Teen Night Owls:
Doctors Probe Why It's Hard
for Many Kids to Get Up
UP LATE and sleeping until noon usually seems like normal
But there's increasing concern among doctors that many teen
may actually be suffering from a little-known sleep disorder.
The problem, called delayed sleep phase syndrome, isn't well
known and is often underdiagnosed, but it may afflict anywhere
from 360,000 to several million teens and young adults, according
to a 2004 review article in the medical journal Sleep. One
of the gravest concerns, researchers say, is that it is often
misdiagnosed as attention deficit disorder, depression or
a behavioral problem that is treated with prescription drugs.
The sleep disorder, however, can usually be treated without
DSPS is believed to be the result of the body's internal clock-called
the circadian system-getting stuck in the wrong place, causing
kids to stay up late. As kids enter puberty, circadian rhythms
that affect sleep begin to change, which is why most kids'
bedtimes shift about and hour later as they get older. But
for reasons no one understands, some kids experience more
dramatic changes as their internal clocks shift forward too
far. Those kids can't fall asleep until the early hours of
the morning, but still have to get up early for school, so
they have to get by on just a few hours of sleep each night.
It isn't clear why this happens. It may be hereditary. External
factors may also play a role. As kids get older, schools start
earlier, and homework loads and extracurricular activities
increase, often forcing kids to stay up later than normal.
Every adolescent has to deal with these pressures, but in
some kids, the changes may upset the circadian system, causing
it to essentially get stuck in a place where sleep is consistently
"The parents get stigmatized as not having control over
their kids when they can't get them to school in time,"
says James Wyatt, co-director of the sleep-disorders
center at Rush University Medical Center in Chicago
who is conducting research looking for ways to better diagnose
the disorder. "Children themselves get stigmatized as
avoiding school or lazy. There's a lot of baggage associated
One of the biggest challenges of delayed sleep phase syndrome
is getting the right diagnosis. Sleep problems aren't usually
on the radar screen of pediatricians, school counselors or
parents. "If teachers were more aware and if parents
more aware that they should go to a sleep specialist, then
it's usually pretty easy to fix," says Lawrence MacDonald,
medical director for the Sinai-Grace Hospital Sleep Disorders
Center in Detroit.
One of Dr. MacDonald's patients is a 17-year old Grosse
Pointe, Mich., boy whose grades started falling two years
ago. After making straight A's in junior high, the teen started
bringing home low C's from high school. He was often unable
to pay attention in class, and complained of constant fatigue
and feeling overwhelmed. After visits with the school counselors,
pediatrician and a psychiatrist, he was diagnosed with depression
and started therapy. But the psychiatrist eventually said
he didn't seem depressed and suggested his problems at school
might be due to ADD. He was given the drug Strattera.
His mother, a nurse, heard about Dr. MacDonald after
talking with a colleague who had recently attended a medical
seminar with the doctor. After hearing about the teen's sleep
troubles, Dr. MacDonald suspected the boy might be
suffering from DSPS.
When the teen tried to go to bed at a normal time, he would
lay awake for hours, or get up and play on the computer or
watch TV. He would finally fall asleep around 4 a.m. only
to be awakened at 7 a.m. for school. The cycle lasted about
two years before he was correctly diagnosed.
Short-term use of melatonin, a hormone that influences sleep
patterns, may help, but the problem can return when the treatment
is stopped. Prescription sleeping aids also can offer short-term
relief, but they typically aren't recommended for adolescents.
A nondrug treatment called chronotherapy can be used to "re-set"
the body clock. Chronotherapy essentially "winds' the
body clock forward three hours at a time, moving the child's
bedtime around the clock until he or she ends up with a "normal"
For instance, for a child who can't fall asleep until 4 a.m.,
the bedtime is first delayed until 7 a.m., and the child is
allowed to sleep until about 3 p.m. The next day bedtime is
delayed another three hours, this time until 10 a.m., and
the child is awakened at 6 p.m. The process continues, with
bedtime moving around the clock to 1 p.m., 4 p.m., 7 p.m.
and 10 p.m. until the desired bedtime is reached. Windows
are taped up and phones are turned off so midday sleep stretches
won't be interrupted.
Parents typically have to sacrifice sleep themselves and take
turns staying up late and helping kids pass the time in the
middle of the night. The treatment typically takes about a
week, so a parent can choose to do it during a school vacation.
But it is well worth the effort. In the case of Dr. MacDonald's
patient, the teen now consistently falls asleep at 11 p.m.
and wakes at 7 a.m. His grades are mostly A's and B's.
Most kids and young adults eventually outgrow the problem,
but they remain at risk for relapsing.
Once the treatment is finished, teens are advised not to stay
up late on weekends and avoid late-night cramming for tests
for fear of throwing off the schedule. Because the circadian
system is sensitive to light, television and computer use
are discouraged within an hour before bedtime. Light boxes
are sometimes advised for 15 minutes or so in the morning
after waking, to keep the circadian system on track and help
reinforce the new wake-up time.