During infancy, a baby will sleep about sixteen to eighteen hours each day, while adults spend about seven to eight hours in sleep on a daily basis. For teenagers, the sleep requirement is increased, but certainly not on the order of an infant or toddler’s needs. Most adolescents probably need about eight to ten hours of sleep each day, but school schedules do not usually accommodate this. As a result, daytime sleepiness in adolescence is common and this is usually due to the teen not having enough nighttime sleep.
Sleep is divided in REM or rapid eye movement sleep and NREM which is termed non-rapid eye movement sleep. REM sleep cycles on and off throughout the night starting about one and one half hours after the teen falls asleep; brain activity is comparable to that during the wake period. Interestingly, the skeletal muscles are virtually paralyzed. The duration of REM sleep increases during the night and is longest in the early morning hours. Dreaming occurs during REM sleep. NREM sleep is divided into four stages, and the deepest two stages occur in the first part of the night and account for ten to twenty percent of sleep time. These deep stages are most difficult to interrupt and are the most refreshing for the teen. There is some evidence, though not conclusive, that protein synthesis and RNA transcription are prominent during the deep phase of sleep, and some authorities believe that the deep phases of NREM allow for recovery from activity debts. Others feel that NREM sleep is important in bolstering the immune system. With sleep deprivation, adolescents as well as adults have a decline of cognitive function. Sleep will allow restoration of cognition, and this may be due, in part, to the functions of the deep sleep stages.
The sleep-wake cycle is matched to the solar night-day cycle. This is generated internally by the circadian rhythm with some influence by the environment. If a teen is placed in a totally dark room for days, the circadian rhythm will adjust to a bit longer than twenty-four hours. Light signals help to reset the circadian cycle each day. Twenty-four hour days or nights, as seen in areas above the arctic circle, may have an influence on the sleep cycle, and individuals who are totally blind have sleep and rhythm disturbances.
Disorders with the circadian rhythm such as delayed sleep phase syndrome, DSPS, may lead to sleep problems in adolescents. The onset of sleep may be delayed by several hours, as the teen may not become sleepy until the early morning hours. Then the teen needs to arise for school. As a result he or she may have excessive daytime sleepiness manifested by falling asleep in class. Academics may suffer, grades could fall and the teen may become depressed. There is some belief that melatonin secretion, which helps to induce sleep, becomes off schedule in this disorder since it should be secreted at the transition to darkness at night. Most cases of DSPS can be managed by attempting to adjust the circadian rhythm using bright-light treatment and medications.
Jet lag is another problem that is related to disruption of the circadian rhythm. After rapid travel, especially in an eastward direction resulting in a shortened day, the circadian rhythm is disturbed. A prominent symptom of jetlag is difficulty in sleeping. Going to bed earlier for a few days prior to an eastward trip may be helpful, as will exposure to sunlight at the destination.
In teens, daytime sleepiness may also be a symptom of sleep apnea. Obstructive sleep apnea occurs when the tissues in the upper part of the throat collapse and block the passage of air. Teens with this problem may stop breathing for ten seconds or longer hundreds of times during the night. When breathing stops, the oxygen level in the blood decreases and eventually sends a signal to the brain. The brain then triggers the lungs to take a deep breath. This does not usually awaken the teen, but it does not allow for restful sleep. Sometimes, large tonsils or adenoids that cause obstruction may cause sleep apnea.
Teens with sleep apnea are at higher risk for automobile accidents and may have impaired concentration. Polysomnography is useful in making the diagnosis. If the tonsils and adenoids are enlarged, then surgical removal may be helpful. Continuous positive airway pressure, CPAP, may help to prevent collapse of the upper airway and prevent the apnea.
Snoring may be a sign of sleep apnea or it may occur for other reasons. This noisy problem occurs when there are structures in the upper airway that vibrate when the teen breathes or if there is obstruction to the smooth passage of the air. Snoring may be due to blockage from allergies, a cold or sinus infection, an injury that has changed the shape of the nose or even sleeping on the back. When a teen sleeps on his or her back, the tongue may fall backward partially obstructing the throat. This could lead to the snoring sounds. Some of the solutions to snoring include sleeping on one’s side or stomach, using medication to unclog nasal passages or raising the head of the bed.
Sleepwalking or somnambulism is seen in children and teens. Up to forty percent of children and adolescents have had at least one episode of sleepwalking, and these episodes occur in the deepest levels of sleep. Typically the teen walks while asleep with his or her eyes open but with a blank look. Some semi purposeful acts may be performed including turning lights on and off or dressing and undressing. Most sleepwalking occurs about one to two hours after the onset of sleep and lasts fifteen to twenty minutes. The teen cannot be awakened. Most teens outgrow sleepwalking. It is important to provide protection since serious injury can occur during the sleepwalking episode.
Sleep deprivation may increase the likelihood of sleepwalking in an adolescent who is prone to the problem.
Some teens who have a sleep debt may develop an eyelid twitch. These usually go away without treatment especially if the reason for lack of sleep is elicited. For example, teens who are over stressed, take in excessive amounts of caffeine, abuse substances or have late hours may develop sleep debt. As a result eyelid twitches may occur.
Insomnia in teens may also be due to medications or stress. Caffeine, alcohol or medications such as pseudoephedrine or methylphenidate (Ritalin), may cause wakefulness. Nicotine may also lead to wakefulness. Stress from academics or life situations can cause temporary insomnia.
Interestingly progesterone may promote sleep. This hormone usually is lowest during menstruation and could cause insomnia at that time. It rises during and after ovulation and some females report better sleep in the second half of the menstrual cycle.
Insomnia may be a symptom of depression in adolescents. Depressed adolescents may also have early morning awakenings resulting in fewer hours of sleep.
A variety of therapies have been proposed for insomnia in adolescents. These include herbs, homeopathy, acupuncture, massage, light therapy, exercise as well as traditional medications. If there is a reason, such as depression, the root cause should be evaluated and treated. All teens should strive for proper sleep habits that include the following:
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Use the bed for sleep only rather than eating or studying
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Avoid caffeine in the hours before sleep
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Keep away from a large meal before sleep
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Evening naps should be avoided
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Regular bedtime and awakening hours are usually helpful
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Do something relaxing and enjoyable in the thirty minutes prior to sleep including reading or meditation
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Exercise in the evening may be helpful, but try not to have vigorous exercise very close to bedtime
Related topics:
Academics, accidents, alcohol, blindness, depression, exercise, insomnia, menstruation, narcolepsy and cataplexy, sleepwalking
