I recently saw a teenager in my sleep clinic whose mother had brought her to see me because she "couldn't wake up in the morning".
It turned out that this very pleasant 13 year old had had increasing difficulties getting out of bed and to school on time in the morning, which had started a few months earlier, and had gotten progressively worse. Her grades had plummeted, and she was falling asleep in class several times a week. She had had so many tardies and absences that discussions had begun in earnest about possible home schooling.
While her parents had tried to get her to go to bed at what they thought was a reasonable time for a girl her age (10 PM), once in her room she kept the lights on, and alternated between watching TV, texting her friends, and listening to music until 1, 2 and sometimes 3 in the morning. This then made it very difficult for her to get up at 6:20 in the morning in order to catch the bus, be in class on time, and to function at even the most basic of levels. Many days she simply would not get out of bed, and her parents would give up after multiple attempts to rouse her, allowing her to sleep in until 10-11 AM. After returning home from school on those days she still attended classes, she would usually nap in the afternoon for 1-2 hours.
On Fridays and Saturdays she would stay up as late, or later, than she did during the week. Her parents felt badly for her, seeing how sleepy she was, and would let her sleep in on Saturday and Sunday until 12-1 PM. While she was clearly more rested on the weekends, starting the week afresh come Monday morning was close to impossible.
The first questions I had for her was whether she understood that her sleeping patterns were problematic, and if she was interested in changing them so as to improve her situation at school and to feel more alert and better overall during the day. She answered yes to both, which was heartening, since without active cooperation, it is impossible to bring about changes in a teenager's sleep patterns.
We discussed the main problem, a circadian phase delay, or derangement of her inner clock, caused by her staying up late and sleeping in late, especially on the weekends. We also discussed the fact that sleep deprivation makes you sleepy, and that by napping one reduces the sleep pressure to fall asleep, and makes it easier to stay up even later. Finally, we discussed the negative effect that poor sleep hygiene has on falling asleep.
I am happy to report that after her getting her on to a regular schedule, the most important part of which was maintaining a regular and consistent wake up time 7 days a week, eliminating naps, removing the TV from her bedroom, depositing her cell phone with her parents at 9:30 PM, shutting off the lights at 10, removing the cats from her room (did I mention she had two cats who were in the habit of sleeping in her bed at night?), she was able to quickly turn around. Her school performance has improved, she no longer is missing school the way she was only a few weeks earlier, and she feels better, too.
Dennis Rosen, M.D.
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