Adolescent Sleep Disorders Not To Be Ignored

By Nancy K. Crevier

“O sleep, O gentle sleep, Nature’s soft nurse, how have I frighted thee, That thou no more wilt weigh my eyelids down And steep my sense in forgetfulness?”

William Shakespeare may have been more eloquent in Henry IV, but why sleep eludes people is a question that Dr Andrew Tucker confronts on a regular basis.

Dr Tucker, the former administrative director of the Sleep Disorder Center at Danbury Hospital, recently opened an office at 15 Berkshire Road in Sandy Hook, where he treats patients of all ages suffering from sleep disorders.

He started out as a sleep technician in a sleep center at the suggestion of a professor at the University of California, where he earned his undergraduate degree. “I was the poor soul who stayed awake all night listening to old men snore,” laughed Dr Tucker, “but I loved it.”

He received his PhD in clinical health psychology from Albert Einstein College of Medicine in 1998 and has specialized in the treatment of sleep disorders for nearly 15 years.

It is no longer just the snoring of old men that Dr Tucker addresses. Sleep issues haunt younger people in great numbers, said Dr Tucker, particularly adolescents who are caught in the perfect storm of increased need for sleep, a biological inability to get to sleep at earlier hours, and the necessity of rising early for the school day.

“After puberty,” explained Dr Tucker, “there are a lot of changes, physically and mentally, in teenagers. One is a change in the circadian rhythm.” The circadian rhythm is a physical and mental response to light and darkness that follows an approximately 24-hour cycle. In adolescence, the circadian rhythm naturally begins to shift to a later hour for sleep. But late hours do not meld well with the early wake-up times that are often required for young people during the school year. The upset of the natural sleep and wake cycle leads to the majority of adolescents suffering from sleep deprivation to some extent.

There is variability in how greatly a child is affected by the disturbed sleep cycle, he said. “The majority of young people can overcome these issues without outside help,” said Dr Tucker. But he estimates 20 to 25 percent of adolescents have a clinically significant problem with sleep deprivation, and that is when his help is sought.

With numerous social, athletic, and school activities in this age group and a societal trend toward less downtime, young people are burning the candle at both ends. “Sleep is sacrificed,” he said.

“If you know your child has trouble sleeping regularly and they say they are unable to stay awake in class or to focus during school, that’s a sign that something is not right. If he or she is irritable, moody, or feeling depressed,” Dr Tucker said, it might be time for professional intervention.

For teenagers who are willing to follow through on his suggestions, relief from insomnia (difficulty falling or staying asleep, or waking up early and being so tired that daytime activities are impaired) can be just a few weeks away. For some, Dr Tucker recommends the use of over the counter melatonin, a natural hormone that regulates the internal clock, helping people to feel ready to sleep earlier. A bright light box or getting a lot of direct sunlight first thing in the morning can help adapt a person to an early wake up time. Used in conjunction, “It gives help on both ends of the day,” Dr Tucker said.

Reducing or preferably eliminating caffeine in the diet, is his next recommendation. Caffeine is found not just in coffee, but tea, soda, energy drinks, and chocolate.

“Teens should have a quiet routine before bedtime. I often suggest reading something pleasurable — not schoolwork — before bedtime, and keeping the lights dim in the room. And kids who are tired often come home and take a nap in the afternoon, but that should be avoided. It just throws off everything,” he said.

Keeping a regular sleep and waking time, even on holidays and weekends, also improves sleep patterns.

Chronic sleep deprivation in teenagers, not related to physical issues or medications, should not be taken lightly, said Dr Tucker.

“The main concern with teens is a higher risk for depression and suicide,” he said. Sleep deprivation can lead to weight gain due to hormonal changes that cause increased hunger and lethargy. In some cases, sleep deprivation can lead to insulin resistance and diabetes, he said, making sleep deprivation a serious medical issue.

Nor should parents forget, said Dr Tucker, that overly tired teenager drivers are more apt to be involved in car accidents.

“Sleep deprivation in adolescents has a wide impact on health, well-being, mood, and social relationships, and impacts the entire family,” he added.

A less common reason for adolescent fatigue, but one that must be explored, is that of sleep apnea. Relaxation of muscles and soft tissues occurs when people fall asleep. With sleep apnea, the tissue at the back of the throat relaxes to the point that the airway closes. “People stop breathing for 10 to 15 seconds at a time, and this happens repeatedly during the night. Of course, that person wakes up not rested,” Dr Tucker said.

The only clue parents may have that sleep apnea is the problem is that they may hear a gasp followed by brief silence or snoring when the child is asleep, or detect irregular breathing. Sleep apnea is more common in overweight adolescents, but any young person with enlarged tonsils can be plagued by sleep apnea.

Oddly, in addition to daytime fatigue and moodiness, hyperactivity is a symptom of a teen suffering from sleep apnea.

Dental appliances or a positive pressure mask to keep airways open during the night are two interventions available to treat sleep apnea. Children with enlarged tonsils may find relief through the surgical tonsillectomy.

“By and large, it is insomnia that I see young people for,” Dr Tucker said, and he is confident that patients sleep health can improve by using the tools he shares.

“Sleep deprivation can have a profound effect,” he said, “so don’t be afraid to seek help if you think there is a problem. There is very effective help available.”

Dr Andrew Tucker’s office is at 15 Berkshire Road in Sandy Hook. He can be reached by calling 860-799-6282.