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Sleep Phase Disorder - or "he/she stays up so late and then sleeps the day away!"
Preschool age children typically need 10-12
hours of sleep, elementary school age children need 8-10 hours, while
teens and adults need about 8 hours. Right?... Well, not quite. The need
for sleep varies quite a bit from person to person but generally does
follow the age pattern above except for teenagers.
Sleep studies show that adolescents need as
much sleep as younger children, 8-10 hours for most. Our society operates
under the theory that teens actually need less sleep and even incudes a
later bedtime as a sign of developing maturity. The result is that many
teens (and young adults) try to get by on 6-8 hours which leaves a sleep
debt building up night after night. The bad news is that the sleep debt
must be paid in full, and soon, or suffer the consequences.
So, the sleep deprived teenager either naps or
sleeps in, usually on the weekend. After getting up around noon on
Saturday the debt is pretty well paid...that is until the teen stays up
Saturday night and then sleeps in on Sunday AM (or takes a nap.) Now, he
or she isn't tired at a reasonable bedtime on Sunday night because of
sleeping in or taking a nap.
Then s/he has to get up early for school Monday morning ... bang!. back into sleep debt!
So, how do you recognize chronic sleep debt? The #1 sign is
difficulty getting up and out of bed on one's own in the morning. Other
signs include chronic fatigue, increased grouchy or irritable behavior,
less sharp thinking, and moodiness; all this improves with a good night's
sleep.
This pattern gets amplified with long school
breaks such as 3 day weekends, Thanksgiving break, Christmas break, spring
break, and the worst of all...summer … or college. Frequently the youth
is allowed or demands to sleep in "because it's vacation." When
the sleep debt gets chronic, a pattern of staying up late (midnight, 2 AM
or even later) and sleeping late (11 AM, noon, or even later) takes hold
and for many becomes virtually unchangeable, "I can't go to sleep
even if I do go to bed earlier!", "I can't get up earlier even
if I want to!". This is now called Sleep
Phase Disorder and is a diagnosable disorder of sleep. This is very
similar to what shift workers experience and is like the severe jet lag of
flying to Europe or Asia and back. Some people are little affected by such
sleep cycle shifts, some become stuck in this new pattern for decades (eg.,
college students sleeping through afternoon classes), some are just called
"night owls" who choose to work evening or night shift, and most
struggle greatly (or should I say their parents struggle greatly) trying
to reset their clocks; not really understanding what they have done to
themselves. Doctors see this often, especially after the long Christmas
break and as summer ends and school begins each year.
What is the treatment? The best answer is easy to say but hard to do. The teen
"simply" has to get up early every day for a week (without naps)
to reset their body clock which will then allow him or her to fall asleep
normally at a reasonable hour. To prevent relapse he or she must then
maintain that schedule, sleeping in past 9 am only on truly rare
occasions. Going to bed earlier won't help, and won't be successful as
long as getting up late and/or taking naps is continued. Medications will
not do it alone and are best avoided if possible. This process will be
very difficult the first few days as s/he will have to drag him/herself
out of bed and go on for several days feeling miserable until the sleep
cycle switches back to normal. Then s/he can get to sleep at 9, 10, or 11
PM and awaken early (6 to 9 AM), feeling refreshed after 8-10 hours of
sleep. This will take 3 days for the lucky few who are born to be shift
workers or traveling salespersons, 7 days for most and 2 weeks for the
unlucky and those deeply entrenched in this pattern.
See the Sleep
Tips on my web site’s home page.
These "Sleep Hygiene"
steps include such basics as allowing the time needed for good sleep;
setting up a restful room and bed; allowing 30-60 minutes of wind down
time before bed perhaps with a relaxation tape, restful reading or music,
prayer or meditation; not using the bed for anything besides sleep (or
sex); exercising daily but not right before bed; not taking naps; avoiding
caffeine, nicotine, or other medicines or drugs that may disturb sleep;
keeping a regular sleep schedule; being mindful of signs of health or
mental health disorders or life worries that may impair sleep and seeking
help; and use sleep aids only briefly if at all and with caution.
As
mentioned earlier, some people can make this adjustment easier than
others. I have seen teens and young adults who sleep through multiple
alarms, door pounding, yelling, water dumpings and being dragged out of
bed. As mentioned above, some choose to lead an "evening shift"
lifestyle which unfortunately doesn't fit well with the primary job of
children and teens...school. Two of the other most powerful motivators to
get up early regularly for older teens and young adults are a paying job
and/or a baby (not yet please!). Once sleep phase disorder is identified,
the treatment is straightforward.
Other
Sleep Disorders may occur in children, teens, and adults.
Any of these disorders can impair sleep resulting in fatigue,
irritability, moodiness, reduced concentration and thinking abilities, and
weight changes. A good sleep and health history, physical exam and
sometimes a sleep study (polysomnography) can help make the diagnosis.
Narcolepsy
can
begin in childhood and usually begins by the end of the teen years.
It is marked by “sleep attacks” (sudden prominent daytime
sleepiness), and may include “cataplexy” (sudden falling asleep due to
strong emotions) and “hypnagogic or hypnopompic hallucinations” (going
into dream sleep just before falling asleep or when awakening) and
“sleep paralysis” (having fallen asleep and thuslosing ability to move
normally although still awake). Only
sleep attacks are always present. Treatment
involves good sleep “hygiene” habits and often medication.
Restless
Legs Syndrome
(RLS) is the experience of varying uncomfortable feelings in the legs
while resting that require the person to move their legs to feel
comfortable. Sometimes this
is most often apparent to the afflicted person’s bed partner who is
often awakenined by all the moving around. It can be severe enough that
the arms are affected and can begin in the evening or afternoon before
even going to bed. RLS is
sometimes associated with iron deficiency which can be checked by testing
blood for Ferritin level. Other
health conditions and some medications or drugs can also cause RLS
patterns. Treatment may include treating the underlying cause such as
iron, stretching, or medications such as clonazepam, gabapentin, and
especially dopamine agonists like Requip or Mirapex.
Sleep
Walking, Sleep Talking, Night Terrors, and Bedwetting (Enuresis) all occur in the deep stages of
sleep – not REM (Rapid Eye Movement) which is the stage where dreams and
nightmares occur. These are
most common in childhood and tend to decrease with age probably as brain
development progresses. Sleep
“hygiene” habits, ensuring safety, behavior therapy, and sometimes
medication may help if warranted.
Two good links for more information :
National Center on Sleep Disorders
http://www.nhlbi.nih.gov/about/ncsdr/patpub/patpub-a.htm
National Sleep Foundation
http://www.sleepfoundation.org/