Circadian Rhythm Sleep Disorder
As children become adolescents, many will develop sleep disorders. Oftentimes, the biological clock shifts to a later bedtime and wake-up time. Adolescents tend to become night owls. The consequence is difficulty rising in the morning to attend school. In severe cases, chronic absenteeism will result in non-passing grades. In extreme cases, the social isolation and loss of control can have some significant consequences. Some teens might be treated for mental disorders while others experience depression. For adolescents who have either daytime sleepiness or excessive school absences, a complete sleep evaluation is indicated to detect a possible circadian rhythm disorder.
Delayed Sleep Phase Syndrome
When an adolescent presents with insomnia, one must consider the diagnosis of a circadian rhythm sleep disorder (CRSD). The most common CRSD is a delayed sleep phase disorder (DSPS). DSPS occurs when the patient wakes up later than socially acceptable. One should be suspicious of a DSPS if a child cannot not fall asleep until 3 am. If allowed, the child would sleep soundly for greater than eight hours and wake up refreshed in the early afternoon.
The human body has a natural sleep rhythm, circadian rhythm, which has a cycle of just over 24 hours. The circadian rhythm is an internal body rhythm that is influenced by environmental (external) stimuli. Light is the primary influence on the circadian rhythm, but others include exercise, social interaction, and meals. Since light is the dominant time keeper, the most reasonable approach to revise your circadian rhythm is with light therapy. Besides bright light’s ability to produce phase shifts, it has an alerting potential.
To assist in reestablishing a "normal" sleep-wake pattern, one must have at least two weeks of sleep logs (.pdf). The sleep logs, or diary, helps to establish what the patient's natural wake-up time is. Ideally, these logs are collected during a vacation period when the child may sleep late. Otherwise, one has to estimate their wake-up time by looking at the weekend sleep pattern.
To maintain circadian cycling remain active and expose oneself to bright light during day
- Quiet activities prior to sleep will help you unwind. This would include reading, with the light behind you and not shining directly into your face, and listening to soft music or relaxation tapes.
- Regular exercise in late afternoon or early evening promotes sleep, but avoid strenuous activity just prior to bed
- Napping, if it interferes with nighttime sleep, should be avoided
- Avoid bright lights in the evening. This includes direct exposure to television, computers and video games.
- If sensitive to caffeine, avoid caffeine following lunch
- Only stay in bed for as long as sleep is needed
- Ignore intrusive ideas and thoughts
- Bedroom environment: quiet, dark and a comfortable temperature
- Ensure you are sleeping in a comfortable bed
- Bed is only for sleeping and no other daily activities
- Turn clock away from you
Be aware that:
- Nicotine is a stimulant
- Alcohol fragments sleep