More teens suffering from insomnia, other sleep problems

Dequicia Rawls often cannot stay awake in school, no matter how hard she tries.

The 15-year-old sits in her 10th-grade classes at Douglas County High School in Atlanta and "zones out" before falling asleep.

Dequicia sleeps during the day because a sleeping disorder called restless leg syndrome makes it difficult for her to sleep at night.

Dequicia is among a growing number of teenagers suffering from sleeping disorders. Experts say the problems are driven partly by biology, but over-scheduling, peer pressure and school activities also are to blame.

"It's almost like having a newborn," said her mother, Santrienia Rawls. "She's up at night and it scared me. I don't want her walking the house at night. But she would say 'I can't sleep, I can't sleep.' She's just anxious, really anxious."

To make up for the lost sleep during the week, Dequicia will often sleep from Friday evening until Sunday night, before starting the cycle again.

"Sometimes when I'm in class, it seems like I'm looking at the teacher, but I would be in my own little world, sort of doze off into a different state," Dequicia said. "Sometimes I'm just really tired all day, and it doesn't matter how much sleep I got."

While nearly all teenagers have occasional trouble sleeping, doctors are treating teens for significant problems, particularly insomnia, which is trouble falling asleep or staying asleep at least twice a week for a month or more, causing noticeable problems in daytime functioning.

Eric Johnson, a research scientist at Henry Ford Hospital in Detroit, recently completed a study in which nearly one-third of the 1,014 people between 13 and 16 that he surveyed reported having insomnia-type symptoms at least once in their lives. Nearly 17 percent of those teens met the stricter criteria for actual insomnia, he said.

"The prevalence seemed higher than we would have anticipated," said Johnson, with the most common problem being difficulty falling asleep, followed by non-restorative sleep -- when a person sleeps but wakes up tired.

Simple biology is partly to blame. During puberty, the body releases the sleep-inducing hormone melatonin at a different time, which changes the circadian rhythms that determine the sleep cycle. And many people have significant growth spurts from 12 to 18 years old. Those two factors mean many teenagers need between nine and 11 hours of sleep.

"It's a natural evolution of their development," said Dr. Jeffrey Durmer, director of the sleep clinic at Emory Children's Center of HealthCare of Atlanta. "They are becoming more like adults and less like children in terms of their habits and circadian rhythms."

Teenagers also experience delayed sleep phases, which means they simply can't go to sleep until late, often midnight or 1 a.m., wreaking havoc on the body when someone has to get up early for school, Durmer said.

"Society simply refuses to acknowledge that sleep delay and react accordingly," Durmer said. "With the increased social and academic pressures teens face, it adds up to a lot of problems that aren't remedied until they go to college and can take classes that start later in the day."

Besides falling asleep in school, sleep deprivation often leads to weakened immune systems, can delay bone growth and is associated with mental health problems such as depression.

Most teenagers are too concerned with their social lives, jobs, extra-curricular activities and academic work to heed warnings about their lack of sleep, said Dr. Ken Haller, assistant professor of pediatrics at Saint Louis University's School of Medicine.

It is often when parents bring them to a doctor with infections or other health problems that the importance of sleep might come up, he said.

"It's the teachable moment," Haller said. "I can ask them 'how much sleep are you getting?' I tell them 'you would feel a lot better if you tried sleeping instead."'

Haller said he also appeals to teenage vanity, noting that more sleep means fewer bags under their eyes, good skin color, no slouching.

"It will make them more attractive to their peers, which is extremely important to them," he said.

Dr. Ann Romaker, medical director of the Sleep Disorders Center at St. Luke's Hospital in Kansas City, cites another thing making teens tired -- "adults believe that sleep is optional.

"We pass that idea on to our children, that it's OK to give up sleep to accomplish everything you need to accomplish," she said.

Beyond difficulties in school, sleep deprivation is dangerous for teenage drivers, said Romaker, citing one study that showed a sleep-deprived teenager who had one alcoholic drink is more impaired than a completely rested teen whose blood-alcohol level is above the legal drinking age.

Romaker treats some of her patients with therapies designed to change teens' biological clocks. She sometimes has patients start bedtimes at different three-hour intervals through a 24-hour period until the patient has reached the best time to fall asleep. Or she uses bright lights to influence the melatonin release. For some patients under 14, she will do a one-time "shock therapy," making them stay up all night and the next day, then setting their times to sleep and wake up.

"The important thing is, you have to lock in that sleep time, and leave it locked in," she said. "Don't let them sleep later on weekends. You have to find ways to deal with their social lives and still have a normal sleep time."

Medication is needed for some sleep disorders, such as Dequicia Rawls' restless leg syndrome, an uncomfortable feeling or pain in the legs that worsens when someone lies down to sleep. Durmer, her doctor, has started her on medication to reduce the severity of the syndrome.

The family also rearranged her sleep schedule and reduced the stimulation in her bedroom from electronics and color, her mother said. So far, after about a month, the restless leg syndrome is better but she is still sleeping most of the weekend.

"We're not all the way there yet, but at least she's getting some good night's sleep," said her mother, who has two other children with sleeping problems. "It's just been round the clock. Now I'm able to get some sleep too."