Question
For the last year, my 14-year-old son has been finding it hard to get to sleep at night. He says he can just lie there for hours unable to sleep (before he finally does) and then he is really tired in the morning.
It was a big problem in the last term in school as he struggled to go in and then was tired and disengaged when he was there. He assures me that there was nothing worrying him about school – it was just that he could not get off to sleep. Now, in the summer, sleep is less of an issue as he goes to bed later and there is no pressure to get up in morning – thought I don’t think the problem has gone away. Also he is due to start in the Gaeltacht next month which has a strict schedule in the morning and I am worried how he will manage. I should also say that he has struggled a bit in school over the years, and he is on a waiting list for an ADHD assessment. I am not sure if his main problem is his lack of a good sleep routine or ADHD or maybe a bit of both. I have also wondered about asking the GP about melatonin.
I am aware that he will be starting his Junior Cert year in September and I want to get him in a better routine by then.
Answer
Lots of children can habitually take a long time to fall asleep when they go to bed even when there is no simple identifiable cause such as anxiety or worry. When sleep/wake-up times are delayed by more than two hours a formal diagnosis of delayed sleep phase syndrome (DSPS) is often used. DSPS is a disruption to the circadian rhythm whereby a person’s sleep routine gets out of sync with desired patterns – DSPS does not mean the person does not need the sleep, it is just that they can’t go to sleep when they want to.
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This is, of course, can be very disruptive around school and work routines and can lead to sleep deprivation and underperformance. DSPS occurs a lot in adolescence, when sleep patterns naturally change such as needing more sleep during periods of developmental spurts or when their time of alertness can occur later in the day, etc. There is also a strong correlation between sleep problems and ADHD and, as you indicate, the interrelationship is complicated. Certainly, sleep problems can aggravate ADHD symptoms of inattention and distractibility and aspects of ADHD such as a racing mind or high physical energy can make sleep more challenging.
Resetting the circadian rhythm
There are lots of different things that can assist with creating a better sleep routine and it is usually a case of trial and error to find what works for your son. Many people recommend ‘light therapy’ as a means to reset the circadian rhythm. This means that your son should get up at the same desired each morning and immediately go outdoors to spend time in natural sunlight. In the winter you can use natural light lamps which can be turned on at wake-up time to mimic outdoor light. Additionally, increasing physical exercise can help, though this might need to be done at the right time such as early in the day so it helps build a better sleep routine.
Developing relaxing wind-down activities before sleep can also be really helpful, whether this is reading a book, doing a jigsaw, drawing or listening to a podcast. Different activities work for different children – help your son choose something that he enjoys, which is relaxing, rather than stimulating and which is easily accessible before bed.
In addition, lying awake for hours can be frustrating and this frustration can make it harder to sleep. As a result it is also important to agree a plan of action with your son as to what he can do on the nights he can’t sleep. This might mean getting up for a few minutes and reading or doing a relaxation exercise or simply recalling happy events as he lies awake.
Melatonin and sleep
Melatonin is the naturally produced hormone that regulates the body’s circadian rhythm. When a person’s circadian rhythm is in balance, melatonin levels rise in the evening as a person winds down before they go to bed. These levels peak in the middle of the night before falling in the morning at the time of waking. For many people, taking melatonin in the evening can help reset the circadian rhythm and ensuring a better nights sleep. Melatonin is available by prescription via GPs in Ireland who may recommend this when standard sleep techniques have not been successful and when the lack of sleep is disruptive to the teenager.
You could contact your GP now for an assessment or you could wait until the new school year when extra support to get into a better sleep routine might be needed.
- John Sharry is clinical director of the Parents Plus Charity and an adjunct professor at the UCD School of psychology. See solutiontalk.ie
