Sleep Problems in Teens

Most teens don't get enough sleep, usually because their schedules are overloaded or they spend too much time texting or chatting on the computer with friends until the wee hours of the morning. Other teens try to go to sleep early, but sleep problems prevent them from doing so.

Over time, 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. Teens with a sleep deficit are unable to concentrate, study, and work effectively. They can also experience emotional problems, like depression.

What Happens During Sleep?

As we sleep, our 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.

What Prevents an Early Bedtime?

Research shows that teens need 8½ to 9½ hours of sleep a night. So, a teen who wakes up for school at 6 a.m. would have to go to bed at 9 p.m. to reach the 9-hour mark. Studies have found that many teens 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 (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. Read on to learn about some of the biggest causes of sleep deprivation.

Insomnia

Lots of us 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 teenagers to have insomnia from time to time. But if insomnia lasts for a month or longer with no relief, 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. Teens with chronic insomnia can often get help for their condition from a doctor, therapist, or other counselor.

For some, insomnia can be made worse by worrying about the insomnia itself. A brief period of insomnia can build into something longer lasting when someone becomes anxious about not sleeping or worried about feeling tired the next day. Doctors call this psychophysiologic insomnia.

Periodic Limb Movement Disorder and Restless Legs Syndrome

Teens 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.

Teens 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 with medications. For some teens, treating an iron deficiency can make the conditions go away.

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 also can lead someone to develop obstructive sleep apnea.

Teens with obstructive sleep apnea might 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.

Treatment is available for teens with sleep apnea. Those who show signs of the condition, such as loud snoring or excessive daytime sleepiness, should be evaluated by a doctor.

Reflux

Gastroesophageal reflux disease (GERD) is another common culprit of sleep loss. With GERD, stomach acids move backward up into the esophagus, producing the uncomfortable, burning sensation known as heartburn.

GERD symptoms can be worse when a person 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. Some people find they are better able to sleep by lying in an elevated position or by taking medications.

If your teen suffers from GERD, it could be interfering with his or her sleep. Talk to a doctor about treatment options or lifestyle changes, such as changes in diet.

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 also can be a cause. The most common triggers for more frequent nightmares are emotional, such as stress or anxiety.

If nightmares are interfering with your teen's sleep, consider consulting a doctor, therapist, or other counselor.

Narcolepsy

Teens 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. Nighttime sleep may be disrupted, with frequent awakenings throughout the night.

Narcolepsy can be disturbing because teens fall asleep without warning, making it hazardous to do things like ride a bike or drive. A teens's schooling, work, or social life can be affected by the unusual sleep patterns.

Narcolepsy is not commonly diagnosed in teens, although many cases go unrecognized. People usually begin to have symptoms between the ages of 10 and 25, but might 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.

How to Help

If your teen seems to be getting enough rest at night but is still feeling tired during the day, it's a good idea to visit the doctor. Excessive tiredness can be caused by all sorts of health problems, not just difficulties with sleep.

If a sleep problem is suspected, the doctor will evaluate your teen's overall health and sleep habits. In addition to doing a physical examination, the doctor will take a medical history by asking about any concerns and symptoms your teen has, and about his or her past health, your family's health, and any medications your teen is taking. The doctor may also do tests to find out whether any conditions — such as obstructive sleep apnea — might be interfering with 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.

When teens have sleep problems, doctors often encourage them to make lifestyle changes — like turning off the cell phone or computer before bed, cutting down on caffeine, or avoiding violent video games or movies at night — to promote good sleeping habits.

Reviewed by: Mary L. Gavin, MD
Date reviewed: May 2011

Source:  http://kidshealth.org/parent/growth/sleep/sleep_problems.html#

All About Sleep

Sleep — or lack of it — is probably the most-discussed aspect of baby care. New parents discover its vital importance those first few weeks and months. The quality and quantity of an infant's sleep affects the well-being of everyone in the household.

And sleep struggles rarely end with a growing child's move from crib to bed. It simply changes form. Instead of cries, it's pleas or refusals. Instead of a feeding at 3:00 AM, it's a nightmare or request for water.

So how do you get your child to bed through the cries, screams, avoidance tactics, and pleas? How should you respond when you're awakened in the middle of the night? And how much sleep is enough for your kids?

How Much Is Enough?

It all depends on a child's age. Charts that list the hours of sleep likely to be required by an infant or a 2-year-old may cause concern when individual differences aren't considered. These numbers are simply averages reported for large groups of kids of particular ages.

There's no magical number of hours required by all kids in a certain age group. Two-year-old Sarah might sleep from 8:00 PM to 8:00 AM, whereas 2-year-old Johnny is just as alert the next day after sleeping from 9:00 PM to 6:00 AM.

Still, sleep is very important to kids' well-being. The link between a lack of sleep and a child's behavior isn't always obvious. When adults are tired, they can be grumpy or have low energy, but kids can become hyper, disagreeable, and have extremes in behavior.

Most kids' sleep requirements fall within a predictable range of hours based on their age, but each child is a unique individual with distinct sleep needs.

Here are some approximate numbers based on age, accompanied by age-appropriate pro-sleep tactics.

Babies (up to 6 Months)

There is no sleep formula for newborns because their internal clocks aren't fully developed yet. They generally sleep or drowse for 16 to 20 hours a day, divided about equally between night and day.

Newborns should be awakened every 3 to 4 hours until their weight gain is established, which typically happens within the first couple of weeks. After that, it's OK if a baby sleeps for longer periods of time. But don't get your slumber hopes up just yet — most infants won't snooze for extended periods of time because they get hungry.

After the first couple of weeks, infants may sleep for as long as 4 or 5 hours — this is about how long their small bellies can go between feedings. If babies do sleep a good stretch at night, they may want to nurse or get the bottle more frequently during the day.

Just when parents feel that sleeping through the night seems like a far-off dream, their baby's sleep time usually begins to shift toward night. At 3 months, a baby averages about 13 hours of sleep in a 24 hour period (4-5 hours of sleep during the day broken into several naps and 8-9 hours at night, usually with an interruption or two). About 90% of babies this age sleep through the night, meaning 5 to 6 hours in a row.

But it's important to recognize that babies aren't always awake when they sound like they are; they can cry and make all sorts of other noises during light sleep. Even if they do wake up in the night, they may only be awake for a few minutes before falling asleep again on their own.

If a baby under 6 months old continues to cry, it's time to respond. Your baby may be genuinely uncomfortable: hungry, wet, cold, or even sick. But routine nighttime awakenings for changing and feeding should be as quick and quiet as possible. Don't provide any unnecessary stimulation, such as talking, playing, or turning on the lights. Encourage the idea that nighttime is for sleeping. You have to teach this because your baby doesn't care what time it is as long as his or her needs are met.

Ideally, your baby should be placed in the crib before falling asleep. And it's not too early to establish a simple bedtime routine. Any soothing activities, performed consistently and in the same order each night, can make up the routine. Your baby will associate these with sleeping, and they'll help him or her wind down.

The goal is for babies to fall asleep independently, and to learn to soothe themselves and go back to sleep if they should wake up in the middle of the night.

6 to 12 Months

At 6 months, an infant may nap about 3 hours during the day and sleep about 9 to 11 hours at night. At this age, you can begin to change your response to an infant who awakens and cries during the night.

Parents can give babies a little more time to settle down on their own and go back to sleep. If they don't, comfort them without picking them up (talk softly, rub their backs), then leave — unless they appear to be sick. Sick babies need to be picked up and cared for. If your baby doesn't seem sick and continues to cry, you can wait a little longer, then repeat the short crib-side visit.

Between 6 and 12 months, separation anxiety, a normal developmental phase, comes into play. But the rules for nighttime awakenings are the same through a baby's first birthday: Try not to pick up your baby, turn on the lights, sing, talk, play, or feed your child. All of these activities do not allow your baby to learn to fall asleep on his or her own and encourage repeat awakenings.

Toddlers

From ages 1 to 3, most toddlers sleep about 10 to 13 hours. Separation anxiety, or just the desire to be up with mom and dad (and not miss anything), can motivate a child to stay awake. So can simple toddler-style contrariness.

Parents sometimes make the mistake of thinking that keeping a child up will make him or her sleepier for bedtime. In fact, though, kids can have a harder time sleeping if they're overtired. Set regular bedtimes and naptimes. Though most toddlers take naps during the day, you don't have to force your child to nap. But it's important to schedule some quiet time, even if your child chooses not to sleep.

Establishing a bedtime routine helps kids relax and get ready for sleep. For a toddler, the routine may be from 15 to 30 minutes long and include calming activities such as reading a story, bathing, and listening to soft music.

Whatever the nightly ritual is, your toddler will probably insist that it be the same every night. Just don't allow rituals to become too long or too complicated. Whenever possible, allow your toddler to make bedtime choices within the routine: which pajamas to wear, which stuffed animal to take to bed, what music to play. This gives your little one a sense of control over the routine.

But even the best sleepers give parents an occasional wake-up call. Teething can awaken a toddler and so can dreams. Active dreaming begins at this age, and for very young children, dreams can be pretty alarming. Nightmares are particularly frightening to a toddler, who can't distinguish imagination from reality. (So carefully select what TV programs, if any, your toddler sees before bedtime.)

Comfort and hold your child at these times. Let your toddler talk about the dream if he or she wants to, and stay until your child is calm. Then encourage your child to go back to sleep as soon as possible.

Preschoolers

Preschoolers sleep about 10 to 12 hours per night. A preschool child who gets adequate rest at night may no longer needs a daytime nap. Instead, a quiet time may be substituted.

Most nursery schools and kindergartens have quiet periods when the kids lie on mats or just rest. As kids give up their naps, bedtimes may come earlier than during the toddler years.

School-Age Children and Preteens

School-age kids need 10 to 12 hours of sleep a night. Bedtime difficulties can arise at this age for a variety of reasons. Homework, sports and after-school activities, TVs, computers, and video games, as well as hectic family schedules might contribute to kids not getting enough sleep.

Lack of sleep can cause irritable or hyper types of behavior and may make it difficult for kids to pay attention in school. It is important to have a consistent bedtime, especially on school nights. Be sure to leave enough time before bed to allow your child to unwind before lights out.

Teens

Adolescents need about 8½ to 9½ hours of sleep per night, but many don't get it. Because of early school start times on top of schedules packed with school, homework, friends, and activities, they're typically chronically sleep deprived.

And sleep deprivation adds up over time, so an hour less per night is like a full night without sleep by the end of the week. Among other things, an insufficient amount of sleep can lead to:

• decreased attentiveness
• decreased short-term memory
• inconsistent performance
• delayed response time

These can cause bad tempers, problems in school, stimulant use, and driving accidents (more than half of "asleep-at-the-wheel" car accidents are caused by teens).

Teens also experience a change in their sleep patterns — their bodies want to stay up late and wake up later, which often leads to them trying to catch up on sleep during the weekend. This sleep schedule irregularity can actually aggravate the problems and make getting to sleep at a reasonable hour during the week even harder.

Ideally, a teen should try to go to bed at the same time every night and wake up at the same time every morning, allowing for at least 8 to 9 hours of sleep.

Bedtime Routines

No matter what your child's age, establish a bedtime routine that encourages good sleep habits. These tips can help kids ease into a good night's sleep:

• Include a winding-down period in the routine.
• Stick to a bedtime, alerting your child both half an hour and 10 minutes beforehand.
• Encourage older kids and teens to set and maintain a bedtime that allows for the full hours of sleep needed at their age.

Reviewed by: Mary L. Gavin, MD
Date reviewed: January 2011

Source:  http://kidshealth.org/parent/growth/sleep/sleep.html#

Sleep Tips and Advice (BBC)

Do you like to have a weekend lie-in or a nightcap before going to bed? These habits could actually be harming your sleep.

Relax your mind

• Simple breathing exercises can help. Breathe, using your abdomen not your chest, through your nose for three seconds, then breathe out for three seconds. Pause for three seconds before breathing in again. Practise this for ten minutes at night (five minutes is better than nothing).
• Some people find that lavender oil, valerian or other herbs help them to sleep.
• If you still have problems, you could try massage, aromatherapy, or even acupuncture.
• If you still find yourself tossing and turning, abandon the bedroom and find something enjoyable and absorbing to do. Jigsaws are perfect. Don't go back to bed until you begin to feel sleepy.

Exercise regularly

• Regular exercise is a great way to improve your sleep. Just be careful not to do it close to bed time as exercise produces stimulants that stop the brain from relaxing quickly.
• This being the case, exercising in the morning is an excellent way to wake up the body. Going for a run or doing some aerobics releases stimulants into the body, which perks you up.
• If you are injured or disabled, you can still benefit from exercise. Check out disability exercise tips.

Create a calm bedroom environment

• Your bedroom should be for sleep only. Avoid turning it into an entertainment centre with televisions, computers and stereos.
• Two thirds of British children have a computer, games machine or TV in their bedroom and could be losing out on sleep as a result.

Avoid alcohol

• It's fine to have a nightcap, but too much alcohol can make you restless. Alcohol is also a diuretic, which means it encourages you to urinate (never welcomed during the night).
• Drinking is also more likely to lead to snoring, which can restrict airflow into the lungs. This reduces oxygen in your blood which disturbs your sleep and contributes to your hangover.

Avoid caffeine

• Caffeine is a stimulant which can stay in your system for many hours. So avoid sources of caffeine such as coffee, chocolate, cola drinks and non-herbal teas.

Watch what you eat

• Eating a large heavy meal too close to bedtime will interfere with your sleep.
• Spicy or fatty foods may cause heartburn, which leads to difficulty in falling asleep and discomfort throughout the night.
• Foods containing tyramine (bacon, cheese, ham, aubergines, pepperoni, raspberries avocado, nuts, soy sauce, red wine) might keep you awake at night. Tyramine causes the release of norepinephrine, a brain stimulant.
• If you get the munchies close to bedtime, eat something that triggers the hormone serotonin, which makes you sleepy. Carbohydrates such as bread or cereal will do the trick.

Set a regular bedtime and wake up time

• Create a habit of going to bed and waking up at the same time each day, even on weekends. This helps anchor your body clock to these times. Resisting the urge for a lie-in can pay dividends in alertness.
• If you feel you haven't slept well, resist the urge to sleep in longer than normal; getting up on schedule keeps your body in its normal wake-up routine.
• Remember, even after only four hours, the brain has gained many of the important benefits of sleep.

It's only natural

• Most of us have a natural dip in alertness between 2 - 4pm.
• A 15 minute nap when you're tired can be a very effective way of staying alert throughout the day. Avoid napping for longer than 20 minutes, after which you will enter deep sleep and feel even worse when you wake up.

See a doctor if your problem continues

• If you have trouble falling asleep night after night, or if you always feel tired the next day, you might have a sleep disorder. It is advisable to seek more advice from your doctor. Most sleep disorders can be treated effectively.

Source:  http://www.bbc.co.uk/science/humanbody/sleep/articles/advicetips.shtml