wanting to change; then both education and guidance are critical (and a little psychology doesn’t hurt). One of my patients, 13-year-old Eric, told me that his mother was “stupid” for bringing him to a doctor and that although his teachers said he was exhausted and falling asleep in class, he was only falling asleep because he was completely bored. Hostility oozed out of every pore, and I knew that laying down a lot of rules on him wasn’t going to work. Instead, I asked him if he was able to fall asleep at 9:00 a.m. His answer was a snarly “Sure.” Well, I said, most people are well rested at 9:00 in the morning, and if you can fall asleep then, something is wrong—you’re not getting enough rest. If you think nothing’s wrong, though, why don’t you show me? Do a daytime sleep study for me, and after we do it tell me what you think happened and I’ll tell you what your brain waves told me happened. If you’re not falling asleep quicker than what’s normal during the day, then I’ll get everyone off your case and you can keep on going just the way you’re going.
There was a lot of fast talking on my part, to be sure. But I chose my words carefully to allow Eric to see for himself that something was wrong—and he did. When his sleep study showed that he was falling asleep immediately after being given the opportunity to nap during the day, he began to see that there was a problem—and, after putting up a bit longer with my spiel, that something could be done to make him less drowsy and irritable.
In addition to using a light box and taking melatonin—part of the treatment I typically prescribe and that I’ll detail below—I recommended that this patient, who was a little pudgy, start working out with weights and paying attention to his body (I also recommended that he check in with his pediatrician or family doctor, which I always do before having an adolescent patient embark on an exercise program, especially one that involves weights). This encouraged him even more, because the idea of getting buff appealed to him. I wouldn’t say he was the most compliant patient I’ve ever had, but education, evidence, and a little bit of stroking helped him agree to begin treatment— and put effort into adjusting his sleep phase delay.