Looking back at my teen years at Stuyvesant High School in the mid 1980s, it's amazing what I was able to accomplish: Beside the rigors of academics, I was in the symphonic band, orchestra, jazz band, captain of the track team, and a major science geek, entering and placing in various prestigious competitions, including reaching the semi-finals of the Westinghouse Science Talent Search (now renamed Intel). I also remember having the hardest time getting up in the mornings, since I had to commute over an hour by public transportation to get to school. Many of my friends had to travel much further and had even more impressive activities.
Late To Bed, Early To Rise
It's almost a given that if you have a teenager, he or she will be sleepy, especially in the morning. Various experts describe teens' hectic schedules as a major cause of their sleepiness. One particular explanation is that teens' sleep cycles are shifted later into the night, going to bed later and waking up later. But because most of our schools begin at 8AM, teens have to get up hours before their normal wake times. But can there be an alternative explanation to why their sleep times are shifted and why they have trouble getting up in the morning? Is their delayed sleep time a natural part of their development, or is it an artificial product of modern society?
My sleep-breathing paradigm proposes that all modern humans are susceptible to breathing problems while sleeping due to our smaller jaws. Coupled with this paradigm, there are also various developmental and anatomic changes that teens undergo that can explain why teens are so sleep deprived, and why paradoxically, they can be extremely active and productive during the day.
In my book, Sleep, Interrupted, I describe a phenomenon where due to a major change in modern humans' diets along with the invention of bottle-feeding, our jaws are getting smaller with more dental crowding. Another variable that compounds this problem is that we're able to talk and communicate—this make our tongue prone to collapse, especially when on our backs and in deep sleep (due to muscle relaxation).
Growing Up Can Cause Sleep Problems
Throughout life, there are various accelerated periods of growth or change with our voice boxes as it relates to our upper airways. This first period occurs between 4-6 months, when the voice box separates away from the soft palate, creating a uniquely human area in the throat called the oropharynx. The oropharynx is the space that's behind your tongue, between the tonsils and below the soft palate. Humans infants, who are born able to breathe and suckle at the same time, have to relearn this process during this timeframe. Interestingly, this is also the period of time when SIDS (sudden infant death syndrome) peaks.
The Tonsil Dilemma
During ages 3 to 6, childrens' tonsils grow significantly larger, and not too surprisingly, this is also the time period in which tonsils are most frequently removed, especially for snoring and obstructive sleep apnea. Once tonsils (and adenoids) are removed, most children do well, but recently, we're realizing that this is not necessarily the case.
The problem is that removing tonsils and adenoids only addresses part of the problem—it doesn't address the smaller jaws that these children have. Having smaller jaws means that the tongue can fall back easier and cause more of a vacuum effect in the throat that suctions up normal stomach juices into the throat, causing the tonsils to become even larger. This creates more obstructions, preventing the jaws from widening and developing more fully. This is why rapid palatal expansion alone was found to be equivalent to tonsillectomy, and doing both gave additive results.
Let's say that your child's large tonsils were removed, but the jaws never fully developed properly. Most young teens will eventually need braces to correct for crowded teeth. Unfortunately, most orthodontics is focused on straightening teeth, rather than enlarging the airway.
As your child goes through puberty, an obvious thing also happens: his or her voice becomes lower. One major consequence of a deepening voice is that the voice box has to drop in the neck. This opens up the oropharynx even further, creating even more space for the tongue to fall back. This process continues into early adulthood, where the voice box settles in its' final location (it's been shown that the voice box continues to drop an additional 1/2 vertebral body length slowly even up to age 70).
Delayed Sleep or Deficient Sleep?
As your teen undergoes this transition, by definition, sleep quality diminishes, with various consequences, both good and bad. Because they're not able to sleep efficiently, it's hard to get out of bed in the morning. To compensate for their fatigue, they tend to participate in numerous activities throughout the day, including sometimes very physical sports. I've also commented in my book about a possible connection between mild sleep deprivation and creativity promotion, since your senses are heightened. After a full days worth of school and after-school activities, they'll have dinner and then have another few hours of homework to tackle.
With this schedule, it's not surprising that most teens don't get to bed before 11 or 12 PM, if not later. If you add to this all the media distractions like the computer, phones and television, they'll get even less sleep. Eventually, they crash, and are forced to wake up earlier than they want to to begin the next day. When I was is high school, I didn't have that much homework, so I usually went to bed at a reasonable time, around 9 to 10 PM. These days, I'm sure that teens probably go to bed much later than this. Their minds are so wired at night that it's difficult to go to bed earlier. In essence bad sleep hygiene such as this can lead to delayed sleep times, similar to many adults with delayed sleep phase syndrome.
An Explanation For The Freshman 10
If one or both parents snore or have documented obstructive sleep apnea, the teen has a higher risk of having sleep apnea as well, or developing it later in life. For some reason, sleep apnea in teens is not seen too often. But I'm willing to bet that it's a major problem that's not being addressed. Similar to the natural anatomic changes that occur during menopause, adolescence is a period of change in the sleep-breathing status that can cause paradoxical patterns of moodiness and irritability, along with intense creativity and productivity.
Notice that the incidence of depression and anxiety also begins to spike in the late teens and early adulthood. Imagine taking a teen out of his protected home environment with regular, healthy meals and place him suddenly in college where he'll binge in the cafeteria, stay up late, and even drink alcohol.
All this can lead to, or aggravate underlying sleep-breathing problems. Since inefficient sleep causes weight gain, and weight gain can narrow the throat, all this is not surprising. Perhaps the freshman 10 weight gain is an expected consequence of this expected life transition (an anatomic transition) that can unmask any underlying sleep-breathing problems.