Q: My 15-year-old boy stays up until late and can’t get up in the mornings–is he just a “night owl”?
A: Perhaps. However, social and environmental factors can cause adolescents to shift the phase of their sleep-wake pattern. Factors that can contribute to this shift include a full extracurricular program (lots of homework as well as after school activities), a busy social life, a television and computer in the bedroom that can be used till late, poor adherence to a regular sleep-wake schedule, or parents who have difficulty with limit-setting. Of course, there may be a genetic determinant to staying up late, but this must be distinguished from behaviors that have led to the exacerbation or development of this tendency.
Q: When does staying up late into the night become a problem?
A: Staying up late and going to bed late becomes a problem if it starts interfering with daytime functioning. If an adolescent has difficulty sleeping at a normal time, and because sleep needs are still high (9–10 hours a night), he or she might find it difficult to get up in the morning. If this means being late for school, missing the first class, or falling asleep in class, your adolescent has a problem.
Q: Could my 15-year-old have delayed sleep phase syndrome (DSPS)?
A: Most often, the answer is “no” and the phase shift is due to behavioral reasons, such as an overloaded activity and school schedule, social activities, or work schedule. There must also be an absence of any mood or medical disorder. DSPS is a circadian rhythm disorder with an exaggerated “night owl” pattern of sleep and wakefulness.
Q: How will I know whether my teen has DSPS?
A: Generally, the adolescent with delayed sleep phase syndrome (DSPS) has sleep onset and waking times that are delayed by 3–6 hours when compared to conventional sleep-wake times. The disorder should be present for one month or longer and other possible reasons for daytime sleepiness should be discounted. If your adolescent does have DSPS, he is likely to be sleepy and ready to go to bed between 2am and 6am and will generally get up some time between 10am and 1pm. You can expect his sleep to be normal. He will normally not be hungry in the mornings and will tend to want to eat closer to bedtime. If allowed to sleep late, he will also feel better and report less daytime sleepiness, especially on weekends and holidays.
Q: How can I help my 15-year-old son to get back into a more normal pattern of sleeping and waking?
A: The most important thing for you to do is to evaluate not only your 15-year-old’s lifestyle but also the way in which you help–or don’t help–reinforce a consistent sleep-wake schedule. Look at his activities both at school and after school, and note down the times at which they occur. Try to schedule activities for earlier parts of the day or reschedule them outside the school week. Sleep hygiene is still incredibly important at this age, just as it is at any other. It is extremely important to establish a consistent bedtime and, crucially, a getting-up time for the mornings. Together, these will help train his circadian rhythm. Televisions have no place in the bedroom, where they are a common distraction for adolescents, and they should be removed and placed elsewhere in the home; if possible, computers should also be moved out of the bedroom. Encourage your teen to avoid caffeinated drinks, including caffeine-containing soft drinks, late at night.
Q: What about bright light therapy for DSPS?
A: Apart from the common-sense measures discussed before, bright light therapy can be very useful. Bright light exposure should be scheduled for early in the morning. Strong light after sunset should be avoided. Remove coverings and dark curtains from windows and place the bed where the most direct sunlight will be present. An east-facing or south-facing bedroom will increase morning light exposure. In the winter, a lightbox may be very effective and generally a box that emits 10,000 lux will be sufficient (a lux is a measurement of light intensity). Light exposure is more effective if combined with exercise. Avoid light after sunset as much as possible. Even the glare from a computer screen may be sufficient to phase delay someone. As the morning exposure to light is introduced, the time of going to bed generally advances.
Q: Are there any other forms for treatment apart from bright light therapy?
A: Melatonin can be useful for the treatment of DSPS–discuss the dose with your doctor. Occasionally, advancing bedtime one hour at a time, until the appropriate bedtime has been reached, can be tried. This should only be done during a period when school and other activities will not be affected. Guidance from a health professional is ideal.
Q: How can a new sleep-wake schedule be maintained?
A: Once the DSPS has been controlled, a strategy must be put in place by the family to try and counter any instances which may put the adolescent back into his old sleeping patterns. Danger times for this are weekends and school vacations, when a few late nights followed by sleeping late will put everything back to where it started.
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