school. He was worried about being able to keep up with classes and the school was concerned about his absenteeism. Finally, a school administrator contacted the family, who contacted their family doctor. But the doctor wasn’t able to find the cause of the headaches and sent Henry to a neurologist. Complicating the already confusing situation was the fact that Henry’s mother suffered from migraines, so everyone he saw had looked for a link.

Months went on, with Henry trying four different migraine medications that the neurologist prescribed. But the headaches improved only minimally both in terms of frequency and severity and continued starting up within an hour of Henry’s waking up. He was getting no relief and often missed morning classes. When he did make it to school on time he generally wound up in the nurse’s office, too sick to finish the day.

After determining that the migraine medications were not helping to the extent they should have, the astute neurologist thought that lack of sleep might be causing the problem. He referred Henry to my office, and after testing and consultation, it turned out that Henry was severely sleep deprived. On most weeknights he would get into bed sometime around 11:00 but then just lie there until close to 1:00, unable to fall asleep. When he finally nodded off, it was only a little more than five hours until his alarm started blaring at him to get to school on time. And by the time he got out of the shower, another splitting headache had developed.

Once I found that Henry had a major sleep phase delay, I started him on a course of treatment. The first step for him, and for all my patients, was education. I sat down with Henry and his parents and talked about sleep: its phases, its requirements, the changes in patterns associated with adolescence, and particularly why Henry was feeling so awful and needed to get more sleep—his brain was running late but his school was starting early. I also told him how my staff and I were going to help him.

It all came as a surprise. Like many teens and their parents, Henry and his folks had no idea that teens need at least nine hours of sleep to function at their best and that their sleep-wake cycle is wired to be out of sync with everything around them. But Henry was so medically ill



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