When Sleep Becomes a Nightmare in Teenagers

By now we all know that the body uses sleep to re-energize many of its cells and the brain uses it to enhance memories and solve problems.  Studies show you are more likely to remember something later when you get some zzz’s after learning it.  First to understand sleep — our Circadian Rhythm is an internal clock that tells us when it is time to wake and time to sleep.  Our brain does this by releasing a hormone called melatonin which makes us drowsy. But in puberty, this clock shifts, and you feel like sleeping and waking 1 to 3 hours later than usual – even though school starts at the same time.  Biochemicals, including one called adenosine, build up in the brain the longer you’re awake.  The more biochemicals your brain collects, the more tired you get.  But in teenagers, this buildup happens more slowly, than in children making them more able to stay up later.

Teenagers actually need more sleep than adults because their bodies are changing.  But a recent survey found that as few as 14% of them get that nine or more hours of sleep needed on weeknights. Twice as many get seven hours or less and this sleep deficit can drag down their mental and physical health, perhaps even permanently.  Over the long term, lack of sleep in teenagers has been shown to put them at a higher risk for depression, anxiety, drug use, bad grades, and low self-esteem.  Sleep deprivation may also cause permanent cellular damage and adolescence is a terrible time to put added stress on the brain because it is changing rapidly, creating new pathways and pruning old ones.

Today’s teenagers also have the technological temptations that earlier generations didn’t face.  In one study of 100 adolescents, the teens did an average of four different tech-related activities after 9pm, including going online, watching TV, playing video games, and using their cell phones.  The more tech they used, the harder it was to fall asleep and the sleepier they were in school.  One reason tech use inhibits sleep is that their blue-wave light tells the body that it is still daytime, preventing the release of melatonin.

Mary Carskadon, a professor of psychiatry and human behavior at Brown University has called the combination of factors that affect sleep in teenagers – circadian rhythm delay, reduced sleep pressure, electronic use, increased academic pressure, early school start times and freedom to set their own bed time –a “perfect storm” for sleep deficit.

WHAT TO DO:

• Get all technology out of the bedroom
• Avoid bright lights right before bed
• Create a pre-sleep ritual that helps you wind down at the end of the day
• Use your bed only for sleeping.  If you use it for reading, working or talking, tucking in won’t act as a trigger for sleep.

DON’T

• Go to sleep at different times every night.
• Drink any caffeine for 6-8 hours before bed (it lasts in your body long after the initial buzz wears off).
• Ignore the signals you’re getting from your body if you are feeling tired and anxious and falling asleep in class. Go to bed earlier and follow the other sleep tips.

Introduction – Stages of the Sleep Cycle

Why do we sleep?  The answer  is short, simple and obvious…sleep is a necessary process to sustain life and sleep disorders at any level, rob a person of this sustenance.  Hundreds of thousands of people are dying each year in part because of undiagnosed and untreated sleep disorders.  For the estimated 40 million Americans who suffer from a chronic sleep disorder and the 20 to 30 million others who experience occasional sleep disturbances, going to bed doesn’t always mean going to sleep.  According to The National Sleep Foundation, on any giving night, 1 in 4 Americans rate the quality of their night’s sleep as either “fair” or “poor”.  We have tendency to overlook our need for sleep which puts us at higher risk for accidents (more than 100,000 auto accidents, many fatal, are directly attributed to sleepy drivers each year) and more vulnerable to a whole host of physical ailments, including heart disease, high blood pressure, obesity, and diabetes, to name a few.

If you think nothing really happens when you sleep, think again.  Sleep is the time when the brain directs the body to heal and repair itself, rebuild damaged or worn-out tissues, and restore chemical balance.  Your immune system manufacturers more natural killer cells to fight infection and disease and your pituitary gland produces growth hormone (in children, growth hormone promotes growth; in adults it helps repair and renew tissue).  Even though your body may essentially be motionless while you sleep, your brain is active, cycling though the Five Stages of Sleep, and organizing and storing memories.  Even with all this activity, your brain still manages to recharge during a good night’s sleep so you feel energized and ready to go.

THE FIVE STAGES OF SLEEP

Sleep is divided into 5 stages and serve different purposes.  Stage 1-4 are non as non-rapid eye movement sleep (NREM) and the 5th is rapid eye movement sleep (REM), the stage when most dreaming occurs.  The brain cycles through these stages about 5-6 times each night.  During the first sleep cycle, you spend a long time in deep sleep  or Stages 3 and 4, and relatively short time in the 5th stage REM sleep.  As the night progresses, your brain continues to cycle through the sleep stages with REM sleep periods getting longer and deep sleep periods shorter.  As morning approaches, deep sleep ceases almost completely and your brain cycles between Stages 1 and 2 and REM sleep.

STAGE 1 : The transition between wakefulness and sleep.  Your brain and body relax, your breathing becomes more regular and your muscle activity gradually decreases, although you may make some jerky movements as you pass from wakefulness to sleep.  You may experience dream-like flashes of images, hear loud noises or even distinct voices.  Most people who sleep normally stay in this stage for about 5 minutes.

STAGE 2 : Your heartbeat and respiration slow and become very regular, your body relaxes more deeply. Most spend about 30 minutes in Stage 1 and 2 before passing into a deep sleep Stage 3.

STAGE 3 & 4 : These are deep sleep states.  There is no visible eye or muscle movement especially as you progress into Stage 4, which is the deepest and most restorative sleep.  The body performs much of its necessary repair work during Stage 3 & 4.

The first deep sleep of the night usually lasts about 1 hour in the young adult before the sleep cycle begins its first REM sleep.  As people get older, their deep sleep shortens and they may feel less rested after sleeping.

STAGE 5 (REM) : This is when you dream. Your eyes move rapidly back and forth.  During REM sleep you are actually temporarily paralyzed, Mother Nature’s safeguard to prevent the physical acting out of dreams.  Brain blood increases, heartbeat speeds up and breathing rate increases.  Sleepers usually spend about 90 minutes in the first four stages of sleep before passing into the first REM of the night.  The first REM usually last about 10 minutes and become progressively longer in successive NREM-REM cycles with the final REM episode lasting as long as an hour.

The Causes & Diagnosis

Just because you’ve had a few restless nights does not mean you need to go running to your doctor. However, if you’re staring at the ceiling night after night and drag yourself through your days, then what are you waiting for?

Many people today are living a fast paced life and there are many causes to sleepless nights which doesn’t necessarily mean you have a sleeping disorder, you may be just going through a stressful time in your life.  You could be in the middle of a divorce, kid failing in school, bills piling up, company relocating without you, college exams, 8 months pregnant — these are temporary and as soon as these issues are resolved, your sleep habits should go back to normal.  This does not mean you have to ignore the sleeping problem.  Poor quality sleep is a medical concern no matter what its cause or duration and your doctor can still offer several suggestions to help you sleep better.

Poor sleep presents itself in many ways; you fall asleep quickly but wake up in the middle of the night and pace the floor, or maybe you lie awake staring at the ceiling for hours, or you fall asleep fast but awake much earlier than you would like or even sleep totally fine but awaken unrefreshed? No matter how the problem presents itself, these are disruptions resulting in less-then-optimal sleep.

These are common factors for occasional sleeplessness:

• Battling nasal congestion
• Consuming caffeine, especially close to bedtime
• Exercising too vigorously close to bedtime
• Experiencing pain from arthritis, headaches, or illness
• Lying on an uncomfortable mattress and/or pillow
• Overindulging in rich or spicy foods, especially close to bedtime
• Sharing your bed with kids, pets or spouse that toss and turn a lot
• Sleeping in a cluttered room
• Environment is too cold or too hot
• Smoking and/or drinking alcohol close to bedtime
• Stressful life event
• Taking stimulating herbal supplements

If you start dreading bedtime, find yourself nodding off time and again during the day or if you wake up repeatedly during the night, then that may be a clue you’re heading towards chronic status.  Chronic sleeplessness can also be caused by a variety of problem but if just changing your sleep environment or cutting back on caffeine doesn’t solve the issue, chances are you have an undiagnosed sleep disorder.

It’s time to see a doctor if:

• Your sleeplessness is starting to interfere with your job performance
• You feel sluggish, irritable and less sharp than normal
• You’re making lots of mistakes or errors in judgment
• You can’t stay focused; your attention keeps wandering
• You’re impatient and quick to anger even though this is not normal personality behavior
• You keep dozing off, even in important meetings or while driving

Chronic sleeplessness can be associated with a host of physical, emotional and mental conditions including:

• Congestive heart failure and heart attacks
• Decreased ability to process information
• Depression
• High blood pressure
• Insulin resistance
• Memory impairment, moodiness and irritability
• Increase risk of accidents and on-the-job injuries
• Obesity
• Stroke

As you can see, many consequences of chronic sleep deprivation or disruption are quite serious, and some, if left untreated, can even be fatal. If you have one or more of these symptoms, and especially if you have several, it may be time to get a check-up and see what’s causing your sleep disturbance. After you have your diagnosis and are receiving proper treatment and sleeping well again, your world will look like a different and better place.