Teenagers are not getting enough sleep

 

When we think about teenagers, we often think that they sleep too much. However, in reality, this is not the case at all. Teenagers are actually not getting enough sleep, which can negatively impact their health and wellbeing–they struggle to get the recommended eight to nine hours per night.

According to the Centers for Disease Control and Prevention, about one-third of American adults don’t get the recommended seven hours of sleep per night. This might be because of their jobs or hectic schedules, including working long shifts and then having to take their kids to school every day of the week. To add to that, about 50 to 70 million Americans suffer from a chronic sleep disorder, such as sleep apnea, according to a study by the  Institute of Medicine (US) Committee on Sleep Medicine and Research.

The benefits of sleep for our patients

There is an abundance of research out there that suggests sleep helps us perform a range of vital functions including:

  • Restoring damaged tissues.
  • Boosting learning.
  • Improving memory.
  • Flushing toxins from the brain.

Sleep can also help our patients to remain motivated throughout the day, while also remaining safe behind the wheel of a car. Too little sleep can also have serious consequences on our patients’ health, such as an increased risk for obesity, diabetes and cardiovascular disease.

A lack of sleep for teenagers

In the journal Pediatrics, a recent study highlighted the importance of sleep for teenagers. With such busy lives, teenagers often struggle to meet the recommended eight to nine hours of sleep a night. More than 800 teens participated in this study and only 2.2 percent got enough sleep. And less than half of participants achieved desirable rates of sleep efficiency, which is the percentage of total time in bed that they are actually asleep.

As a result, teens that missed out on key amounts of sleep were more likely to be obese and scored higher on several other risk factors for cardiovascular disease, such as high blood pressure. For teens who were able to sleep for longer and better quality, tended to have less fat around their waists, lower systolic BP and higher levels of “good” cholesterol. These were all signs of cardiovascular health.

We need to be on the lookout for various signs and symptoms in our teenage patients so we can take preventive steps. By understanding how sleep apnea can negatively affect their health, we can better care for our patients.

ADHD can exacerbate sleep apnea symptoms

Our patients should not have a problem sleeping–it should be a simple solution. When it’s nighttime and you get tired, going to bed should be the least of our patients’ worries. However, when attention deficit disorder (ADD or ADHD) is in the picture, it can be even more difficult. Sleep apnea and other sleep disorders and ADHD have a significant connection.

Patients with ADHD are more prone to sleep problems than anyone, and they often go undiagnosed. Sleep apnea, restless leg syndrome and even delayed sleep phase syndrome exacerbate ADHD symptoms. And, other times, patients might even be misdiagnosed with ADHD when they really have a sleep disorder.

Tips to help patients sleep

Sleep apnea can often mimic ADHD symptoms, which can cause inattentiveness and restlessness in those who do not have ADHD. At the same time, sleep apnea can also worsen symptoms in patients who do have ADHD.

Before we dive into some tips to share with your patients, let’s look at primary and behavioral sleep problems. Primary sleep disorders are physical conditions that disrupt sleep. This would include sleep apnea. For behaviorally based sleep problems, it is linked to ADHD and are common in children who cannot make the transition to bedtime without commotion that ends up disrupting sleep.

If the sleep condition is related to behavior, try to encourage your patients to do the following:

  • Remove all screens from the bedroom. If they remain, try to turn off all screens at least two hours before bedtime.
  • Go to bed at the same time every night.
  • Get up at the same time every morning.
  • Don’t do work in your bed. Avoid working in your bedroom.
  • Exercise regularly.
  • Reduce alcohol and caffeine intake.
  • Review ADHD medications with their doctor.
  • Establish a “winding down” routine before bedtime.

These tips can potentially help patients with ADHD and sleep apnea, but the use of an oral appliance will significantly improve sleep as well. What other tips do you have for your patients that have worked?

Dental sleep medicine standards for sleep-related breathing

Sleep-related breathing disorders are one of six classifications of sleep disorders identified in the International Classification of Sleep Disorders – Third Edition, the American Academy of Sleep Medicine’s clinical text for the diagnosis of sleep disorders, according to a recent article in the Journal of Dental Sleep Medicine.

The article states that obstructive sleep apnea (OSA) has an estimated prevalence of 12 percent, which includes both diagnosed and undiagnosed. There is also a lot of literature out there to support the use of oral appliances as an effective treatment of OSA in adults. However, limited evidence exists to suggest that mandibular advancement and maxillary expansion is an effective treatment modality for the management of pediatric OSA.

The American Academy of Dental Sleep Medicine understands there is inconsistent information about sleep medicine in U.S. schools. For this reason, they are looking to offer additional educational opportunities. This is to help improve dentists’ knowledge and experience in treating and managing OSA patients. However, there is still a lack of uniform standards for the practice of dental sleep medicine.

Current standards available

The AASM and AADSM released a clinical practice guideline for the treatment of OSA with oral appliances. The guideline was created to provide dentists with qualifications required or needed in the treatment and management of OSA.

It states that a dentist should have at least one of the following to treat sleep apnea patients:

  • Diplomate certification in dental sleep medicine by a nonprofit organization.
  • Designation as the dental director of a dental sleep medicine facility accredited by a nonprofit organization.
  • Obtain the designation of “qualified dentist.”

While completing continuing education in dental sleep medicine, dentists must also seek diplomate and/or dental director status.  The AADSM also commissioned a task force of experts to create a document defining the scope of a DSM practice.

The paper goes into clear set guidelines and standards for dentists. To learn more, check out the AADSM’s paper that sets clear guidelines for dentists.

What is the prevalence of general dentists who screen for OSA?

Now this is an interesting study that I know many of you will want to learn more about. While I was searching the internet for new studies and information on sleep apnea I found this study in the Journal of Dental Sleep Medicine. The researchers were looking to determine the prevalence of general dentists screening for obstructive sleep apnea (OSA).

One thousand general dentists across the U.S. received a brief 12-item questionnaire consisting of a demographic section and questions about OSA screening methods, parameters and preferences. Here is what researchers found.

General dentists screen for OSA

Out of 1,000 general dentists who received the questionnaire from researchers, only 71 responded. However, based on demographic results, those who did respond represent a broad range of general dentists practicing in the U.S.

Dentists were asked to select which screening modalities they use and to supply specific information to provide validity to their responses. Researchers found that 76 percent of general dentists who responded, reported that they screen for sleep apnea.

Dentists use more than one modality

Most of these dentists also use more than one modality when screening for sleep apnea in their patients.  The questionnaire found that 60 percent do not routinely screen more than 70 percent of their patients. And a total of 37 percent ranked themselves a three or less on a scale of one to five regarding their confidence in screening for sleep apnea (one being uncomfortable and five being confident).

To screen for OSA, 72 percent of dentists reported using a patient interview, 52 percent identified anatomical parameters and 39 percent used patient questionnaires. Of the dentists who screen for OSA, 41 percent stated that they have their patients perform an at-home sleep test. There were also 87 percent of dentists suspecting OSA who referred their patients to physicians for further evaluation.

Additionally, dentists with fewer than 30 years of experience were significantly more likely to screen for OSA (87 percent) than those with more than 30 years of experience (63 percent).

A majority of general dentists do screen for OSA in their patients. However, most lack the confidence in performing accurate routine screenings. They do so in fewer than 70 percent of their patients. If you are a general dentist, reach out for help. By completing education courses and attending upcoming lectures, you can better prepare for screening for sleep apnea.