Sleep is important, but hard

especially for teens

I’ve written about the importance of self-care for teens recently (here and here) and want to talk about the very important self-care topic of sleep more in depth today and tomorrow. We’ll cover other aspects of self-care soon too!

Getting a good night's sleep is crucial for everyone, but for teens — especially those with anxiety or ADHD, sleep plays an even more significant role in managing symptoms and maintaining overall well-being. Yet, sleep can be challenging due to difficulties falling asleep and staying asleep. Especially considering the teen circadian rhythm and early school and activity start times.

Teens often struggle with focus, attention, and emotional regulation with too little sleep. Some even think they have developed ADHD, but the problems only started after their sleep habits changed and if they improve sleep, they resume their baseline functions. When teens have ADHD, the lack of sleep exacerbates their baseline struggles and makes treatments less effective.

Understanding the connection between ADHD and sleep, and finding strategies to improve sleep quality, can make a world of difference in daily functioning and quality of life.

Why Sleep Matters

Sleep is essential for the brain and body to repair, recharge, and function optimally. As mentioned above, without enough sleep, it becomes hard to stay focused, manage emotions, and complete daily tasks.

Sleep deprivation may lead to:

• decreased immune function (more infections)

• increased risk of anxiety, depression and poor stress management

• increased risk of obesity and all the risks associated with it (heart attacks, diabetes, orthopedic problems, lowered self-esteem)

• increased blood pressure

• decreased productivity and quality of work

• decreased athletic performance and coordination

• increased perception of pain

• lack of energy or falling asleep at inappropriate times — or the opposite: hyperactivity (more common in children)

• car (and other) accidents

Sleep Challenges in Teens

Teens notoriously get too little sleep due to early school start times, packed schedules, screen use, and altered circadian rhythms.

• Routines and habits: Daytime habits can either help or hinder nighttime sleep. Getting up at the same time each day, being active and getting exercise, and turning off screens at least an hour before bedtime can help sleep. Sleep deprivation can be caused by poor sleep habits, such as using a cell phone, TV, or other electronics in bed, drinking caffeine too close to bedtime, or having an inconsistent sleep schedule.

• Full schedules: A common reason for losing sleep is a busy schedule that involves activities in the late evening. Teens with late activities cannot get the sleep they need with an early school start time. Those who have homework on top of hours of work or activities after school simply need more hours to get things done. They must sacrifice sleep during the week to get it all done, then try to rely on sleeping more over the weekend. Unfortunately, extra sleep on the weekend is not able to fully compensate for lost sleep during the week. I often say sleep is like money. If you take out loans from a bank, you need to pay back with interest. It’s better to pay cash and live within your means rather than get steeper into debt with interest payments. Sleep is very similar: it’s better to get the sleep needed each day rather than rely on catch up sleep later.

• Stress: Stress is a natural reaction to challenging situations, but if left unchecked it can make it more difficult to fall asleep. Stress causes the body to release hormones that trigger alertness, which can interfere with normal sleep. Chronic stress significantly affects our sleep as well as mental and physical health.

• Issues in the sleep environment: A person’s sleep environment can have a significant impact on their sleep. People who live in noisy areas may find it difficult to get quality sleep. Sleep can also be interrupted by too much light. Many find it hard to sleep in temperatures that are too hot or too cold.

• Medical conditions: Many medical problems can interfere with sleep, including pain, colds and coughs, and asthma. Many of these conditions, like pain, acid reflux, or coughs, may get worse at night, making it hard to sleep.

• Medications and substances: A wide variety of medications can interrupt sleep or make it more challenging to doze off. These include certain steroids, alcohol, decongestants, pain medications, stimulants (including prescriptions, nicotine, and caffeine) and drugs used to treat anxiety and depression. Alcohol can negatively affect sleep quality. Even those who think they can fall to sleep better with alcohol so have a “nightcap” to sleep better actually get less effective, poor quality, sleep.

• Mental health conditions: Several mental health conditions are linked to sleep challenges, including depression, anxiety, and bipolar disorder, attention deficit hyperactivity disorder (ADHD), and autism spectrum disorder.

• Circadian rhythm: During adolescence, the body’s natural sleep-wake cycle, or circadian rhythm, undergoes changes that can significantly affect sleep patterns.

  1. Delayed Sleep Phase

  In teens, the circadian rhythm shifts later, meaning they naturally feel more awake at night and sleepy in the morning. This delay is due to a change in the timing of melatonin release, a hormone that signals the body to prepare for sleep. In adolescents, melatonin is released later in the evening compared to children and adults, making it harder for them to fall asleep early.

  2. Difficulty Waking Up Early

  Since teens are biologically programmed to fall asleep and wake up later, they often struggle with early school start times. When forced to wake up before their bodies are ready, they often don’t get the recommended 8-10 hours of sleep needed for their age group.

  3. Impact on Sleep Quality

  The shift in the circadian rhythm can also affect the quality of sleep. When teens are unable to fall asleep until late but have to wake up early, they may miss out on the deeper, more restorative stages of sleep, which are crucial for learning, memory, and emotional regulation.

  4. Catch up sleep patterns

  Teens often try to catch up on lost sleep during the weekend by sleeping in, which can further disrupt their sleep patterns. This irregular sleep schedule can create a "social jet lag" effect, making it even harder to adjust back to early wake-up times during the week.

  5. Behavioral and Emotional Effects

  The misalignment between teens' natural sleep patterns and their daily schedules can lead to mood swings, irritability, difficulty concentrating, and increased risk of anxiety or depression.

Sleep Challenges with ADHD

Research shows that ADHD is often associated with sleep disturbances, such as delayed sleep phase (a tendency to stay up late and wake up late) and waking in the middle of the night. These sleep issues can create a cycle where poor sleep exacerbates ADHD symptoms, and those symptoms make it harder to sleep well.

Common sleep problems for people with ADHD:

• Difficulty Falling Asleep: Racing thoughts, hyperactivity, or anxiety can keep the mind active at bedtime, making it hard to wind down.

• Medications: ADHD medications can affect sleep in a few ways. When the medication is working, it helps calm the brain, but this can make it harder to manage racing thoughts when the effects wear off. These wandering thoughts, whether caused by excitement, worry, or the natural activity of an ADHD mind, can make falling asleep difficult. Stimulant medications can also directly impact sleep if taken too late in the day, as they may delay the time it takes to fall asleep. Additionally, they can interfere with the quality of sleep by disrupting sleep cycles.

• Restless Leg Syndrome and Periodic Limb Movement Syndrome: Restless leg syndrome (RLS) and periodic limb movement syndrome (PLMS) are more common in people with ADHD than without. Symptoms of RLS include an uncomfortable tingling, burning, or crawling sensation in the legs when trying to go to sleep. This causes an almost uncontrollable need to twitch, move the legs, or thrash around. Among those who have RLS, as many as 80% also have symptoms of PLMS. PLMS causes the arms or legs to cramp and jerk during sleep. The sudden movements may wake the person up. Because these movements often jolt one awake, they can cause trouble falling back asleep or staying asleep. Episodes of PLMS can last from a few seconds to nearly 2 minutes. They may happen frequently over several hours, leading to significant sleep disruption.

• Difficulty Staying Asleep: Restless sleep or waking up frequently can prevent a deep, restorative sleep.

• Trouble Waking Up in the Morning: When sleep quality is poor, waking up feeling refreshed can be a struggle, leading to grogginess or "sleep inertia."

Next up…

Now that you have a better understanding of the importance of sleep and some of the sleep challenges, you’re probably wondering what to do to get better sleep. That will be covered tomorrow — stay tuned!

I also try to motivate teens to get better sleep and practice other self-cares in “Setting the Stage for Success” — a 90-minute online workshop for teens. It will be offered November 2nd, but hurry — registration closes soon!