Teenagers are naturally struggling with sleep deprivation and sleep debt built up over time as they shift into adult sleep still ensconced in a world that is unable to accommodate their shift in sleep habits and needs. Changing sleep in teens results in their not becoming tired until 11:00 in the evening despite the fact that they have to get up approximately five to six hours later. Therefore from a general perspective (by virtue of not being tired due to hard wired developmental changes in their sleep) all teenagers are at risk for sleep deprivation for a significant period of time (until completion of high school) due to not becoming tired until later evening hours although having to get up even earlier than they did in junior high years. Attempting to go to sleep without being tired leaves individuals at risk to develop insomnia. Consequently the sleep of teenagers is automatically limited by lack of tiredness and society demands of school start times automatically resulting in unfulfilled sleep needs over time without relief other than the summer and vacation time.
Aside from the above issues which are developmentally “normal”, sleep disorders when present will automatically carry the obvious increased risk of daytime sleepiness. When there is a sleep disorder that is fragmenting sleep, limiting restorative sleep, the teenager will not feel “awake” or “aware” until later morning hours. This tends to be true of adults as well.
The life of the teenager becomes that of trying to roll themselves out of bed in the morning (or someone else rolls them out of bed), and hopefully becoming more awake in the shower. The typical teen gulps down breakfast on a good day; then shuffles off to school in a semi-wake state. By the time they feel more awake during early morning hours, there may be another natural dip mid-morning and increased likelihood of becoming sleepy. By the time the morning is completed, academic classes are over and by the time the teenager actually feels “awake” and ready to learn, school is over.
Generally people report better attention during morning hours, although those with sleep deprivation or poor sleep tend to find a morning “dip” occurring, at which time they may actually become more impaired in their functioning. One of the reasons why teens love the afternoon nap is that by this time their natural circadian rhythm has joined forces with the sleep drive built up by sleep deprivation. As sleep becomes a more pressing need, the teen will then lie down for a “quick nap.” The problem is that rather than lasting 20 to 30 minutes in duration, this nap may stretch to hours, risking problematic night time sleep, generally a problem of sleep onset. Having napped longer during the day, the sleep drive is now fulfilled and the teen is even less tired when bedtime occurs. So once again they move into sleep deprivation due to the time they are finally getting to sleep and the time that they have to wake up for school.
There is a sleep debt that occurs with increased nights of poor sleep: The teen attempts to make up this debt by “sleeping in” on the weekend. Sleeping a much longer time than usual allows the recouping of some losses, however parents who do not want to see their child sleeping their day away naturally try to deter this process. Recent research indicates that sleep debt is never eradicated regardless the amount of makeup sleep.
Sleep is a necessary dynamic process with far reaching consequences when there is deprivation. Difficulty processing information, increased anger and becoming more emotionally reactive are typically seen symptoms accompanying a lack of sleep. Sleep deprivation can result in people becoming crankier, more emotionally fragile, easily stressed, whereby everything disturbs them. Women tend towards increased depression while men become less tolerant and mean.
Daytime sleepiness can be due to several causal factors when seen in teenagers. The most common disorders to rule out would be the following:
- Delayed sleep phase syndrome (DSPS)
- Obstructive sleep apnea
- Upper Airway Resistance Syndrome (UARS)
- Insufficient sleep
- Restless legs syndrome (RLS) or periodic leg movement disorder (PLMD)
- Additional disorders or conditions disturbing sleep, such as sleepwalking, sleep talking, sleep eating