Is It Typical Teenage Behavior -- Or A Sleep Disorder?

Several years ago a mother, father and their 17-year-old son came to our sleep clinic to discuss the son's "sleeping problem." A senior in high school, the teenager had missed about 50 percent of his first period classes and was in danger of failing. According to his mother, the problem was simple: "He cannot get up in time for school."

His father was less concerned. Dad believed the problem was also simple -- his son was a "slacker" and just needed to go to bed on time. Weeks before their appointment, the son's sleep problems had resulted in a somewhat tumultuous home situation with the police having to break up a family disturbance. Dad, tired of trying unsuccessfully to wake up his "slacker" son each morning, threw a bucket of ice water on him. Obviously shocked (and cold), the son jumped out of bed and began punching his father, while mom looked on and called 911.

Not all presentations of this scenario are quite so dramatic, but many do involve family discord. After obtaining a complete sleep history, it was apparent that this young man was not lazy or oppositional -- he had Delayed Sleep Phase Syndrome (DSPS).

DSPS is a circadian rhythm disorder affecting the timing of the brain's sleep-wake clock. Individuals with DSPS are unable to fall asleep earlier than their usual sleep time, despite being sleep deprived from staying up the night before.

DSPS is a disorder that affects 7-16 percent of children and teenagers. The causes of DSPS have not been confirmed although most sleep specialists believe it may be an exaggerated reaction to the normal shift in internal clocks that adolescents experience during puberty.

Most of us have an internal clock that runs slightly longer than 24 hours, resulting in a natural tendency to delay sleep. Environmental factors such as social routines, timing of meals and exposure to light serve to reset the clock to keep it stable. Sensitivity to environmental factors that regulate the sleep-wake cycle may be attenuated in adolescence. DSPS often runs in families, so if you were a night owl during your teenage years, your son or daughter may inherit a similar sleep pattern.

Are you constantly dragging your son or daughter out of the bed? The symptoms of DSPS include:

Inability to Fall Asleep Before 2 or 3 a.m. Many individuals with DSPS first believe they are insomniacs. For teenagers, the inability to initiate sleep at conventional hours may be exacerbated by social pressure to communicate throughout the night via cell phones or computers.

Inability to Wake Up On Time for School or Work. While most people do not jump out of bed each morning when their alarm goes off, a person with DSPS will often sleep through multiple alarms and be very difficult to arouse even if given substantial incentives to do so.

Excessive Daytime Sleepiness. A common complaint of DSPS is the overwhelming feeling of sleepiness in the morning and up to the early afternoon. Sleeping during morning classes is a common sign.

Depression and Drug Abuse. Children and teenagers with DSPS are more likely to experience depression and other behavioral problems.

If you believe your son or daughter has DSPS, contact your family doctor or a sleep specialist. Most sleep specialists will suggest keeping a sleep diary, allowing both the doctor and the patient to gain a quick, clear understanding of sleep-wake patterns. A sleep study is not required to make the diagnosis.

Once diagnosed with DSPS, treatment options may include:

Light Therapy. Exposure to a bright light will help naturally reset your child's internal clock and advance the circadian rhythm. Sitting in a sunlit room or taking a walk in the morning is effective. However, that might not be practical given the sunrise schedule and/or weather conditions. There are several good commercially available light boxes, also used for treating Seasonal Affective Disorder (SAD). Physicians most often recommend turning on the light box for around 30 minutes in the morning. The production of sleep regulator melatonin is inhibited by light, helping your child wake up earlier and on time.

Schedule Adjustment. Depending on your child's natural sleep rhythm, DSPS may be controlled by slight, incremental changes in bed time. If your child normally falls asleep around 1 am when he or she needs to be asleep by 11, set the bedtime to 12:45 one night, 12:30 the next night, and so on until the child is naturally falling asleep by the target time. For children who fall asleep too early, the same practice can be followed by setting the bedtime 15 minutes ahead each night.

Good Sleep Hygiene. The most important part of restful, healthy sleep is a consistent sleep-wake routine. Those at risk of or with DSPS should adopt a regimented sleep schedule, going to bed and waking up at the same time each day. Limit the child's exposure to stimulants such as caffeine and sugar as well. In the bedroom, try to keep it as cool and quiet as possible. Limit their exposure to sensory-awakening activities like television and video games in the evening.

Medication. There are no FDA-approved drugs for the treatment of DSPS. A sleep doctor may recommend a low dose of melatonin to be given in late afternoon or early evening in addition to bright light exposure.

As your son or daughter continues to develop, he or she will most likely outgrow DSPS. However, it is important to treat the condition, once diagnosed, to ensure that your child is receiving the proper amount of rest throughout all developmental stages. Teenagers needs 8-9 hours of sleep each night.

For more information on DSPS and treatment options, visit the National Sleep Foundation at www.sleepfoundation.org.

 

Comments

[unique]

06:49 PM on 10/09/2011

My sister is in the Army in Iraq. Her son 19 /yo, my nephew is staying with me.
When I am ready to go to sleep 9:30 PM, he is ready to go out with his friends.
My friend that has two teenage boys, says that is what teenagers do. As long
as he does not get in trouble I have no problem.

[investment8813]

09:50 AM on 09/03/2011

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[ChrisL920]

04:45 PM on 09/02/2011

I have to be honest, this disorder describes every summer vacation I had since the sixth grade. I looked into it, and I read it has to do with melatonin.

I just thought it was because I wasn't burning as much energy in the summer as I was in the school year. I'd bust my ass in school and relax in the summer, even if I couldn't sleep till 2:00 or 3:00 a.m.

[George Howard]

03:53 PM on 09/02/2011

The world is having a difficult time working with ME! My goals are to ensure healthcare for every child and human on the planet, to do nothing that degrades the Earth and steals from the future's humans, to have a U.S. vote granted at birth for life and public financed elections without corporate influence, and to have free schooling for life for all citizens. Uneducated, sick, disenfranchised people are easily led, easily scared, and are putty in the hands of the inhuman corporation, whose only reason for existence is profit. Anyone who is angry at these words is certainly not a Christian, Jesus would say, "Amen, brother!" Staying up late at night? Not fitting in with society? Society isn't fitting ME! Find your own rhythm, fight for the children.

[mkthinker]

01:17 AM on 09/02/2011

I had a boyfriend in college. When he was in high school he got up early for marching band practice before school. Then after they had non-marching band practice. So when he go home at like 5 he generally took a nap. His parents assumed he was on drugs, they always accused him of random drug use (they didn't know there were different kinds, so to them heroin and pot were 2 different names for the same substance). Eventually, since he already had to deal with the accusations he ended up smoking quite a bit of pot and not doing well grade-wise in college. As his 18 year old gf he told me how he 'slept all the time' when he was like 14-16 and I asked 'well did you grow any?. -come to find out he at that time grew over a foot in a year- that takes some energy and sleeping time. It's funny to me I figured this out at 18 and his parents basically were stumped and sort of screwed up their relationship with him and almost gave him a 'free pass' to drugs (if you are going to be treated like you do them, you might as well do them). Teenagers are going through a lot. Don't label people 'disordered' when they are in a period of great change.

[burtongrl]

02:58 PM on 09/01/2011

Limit kids exposure to video games, Internet and television. I see too many kids with their faces buried in a nintendo ds, iPod, iPad, cell phone..it's ridiculous. Let them play outside or something, burn off some energy.

[SonyaInTx]

08:37 AM on 09/01/2011

If kids have a full and active schedule, they will have no problem going to bed at a reasonable hour.

Ans parents in turn need to get the child out of bed at the same time each day.

Adults need to go to work on time. Students need to get to school on time too.

Learning to manage time is a part of becoming a responsible adult.

[Quint Michael Long]

07:51 AM on 09/01/2011

I normally dont go to bed until 2am, then I wake up at 6 am, except for on the weekends and im 17. I function fine, unless I go to sleep earlier than the normal time I go to bed which is actually between 1 and 2 am. I don't have a disorder, I just like to stay up later. My body is used to that schedule. I do my best work at night, usually between 11pm amd 1am. Not saying that this person didn't actually have a disorder, but still, going to bed at 2am and not wanting to get up at 6 isn't always a disorder. Maybe he just wants to sleep!! Every teen does.

[yogini4]

04:00 AM on 09/01/2011

I had this as a teen, but then so did my Mom.. and now so does my daughter. I don't think it's a disorder; we are just wired to be night owls. My perfect work schedule has always been 12 p-8p. I see it more as a diversity issue, that makes life more difficult for some than for others.

[George Howard]

04:06 PM on 09/02/2011

Yogini4, as always, you refresh and raise me up. Diversity is the goal, everyone into the square hole is the goal of Facism. I have come to see that almost all differences between people, as long as they don't hurt others, are nature's way of filling the gaps. There is room for the fast and the slow, the far-sighted and the near-sighted, the tall and the short, and every difference under the sun. Narrow-mindedness is the enemy, and, as you have said, diversity is the goal. I love your posts, keep it up, girl!

[yogini4]

10:57 PM on 09/03/2011

Thank you kindly!

[ThirdWorldAmerika]

12:54 AM on 09/01/2011

What I don't get is anything "outside the norm" is now considered a disorder. I find it insulting.

[skunky93]

01:21 PM on 09/02/2011

It's when it affects one's ability to function in society that it becomes alarming. Not just because it's outside the norm. For example, someone who routinely goes to bed at 3 am is normally unable to wake up at their best functioning level at 7am so they would find it difficult to focus on writing tasks e.g. resume/cover letter writing; job hunting; planning, etc. They would start to blame themselves for being a slacker but find it just as hard the following night to go to bed. So not only does this affect goal reaching abilities but it also starts to affect self-image. It's a disorder when the person is unable to change the pattern or control it in order to gain some control over their lives.
That's what I've found with myself and my siblings who have this problem. It frustrates us and it has frustrated anyone who it ends up affecting since childhood. No matter what my parents did, I would lie awake. My brother has the same problem.

[Chris Mcpeek]

09:11 PM on 08/31/2011

im 17 i go to sleep at 10:00 and wake up at 6:00 and when i get home i immediately take a afternoon nap is that bad, plus i sleep in 1st period?

[IconoclasticYouth]

10:24 PM on 08/31/2011

Just human....

[Taymullah]

09:10 PM on 08/31/2011

Smoke a bowl, I cant sleep before 2 or 3 am a lot, but a lil pot and im out like a rock.

[ldyqtee6]

08:12 PM on 08/31/2011

Sleep disorder my arse. Instill appropriate bed time routines when young and it will continue. Set some ground rules that include no phone calls, computers, video games, text messaging, hanging out (ever heard of a curfew?) etc. after a set time at night, even if it means taking the items away.

I do not allow anyone to call me after 8:30PM unless it's an absolute emergency (like a family member has been in an accident and has been rushed to the hospital) and I'm an adult. When my kids decide they want to stay up late at night, I purposely wake them up early the next morning and make them do things (I've been known to wake them at 6AM knowing full well they didn't go to sleep until 3 or 4) and never allow them to be late to school because they were "too tired". Simply put, every action has a consequence; teenagers need to be taught that and deal with it.

Society is too busy trying to adjust to people's bad choices instead of people adjusting themselves to societal norms. High schools starting later to accommodate teenagers who refuse to arrive to school on time only encourages more poor time management skills on the part of teens.

[yogini4]

03:58 AM on 09/01/2011

I agree with your theory but your methods are harsh and will probably backfire. Out of resentment they may now have issues with wake/sleep their entire lives.

[Quint Michael Long]

08:00 AM on 09/01/2011

I agree with yogini4. My parents are the same way with people calling after a certain hour (10:00 at the latest). But allowing them to stay up and then purpously waking them up at 6am, is just harsh. If your going to be the one to allow them to sleep in then you should also allow them a full nights rest, as long as it is not a school day, if it is then they should have to face the consequences like every other tired teenager who stays up late and drags their butt into school the next day. Im not trying to tell you how to raise your children, but dang give them a break. If they wanna stay up on the weekends and sleep in then let them.

[merlinspinoza]

05:53 PM on 08/31/2011

i am a peasant .....my true calling was being a conscious player in the stock market ...making abillion dollars selling noflush composting toilets in India was also a possibility

i trust this a helpful comment.

disorder is lack of order .... lack of order is lack of pure spirituality integrated in neurophysiology!

no doubt this is even more helpfull.

...at this satge in human history any PHD who doesnt recommend meditation for any socalled disorder is not a PHD

Transcendental meditation (TM) [ qualifies for CME credits ] is the beginning of any healing or normalization.

the complete solution is Maharishi ayurveda [ accepted as CME credit for MDs ] and

maharishi sthapatya veda architecture and planning [ green and cosmic architecture in accord with natural law, to resolve the environment component]

[springhillsleep]

03:24 PM on 08/31/2011

Actually, the schedule adjustment advise is wrong. Advising people that have DSPS to go to bed 15 minutes earlier each night doesn't work. The problem is that they can not fall asleep until 2 am. How is laying in bed 15 minutes earlier each night going to work? The actual schedule adjustment treatment is to have them stay up 15 minutes later each night until they reach the desired sleep time. Obviously the best time for a teenager is during summer break.

[Quint Michael Long]

07:55 AM on 09/01/2011

I agree. Im 17, dont have this disorder, but I cant fall asleep until the early morning hours. Going to sleep 15 minues early isn't going to change anything. I always end up staring at the ceiling until between 1 and 2 am until I fall asleep.

[yogini4]

10:56 PM on 09/03/2011

All the recent sleep studies show that teens have this tendency. Did you know medical organizations have recommended that schools start later to accommodate this biological need? I recommended to my daughter that she use that time wisely, and read something informative but mildly boring, like history or even spiritual tomes. Now she knows quite a bit about the Lewis and Clark expedition :).