The sight of a teenager awake even at midnight, when the rest of the family members are asleep, watching random videos, and occasionally staring at the ceiling, is a common sight in many homes. Treating sleep issues in children is the need of the hour instead of labeling them as lazy and unproductive when their actual problem is unable to fall asleep, say experts.
What causes insomnia and sleep issues in teenagers?
Dr Bharath Reddy, Pediatric Pulmonologist and director of Shishuka Children’s Hospital, Bengaluru, elaborates on the lack of sleep emerging as a growing concern among teenagers. Contributing factors are a sedentary lifestyle, lack of physical activity, and constant exposure to smart screens and gadgets.
Dr. Stacey Simon, pediatric sleep psychologist, associate professor, department of pediatric pulmonary general operations, University of Colorado, recalls the case of a 15-year-old girl from Colorado who has insomnia, whom she treated in 2020. The girl had a delayed sleep schedule that affected her overall health and academics. The girl could not sleep throughout the night and even till early morning.
“Her late awakening in the morning interfered with her interaction, mealtime with her family, as she would be asleep in the daytime. She was labelled as lazy,” said Dr. Simon. During treatment, her circadian rhythm was improved by delayed sleep and waking up cycle initially by three hours after employing a behavioral approach called Chronotherapy.
According to a study published in the Journal of American Medical Association (JAMA Psychiatry), available in the National Library of Medicine, Chronotherapy is defined as: “A behavioural approach in which the circadian clock is reset by progressively delaying sleep and wake times by approximately three hours every two days, until the desired sleep and wake times are achieved and maintained by adhering to a set sleep-wake schedule and good sleep hygiene practices.”
Dr. Simon is working on a study on metabolism and lack of sleep, such as obesity, early onset of insulin resistance, cardiovascular diseases, and sleep behavior among children.
Teenage sleep hygiene habits worsened during the pandemic.
According to Dr Reddy and Dr Simon, the COVID-triggered pandemic has further worsened the sleeping habits among teenagers, as it led to delayed sleep-wake-up phase disorder. They add that during the lockdown scenario, children were in an online school set-up and hence had inevitable exposure to gadgets for learning, which added to the wreck of the sleep cycle. Doctors have also witnessed an increase in weight gain among children, early onset of type-2 diabetes, sedentary lifestyle, and lack of exercise.
Treating sleep problems in adolescents
Experts explain some of the ways to treat sleep issues among children:
- Bright light therapy: The body has an internal clock that is fueled by circadian rhythm, which regulates the time to sleep and wake up. When that goes for a toss, bright light therapy is used to provide artificial light through light boxes to regulate circadian rhythm. This is done by waking them up in the morning and giving them exposure to a lightbox so as to stop the melatonin production during the day. “Using it immediately after waking up simulates the sunlight,” Prof Simon told Happiest Health. It is used especially in places where there is less daylight, especially in winter in Western countries.
- Advancing sleeping time: According to Dr Reddy, one of the effective ways to increase the sleep timing of children affected by lack of sleep is to improve it. “For example, if the child was getting sleep only by 2 pm, we try to advance it by half hour or one hour and gradually bring it down to making the child sleep at 10 pm,” said Dr. Reddy, explaining what is practiced in India as a measure to correct sleeplessness in children.
- Counseling: While many sleep-deprived persons are labeled lazy or suffer from depression and social isolation, the need would be to address their sleep issues. “The treating physician must identify the sleep issues and refer such cases to sleep specialists if need be. One got to sit and negotiate on the sleeping timings. If the problem is with sleep, giving them anti-depressants won’t help,” says Dr Reddy, adding that the actual problem needs to be discussed and addressed. He suggests maintaining a sleep diary to record sleeping and waking up time.
- Chronotherapy: A method of shifting the bedtime and waking up by 2-3 hours every day so that children or adults with sleep problems gradually get into a normal night sleep cycle. Prof Simon explains it with an example, “if the girl was able to sleep at 5 am, we would further delay her sleep by 3 more hours, to 8 am. Gradually she was able to sleep by night and wake up by morning,” she said.
- Melatonin supplements: One of the causes behind sleeplessness is melatonin deficiency, which needs to be addressed by sleep supplements like melatonin, given only based on the need considering the person’s condition. “Melatonin is a sleep-inducing hormone. The supplement is given only to those with acute sleep issues. It’s given at a particular time in the night to induce sleep and improve the circadian rhythm,” said Dr Reddy.
- Morning walk: One of the important aspects of treating insomnia in kids is through non-pharmaceutical interventions like encouraging the child to have a morning walk. “Being out in the sun in the morning makes a lot of difference as the melatonin hormone production takes place well when the person has sufficient Vitamin D absorption. Early morning walk amidst sunlight is hence helpful,” said Dr Reddy.
- Outdoor Games: Kids who actively engage in outdoor games sleep well, says Dr Simon, adding that she encourages parents of children with sleep issues to introduce them to outdoor games. “Any physical activity would do,” she said.
Takeaway
Sleeping problems in children are a growing concern, and there are various factors contributing to the same, including gadget exposure and lack of exercise. Identifying the problem is the need of the hour, say doctors elaborating on the mode of treatment modalities.