Sleep Disorders

Glossary

"The golden chain that ties health and our bodies together" - Thomas Dekker

Adolescent Sleep Needs

Teens need more sleep as they go through adolescence. Even with more than 9 hours of sleep a night many teens struggle with drowsiness, especially early in the day. This problem has gotten worse in recent years, as teen culture pushes kids to delay bedtimes, while high school start times have been pushed earlier. Many teens report sleeping 7 hours or less on weeknights rather than the 8 or 9 hours they need to be alert during the day.

Research suggests that the sleep-wake cycle shifts during adolescence. As a result, teenagers have a natural tendency to fall asleep later and wake up later. When this pattern occurs in mature adults it is sometimes diagnosed as Delayed Sleep Phase Syndrome (DSPS). In some sense, it is normal for teens to have DPSD. What is a disorder for adults is normal for adolescents.

The problem is not the shift in the time of sleep, but the total amount of sleep that the kids are getting. Psychosocial and environmental conditions make it easier for adolescents to delay bedtimes. Sports, homework, jobs, socializing contribute to a busy schedule that leave little time for sleep. Modern electronics and entertainment systems keep minds occupied when they should be sleeping. Combining work and school is also a challenge for teens, often to the detriment of their sleep lives. Research shows that working more than 20 hours a week during the school year is associated insufficient sleep and exercise.

Recent academic studies have attempted to get some data on teens, but like other sleep studies they are subject to suspicion because of low sample sizes, the subjective nature of sleep quality, and standardization in reporting. It appears that 10% to 15% of adolescents have insomnia. This is actually lower than any age group in adults. There is some evidence of heritability, with mothers being the family member that most often shares insomnia. However, all researchers agree that sleep disorders are not as simple as genetic.

Many sleep experts are calling for revision of school start times. They want schools to start later in the morning and run later in the afternoon, to accomodate the delayed sleep cycles of teens.

Cross-sectional studies suggest widepread insomnia among US teens. A minority, but a substantial minority (about a quarter) of adolescents report chronic insomnia, even after kids with psychiatric disorders are not counted. Lost sleep accumulates over time. The effects of chronic sleep loss are more than just fatigue; people can’t learn as well when they have accumulated sleep debt — school performance suffers.

Consequences of insufficient sleep in adolescents include missed school, sleepiness, tiredness and decreased motivation, and difficulties with self-control of attention, emotion and behavior.

Treatment and Behavioral Patterns

Teens with insomnia (primary insomnia) are treated the same way as adults. Education and behavioral modification is the first approach to the problem (before drugs.) This means sleep hygiene, stimulus control, sleep restriction therapy, and relaxation techniques.

The FDA has not approved any sleeping pills (insomnia medication) for children or teens. That doesn’t mean medicines are not used. Experienced pediatricians and psychiatrists may wish to prescribe sleeping aids off-label for children. They usually do so as part of an overall sleep strategy that includes behavioral modification. The fact that children have different sleep architectures from adults (longer time in Stage 3) and generally smaller bodies (resulting in dosing challenges) means doctors have to be careful with medicines and cannot simply use the same regimens they apply to adults. As with adults, doctors weigh the teenage patient’s overall health and other conditions when determining a regimen. When the patient has sleep onset insomnia, a fast-acting drug with a short half-life might be used. Sleep maintenance insomnia (more often seen in the elderly than in young people) is frequently treated with longer half-life drugs.

Another big problem seen in teens is drowsy driving. Young people fall for this much more than more experienced drivers. The National Highway Safety Administration estimates that more than 1500 Americans under age 21 are killed because of car crashes due to drowsy driving every year. A recent study found teens who haven't been sleeping enough take more risks than they would otherwise.

Many teens try to catch up on their sleep on weekends, and to some extent this works. But irregular sleep schedules also pose problems. Delaying weekend bedtimes and rising times for several hours can disrupt the normal sleep cycle much the way jet lag can affect long-distance travelers.

Adolescents may also suffer from sleep disorders, just like people oin any age range. For instance, narcolepsy typcially first appears between the ages of 10 and 20, although the symptoms are sometimes different from those in adults. Mood disorders often begin in adolescense, and sleep problems are often a problem. Insomnia can also be a warning sign for depression in later life.

Adolescents may also be more affected by caffeine and nicotine than adults so that an equal amount of these stimulant consumed could lead to more insomnia.

Exercising, sleep-EEG patterns, and psychological functioning are related among adolescents.