What Factors Contribute to Sleep Disorders in Adolescents?

Although the average sleep recommended for an adolescent is 8 to 10 hours per night, 72.7% of students in a Youth Risk Behavior Survey from the CDC indicated they get less than 8 hours on school nights. Sleep deprivation among adolescents could prove significantly detrimental to their behavioral and social well-being, which may affect their school performance and their physical and mental health.

Addressing issues contributing to and resulting from sleep disorders in adolescents, researcher Sujay Kansagra, MD, published an article in Pediatrics, discussing factors such as poor sleep hygiene (ie, habits that support good sleep), circadian rhythm disorders, and insomnia, with additional data to support treatment strategies.

When it comes to sleep hygiene, Kansagra notes that several modifiable behaviors and environmental factors play distinct roles in affecting sleep. Aspects of good sleep hygiene involve a nighttime routine; maintaining a consistent sleep schedule; keeping the sleeping environment cool and free from noise; and avoiding disruptors of sleep, such as light and screen time.

Technology use has also been explored in prior epidemiological studies, which have linked screen-based activities with sleep disruption. In fact, screen time restrictions were referenced as a prominent intervention supported by parents in a Canadian study that also promoted healthy sleep as the top parental behavior.

Beyond behaviors that promote sleep, biological factors also contribute to impaired sleep in adolescents as the onset of puberty corresponds with a biologically mediated shift in sleep timing and a predisposition to a later sleep-wake cycle, notes Kansagra. Compared with postpubertal and prepubertal teenagers, taking longer to fall asleep and finding it easier to stay awake are attributed to the homeostatic drive in this distinct group. Additionally, melatonin secretion shifts to a later time, which causes a delay in the circadian rhythm.

“A delay in circadian physiology predisposes to a mismatch between an adolescent’s preferred sleep time and social demands, such as school,” said Kansagra. This mismatch leads to the diagnosis of delayed sleep-wake phase disorder in up to 14% of the adolescent population.

Insomnia is an additional sleep disorder commonly found in adolescents, with rates ranging between 7% and 40% on the basis of the criteria used, highlights Kansagra. Moreover, the rise in mental health issues among adolescents may expose these populations to psychophysiological insomnia (PI), a common subtype of insomnia characterized by the inability to fall asleep or stay asleep due to anxious or stressful thoughts while in bed. In those affected, PI can be a severe condition, with up to 88% of those with prior history reporting difficulties with ongoing insomnia.

To treat this chronic condition, cognitive behavioral therapy for insomnia (CBTi) was described as an effective treatment in adults, with less rigorous studies also indicating a benefit among adolescents. However, Kansagra notes that more studies examining CBTi are needed to determine long-term benefits, ideal method of delivery, and comparison of cognitive behavioral therapy to pharmacologic therapy.

Kansagra highlights that although the last 4 decades has seen major steps in understanding the mechanisms of sleep, the increase in the incidence of sleep deprivation has coincided with these innovations. “With growing literature to support the role of good sleep health and efficacy of treatments, there is an increased need to proactively screen adolescents for common sleep disorders,” he said.

In guiding future initiatives, Kansagra said that future research is warranted to understand which strategies best promote optimal sleep health among adolescents.

Reference

Kansagra S. Sleep disorders in adolescents. Pediatrics. 2020;145(suppl 2):S204-S209. doi: 10.1542/peds.2019-2056I.