Wake up!

Seventy per cent adolescents are affected by altered sleep patterns

Sleep is when all the unsorted stuff comes flying out as from a dustbin upset in a high wind.
William Golding:
Pincher Martin

Although the functions of sleep remain unknown, it is clear that the organ responsible for generating sleep and the only organ served by sleep is the brain. Adolescents need nine hours of sleep, but rarely get that much owing to changing academic demands, expanding social opportunities and altered parent-child relationships. Ultimately, they should go to bed and wake up at the same time. This is considered good sleep hygiene.

Alterations in sleeping and waking patterns affect as many as 70 per cent of adolescents. These changes can be based on physiological processes. And the personal and social consequences of these problems going unrecognised or untreated can be catastrophic.

Delayed sleep phase syndrome: Its prevalence is 17 per cent. Teens affected by this syndrome often describe feeling wide awake in the late evening hours, with sleep setting in only by 3am or 4am. When they manage to drag themselves to school, their performance is impaired and may fall asleep in morning classes.

Psychophysiologic insomnia: The adolescent develops conditioned anxiety about difficulty falling or staying asleep, which leads to frightened arousal. This further compromises the ability to sleep.

Narcolepsy: This is characterised by episodes of sleepiness that may occur both at rest and during activity (bathing, eating etc). These 'sleep attacks' may be very brief (micro sleep), resulting in attention lapses and mood disturbances.

Restless leg syndrome (RLS): Often described as uncomfortable creeping-crawling sensation in the lower limbs during periods of inactivity, this is relieved by movement. Around 80 per cent of RLS patients also have periodic limb movements during sleep, which and the resultant sleep fragmentation they are usually unaware of. This may cause daytime sleepiness, inattention and hyperactivity.

Tips for good sleep hygiene in adolescents
* Wake up and go to bed at about the same time every night. Bedtime and wake-up time should not differ from school to non-school nights by more than an hour.
* Avoid bright light in the evening, but open blinds or turn on lights in the morning alarm goes off to aid awakening.
* Avoid sleeping in on weekends to 'catch-up' on sleep. It is likely that the child will later have problems falling asleep.
* Don't use sleeping pills unless recommended by the doctor. The sleep problems often return when the medicine is stopped.
* Regular exercise may help the child fall asleep and sleep deeply.
* Keep caffeine, nicotine, cola and chocolates away.
* Naps should not be for more than an hour, scheduled in the early to mid afternoon.
* Spend time outside every day. Exposure to sunlight helps keep body's internal clock on track.
* Eat regular meals and don't go to bed hungry. A light snack before bed is a good idea, a full meal is not.
* Use your bed for sleeping only. Don't study, watch exciting matches/movies, exercise, or involve in energising activities and arguments just before bed.
* Make the hour before bed time a wind-down time. Activities such as reading a book or listening to calm music helps your body and mind slow down enough to let you sleep.

Sleep deprivation can lead to...
* Impaired memory and imagination
* Depression, bad temper
* Lack of self confidence and mood swings
* Weak immune system and increased vulnerability to illnesses
* Educational difficulties
* Low cognitive performance

The writer is a consultant paediatrician at Rungta Hospital, Jaipur.

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