• Teenagers & Sleep

    Introduction

    Have you ever looked at your teenage son or daughter and thought, "Oh, to be young again?" They have so much energy, potential, life, and sleepiness. Wait... Sleepiness?

    Research indicates that teenagers need more sleep than adults - close to nine hours every night, on average. Yet, a recent survey of teens shows that only 15% of them actually get that amount of sleep regularly. That means that 85% of today's teenagers are not getting enough sleep. In fact, the survey showed that a full 26% are only getting six or fewer hours of sleep on school nights.

    The factors that contribute to poor teenage sleep include rapidly changing bodies, lifestyle choices, and peer pressure, to name a few. Because of these trends, teenagers are at risk for the serious consequences of a chronic sleepiness.

    Definition: Teenager

    A "teenager" is typically defined by age, meaning that people from the ages of 13 to 19 are considered teens. Yet, teen sleep problems can occur both before and after those exact ages. In fact, the sleep habits of young adults and the changing bodies of pre-adolescents also relate to teenage sleep problems.

    For this reason, this page offers information that applies to anyone who has begun puberty (or is at least 11 years old) or is up to 25 years of age.

    The Need for Sleep

    There are two general factors that influence how sleepy or how alert anyone is at any given time in a 24-hour period. The first is how long it has been since you last slept, which is called the sleep-wake balance. It basically means that the longer you stay awake, the sleepier you will become.

    The second factor that influences sleepiness or alertness is called "circadian rhythm," also referred to as your body's "biological clock." Everyone's body has this natural timing system, which tells you when you should be awake, and when you should be sleeping. When you feel sleepy at night, it is your circadian rhythm telling you it is time to go to sleep. Most people feel a mild need for sleep in the mid-afternoon, and a strong need to sleep at night. Because this rhythm is set, the urge to sleep will be triggered at specific pre-set times, no matter how much sleep you got the night before. A young person can throw off his or her circadian rhythm by frequently staying up late or by following a constantly changing bedtime and wake-schedule. This will cause daytime sleepiness often when the teen needs to be alert, such as during school or work hours, or while driving.

    A Shift in Rhythm - Sleep Phase Delay

    A teenager's body goes through many changes during puberty, and one of these normal changes is a shift in circadian rhythm. Before puberty, your son or daughter's body will trigger him or her to fall asleep around 8:00 or 9:00 p.m. When puberty begins, that rhythm shifts to a couple hours later, usually to around 10:00 or 11:00 p.m.

    The natural shift in a teenager's circadian rhythm is called "sleep phase delay," because the need to sleep is delayed for about two hours. When you first notice this change, it may seem like your teen is suffering from insomnia. Yet, by recognizing the shift in your teenager's body clock, you can help him or her understand why he or she can't fall asleep at the usual time. It is important to understand, too, that your teenager still needs the same amount of sleep (usually about nine hours), even if he or she needs to go to sleep later. Encourage your teen not to be frustrated by these changes. Tell your teen that these changes are a completely normal part of growing up and that, with some extra care, his or her body will soon adjust.

    "... 85% of today's teenagers are not getting enough sleep."

    When teens don't understand these normal changes and actually resist or ignore them, they complicate their bodies' transition to "sleep phase delay" and have more trouble adjusting to their body's new circadian rhythm. Staying up too late at night doing homework, socializing and/or consuming nicotine and caffeine make it even more difficult for a teenager's body to get the rest it needs. While it may seem that allowing your teen to sleep-in much later on weekends will him or her "catch up," it may actually keep your teen from falling asleep at an appropriate time during the week, and prolong your teen's transition into the new circadian rhythm.

    Sleep is One of Many Demands for Teenagers' Time

    Our society makes it more difficult for teens to get enough sleep at night. For instance, early school start time prevent teens from getting the sleep they need. Their shift in circadian rhythm (sleep phase delay) doesn't allow them to fall asleep until later at night, but they are still expected to wake up, sometimes very early in the morning, for school. Many sleep specialists are now active in addressing this issue in the nation's school systems, often lobbying for later school start times. Allowing teenagers to start school later would help this shift in circadian rhythms, not to mention emphasize the importance of a good night's sleep.

    School and family pressures also can contribute to sleep problems in teens. Responsibilities like part-time jobs, family chores, and schoolwork can put stress and time constraints on a teenager's sleep schedule. Teenagers may also give in to peer pressure and make poor decisions, staying out late at night, smoking, drinking alcohol, and using drugs, all of which can disrupt sleep. When teens are just beginning to make their own decisions, their need for enough sleep is rarely an important consideration. As a parent, you need to educate your teenager on the importance of a good night's sleep.

    "Our society makes it more difficult for teens to get enough sleep at night"

    These pressures, along with a teen's shifting body rhythms, are the cause for the battles that so many teenagers fight against "daytime sleepiness." Many teens struggle so much that they have a hard time getting up for school, or they fall asleep during class, sleep through evening and weekend family time, or experience difficulty with personal relationships. If deprived of sleep on a regular basis, they are also at higher risk for an automobile or on-the-job accidents.
    Physiological changes, societal pressures, and poor decision making all combine to present overwhelming obstacles to a teen getting an appropriate amount of sleep. As teens struggle to adapt to new life stresses and the emotions and mood swings of puberty, sleep deprivation can make this transition period even more difficult.

    Intervention and Treatment

    If your teenager exhibits signs of excessive sleepiness, you need to consider several different options. Excessive sleepiness can be caused by more than just sleep deprivation. Other sleep disorders, such as sleep apnea (throat muscles relaxing too much during sleep, causing difficult breathing and repeated awakenings during the night) and narcolepsy, can develop during the teenage years. Emotional problems (e.g., depression), common in teenagers, can also disrupt sleep and daytime alertness. Additionally, medical conditions (such as epilepsy) may be involved with your teen's sleep problems, as well as any use of drugs or alcohol.

    You need to examine these different scenarios in relation to your teen to determine how to correct his or her sleep problem. Sometimes a teenager's sleep problems can be remedied by simply changing habits. However, if your teen's sleep problems do not seem to be easily treated with a change in habits and choices, he or she may benefit from seeing a sleep specialist. A sleep specialist would diagnose your teenager's problem based on careful evaluation, and on the symptoms he or she reports. The sleep specialist would then discuss the best treatment plan with you and your teen.

    Common Treatment Options for Sleep Phase Disorders

    There are two treatments that sleep specialists often recommend for teenagers with sleep phase delay problems. These include ways for your teenage to develop healthy sleep habits.

    Light Therapy

    Light therapy involves exposure to bright light or darkness to help reset the biological clock, encouraging a more appropriate sleep-wake schedule. This form of therapy is usually done at home. Your teenage would be exposed to light early in the morning, to help his or her body to know it is time to wake up. Then, in the evening, he or she would be in darkness or subdued light, signaling to the body that it is now time to sleep. Light therapy may make use of natural home light, or a device called a light box. Light boxes come in the form of a dawn simulator, tabletop light box, or a visor that is worn on the patient's head. For more information about this therapy, see your healthcare professional, or a sleep specialist.

    Chronotherapy

    Chronotherapy is a rigorous treatment, and requires strong and consistent motivation from both the teenager and parents. It involves delaying you teenagers bedtime in two- or three-hour increments every night until your teen's body clock is shifted all the way around the clock to the ideal time for him or her to go to bed. For example, if your teenager is going to bed regularly at 3:00 a.m., the first night he or she would stay up until 6:00 a.m., the next 9:00 a.m., and so on until he or she reaches 10:00 or 11:00 p.m. Then your teen's body clock would be shifted to ideal bedtime. Once on the new schedule, it must be strictly maintained.
    Of course, to perform chronotherapy, parents need to choose a period when they and their teenager are free to make these adjustments, such as during school holidays and summer vacation.

    Chronotherapy is usually combined with light therapy, as it seems to work best when the teen is stimulated by light on a consistent schedule. This treatment may require future sessions as well, as it is possible for your teenager to slip back into his or her old habits of staying up too late

    Overcoming Your Teen's Sleep Problems

    To help your teen overcome his or her sleep problems, you should be aware of the signs of sleep deprivation. Take notice if your teen consistently has trouble waking up in the morning, is irritable in the early afternoon, is falling asleep easily during the day, has a sudden drop in grades, or is sleeping extra long periods on the weekends. Other signs can mimic behaviors commonly associated with attention hyperactivity disorder (ADHD). These might include trouble concentrating, mood swings, hyperactivity (trouble sitting for long periods), or aggressive behavior.

    Remind your teen often that he or she should never drive when feeling tired. If a situation arises when your teen feels he or she cannot safely drive home, you or someone you trust must be available to pick him or her up. If this is not possible, make sure your teen has money to take a taxi. As a parent, you need to help your teenager make wise choices regarding after-school and social activities. Check up on your teen's schoolwork load and other responsibilities. Help your teen decide what is most important, help him or her make decisions about what activities may need to be dropped if they interfere with getting enough sleep. If your teen needs to work to help contribute money to your family, see if his or her work hours can be minimized during the week and maximized on weekend days.

    "Excessive sleepiness can be caused by more than just sleep deprivation."

    It is important for you to pay attention to any changes in your teen's mood and/or school performance. Such changes are often early signs of a sleep phase problem, or a possible sleep disorder. If sleep problems are persistent, it is often helpful to see a sleep specialist to make an appropriate diagnosis for your teenager and start the necessary treatment.

    If you are concerned with your teenager's sleep habits, consult a sleep specialist. Help is available, and many times the treatment is as simple as teaching your teenager to make wise decisions, and helping him or her to modify behavior.

    By paying attention and talking to your teen about his or her sleep habits, and by seeking the advice or your healthcare professional, you will help your teen increase his or her awareness of the importance of sleep. That valuable lesson could lead lifetime of feeling well rested.

    Courtesy of the American Academy of Sleep Medicine (http://www.aasmnet.org)

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