Lisa dreaded going to parent-teacher conferences. Even though she knew Brian was a bright boy, he was struggling in school. His teachers repeatedly reported that he had trouble paying attention and wasn’t applying himself. As a result, his grades were beginning to suffer. How is this a sleep problem?
Although the attention deficit disorder (ADD) label had come up in conversations about Brian, Lisa knew something had to be going on. When Brian wasn’t bouncing off the walls, he was so groggy he had trouble holding up his head. It was always difficult rousing him in the morning, and he often nodded off while trying to do his homework in the evening.
An examination of Brian’s oral health finally led to the culprit—an obstructed airway caused by enlarged tonsils and adenoids. Brian wasn’t getting enough air, during the day or when sleeping at night. He was suffering from sleep-disordered breathing. The most severe type of sleep-disordered breathing is sleep apnea.
Sleep apnea is defined by pauses in breathing during sleep. The severity of sleep apnea is measured based on what’s called the apnea-hypopnea index (AHI). The AHI measures the number of breathing disruptions lasting at least 10 seconds per hour. In their sleep, many people stop breathing more than 30 times an hour for 10 seconds or more. That’s more than 240 times during an eight-hour night of sleep. AHI is a combination of apneic events (cessation of breathing for a minimum of 10 seconds and oxygen levels decreasing by 4% or more).
Imagine what it’s like dealing with a child who hasn’t had enough sleep. Now, imagine what it’s like to be that child! To determine the number of apneic events vs. hypopnea seek a professional opinion or turn to a sleep study.
So, adults aren’t the only people afflicted with sleep apnea, kids and teens can have it, too. In fact, if a parent is diagnosed with sleep apnea, their children are also at risk. Consider these potential indicators of sleep apnea in a child:
- Snoring, especially if it’s accompanied by jerking awake and gasping for breath.
- Bedwetting, which happens because of a disruption in the brain’s signal to the body to get up and go to the bathroom.
- Malformations of the teeth and jaws such as overbite, underbite, open bite
- Having a jaw too narrow or too small to house the tongue
- An obstruction in the airway caused by inflammation
- Being overweight
- Daytime fatigue
- Diagnosis of attention deficit disorder, ADD, or ADHD
At night, the body needs to enter deep phases of sleep to rejuvenate. Repeated disruptions of the sleep cycle keep the sleep apnea sufferer from entering those deep, restorative phases of sleep. In kids, that can mean groggy, cranky mornings and problems focusing throughout the day. Over time, those repeated disruptions can lower the levels of oxygen in the brain. When the brain is starved for oxygen, it does not develop. In children, that can lead to autism, attention deficit disorder (ADD), and hyperactivity. In teens, those problems of adolescence may then become learning disabilities, poor school performance, or even diabetes. Long-term sleep disturbances can even lead to depression and anxiety, and even thoughts of suicide.
Some of the problems that youth deal with can be resolved with orthodontic treatment, sleep therapy, and lifestyle changes. Unfortunately, too often the solution in traditional medicine is to prescribe a drug to address the symptoms. Teens, adolescents, children, and even infants are given a drug to deal with their behavior problems, when their behavior is being caused by a lack of good, quality sleep.
Treatments at the Julian Center involve customized intraoral appliances that are designed to get the tongue out of the back of the airway by either pulling the jaw forward or by expanding the arches to make room for the tongue. However, in children, the obstruction often stems from enlarged tonsils or adenoids, tissue at the back of throat that can block airflow through the nose. While changes in nutrition can sometimes reduce the inflammation in these tissues, for many children (like Brian), the solution is surgical removal of the tonsils and/or adenoids. If this doesn’t completely resolve the issue, consider intervention with dental appliances and/or myofunctional therapy.