Teens and Sleep: How much do they need?

An excellent article from the World Economic Forum.

Sleep, teenage brains and getting up for school

Millions of high schoolers are having to wake up early as they start another academic year. It is not uncommon to hear comments from parents such as,

“I have a battle every morning to get my teenager out of bed and off to school. It’s a hard way to start every day.”

Sleep deprivation in teenagers as a result of early school start has been a topic of concernand debate for nearly two decades. School principals, superintendents and school boardsacross the country have struggled with the question of whether their local high school should start later.

So, are teenagers just lazy?

I have been researching the impact of later high school start times for 20 years. Research findings show that teens’ inability to get out of bed before 8 a.m. is a matter of human biology, not a matter of attitude.

At issue here are the sleep patterns of the teenage brain, which are different from those of younger children and adults. Due to the biology of human development, the sleep mechanism in teens does not allow the brain to naturally awaken before about 8 a.m. This often gets into conflict with school schedules in many communities.

History of school timing

In the earliest days of American education, all students attended a single school with a single starting time. In fact, as late as 1910, half of all children attended one-room schools. As schools and districts grew in size in the late 1890s-1920s, staggered starting times became the norm across the country.

In cities and large towns, high school students went first, followed by middle schoolers and then elementary students.

Here’s what research shows

Research findings during the 1980s started to cast a new light on teenagers’ sleep patterns.

Researcher Mary Carskadon and others at Brown University found that the human brain has a marked shift in its sleep/wake pattern during adolescence.

Researchers around the world corroborated those findings. At the onset of puberty, nearly all humans (and most mammals) experience a delay of sleep timing in the brain. As a result, the adolescent body does not begin to feel sleepy until about 10:45 p.m.

At the same time, medical researchers also found that sleep patterns of younger childrenenabled them to rise early and be ready for learning much earlier than adolescents.

In other words, the biology of the teenage brain is in conflict with early school start times, whereas sleep patterns of most younger children are in sync with schools that start early.

Biology of teenage brain

So, what exactly happens to the teenage brain during the growth years?

In the teens, the secretion of the sleep hormone melatonin begins at about 10:45 p.m. and continues until about 8 a.m. What this means is that teenagers are unable to fall asleep until melatonin secretion begins and they are also not able to awaken until the melatonin secretion stops.

These changes in the sleep/wake pattern of teens are dramatic and beyond their control. Just expecting teens to go to bed earlier is not a solution.

I have interviewed hundreds of teens who all said that if they went to bed early, they were unable to sleep – they just stared at the ceiling until sleep set in around 10:45 p.m.

According to the National Sleep Foundation, the sleep requirement for teenagers is between 8-10 hours per night. That indicates that the earliest healthy wake-up time for teens should not be before 7 a.m.

A recent research study that I led shows that it takes an average of 54 minutes from the time teens wake up until they leave the house for school. With nearly half of all high schools in the U.S. starting before 8:00 a.m., and over 86 percent starting before 8:30 a.m., leaving home by 7:54 a.m. would be a challenge for most teens in America.

What happens with less sleep

Studies on sleep in general, and on sleep in teens in particular, have revealed the serious negative consequences of lack of adequate sleep. Teens who are sleep-deprived – defined as obtaining less than eight hours per night – are significantly more likely to use cigarettes, drugs and alcohol.

What happens with less sleep?Student image via

The incidence of depression among teens significantly rises with less than nine hours of sleep. Feelings of sadness and hopelessness increase from 19 percent up to nearly 52 percent in teens who sleep four hours or less per night.

Teen car crashes, the primary cause of death for teenagers, are found to significantly decline when teens obtain more than eight hours of sleep per night.

What changes with later start time?

Results from schools that switched to a late start time are encouraging. Not only does the teens’ use of drugs, cigarettes, and alcohol decline, their academic performance improvessignificantly with later start time.

The Edina (Minnesota) School District superintendent and school board was the first district in the country to make the change. The decision was a result of a recommendation from the Minnesota Medical Association, back in 1996.

Research showed significant benefits for teens from that school as well as others with later start times.

For example, the crash rate for teens in Jackson Hole, Wyoming in 2013 dropped by 70 percent in the first year after the district adopted a later high school start.

At this point, hundreds of schools across the country in 44 states have been able to make the shift. The National Sleep Foundation had a count of over 250 high schools having made a change to a later start as early as 2007.

Furthermore, since 2014, major national health organizations have taken a policy stand to support the implementation of later starting time for high school. The American Academy of Pediatrics, the American Medical Association and the Centers for Disease Control and Prevention have all come out with statements that support the starting time of high schools to be 8:30 a.m. or later.

Challenges and benefits

However, there are many schools and districts across the U.S. that are resisting delaying the starting time of their high schools. There are many reasons.

Issues such as changing transportation routes and altering the timing for other grade levels often head the list of factors making the later start difficult. Schools are also concerned about afterschool sports and activities.

Such concerns are valid. However, there could be creative ways of finding solutions. We already know that schools that were able to make the change found solutions that show “out of the box” thinking. For example, schools adopted mixed-age busing, coordinated with public transport systems and expanded afterschool child care.

I do understand that there are other realistic concerns that need to be addressed in making the change. But, in the end, communities that value maximum development for all of its children would also be willing to grapple with solutions.

After all, our children’s ability to move into healthy adult lives tomorrow depends on what we as adults are deciding for them today.




Orthodontics and Breathing: An Essential Link

We would like to take the opportunity to reintroduce a previous post. Childhood apnea is now being recognized as a significant health issue, particularly in children with a skeletal discrepancy where the lower jaw is well behind the upper jaw and rotated downward, in a clockwise direction, as seen in the pre-surgical x-ray below. A physician prescribed sleep-study is key. This can affect how and when orthodontics is performed. In many adult patients, orthodontic treatment combined with corrective jaw surgery, has worked very well for a number of our patients. In the growing patient however, certain bite-relationships (where the upper teeth are out in front of the lower teeth, known as a Class II malocclusion) may need to be seen in a different light. If there are sleep issues when young, conventional orthodontic treatment, in particular circumstances, not all, may not be appropriate. It may be necessary to await completion of growth so that corrective jaw surgery can be undertaken to help prevent the serious health effects of apnea in the future. Attached are links to two informative articles.  The xrays show the changes in the airway of a patient who underwent the procedure discussed today.



You Have Heard About “Overbites”, Now Let’s Chat About “Underbites”

Early Treatment of “Underbites”

A Class III malocclusion is the technical term for an “underbite”, where the size and position of the jaws are such that the lower teeth are out in front of the upper teeth.

This issue can be easily addressed while your child sleeps! A conventional expander appliance is used in conjunction with what is called a facemask (a headgear but in reverse!). The facemask is only worn to bed and the expander cannot even be seen when talking or smiling. A realignment of the jaws results in an improved bite.

Why should we treat “underbites”?

1. To avoid the need for future corrective jaw surgery.
2. To prevent irreversible wear on the enamel and soft tissue changes.
3. To improve function.
4. To improve facial esthetics and aid the child’s psychosocial development.

When can treatment start?

The earlier the better! Once the child has turned 10 years old skeletal changes are more difficult to achieve but can be addressed, if need be.



2 months into treatment



Say Good-Bye To Impressions!

iTero Scanner

We have recently acquired an iTero scanner, a technology that allows for fabrication of orthodontic appliances and Invisalign aligners, without the need for conventional dental impressions, a process no patient likes!

At Freeman Orthodontics we make every effort to respect the environment by not adding to the problem of disposable waste and excessive use of water. This is all possible with 3-D scanning technology. These same scans will eventually be used to fabricate other orthodontic appliances, not just Invisalign aligners.

The scanning technology offered by iTero is a major benefit to the patient not just due to improved comfort with procedures but increased accuracy in appliance fabrication and fit. Scanning technology is another way we can provide the best care possible for our patients while also protecting the environment for future generations.



How To Handle Multiple Missing Teeth: Help Is Available

Up to 10% of the population exhibit missing permanent teeth from birth (hypodontia). The most commonly missing teeth are maxillary (upper) lateral incisors and second premolars. When you are missing six or more permanent teeth (excluding wisdom teeth) this is called oligodontia.
There can be many treatment costs associated with missing teeth that can involve multiple dental procedures such as orthodontics and dental implants.
There is a program in place that many may not realize is an option when your child has multiple missing teeth. There is a program funded through the Ministry of Health. The requirements include:
1. An Ontario resident with a valid OHIP number.
2. Diagnosis by a designated treatment centre as having a craniofacial anomaly (multiple missing teeth).
3. Registration in the program before their 18th birthday.
Once you have been registered, this program will provide some financial support for the costs in treating the missing teeth. This program also works if you have private insurance. Private insurance will be processed first followed by the Ministry of Health program. There is however, a funding limit. You must be aware that certain procedures need to be completed by a dental specialist such as the orthodontic treatment as well as the restoration of teeth, including dental implants. Even after approval in the program, the treatment must be approved by the designated centre, before the treatment is initiated.
A consultation with a certified orthodontic specialist can help in the assessment of the suitability of a patient for this program.



“But Dr. Oz says…..”

The phrase that makes health-care practitioners cringe.
Many people rely on what Dr. Oz says. He is a respected surgeon.
Unfortunately he has take to recommending supplements and diets that have no foundation in appropriate scientific research. This has become such a problem that even the United States Senate has become involved.

To be healthy takes work. Health is not found in the bottom of a supplement bottle.
Regulation of supplements in North America is not the same as in most European countries where these products must adhere to the same strict guidelines applied to pharmaceuticals.

Benjamin Mazer, a young medical student at the University of Rochester is taking a stand against the promotion of questionable health-care information. He is concerned with patients forgoing appropriate medical advice and seeking a treatment they heard/read about in the media that has not been substantiated by appropriated scientific research.
Benjamin is urging medical regulatory boards to join in his campaign to help protect the public.

Just today I bought some pricey organic blueberries.
The young lady at the counter commented on them and said “they are the expensive but they are the best and you get what you pay for”.
As I have written previously, the public must do their due diligence. Products and procedures must be fully researched before they are chosen.
The appropriate specialist consulted.
Questions must be asked. You cannot just take the word of a television presenter or ad on the Internet, particularly when it comes to your health.

Many people take months to research the perfect laptop yet will jump right in and have a medical/dental procedure undertaken by someone whom they did not research and worse, is not qualified and may also be promoting a treatment that is not substantiated by proper research and clinical trials.

If it sounds to good to be true, you can bet that it is!
Do your homework.
Your health is worth it.

Please take a moment to learn more about the United States Senate v. Dr. Oz and the outstanding campaign led by Benjamin Mazer.

Dr. Oz dietary supplements under investigation – CNN

Meet the medical student who wants to bring down Dr. Oz – Vox


If it sounds too good to be true….

From the beginning of time there has always been the sale of “overnight cures”.

In 2014 nothing has changed but the sales pitch is now disseminated via the web and social media which does not require the advertiser to support their claims with scientific research.

To become an orthodontist, as discussed here previously, takes years of study. Thousands of hours to learn the best and safest way to provide a healthy and functional smile.

There are a number of quick-fixes being sold to straighten teeth. It is up to the patient to do their homework and ask questions. A week-end course to learn how to instantly align your teeth is not in the best interest of you, the patient.

Please take a moment to read the article provided in the link. I think you will find the information to be invaluable.

British Dental Journal


Something to really chew on!

A recent article about chronic headaches and gum chewing among teens has clearly shown that all test subjects reported significant or complete improvement of their headache complaints when they stopped chewing gum.

Headaches returned when, you guessed it, gum chewing resumed!

So for all you frequent gum chewers with chronic headaches, tossing away that pack of gum may be the answer!

The Influence of Excessive Chewing Gum Use on Headache Frequency and Severity Among Adolescents. Watemberg N, Matar M et al: Pediatric Neurology 2014; 50 (January): 69-72.