Garrett had a hard time waking up for school during his
sophomore year. At first he thought it was because he'd been
going to bed late over summer vacation and then sleeping in the
next day. He assumed he'd adjust to his school schedule after a
couple of weeks. But as the school year progressed, Garrett found
himself lying awake in bed until 2 or 3 in the morning, even though
he got up at 6:30 AM every day. He began falling asleep in class
and his grades started to suffer.
Most teens don't get enough sleep, but that's usually
because they're overloaded and tend to skimp on sleep. But
sleep problems can keep some teens, like Garrett, awake at night
even when they want to sleep.
Over time, those nights of missed sleep (whether they're
caused by a sleep disorder or simply not scheduling enough time for
the necessary ZZZs) can build into a sleep deficit. People with a
sleep deficit are unable to concentrate, study, and work
effectively. They can also experience emotional problems, like
depression.
What Happens During Sleep?
You don't notice it, of course, but while you're asleep,
your brain is still active. As people sleep, their brains pass
through five stages of sleep. Together, stages 1, 2, 3, 4, and REM
(rapid eye movement) sleep make up a
sleep cycle
. One complete sleep cycle lasts about 90 to 100 minutes. So during
an average night's sleep, a person will experience about four
or five cycles of sleep.
Stages 1 and 2 are periods of light sleep from which a person
can easily be awakened. During these stages, eye movements slow
down and eventually stop, heart and breathing rates slow down, and
body temperature decreases. Stages 3 and 4 are deep sleep stages.
It's more difficult to awaken someone during these stages, and
when awakened, a person will often feel groggy and disoriented for
a few minutes. Stages 3 and 4 are the most refreshing of the sleep
stages - it is this type of sleep that we crave when we are very
tired.
The final stage of the sleep cycle is known as REM sleep because
of the rapid eye movements that occur during this stage. During REM
sleep, other physical changes take place - breathing becomes rapid,
the heart beats faster, and the limb muscles don't move. This
is the stage of sleep when a person has the most vivid dreams.
Why Do Teens Have Trouble Sleeping?
Research shows that teens need 81/2 to more than 9 hours of
sleep a night. You don't need to be a math whiz to figure out
that if you wake up for school at 6:00 AM, you'd have to go to
bed at 9:00 PM to reach the 9-hour mark. Studies have found that
many teens, like Garrett, have trouble falling asleep that early,
though. It's not because they don't want to sleep. It's
because their brains naturally work on later schedules and
aren't ready for bed.
During adolescence, the body's circadian rhythm (sort
of like an internal biological clock) is reset, telling a teen to
fall asleep later at night and wake up later in the morning. This
change in the circadian rhythm seems to be due to the fact that the
brain hormone melatonin is produced later at night in teens
than it is for kids and adults, making it harder for teens to fall
asleep. Sometimes this delay in the sleep-wake cycle is so severe
that it affects a person's daily functioning. In those cases
it's called
delayed sleep phase syndrome
.
Changes in the body clock aren't the only reason teens lose
sleep, though. Lots of people have
insomnia
- trouble falling or staying asleep. The most common cause of
insomnia is stress. But all sorts of things can lead to insomnia,
including physical discomfort (the stuffy nose of a cold or the
pain of a headache, for example), emotional troubles (like family
problems or relationship difficulties), and even an uncomfortable
sleeping environment (a room that's too hot, cold, or
noisy).
It's common for everyone to have insomnia from time to time.
But if insomnia lasts for a month or longer with no relief, then
doctors consider it
chronic
. Chronic insomnia can be caused by a number of different problems,
including medical conditions, mental-health problems, medication
side effects, or substance abuse. People with chronic insomnia can
often get help for their condition from a doctor, therapist, or
other counselor.
For some people, insomnia can be made worse by worrying about
the insomnia itself. A brief period of insomnia can build into
something longer lasting when a person becomes anxious about not
sleeping or worried about feeling tired the next day. Doctors call
this
psychophysiologic insomnia
.
Other conditions can disrupt sleep too. Some of these are listed
on the following pages.
Periodic Limb Movement Disorder and Restless Legs Syndrome
People with these conditions find their sleep is disrupted by
leg (or, less frequently, arm) movements, leaving them tired or
irritable from lack of sleep. In the case of periodic limb movement
disorder (PLMD), these movements are involuntary twitches or jerks:
They're called involuntary because the person isn't
consciously controlling them and is often unaware of the movement.
People with restless legs syndrome (RLS) actually feel physical
sensations in their limbs, such as tingling, itching, cramping, or
burning. The only way they can relieve these feelings is by moving
their legs or arms to get rid of the discomfort.
Doctors can treat PLMD and RLS. For some people, treating an
iron deficiency can make them go away; other people may need to
take other types of medication.
Obstructive Sleep Apnea
This sleep disorder causes a person to stop breathing
temporarily during sleep. One common cause of obstructive sleep
apnea is enlarged tonsils or adenoids (tissues located in the
passage that connects the nose and throat). Being overweight or
obese can also lead a person to develop obstructive sleep
apnea.
People with obstructive sleep apnea may snore, have difficulty
breathing, and even sweat heavily during sleep. Because it disrupts
sleep, someone with sleep apnea may feel extremely sleepy or
irritable during the day. People who show signs of obstructive
sleep apnea, such as loud snoring or excessive daytime sleepiness,
should be evaluated by a doctor.
Reflux
Some people have gastroesophageal reflux disease (GERD), which
causes stomach acid to move backward up into the esophagus,
producing the uncomfortable, burning sensation known as heartburn.
GERD symptoms can be worse when someone is lying down. Even if
someone doesn't notice the feelings of heartburn during sleep,
the discomfort it causes can still interfere with the sleep
cycle.
Nightmares
Most teens have nightmares on occasion. But frequent nightmares
can disrupt sleep patterns by waking someone during the night. Some
things can trigger more frequent nightmares, including certain
medications, drugs, or alcohol. Ironically, sleep deprivation can
also be a cause. The most common triggers for more frequent
nightmares are emotional, such as stress or anxiety. If nightmares
are interfering with your sleep, it's a good idea to talk to a
doctor, therapist, or other counselor.
Narcolepsy
People with narcolepsy are often very sleepy during the day and
have sleep "attacks" that may make them suddenly fall
asleep, lose muscle control, or see vivid dreamlike images while
dozing off or waking up. Someone's nighttime sleep may be
disrupted, with frequent awakenings throughout the night.
Narcolepsy can be disturbing because people fall asleep without
warning, making it hazardous to do things like drive. A
person's schooling, work, or social life can be affected by the
unusual sleep patterns.
Narcolepsy is not that commonly diagnosed in teens, although
many cases go unrecognized. People usually first begin to have
symptoms between the ages of 10 and 25, but may not be properly
diagnosed until 10-15 years later. Doctors usually treat narcolepsy
with medications and lifestyle changes.
Sleepwalking
It's rare for teens to walk in their sleep; most
sleepwalkers are children. Sleepwalking may run in families. It
tends to happen most often when a person is sick, has a fever, is
not getting enough sleep, or is feeling stress.
Because most sleepwalkers don't sleepwalk often, it's
not usually a serious problem. Sleepwalkers tend to go back to bed
on their own and don't usually remember sleepwalking.
(Sleepwalking often happens during the deeper sleep that takes
place during stages 3 and 4 of the sleep cycle.) Sometimes, though,
a sleepwalker will need help moving around obstacles and getting
back to bed. It's also true that waking sleepwalkers can
startle them (but it isn't harmful), so try to guide a
sleepwalker back to bed gently.
What Should I Do?
If you think you're getting enough rest at night and
you're still feeling tired during the day, it's a good idea
to visit your doctor. Excessive tiredness can be caused by all
sorts of health problems, not just difficulties with sleep.
If your doctor suspects a sleep problem, he or she will look at
your overall health and sleep habits. In addition to doing a
physical examination, the doctor will take your medical history by
asking you about any concerns and symptoms you have, your past
health, your family's health, any medications you're
taking, any allergies you may have, and other issues. The doctor
may also do tests to find out whether any conditions - such as
obstructive sleep apnea - might be interfering with your sleep.
Different sleep problems are treated differently. Some can be
treated with medications, whereas others can be helped by special
techniques such as light therapy (where someone sits in front of a
lightbox for a certain amount of time each day) or other practices
that can help reset a person's body clock.
Doctors also encourage teens to make lifestyle changes that
promote
good sleeping habits
. You probably know that caffeine can keep you awake, but many
teens don't realize that playing video games or watching TV
before sleeping can do the same thing.
Reviewed by:
Elana Pearl Ben-Joseph, MD
Date reviewed: August 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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