How to help a teenager who can’t sleep

With full agendas, school days starting at 8 am and the lure of screens, it’s no wonder that many adolescents in the United States don’t get enough sleep.

National estimates suggest about six in ten high school students get less than recommended nine to twelve hours of sleep per night, while about seven in ten high school students clock less than the recommended eight to ten hours. And more than one in five young people struggle with insomnia, characterized by difficulty falling asleep, staying asleep, or getting enough sleep (or a combination of these).

“There are two basic things that happen” when teens hit puberty, said Dr. Judith Owens, the director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. “The first is there’s a shift in their natural circadian rhythms, so their natural time to fall asleep and wake up later — up to a few hours. The second thing that happens is their sleep drive slows down.” So not only do adolescents want to stay up later, but their bodies are capable of it, she explained.

Despite these biological shifts, experts emphasize that sleep loss is not a normal or natural part of adolescence, and the American Academy of Pediatrics has said that insufficient sleep is one of the most pressing health risks in adolescents, indicating consequences such as decreased mood and attention and impaired impulse control.

The Times spoke to Dr. Owens and other experts in adolescent sleep and mental health on how to help teens who struggle with sleep.

Change a bad sleeping habit.

While the data on teen sleep deprivation is grim, Dr. Sonal Malhotra, an assistant professor of pulmonary and sleep medicine at Baylor College of Medicine and Texas Children’s Hospital, offers parents some reassurance: Many of the teens she treats don’t have what they’d like to consider true chronic insomnia, even on paper. they meet the criteria wrestling three or more nights a week for more than three months. Instead, they are simply plagued by poor sleep hygiene.

Dr. Malhotra shares that not to dismiss the challenges many teens face around sleep, but to reassure families that small changes can often make a dramatic difference. She urges adolescents to make one adjustment to their sleep routine that they think will be achievable and likely to be helpful — for example, making sure their room is dark and comfortable, or having a big drink relatively close to bedtime. meal or caffeine.

“Tackling everything at once isn’t ideal,” said Dr. Malhotra, adding that she tells teens that if they can change one habit for even 50 percent of the week, she considers it a win.

Consider a harm reduction approach to screens.

“We have truckloads of research showing just how destructive technology is to sleep,” said Lisa Damour, a clinical psychologist and the author of “The Emotional Lives of Teenagers.” She firmly believes that no one – including adults – should have a phone in their bedroom at night. Dr. Damour urged parents to establish that rule early on: “The minute a kid asks for a phone, they’ll agree to anything,” she chuckled. “Parents should not squander the enormous influence they have.”

But if that’s not feasible, there are ways to mitigate the damage of nighttime screen use.

Passive use, such as watching a show, is better than active use, such as texting or gaming, said Dave Anderson, a clinical psychologist with the Child Mind Institute. What a teen watches and what they watch is also important: A sitcom, for example, is better than a suspense show, he said. And rather watch on a small screen than on a 60-inch TV, which emits more blue light.

“Exposure to light, especially blue light, suppresses melatonin release,” said Dr. Owens. “And teens are even more sensitive to that melatonin suppression.”

If teens start looking at a computer or other device late at night, Dr. Owens recommends getting them blue light blocking glasses or having them use an app to limit blue light exposure. “It doesn’t lessen the cognitive stimulation of doing homework at 10:30 p.m.,” she said. “But it does help a bit.”

Be mindful of melatonin.

Experts largely discourage the use of melatonin to help teens sleep. The says AAP it should only be given to children after consulting their pediatrician. The group says further research is needed, particularly on long-term use, as there are questions about how it may affect growth and development, especially during puberty.

“It’s definitely something you should discuss with a healthcare provider to really understand the dosage and timing,” said Dr. Malhotra, adding that there is very little regulation of melatonin. “It’s just much more complex than I think people realize.”

Encourage “strategic naps,” but be wary of catching up on the weekend.

Teens are notorious for wanting to sleep in on weekends, but experts warn that this can hinder weekday sleep. “Sunday night they haven’t been up long enough to get to sleep at a reasonable time to get up to school on Monday morning, and things are getting a little out of hand,” said Dr. Owens.

She and Dr. Damour said it’s okay for teens to experiment with sleeping in a bit, but families should keep a close eye on whether it has a downstream effect on their weekday rest.

While naps can’t quite make up for a bad night’s sleep (or a bad night’s sleep), Dr. Owens that she’s a “relative fan” of “strategic naps” to help teens recharge. By that, she means a nap of 30 minutes or less, ideally somewhere between 3 and 5 p.m., when there’s a natural lull in a teen’s circadian rhythm.

Help your teen worry less.

Adolescents, like adults, can get caught in a mental loop that fuels insomnia: I still have so much work to do… If I don’t get enough sleep, I’ll fail my test tomorrow… I couldn’t sleep last night, so tonight will be a disaster too.

To help curb worry, Dr. Malhotra teens to keep a journal where they can write down what they have already accomplished that day and what the plan is for tomorrow, along with any concerns they may have. At night, parents should let their children know that if they lie awake for more than 20 or 30 minutes, they should get out of bed and do something relaxing, such as reading a book or listening to calming music.

In general, parents should take a critical look at whether their child’s schedule is simply too packed, Dr. Anderson said.

He and others also noted that parents should contact a family doctor or mental health professional if they are concerned about long-term sleep problems or feel their child is struggling with unmanageable stress.

Still, Dr. Anderson said parents can help ease some of the pressure on teens by showing them compassion and pushing back against the kind of all-or-nothing thinking that contributes to the stress many of them feel.

Repeatedly telling a teen, “‘Honey, I want you to know that no grade, no activity, no missed social event is going to make or break your life,'” he said, can help.