The Teen, The Pain, and The Missing Zzzs
Did I get your attention? I bet. It’s a lot to take in.
As with anything new in medical research, it takes time for facts to drizzle down to clinicians. It usually involves a lot of heated discussions amongst peers over bad conference coffee. Orthodontists and ENTs are not all completely “in” just yet, but there is a growing mountain of evidence supporting the concept of Sleep Disordered Breathing (“SDB”) and its consequences.
To give you some context on how long medical shifts take, let’s take a quick trip in a time machine. When I first began practicing as a physical therapist, I worked with a number of women diagnosed with fibromyalgia. I was only 22 years old, but I vividly remembered how terrible I felt after being up all night studying (or, let’s be honest, socializing). When I listened to my patients’ complaints, it seemed glaringly obvious to me that they simply weren’t getting adequate sleep.
I decided to ask a referring doctor if poor sleep could be the culprit. His exact, highly professional medical opinion? He told me they were “just crazy.” That was clearly in the late 1970s.
I mention this because clinical observations take time to turn into research, and research takes decades to become standard practice. Today, we know fibromyalgia is a very real central pain state with sleep disordered breathing—and those doctors from the 1970s were the ones missing the mark.
So today, I am going to attempt to tackle the next big frontier: Sleep Disordered Breathing.
What on Earth is Sleep Disordered Breathing?
When you think of sleep and breathing issues, you probably picture a 60-year-old man snoring like a chainsaw. You don’t picture your teenage daughter or son.
But Sleep Disordered Breathing, or SDB, isn’t just full-blown sleep apnea. It is an umbrella term for when your airway partially collapses, narrows, or gets blocked during the night. Think of it as like trying to breathe through a soggy paper straw. You can still get air, but your body has to work ten times harder to pull it in.
The Dynamic Duo: Central Pain and Broken Sleep
An adolescent with central pain (like juvenile fibromyalgia, chronic widespread pain, or complex regional pain) already has a nervous system that is dialed up to an “11.” Their brain’s pain-alarm system is so sensitive that a light breeze can feel like a sunburn.
Now, imagine what happens when you add SDB to the mix:
- The Nightly Panic: Every time your teen’s airway narrows when he/she sleeps, their brain panics, thinking it’s suffocating.
- Adrenaline Spikes: The brain shoots a flare of adrenaline into the body to wake the muscles up and open the airway.
- The Alarm Stays On: Your teen might not fully wake up, but their nervous system stays in a constant state of “Fight or Flight.”
When a nervous system spends all night fighting for oxygen, it cannot heal. It wakes up exhausted, cranky, and with the central pain system completely inflamed.
Signs Your Teen’s “Lazy” Sleep is Actually Broken Sleep
Teenagers are famous for sleeping until 2:00 PM on weekends. But there is a difference between a growing teen and a suffocating teen. Look out for these sneaky signs of SDB:
Temporomandibular pain: The jaw grinds in an effort to open the airway.
The Morning Hangover: They sleep for 10 hours but wake up looking and feeling like they ran a marathon.
The Twisted Sheets: Their bed looks like a wrestling match happened in it because they toss and turn all night.
Mouth Breathing: If they sleep with their mouth wide open, their jaw drops back, which narrows the airway even further.
Heavy Breathing: They don’t have to snore like a freight train; just loud, heavy sighing is a red flag.
The Good News
Just like we eventually proved the 1970s skeptics wrong about fibromyalgia, the medical community is catching up on SDB. If we can fix the airway and restore quiet, peaceful sleep, we can take a massive amount of fuel off the central pain fire.
What Can You Do? Next Steps for Exhausted Parents
If you are reading this thinking, “Oh my gosh, this is my kid,” do not panic. You do not need to perform amateur airway surgery in your living room tonight. Because this field is still emerging—much like fibromyalgia research in the 1980s—you just need to know how to navigate the medical system to get the right eyes on your teen.
Here is your parental action plan:
1. Become a Nighttime Spy
Before you book any appointments, gather some baseline data. Teenagers will rarely admit to sleeping poorly, so you have to investigate.
- Do a drive-by: Observe your teen’s sleep pattern an hour after they fall asleep.
- Listen closely: Are they breathing through their nose or mouth? Is their jaw hanging open? Are they grinding their teeth?
- Record it: If they are snoring, gasping, or breathing heavily, record a quick 30-second audio or video clip on your phone. Doctors love data, and a video of your teen struggling to breathe is worth a thousand words in a clinic.
2. Observe
Does your teen have a tongue-tie or lip-tie? Have your teen place their tongue on their palate and maintain it there as they open their mouth. If there is a tongue-tie, this will be difficult to perform.
3. Assemble Your Airway Avengers
Since the medical community is still playing catch-up, you might need a small team. Look for professionals who specialize in the “airway” rather than just standard practices.
- The Airway-Focused Dentist: Traditional orthodontists often focus just on straight teeth. Airway-focused dentists look at the whole face. They can use specialized, non-invasive expanders to gently widen the roof of the mouth. This opens up the nasal passages and creates more room for the tongue, instantly making breathing easier. Be sure that the splint expands both laterally and anteriorly. Avoid orthodontists that suggest removal of teeth. This only causes further loss of space for the tongue. Also, avoid surgery to expand the palate as they only expand laterally, and kids with pain generally do not do well with surgical intervention.
- The ENT (Ear, Nose, and Throat Doctor): Find an ENT who understands pediatric sleep issues. An ENT can check for physical roadblocks like massive tonsils, adenoids, or a deviated septum that might be choking off airflow.
- The Myofunctional Therapist: Think of this as physical therapy for the mouth. If your teen has spent years mouth-breathing, their tongue and facial muscles are weak. Myofunctional therapists teach teens exercises to keep the tongue on the roof of the mouth, which naturally keeps the airway open at night. If your child has a forward tongue thrust, this must be corrected as it will continue to push the teeth forward.
- The Physical Therapist: The physical therapist can work with your child on posture and proper exercises to help with fibromyalgia and temporomandibular joint pain. They may also address low tongue tone.
4. Practice “The Script” for Your Pediatrician
When you visit your primary doctor, you might run into a modern version of my 1970s colleague. If they brush you off because your teen “doesn’t snore like an adult,” use this script to pivot the conversation:
“I understand my child doesn’t have classic adult sleep apnea. However, given their chronic central pain, I am highly concerned about Upper Airway Resistance Syndrome (UARS) or general Sleep Disordered Breathing. Their nervous system is entirely overwhelmed. I have video evidence of mouth breathing and restless sleep. I would like a referral to an airway-focused specialist or a sleep study that scores for RERAs (Respiratory Effort-Related Arousals).”
Using words like “UARS” and “RERAs” will instantly let the doctor know you’ve done your homework, making them much more likely to hand over that referral.
The Ultimate Goal: Quieting the Alarm
Helping your teen breathe better at night is like turning down the volume on their central pain. It gives their brain the deep, restorative rest it desperately needs to heal. It takes time, patience, and a little bit of detective work—but your teen’s nervous system will thank you for it.
I’d like to finish with a story about a teenager who presented with a narrow jaw, a high palate, and symptoms of ADHD. He wasn’t interested in school or playing any team sports. He was treated by his dentist with an epigenetic splint that expanded his palate anteriorly and laterally. I also worked with him on tongue strength, tongue position, and posture.
At discharge, he had grown in height significantly, had improved grades, and had joined a rowing team. His ADHD symptoms had resolved. Unbelievable, but true. The research has not caught up yet with ADHD, but it is being discussed in dental study groups who are observing this in their practice. It certainly is worth checking it out.
