Sleep Deprivation and Delayed Sleep Phase Syndrome

Sleep deprivation and delayed sleep-phase syndrome are common problems in adolescents for several reasons. The total sleep requirement is as much or more in adolescence as in pre-adolescence (Carskadon and Roth, 2000), but adolescents tend to receive less sleep for both biologic and cultural reasons. School-age children are more likely to be "larks," preferring to wake up early even if they are up late at night. At puberty, a circadian rhythm change occurs that results in a switch from larks to "owls," the preference for a late-night bedtime and late-morning awakening. This biologic tendency is encouraged by the availability of stimulating activities late into the night, whether social events, part-time jobs, or technologic advances (e.g., TV, Internet). Stimulants such as caffeine and tobacco also act to delay sleep. Despite these factors that act to delay sleep, school schedules often require the adolescent to awaken early. Thus, sleep deprivation develops. Also, jet lag-like shifts often develop between the weekday and weekend or holiday schedule. These schedule shifts probably play a role in the most common adolescent sleep problem, delayed sleep-phase syndrome (Dahl, 1998).

The assessment is by history. The main differential diagnosis to consider from delayed sleep-phase syndrome is the teenager who is choosing a late-night schedule for some secondary gain. This person is not distressed by the dysfunctional sleep pattern and is unmotivated to change it. Therefore, the adolescent with secondary gain requires treatment directed at the underlying school or family issues rather than the sleep disturbance.

Treatment of the cooperative adolescent involves attempting a schedule shift and consistently maintaining it. Those with marked difficulty initiating timely sleep may respond to staying awake through an entire night, then reestablishing a regular schedule. Mindell and Owens (2009) provide a practical clinical guide for pediatric sleep.

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