Monday, March 25, 2019

The Trouble With Teenage Sleep – and How to Improve It

By Ryan Lowery, MD
Pediatric Resident at the University of Texas at Austin Dell Medical School
Member, Texas Medical Association

A 14-year-old patient once told me, “I feel tired all the time.” The patient’s mom was in the room and said that her daughter’s “energy level was very low.” She would often take a long nap after school before waking up to complete her homework, hang out with friends, or attend soccer practice. As I asked more questions to clarify what the patient was feeling, it became evident that increased sleepiness was affecting her daily life.

One of the main challenges for doctors working with teenage patients with similar complaints is trying to determine whether he or she is experiencing increased sleepiness or increased fatigue. Increased sleepiness is generally defined as a greater desire to sleep or inclination to fall asleep. Fatigue, on the other hand, is more related to low energy levels. The two can certainly be related, but it is important to understand the differences because they can have two very distinct causes. Increased fatigue, for example, might be related to low blood levels, medications, mental health issues, or thyroid problems. Sleepiness is usually caused by inadequate sleep most commonly related to a poor sleep schedule or poor sleep environment. Although sleepiness may be more common than true fatigue, the consequences of sleepiness can be just as detrimental and dangerous to a teenager’s health and development.

Teens simply don’t sleep enough. 

The American Academy of Pediatrics (AAP) recommends that children ages 13-18 sleep at least eight to 10 hours per night. Many parents say this is rarely the case for their children, and data show less than 10 percent of teenagers get adequate sleep on school nights. Part of the problem is that they must get up early for school. Middle and high schools often start classes before 8:30 am.

Teens are internally wired to stay awake later and sleep later
than in childhood, which can interfere with school performance.
Teens’ “internal clock” resets.

As we move from childhood to teenage years, the sleep-regulating “internal clock” humans have shifts so that teens are internally wired to stay awake later and subsequently sleep later than they did before. As a result, teenagers might have more difficulty waking up for school, miss early classes, fall asleep during class, or take long naps after school. Many catch up on sleep on the weekends by sleeping until well after noon.

Teenagers don’t just get sleepy, however. Missing school, sleeping during class, and having trouble paying attention can lead to academic troubles. A child who previously did well in school may start to have problems in the classroom as he or she hits the teenage years and develops this new sleep cycle. The ramifications can even be dangerous: Unintentional injury remains the leading cause of death in teenagers, and most of those injuries result from driving accidents. Getting behind the wheel while sleepy affects the brain in many of the same ways as driving drunk. A “drowsy driver” will have delayed response time, poor attention to surrounding traffic, and increased likelihood of falling asleep at the wheel. Each of these can lead to a fatal accident.

The negative effects of sleepiness extend beyond the classroom and the car.


Adolescence can be tough enough without struggling to stay awake. Parents, I suggest you help your teen adopt healthy sleep patterns. Here are a few tips:

  • Implement a “no screens” policy before bedtime so the bedroom does not turn into a texting, gaming, or screen-viewing zone. Medical experts advise children ages 14-18 should limit screen time to less than two hours a day.
  • Do away with afternoon naps, as these can often worsen an already interrupted sleep cycle. The same argument goes for sleeping in on the weekends. In trying to “make up” for lost sleep, teenagers (really, any of us) often set ourselves up for failure once our inability to fall asleep Sunday night leads to a poor school (or work) performance on Monday morning.
  • Limit the amount of caffeine and sugar your teen consumes – especially before bed. The AAP says high caffeine intake by someone as young as 12-years-old is linked to shorter periods of sleep, greater difficulty falling asleep, and more sleepiness during the day.
  • You might consider becoming an advocate for your teen by making your community leaders aware of the need to start school later in the morning

Not all the teenage problems will disappear with better sleep, but many teenagers will start to experience benefits. If you have further concerns or questions about sleep, please talk to your physician or a sleep specialist.

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