-term treatments that don’t necessarily require a sleep study for kids who need less intervention.

With the pandemic’s terrible impact on kids’ mental health, behavioral sleep issues and insomnia have become even more common. We’re thrilled to have this new larger Sleep Center and be able to help those kids address their sleep problems. We know better sleep will help them to cope and thrive during this time.

Can you give an example of the kids you’re now seeing?

Yes, a few examples would be:

  • A typically developing child with insomnia. Insomnia is very common but also has a big impact on all aspects of a child’s life. We have very targeted interventions to help these children. In some cases, we only need one or two visits to turn things around.
  • A restless sleeper. Restless sleep disorder is a new diagnosis that was coined at Seattle Children’s by Dr. Lourdes Del Rosso. We think it’s probably more common than we know and have a fairly novel and systematic protocol to treat it.
  • A child who has behavior issues during the day that affect their sleep or that are exacerbated by disordered sleeping. This could be a child with ADHD or autism, for example.
  • A child with a neurologic-based sleep disorder such as parasomnias or narcolepsy/hypersomnia. These kids are often underdiagnosed or under-referred. We have three neurologists cross-trained in sleep disorders.
  • A child who has developed poor sleep habits due to disruption in routine, screen time, anxiety or other reasons.

Are you still at Overlake Medical Center in Bellevue?

Yes, but we have moved buildings, to the Overlake Medical Pavilion (Building 5), third floor.

Are there certain sleep issues that are under-referred?

Yes, two categories spring to mind. But first I’ll acknowledge that community providers are used to our Sleep Center not having capacity to see these kids in the past, perhaps limiting referrals, and not because these are new problems for some of these families. Happily, our expansion allows us to see these kids now.

First, there are kids who have difficulty falling asleep or staying asleep. Often, this is seen as a parenting fail or difficult child temperament, particularly in the younger kids. In the tweens and adolescents, struggles with sleep environment, hygiene, media use and currently pandemic-related issues are on the rise. Regardless of the cause, these situations all tend to deteriorate into daily struggles that negatively affect both child and parent and can cause significant medical impact. Navigating the family complexities surrounding this can be a long process, one that is beyond what a pediatrician can oversee in a typical visit.  We can fill that void and help support that family. Please refer them to us.

Second, there are kids who have significant daytime struggles with attention, behavior or mood, which may be manifestations of an unrecognized sleep disorder.  Though the treatment of those daytime difficulties is typically not primarily managed in sleep medicine, the assessment, identification and treatment of a contributing sleep problem is our domain. Sometimes we will see resolution of those daytime issues with treatment of sleep disorders alone. And if not, we certainly can see some interval improvements with treatment of nighttime issues.

Are there some sleep problems that are minor and families can handle themselves?

Of course — families can be incredibly resourceful, are experts of their own children and the majority of children are reasonable sleepers. I’d say, though, if the family doesn’t know what to do, has tried to resolve it without success or their pediatrician has given them advice and the problem still hasn’t resolved, then our Sleep Center is a good option. Also, if the parents or provider need objective data during sleep, please refer them to us.

In any case, I want to address this point about some sleep problems being “minor” and emphasize that just because sleep problems are common — like insomnia — they can be incredibly impactful on a child’s life. We have effective treatment plans that can be rapidly implemented, sometimes in just a few visits.

Does the Sleep Center have mental health specialists?

No, we don’t have therapists or counselors on our team yet. But the sleep treatments we offer often help significantly with patients’ mental health and provide important adjunctive treatment. For example, it’s not uncommon for a child with insomnia to also have difficulties with mood or anxiety. For insomnia, we offer something called cognitive behavioral therapy of insomnia. Obviously, the targets there for improvement are related to sleep and insomnia, but mental health also tends to improve when sleep and insomnia improve. Mental health treatment can be difficult to find, these days especially, but our insomnia treatment is readily available. Insurance doesn’t consider it a mental health treatment (the diagnosis is insomnia) so they can get treatment as often as they need without draining their mental health benefits.  Our treatment allows kids to get improvement in quality of life and sleep right away, while they pursue mental health treatment at the same time.

Do you see kids with ADHD?

Yes, we see any child with any condition who is experiencing sleep difficulties or that is associated with possible sleep issues. No matter how you cut it, optimizing a child’s sleep helps with everything during the day and makes their condition — whether it’s ADHD or something else — better and easier to treat.

Who are sleep studies for?

We typically recommend a sleep study any time there is a question of whether the child needs objective monitoring — i.e., for sleep apnea, or seizures, or restless/disrupted sleep — any of which may be triggered by a parent or physician inquiry about the child’s sleep. If a pediatrician has taken a first pass at the problem and there’s not an improvement or resolution, we’ll gladly see the child. Fortunately for us, PCPs in our region are generally wonderful at recognizing the importance of sleep to a child’s physical and mental health and helping families find help.

What about access? Will our patients be seen quickly?

We can see most families within one month. We see patients in-person but we also offer telehealth for both initial and return visits. In fact, because about half of our appointments are via telehealth, patients can schedule a visit for just about any day of the week at a variety of locations. Appointments are 45 minutes. We are fortunate that many of our appointments can be converted from in-person to telehealth pending pandemic conditions.

What are the advantages of coming to our Sleep Center versus going elsewhere?

I think most community providers already know we are by far the biggest pediatric-specific sleep program in WAMI (Washington, Alaska, Montana, Idaho). With that comes access to a number of specialists, all of whom are board certified in sleep medicine as well as their own specialty (family medicine, internal medicine, pediatric neurology or pediatric pulmonology). I should emphasize they are pediatric specialists, whereas other sleep centers are more commonly staffed by specialists who mainly see adults and kids just on occasion.

On the not-so-obvious side is our sleep lab, which is also built just for kids. Every room and bed here is designed with a child in mind; our waiting rooms, decor and furniture are kid-friendly. All our sleep lab technicians have extensive experience working with children of all ages, including those with special needs.

We put a lot of extra effort into helping our patients have a good experience. We have “desensitization kits” that we send home with families before their sleep test if their child has sensory issues or is afraid of wires or medical equipment. It has stickers and wires so kids can practice putting them on their body to get ready for their sleep study; it lets them feel these things in advance at home, in their own way, on their own time. We also show our patients pictures of what they will look like when they’re all hooked up to help them feel comfortable. It’s really helpful for kids who need the extra lead time.

For medically complex children, a final benefit is that families get care from our specialists that is high level yet family-centered. We have a coordinated program where the provider team is sharing charts, holding care conferences reviewing the latest studies and working as an integrated team.

What are your thoughts about back-to-school, the pandemic and sleep?

I am hoping for a lot of improvement in sleep as kids resume regular schedules. This happens every September and isn’t unique to this pandemic year, though with COVID-19, nobody quite knows how school will go this year. But I believe the majority of kids will end up thriving with getting back to a regular schedule. It will be bumpy for many — I recommend that pediatricians and parents continue to give themselves grace — but I think the overwhelming majority of kids are resilient, and most families are capable of figuring out a structure and schedule that reinforces good sleep habits.  We are here to help them figure it out if needed!

How do you communicate with PCPs about patients?

Epic is helping us communicate better than ever. It’s been a real help in communicating back and forth with pediatricians about their patients and with patients directly. We welcome questions and dialogue with our patients’ PCPs and families.

Where do you see patients?

We see patients at our main Sleep Center location in Bellevue as well as at Seattle Children’s regional clinics in Federal Way, Everett, Olympia and Tri-Cities. And also via telehealth.

Who’s on the Sleep Medicine team?

Our team of almost 50 includes 8 sleep specialist physicians (including 3 neurologists trained in sleep medicine), 5 ARNPs, 3 registered nurses, 2 CPAP/BiPAP coordinators and 30 (yes 30!) polysomnographic technologists. Our accrediting body, the American Academy of Sleep Medicine, only requires that we have 1 Registered Polysomnographic Technologist (RPsgT) on staff, but all 30 of our technologists are RPsgT credentialed.

Physicians:

  • Jeremy Chan, MD (Neurology)*
  • Maida Chen, MD, director of Sleep Medicine
  • Lourdes DelRosso, MD, MEd
  • Vidhi Kapoor, MD*
  • Casey Lockhart, MD (Neurology)
  • Erin McIntosh, MD*
  • Michelle Sobremonte-King, MD*
  • Joanna Wrede, MD (Neurology)

ARNPs:

  • Stacey Klontz, ARNP, MN
  • Amber McAfee, ARNP, MN
  • Jennifer Patano, ARNP, MSN
  • Melissa Krell, ARNP, DNP*
  • Lisa Musso, ARNP, MSN

*New to our team in the last two years

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