A 14-year-old was just kicked off the soccer team for poor grades. In middle school he was an “A” student but his high school teachers say he just doesn’t pay attention. He has no history of ADD and has not been taking drugs. The patient states that he goes to bed when he feels tired at about midnight and has a tough time waking up in the morning when his alarm goes off at 6 AM. On the weekends he goes to bed at about the same time, but sleeps until 10 or 11 in the morning.
This 14-year-old typifies a problem that is gaining increasing amounts of attention among educators, physicians and parents. Many teenagers are not getting enough sleep, with affected students suffering higher rates of depression and a decreased ability to focus. Lack of sleep has also been associated with obesity, cardiovascular risk, and motor vehicle and workplace accidents in adults. While some studies show that people can compensate for limited amounts of sleep deprivation, research has consistently supported the proposition that ongoing sleep deprivation results in decreased academic achievement.
The first step in recognizing adolescent sleep problems is to understand just how much sleep an average teenager needs. For a long time, conventional wisdom held that teenagers, with their seemingly limitless energy, did not require as much sleep as younger children. There is some truth to this; as infants grow older the amount of sleep they require decreases. Studies have shown that the average sleep required as children grow from 2 to 12 years decreases from 13 to 9 hours. Sleep requirements remain constant throughout adolescence at approximately 9 hours. But teenagers get less and less sleep as they get older decreasing, average sleep from 9 to 7 hours a night.
As adolescents grow they have increasing demands on their time. Jobs, extra-curricular activities, and homework all increase as children grow older and compete with sleep for their time. These competing demands result in a lower priority for sleep and, when combined with early school start-times, increase the rate of insufficient sleep, daytime sleepiness and sleep disorders. To make matters worse, evidence suggests that circadian rhythms for teenagers may be different than that of adults and younger children so that their natural time at which they become sleepy is delayed relative to the rest of the family. These problems are often exacerbated by behavioral patterns such as “sleeping in” on weekends.
If your child has sleeping problems like the patient described above, the most effective treatment is often behavioral modification. In order to change the patient’s sleep patterns it is essentially necessary to reset the patient’s circadian rhythm. This can be accomplished by having the patient go to bed 15 minutes earlier every day until the appropriate bedtime is achieved. If this does not work, the patient’s bedtime should first be stabilized then moved forward two to three hours per night, until the desired bedtime is achieved. These treatments require a motivated patient and strong family support. A single weekend or vacation with a return to earlier sleep patterns may eliminate all previous gains.
These behavioral changes must be combined with good sleep hygiene. “Sleep hygiene” refers to creating the ideal situation for sleep. Essentially a bedroom should be a cave. It should be dark, cool and have the sound of running water (white noise to cover up more distracting noises). And, as in a cave, there is no place for screens, be they television, computer or cell phone. In addition, patients should avoid any caffeine after lunchtime.
If these strategies are not able to improve your child’s sleep schedule you should check one more time to make sure there is no cell phone stashed under the pillow. (Trust me on this one.) However, if that is insufficient then evaluation by a physician for other factors that may interrupt sleep may be necessary as well as additional treatment.
For more information, visit www.essehealth.com.
By Dr. John Madden, Esse Health Pediatrician
Esse Health Pediatric & Adolescent Medicine at Watson Road
9930 Watson Road, Suite 100
St. Louis, MO 63126
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 Dahle et al, Pathways to adolescent health: Sleep regulation and behavior. Journal of Adolescent Health (2002) 31:175-84
 Carskadon et al, Intrinsic circadian period of adolescent humans measured in conditions of forced desyncrony. Neuroscience letters (1999) 260:129-32