One Patient Says …

You need to take the whole problem of changing your schedule head on. Every little thing you do helps. There’s no part of the regimen that can be minimized.

Treating a Resistant Clock

There are four parts to my program for shifting teens’ late-to-bed, late-to-rise cycle. Three of the components are therapies—light therapy, melatonin, and chronotherapy; and one is behavioral—having a mature, responsible attitude. While each can provide a great deal of improvement on its own, studies have shown that it takes therapy plus positive behavior to maximize results. You need to apply the complete package.

One point before I begin. You may be wondering why I don’t recommend simply taking a sleeping pill to adjust patients’ sleep and wake-up times. The answer is: If a teen’s circadian clock is programmed to send her to sleep at 2:00 a.m. and wake her up at 10:00 a.m., taking a sleeping pill, or hypnotic, at 10:00 p.m. isn’t going to make her fall asleep then and sleep for the next eight hours. Sleep-promoting medication works only when taken during the appropriate “circadian window” for sleep, in sync with where the clock is set for sleep. Hypnotics won’t move the clock. Only by shifting a teen’s sleep phase will she be able to fall asleep and wake up at more normal hours.

Light Therapy

While much of my discussion so far has been aimed at getting teens to fall asleep earlier at night, it’s also critical for them to be able to get up earlier in the morning—both to get to school on time and to start the process that will make them sleepy again at a reasonable hour that night. Many teens set alarm clocks all over their rooms or ask their parents or siblings to drag them out of bed each morning—I even had a patient who asked his mother to throw ice water on him—but there’s something more useful, and less jolting, that they can do to help entrain themselves to a more successful pattern.

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