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.

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.