Monthly Archives: February 2012

Time to Help Teens Sleep

Teen Sleep

Do you remember dragging yourself out of bed for high school, then struggling to stay awake during class?  You were not alone in this.  Physiologically, teens are set to go to sleep later, and get up later.  Unfortunately school start times require that students be alert and functioning before their bodies are awake.  The good news is that a national movement to start schools later is gathering momentum, and you can join in!

Teen Body Clocks

As part of puberty, the circadian rhythm or ‘body clock’ shifts later.  Research in the last couple years has shown that this shift to later hours happens early in puberty, before other changes may appear.  Decades ago it was thought teens’ late hours were because they enjoyed late-night socializing or sadly some teens were called ‘lazy’ because they slept late.  We now know these sleep hours are based on their physiology. 

This shift can contribute to teens being sleep deprived in that they aren’t able to go to sleep earlier in the night because they aren’t sleepy, but yet they have to get up at a time they are sleeping well to go to school.  Research shows 80% of high school students are significantly sleep deprived, that’s a higher percentage than adults!

Help your Teen get Adequate Sleep

First, figure out how much sleep your teenager needs each night. It might help to remember a vacation when s/he was sleeping on their own schedule and was rested & energetic during the day. Next, plan to get up at the latest time for school, and count backwards to determine the bedtime that allows enough sleep. If it is not possible to go to bed at that time during the week, allow extra time for sleep on weekends.

Sometimes teens aren’t able to fall asleep even when they are in bed at a reasonable time. This is because their body clock is shifted later. They may need medical help to shift their body clock earlier.

Help Change Teens Sleep Nationally

In the last several months an effort to Start School Later has grown. There is a national petition to legislate that schools not start before 8am. This will be presented to Congress during National Sleep Awareness Week, March 5-11. Please join this effort to improve the teen sleep and the entire teen experience by signing this today (it will take 2 minutes). My hope is that we can change generations of teen experience of highschool and that time of life.

Sign the petition today!http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

Cautions About Sleep Medications

In my office, people who are taking many sleep medications for long-term use often come in looking for alternatives. In naturopathic practice there is a place for medications in the ‘Therapeutic Order.’ In naturopathic medicine the ‘least force’ treatment is used which will be effective. For instance, behavioral medicine will be used for insomnia first. Of course, behavioral strategies may not work for each person, so then herbal or nutrient therapy may be used next, and then pharmaceuticals.

Recently a person came in who had been using a combination of four sleep medications over the last 10 years. He had been alternating the medications on his own schedule as they became ineffective, and to avoid the need to increase dosage. Here was his regimen:
Alprazolam (Xanax) at 4am at his early am wakening to get another 3 hours of sleep. Alprazolam is a benzodiazepine hypnotic. Side effects include an increase in depression. When stopping the medication rebound insomnia can occur. Most of the hypnotics should not be taken with alcohol.
Zolpidem (Ambien) or Eszopiclone (Lunesta) Both are non-benzodiazepine hypnotics. Ambien is long-lasting, and people should be sure to have a full 7-8 hours in bed after taking it. Lunesta is one of the few medications approved for use on long-term basis.
Clonazepam (Klonopin) which is a long-acting benzodiazepine.
Even with these medications he was having interrupted sleep and found his sleep to be unrestful.

Our approach was to first use behavioral strategies to make his sleep robust and restful. Once he was sleeping well, we designed a schedule in collaboration with his PCP to taper down off the medications slowly. In this way we were able to avoid rebound insomnia and other withdrawal symptoms.

So, if you are struggling with insomnia, use the ‘least force’ treatment strategy that will solve your sleep problem. If you are recommended a sleep prescription, find out how long that medication can be safely used, any drug interactions to be aware of, and the typical withdrawal symptoms.

Mommy’s Sleep Holiday

Pretty regularly, women who are desperate for sleep come to me. These women say things like “I’m losing it,” “I’m going to go insane if I don’t get some sleep” or “I can’t take this anymore.”

Most of them are mothers whose sleep is being regularly disrupted by their children. You may think of mothers with infants or toddlers, but this isn’t always the case. Just last week it was a mom of 3 tweens who was being interrupted in the night, and felt completely frazzled because of it.

If this is describes you, or someone close to you – Take It Seriously! When people are so sleep deprived that they are “desperate for sleep” they need help, and soon. Professional sleep help may be needed, however, sometimes a few nights for a ‘Sleep Holiday’ can do wonders.

What do I mean by ‘Sleep Holiday?’ Arrange a few (2-3) nights when the mom can sleep completely uninterrupted. This can make a huge difference helping her feel more emotionally calm, rested, and better able to problem solve and stick to a plan to help her children sleep more independently. (Note – although it’s typically mothers who I see in this situation, it could easily be fathers, or anytone in the position of caregiving in the night).

For those 2-3 nights, arrange for the mother and children to sleep in different places – assign mom the guest room on another floor, better yet, have the children go to grandmas, or mom to go sleep at a hotel or a quiet friends house. The mother should go to bed at her earliest usual time, and sleep until she is done, without an alarm. Do all the things we’ve talked about to make the bedroom an ideal place to sleep, and turn off all phones and alarms.

For mothers who are breastfeeding, it may not be possible to have such long breaks from night-time caregiving, but is just as important. Figure out a strategy that will work for your family to get mom some long periods of uninterrupted sleep. Possibly mom can do the first feeding of the night, then dad can give a bottle later in the night. Even just using this strategy on weekends will result in a better rested mom.

Again, if you or your loved one is feeling ‘desperate for sleep’ take it seriously, and make a plan for them to have a ‘Sleep Holiday’ with less interruptions immediately, starting tonight.