11
Handling Serious Problems That Can Accompany Lack of Sleep

In the previous chapter I talked about how the symptoms and effects of sleep deprivation can sometimes mask very serious sleep disorders, including sleep apnea and narcolepsy. Being the insidious condition that it is, sleep deprivation sometimes also has symptoms in common with serious physical and mental diseases—and may be both a cause and an effect of them and occur at the same time.

This chapter looks at several of those diseases and provides information that can help in understanding their link to sleep deprivation. Because they can all significantly affect your teen’s health and wellbeing, it’s important to keep them in mind when you’re trying to uncover why your adolescent is so exhausted—and trying to turn that around. If you suspect your teen might have a serious medical problem, seek out the evaluation and treatment skills of a qualified health care professional.

Thyroid Disease

The thyroid gland is located at the base of the neck in front of the trachea, or windpipe. The gland makes, stores, and releases two hormones: T4, or thyroxine, and T3, or triiodothyronine. These hormones control the rate at which your body’s various organs work, what’s known as your metabolism. If your thyroid doesn’t produce and put



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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits 11 Handling Serious Problems That Can Accompany Lack of Sleep In the previous chapter I talked about how the symptoms and effects of sleep deprivation can sometimes mask very serious sleep disorders, including sleep apnea and narcolepsy. Being the insidious condition that it is, sleep deprivation sometimes also has symptoms in common with serious physical and mental diseases—and may be both a cause and an effect of them and occur at the same time. This chapter looks at several of those diseases and provides information that can help in understanding their link to sleep deprivation. Because they can all significantly affect your teen’s health and wellbeing, it’s important to keep them in mind when you’re trying to uncover why your adolescent is so exhausted—and trying to turn that around. If you suspect your teen might have a serious medical problem, seek out the evaluation and treatment skills of a qualified health care professional. Thyroid Disease The thyroid gland is located at the base of the neck in front of the trachea, or windpipe. The gland makes, stores, and releases two hormones: T4, or thyroxine, and T3, or triiodothyronine. These hormones control the rate at which your body’s various organs work, what’s known as your metabolism. If your thyroid doesn’t produce and put

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits enough hormone into your bloodstream, you have what is called hypothyroidism, and your metabolism slows down. If your thyroid makes too much hormone, you develop hyperthyroidism and your metabolism revs up too much. Both of these conditions can seriously impair your health by keeping your body from functioning as it should. ADDITIONAL SYMPTOMS OF HYPOTHYROIDISM AND HYPERTHYROIDISM Hypothyroidism: Decreased appetite Change in menstrual periods Feeling cold when others don’t Constipation Muscle aches Brittle nails Hair loss Hyperthyroidism: Rapid heart beat Weight loss Increased sweating Feeling hot when others don’t Changes in menstrual periods More frequent bowel movements Tremors While the two disorders have different causes, both have symptoms in common with sleep deprivation. Hypothyroidism can cause fatigue, weight gain, decreased energy, and puffiness around the eyes, and hyperthyroidism can produce tiredness, nervousness, and difficulty initiating and sustaining sleep. Though either condition can develop at any age, thyroid disease commonly appears in the teens and early twenties, particularly in women, so it’s important to consider it when you have a tired teen evaluated. Some forms of thyroid disease

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits are thought to be genetic, so it’s also important to consider it if you have family members with thyroid problems. To make sure your teen’s thyroid is functioning as it should, the doctor will do a blood test as part of a physical checkup. If thyroid disease is discovered, treatment is readily available and effective: supplemental hormones to increase thyroid hormone production or medication to suppress an overactive thyroid gland. Obesity In other sections of the book I talk about how sleep deprivation can result in weight gain and obesity, but I’m going to mention it again here because it’s so critically important. Childhood obesity has reached epidemic proportions, not only in the United States but in many other countries around the world. It’s particularly damaging because it not only negatively affects childhood health and well-being but it can lead to a lifetime of increased health risks and problems, including hypertension and diabetes. Not only that, but obese children who grow up to be obese adults can then be a factor in their own children becoming obese. A recent study in Japan concluded that parental obesity, in addition to long hours of TV watching and physical inactivity, was significantly associated with childhood obesity. The same study also showed that there is a dose relationship between short sleeping hours and childhood obesity—in other words, the less sleep you get, the more likely you are to become obese in childhood. Late bedtime was also found to be closely related to childhood obesity. The study considered anything less than eight hours of sleep each night as short sleeping time. Lack of sleep is thought to promote obesity by interfering with the feedback-control pathways between the body and the brain that regulate hunger and appetite. It results in a significant reduction in the secretion of leptin, the hormone that signals the brain to suppress appetite so that we’ll stop eating (for more about leptin, see Chapter 2). This in turn results in increased hunger. One study showed a 24 percent increase in hunger that was made even worse by being directed at high-carbohydrate, calorie-filled sweets and starches. Sleep deprivation also promotes obesity because it’s a stressor; the body responds to

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits stress by increasing the activity of the autonomic nervous system, which results in elevated levels of the hormone cortisol, which may increase appetite. Adding to the problem is the fact that when teens are tired they’re probably not motivated to exercise and when they’re overweight they’re not likely to exercise either. But exercise is key to bringing weight down into the normal range, along with eating a nutritional, balanced diet and caring about your body. If your teen is overweight or obese, encourage her to find an exercise program that’s fun, and help out by providing encouragement and a fridge stocked with fruits and vegetables. A trip to a nutritionist can provide valuable information on healthy eating. ANOTHER STUDY REPORTS … The five risks for childhood obesity are: Parental obesity The child’s temperament Low parental concern about the child’s thinness Persistent tantrums by the child over food Less sleep time Diabetes Diabetes is a disease in which the body doesn’t produce or correctly use (resists) insulin, the hormone that’s needed to convert sugar, starch, and other foods into energy. The American Diabetes Association estimates that 18.2 million people in the United States currently have diabetes, but that 5.2 million don’t realize they do. Kids and adults who have diabetes can suffer serious health problems, such as high blood pressure and abnormal cholesterol, which are associated with a dramatic increase in the risk for heart disease and stroke. While the causes of diabetes are not fully known, obesity is a major risk factor. A family history can also contribute to it and immune system problems can trigger it. It is also known now that people who

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits have sleep apnea are at an increased risk for insulin resistance and metabolic syndrome, which includes a group of metabolic risk factors, and that studies of sleep deprivation reveal impaired metabolism of sugar. If there’s a history of diabetes in your family or your teen is obese, is sleep deprivation a major additional risk factor for the disease? Research in adults based on the Sleep Heart Health Study, which was funded by the National Heart, Lung, and Blood Institute, reported that, when compared to participants who slept seven to eight hours a night, the risk of diabetes was two and a half times higher for those who slept five hours or less, one and a half times higher for those who slept six hours, and close to two times higher for those who slept nine hours or more—high risks for both short and long sleepers. In addition, sleep deprivation can make it much more difficult to control blood sugar if you have diabetes. Determining if your sleepy teen has diabetes may be challenging, however, because the two have symptoms in common, including increased fatigue and irritability. Other symptoms of diabetes include frequent urination, excessive thirst, extreme hunger, unusual and unexpected weight loss, and blurry vision. If you think it’s possible that your teen has diabetes or prediabetes, a fasting plasma glucose test or an oral glucose tolerance test in your doctor’s office will tell you. As with many health issues, following a balanced diet and getting plenty of exercise, along with doctor-prescribed medication, will go far in managing the disease. The report on the research mentioned above also suggests that getting the right amount of rest may be a successful addition to the treatment plan for people with reduced glucose tolerance and diabetes. Headaches Frequent, bothersome headaches are a ubiquitous complaint among the teenagers I see who have Delayed Sleep Phase Syndrome (DSPS). And, right along with issues about sleep, they’re also one of the most commonly reported complaints in clinical practice among people of all ages, according to a report by the University of Copenhagen’s Department of Neurophysiology. Headaches and sleep problems often go

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits hand in hand, so if your teen is exhausted and has frequent headaches, she may have a significant sleep delay, sleep deficit, or sleep disturbance. SNOOZE NEWS In a study done through the National Hospital for Nervous Diseases in London and reported in the journal Cephalalgia, 25 healthy subjects who experienced one to three hours of sleep loss for one to three nights suffered subsequent headaches that lasted from one hour to all day. What causes these headaches? The precise mechanism isn’t known yet, but there is evidence that both sleep deprivation and sleepiness itself, whatever its cause, may be associated with an increase in headaches. A study by the Scripps Clinic noted that changes in sleep duration and sleep quality seem to affect headaches of different types and the University of Copenhagen study mentioned above reported that sleep fragmentation and insomnia were both related to headaches. Headaches typically associated with sleep deprivation and sleepiness include tension headaches characterized by a tight bandlike sensation and heaviness that may begin in the morning and build as the day goes on. Pain is often greatest over the temples and the forehead. Migraines, those painful, throbbing headaches that can be accompanied by vomiting or vision disturbances, may also occur more frequently and more intensely in the sleep deprived. A study carried out at Case Western Reserve University found evidence that children who get migraines also have frequent sleep disturbances. Cluster headaches, a variant of migraines that often occur during the night, also may be brought on or aggravated by sleep loss and stress. Altered melatonin levels have been seen in cluster and migraine headaches, making treatment of headaches with melatonin a potential area for future investigation. If a phase delay or a sleep disturbance is resulting in headaches that are making your teen miserable, treating the sleep issue is a must. One Teen Says … “I get morning tension headaches whenever I’m severely sleep deprived. Because of them I get to school late a lot and I feel really sick most of the morning.”

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits In my practice teens with headaches severe enough to keep them out of school often and who haven’t responded to multiple medications have seen significant improvement in headache frequency and intensity when their total sleep time is lengthened and their circadian disturbance treated. A study reported in the journal Seminars in Neurology noted that headaches not secondary to a sleep disturbance also can be eased by addressing sleep issues. Impaired Immune System Will you really get sick if you don’t get a good night’s sleep? Probably not, if it’s just one night. But chronic sleep debt is a different story. With long-term sleep deprivation your body loses some of its ability to fight infection. One of the ways our immune system protects us from disease is by scavenging up free radicals, the atoms formed as byproducts of metabolic activity that can damage our tissues by reacting with our cells or cell membranes. Under healthy conditions, antioxidants are sent by the immune system to end free-radical chain reactions before they can damage vital cells and cause disease. With as little as 5 or 10 days of sleep deprivation, however, one study showed that many different antioxidants decreased in major organs to levels that are associated with impaired health. The data suggested that levels of antioxidants diminish with sleep deprivation and that sleep deprivation is therefore a risk factor for disease, which can include everything from frequent infections to cancer. Frequent infections are something I see regularly in my exhausted teenage patients with sleep phase delay—they seem to catch everything. And not only do they catch everything, but it takes them a long time to get healthy again; they come in coughing and three weeks later when I see them for a follow-up they’re still coughing. Sleep deprivation can not only contribute to catching infections but can aggravate existing ones, prolonging recovery. Detailed experiments based on animal models of sleep deprivation have documented a clear relationship between the immune system and sleep. Carol Everson, a prominent researcher, has led many

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits A TEEN’S TAKE “Sleep deprivation never helps anyone get over a cold and can actually be one of the main factors in contracting a cold or the flu. I know that if I start feeling sniffly or sneezy I have to get extra sleep that night to fight it off. When you feel achy from a cold coming on and you’re sleep deprived, it’s an uncomfortable disaster.” studies involving lab rats that point out how prolonged sleep deprivation clearly disrupts immune function. One study, known as the Table-Over-Water sleep deprivation model, is a case in point. In the study, rats walked on a table that turned over a pool of water. The table had a section missing, and if the rats didn’t keep walking they would fall into the opening, drop into the water, and drown. Because rats have a great survival instinct, the rats in the study kept walking and walking. They were given all the food and water they wanted, but they didn’t sleep. Soon they developed a hypothalamus dysfunction syndrome that resulted in weight loss despite overeating, hair loss, and skin lesions. And then they died—every rat that was sleep deprived for 10 days or longer eventually died. Without suffering a cut or having another source of infection, and despite the activation of their immune response, they died from infection caused by the breakdown of the immune barrier in the gastrointestinal tract. The normal bacteria of the GI tract became pathogenic. IT’S A FACT Though the immune system can fail because of sleep deprivation, the first reaction is actually for it to rev up, a process called upregulation. This appears to be a protective process, almost as though the immune system knows it’s going to have a problem providing immunity when the body and brain don’t get enough sleep. Unfortunately, though, upregulation may not completely compensate for sleep loss. When you’re in a sleep-deprived state, as many teenagers constantly are, infection wins.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits There is good news here, though, along with all the bad. With sleep, your body can fight harder against infection and even reverse its damaging effects. In the study in which many rats died from constantly walking and not sleeping, other rats were rescued from the water table and allowed to sleep. The skinny, hairless, exhausted creatures revived and returned to normal health with no other treatment. When rats get 80 percent of the sleep they require they do not contract fatal infections and they do survive. Seizure Disorders Approximately 1 percent of the population will be diagnosed with epilepsy by the age of 20. The disorder is characterized by recurring seizures that can be associated with loss of consciousness as they begin, jerking movements of the limbs often accompanied by tongue biting or loss of bladder control, and a period of unresponsiveness when the seizure ends. Because two-thirds of those who experience epilepsy first experience it in childhood, many teens around the world must cope with this debilitating condition as they’re coping with adolescence. There are many different forms of seizures. Absence seizures (formally called petit mal seizures) may be associated with a brief interruption of consciousness, sometimes accompanied by staring or rhythmic blinking; and complex partial seizures, experienced as alterations of consciousness in which there can be intrusive thoughts, a sense of disconnection, or a sense of déjà vu accompanied by chewing or fumbling movements. There are also seizures that begin with twitching or sensory disturbances in the face or limbs and then either stop or go on to cause a generalized seizure. What is the connection between seizure disorders and sleep loss or sleep disorders? The risk of having a seizure is greatest during both the transition into or out of sleep as well as during sleep, and it is well established that sleep deprivation and disorders that interfere with the quantity or quality of sleep can increase seizure frequency. Teens with known seizure disorders are at great risk of loss of seizure control when they’re sleep deprived because of DSPS. Sleep deprivation may also be a triggering factor in teens who are at risk for seizures because of a

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits history of serious head trauma or a strong family history of seizures— some types of seizures have an increased genetic risk. At times, distinguishing between subtle seizure disorders and sleep-related phenomena can be challenging. For example, the brief staring spells of absence seizures may look very similar to microsleeps. The chewing or fumbling often seen in complex partial seizures can also be seen during sleep attacks. So if you’ve witnessed unusual behavior in your teen, I recommend that you take her for a consultation with your doctor or a neurologist. Diagnosing a seizure disorder requires taking a careful history and an electroencephalogram (EEG) to monitor brain wave activity and sometimes repeated monitoring and clinical observation. If a seizure disorder is the diagnosis, treatment will likely be an anticonvulsant drug. It’s also critical for your teen to avoid sleep deprivation. VERY CLOSE TO HOME The similarities between sleep disorders and seizure disorders became all too clear to me recently when my 17-year-old patient Brenda slumped in her waiting-room chair and began making chewing motions. When my staff and I rushed out to her, she was hard to wake up and her muscles were limp. As we carried her back to my sleep lab, she came around somewhat but then fell back into the altered state. Quickly we hooked her up to monitoring electrodes to observe her brain wave activity—and were very surprised. Her brain wave pattern showed her to be in REM sleep—she wasn’t having a seizure. Fifteen minutes later, Brenda woke up on her own and told me that she remembered hearing my staff and me talking in the waiting room. A complete workup of Brenda revealed a history of severe sleepiness. There was also evidence of sleep attacks and some weakness episodes brought on by emotion, which were suggestive of cataplexy. I made the diagnosis of narcolepsy, but without EEG monitoring it might have been hard to do.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder If a careful sleep history isn’t taken during an office visit, a sleep-deprived child or adolescent may be misdiagnosed with attention deficit disorder, or ADD, often because the key symptoms of ADD—having difficulty focusing, paying attention, and concentrating—are also key symptoms of sleepiness and sleep deprivation. Kids are also more likely than adults to show evidence of sleepiness in restlessness and distractibility, further confusing sleep deprivation with ADD. Kids with ADD have also been shown to have more nighttime awakenings and arousals, more movement during the night, and poorer quality sleep. ADHD BEHAVIORS According to the Diagnostic and Statistical Manual of Mental Disorders, three patterns of behavior may indicate ADHD: Being consistently inattentive Being consistently hyperactive and impulsive Being consistently inattentive, hyperactive, and impulsive Symptoms often appear over the course of several months, with impulsiveness and hyperactivity often noticeable before inattention. The symptoms are not consistent with the child’s developmental level and some may have been present before the age of 7. The behaviors of the condition can make it hard to function well in social, academic, and work-related activities. Just what is ADD? The disorder is a condition in which kids have trouble paying attention and concentrating. It can be seen without hyperactivity in quiet, distractible kids and with hyperactivity in kids who are also distractible (with hyperactivity the condition is known as attention deficit hyperactivity disorder, or ADHD, but I’m going to use ADD here for both forms of the disorder). The distractibility can cause kids to get into trouble at school, so the condition may be accompanied by behavioral issues. It’s estimated that between 3 and 5 percent of children have ADD, approximately 2 million children in the United

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits States. The causes of the disorder aren’t fully understood, but it appears that genetics and biology may be involved and that environmental factors may contribute to the severity. When teenagers come to my office, it’s not unusual for me to learn that they’ve already been diagnosed with ADD (though I don’t entertain that diagnosis until the patient’s sleep schedule has been regulated and all the aspects of DSPS have been treated). Sometimes it makes me wonder which is the chicken and which is the egg: Do kids with ADD have trouble paying attention because they don’t sleep as well as other kids, or do kids who don’t sleep well develop serious problems with attention? Many researchers are also interested in that question, and the link between sleep deprivation and ADD is now under scrutiny. In a study of that link by M. K. le Bourgeois and colleagues at the Bradley Hospital Sleep and Chronobiology Research Laboratory at Brown Medical School, reported in the journal Sleep, subjects with all types of ADD had poorer quality sleep as well as greater daytime sleepiness than control subjects. Children with ADD have also been found to have more frequent periodic limb movements during sleep, which can fragment sleep and further aggravate daytime alertness and attention. Because ADD and sleep deprivation share so much turf, making an accurate diagnosis can be extremely hard. Your teen’s physician or a specialist can help in the determination, but be sure your teen’s sleep-wake schedule is regulated and that she is well rested before the evaluation takes place. If ADD is the diagnosis, it’s likely the doctor will prescribe a stimulant drug to help with attentiveness. But if your teen has a sleep phase delay and/or is sleep deprived, that condition needs to be taken into account. Stimulant drugs taken during the day can spill over into the nighttime, disturbing sleep and making your teen even more sleep deprived. So it’s important that any medication your teen receives doesn’t relieve one problem while contributing to another. It’s important to ensure that sleep isn’t disturbed.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits IT’S A FACT Research reported by the National Sleep Foundation relays the good news that in many cases people who have ADD and are sleep deprived show great improvement in both conditions when they get enough rest. Drug and Alcohol Abuse In a recent report, the American Academy of Sleep Medicine identified symptoms or a history of drug or alcohol abuse as problems that can accompany sleep difficulties. While drinking too much or taking drugs may seem like a strange bedfellow for sleep deprivation, the decrease in emotional control that too little sleep can bring on can lead to out-of-control behavior. Judgment, too, can be impaired by sleep loss, adding fuel to the fire for engaging in destructive and dangerous behaviors. A report in the journal Drug and Alcohol Dependency describing a study performed at the Henry Ford Health Sciences Center agreed that insomnia significantly predicted the onset of substance abuse in adolescents. The use of cigarettes, alcohol, and illicit drugs was associated with adolescents’ reports of having frequent sleep problems. While part of the association was attributed to psychiatric problems, such as depression and anxiety, a clear relationship between sleep problems and the use of illicit drugs was shown. When evaluating a teen with a delayed sleep phase, drug use and drug abuse should be considered as possible complicating factors, especially if the teen shows persistent hostility, failure to comply with treatment, or failure to respond to treatment. A urine drug screen may be helpful in determining if recreational drug use is involved. Depression Like ADD and sleep deprivation, depression and sleep deprivation often go hand in hand. Research, and my own experience, tell us that: Sleep deprivation increases the risk of depression. Sleep debt often increases the severity of depression.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits SIGNS OF DEPRESSION The National Sleep Foundation lists these symptoms as possible signs of depression, which affects about one out of 12 teenagers before the age of 18. Many of these symptoms are also symptoms of sleep deprivation. Feeling persistently sad, hopeless, or empty for several weeks, months, or longer Sleeping more or less than usual Loss of interest in favorite activities Lack of energy Weight changes and appetite disturbances Moodiness Feeling guilty, helpless, or worthless Having difficulty concentrating, remembering things, and making decisions Withdrawing from friends and family Loss of self-esteem and self-confidence Irritability and restlessness Frequent headaches and stomachaches Doing poorly in school Having thoughts of death or suicide Fourteen percent of insomniacs have major depression. Depressed children and adolescents exhibit disturbed sleep continuity. Some forms of depression are associated with increased sleepiness and lack of energy; some agitated forms of depressions are associated with a high level of difficulty initiating sleep and maintaining sleep. The persistence of sleep disturbances increases the risk of recurrent depression. Waking up regularly at 3:00 a.m. is a classic sign of depression. Sleep deprivation and depression can both interfere with the ability to think clearly, perform everyday activities, feel well, and enjoy life to the fullest. Because of these links, and because they can occur simultaneously, it can be extremely difficult to know if an exhausted teen is actually a

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits One Patient Reports … “I’ve had problems with sleep my entire life. But going to college was my undoing. My already precarious sleep became wracked by all-nighters as well as drinking and procrastinating. I managed to keep my academic performance together for my freshman year, but my sleep problems kept getting worse. I wasn’t able to sleep at night, I slept late into the day and missed classes, and my mood was terrible. I became more and more depressed. The depression and the sleep problem became a vicious cycle. “It took failing out of school to wake me up to the idea that something was actually wrong with me, that I needed help. But the maze of professionals I saw—psychologists, psychiatrists, therapists, psychopharmacologists—only made me feel worse. No one knew what was wrong. But some of the doctors told me that when my depression was better the sleep would come around. “It seems almost ironic that the last doctor I saw was Dr. Emsellem, but making the decision to go there was the turning point for me. Finally I got a diagnosis—Delayed Sleep Phase Syndrome—that made sense to me, and the medication I took and using a light box had a good effect. Even though things are still far from perfect, it was addressing my sleep problems that allowed me to start living again. I don’t know if the sleep problems caused the depression or the other way around, but it was fixing sleep that got me out of that blackly depressed nightmare.” depressed teen—or both. In my practice I see a lot of kids who are both sleepy and depressed; sometimes they’ve been referred to me by a psychiatrist who’s treating them for depression and sometimes I see them and ask them to see a psychiatrist as well. As a sleep doctor I don’t treat teens for depression, but if I suspect it’s a concurrent condition or a product of sleep issues, I’ll refer them so that both problems can be attended to.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits A RESEARCH SURPRISE One unexpected finding, reported by researchers at the National Institutes of Health in the late 1970s, is that in patients with very severe depression, complete sleep deprivation can have an antidepressant effect. However, that effect disappears with just a few minutes—not a few hours—of sleep. And, of course, going without any sleep is not a viable long-term treatment option. If determining the cause of your teen’s tiredness, drop in grades, irritability, and disgust with the world is difficult, helping her get more sleep is a great first step. As long as there’s no clear-cut, deep-seeded depression, fixing the sleep problem often fixes any low-grade accompanying depression. But if your teen’s mood is truly disturbed and negative, especially if there’s a history of depression in your family, it’s best to consult a psychiatrist or psychologist. Talking to a therapist can help teens sort through their issues, and an antidepressant, if prescribed, may be very beneficial in conjunction with strategies to treat a delayed sleep phase. One of those strategies, light therapy (see Chapter 9 for more on this), has been found to improve both mild and moderate depression as well as treat an abnormal circadian rhythm. The Committee on Chronotherapeutics, assembled by the International Society for Affective Disorders, reported that light therapy also is effective for major depression and is a viable treatment for those who can’t or won’t take medication. Suicidal Tendencies According to the National Sleep Foundation, half of all teenagers who go untreated for depression may attempt suicide. The risk of suicide begins to increase during adolescence, and it’s the third leading cause of death among teens. What’s the connection between sleep deprivation and suicide? Suicidal patients often report trouble sleeping, particularly because of insomnia, nightmares, and sleep panic attacks. One reason for this link may be the hormone serotonin, according to an article in Annals of

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits Clinical Psychiatry by R. K. Singareddy and R. Balon. The article notes that serotonin plays an important role in initiating and maintaining both slow wave and REM sleep and that it has been found to be low in patients who either attempted or committed suicide. Adolescents who took part in a sleep study in China gave proof of the association between sleep deprivation and suicidal tendencies. More than 19 percent of the 1,363 students interviewed said they had thought about suicide and more than 10 percent had actually attempted suicide in the previous six months. This is shocking enough, but what is even more shocking is that the average amount of sleep for these students was 7.6 hours a night, not five or six. The conclusion the study drew was that anything less than eight hours of nighttime sleep is associated with an increased risk of suicide. Thoughts of suicide as well as depression are significant problems on college campuses. In a recent survey taken by the National College Health Assessment program, 61.5 percent of students “felt hopeless at least once per school year,” 44 percent “felt so depressed it was difficult to function,” and 9.5 percent “seriously considered suicide.” A 2002 study put the number of campus suicides at 1,088, and an earlier study showed that the suicide rate among young people had tripled between 1952 and 1997. While substance abuse, anxiety, and feelings of desperation increase the risk, mental illness, usually depression, is the cause of 95 percent of college suicides. Research by Roseanne Armitage at the University of Michigan found that increased sleep problems and increasing reports of depression on college campuses were definitely connected. An article in the Lehigh University student newspaper stated that the average amount of sleep students who were polled had gotten the night before was 5.8 hours. To treat the major causes of depression and to prevent suicide, professional help is certainly needed. Parents, schools, community resources, and friends also can be important parts of the support system for clinically depressed or suicidal teens. As the above and other studies found, however, getting enough sleep may also reduce the risk of adolescent suicide.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits WATCHING OUT FOR ANXIETY Anxiety disorders and sleep problems have also been found to be linked. Anxiety can aggravate and exacerbate difficulty falling asleep, particularly in teens with a delayed sleep phase. If your teen has significant, regular trouble initiating sleep, it’s important to consider the possibility of anxiety and to have her evaluated and treated, if necessary.