Seriously, Why Won’t My Teen Sleep?
Your teen would love nothing more than to stay up all night playing video games or reading a fantasy novel. But the truth is, sleep deprivation makes ADHD symptoms exponentially worse — and can have other negative health effects, too. Here’s how to make sure your teen has quality bedtime.
There’s nothing teens with attention deficit disorder (ADHD or ADD) hate more than boring stuff, and there’s nothing more boring to them than sleep. In fact, aside from interesting dreams, the whole point of sleep is to be bored; to melt away your daily cares, so you can rejuvenate for another day. Sounds great, huh? Yet, as a culture, we see sleep as the thing to do when we’re done with everything else or as a lazy escape from waking events we don’t like. Teens are prone to ignore or even rebel against sleep as a core value — oftentimes resulting in sleep deprivation that can seriously impact their ADHD symptoms (and their happiness).
News on Sleep and ADHD
For people with ADHD, sleep can be a challenge. Research shows that good sleep is necessary to stabilize minds caught up in emotional and cognitive storms, and that bad sleep stirs up those storms. In other words, if you have a hard time with attention and your sleep deteriorates, your problem will go from bad to worse. If you don’t have ADHD symptoms, and have a lousy sleep life, at some point you may begin to show what look like ADHD symptoms.
Some researchers recently took this idea a step farther, surmising that ADHD might actually be a sleep disorder, that those who have ADHD are chronically sleep-deprived. Having studied clients for thousands of hours, I can say that’s not the case, but I understand how researchers might think so. People with prolonged sleep deprivation show symptoms of inattention, including the inability to multitask, fuzzy thinking, poor memory, and emotional upheaval. Poor sleep doesn’t cause ADHD, but it can mimic its symptoms.
It’s common for teens (and adults) with correctly diagnosed ADHD to experience sleep disruption as part of the disorder. If your mind is running a mile a minute during the day, it may not want to shut down at 9:30 each night. For some, quiet time amps up the noise levels inside their head.
Stimulant medication may disrupt sleep — and may cause sleepiness. While some teens and young adults experience sleeplessness because of stimulants, we’ve taken others off certain stimulants at our clinic because the meds made them sleepy. In the second case, this means that the stimulant is quieting their mind so well that they drift off when confronted with a boring class or task. More typically, though, we see the opposite, and advise clients to take stimulants to avoid sleep issues.
Figuring out which sleep problem a teen with ADHD has is tough. It may require a sleep study to diagnose restless leg syndrome, narcolepsy, or sleep apnea. But if none of those is found, you’ll have to work with your teen to vary medications, bedtimes, mattresses, pillows, degree of incline on the bed, antihistamines (for free breathing), caffeine intake, late-evening media exposure (no Game of Thrones at 11:30), and so on. As you modify each variable, examine whether sleep improves, gets worse, or is no different. A Fitbit or smartphone app, like Sleep Cycle, can be helpful in gauging how much deep and light sleep your teen is getting, or how long he or she is lying awake.
One of the best indicators of bad sleep habits is the afternoon nap. The generation that hates sleeping at night, teens and young adults, loves napping. That’s no surprise, given that teen circadian rhythms run later in the day than those of a child. Teens with ADHD often put off doing homework and other tasks until the last minute. They start it at 11:30, pushing back the crucial bedtime routine.
And then they crash. If we’re lucky, the crash comes at 3:30 in the afternoon. If not, it comes in the third hour of school. Either way, daytime drowsiness is a clear indicator of poor nighttime sleep. The only exception is the 20-minute power nap. Research shows that this brief pause is reinvigorating, sharpens attention, and won’t disturb the sleep cycle later. Anything longer throws off the daily sleep rhythm and messes up night sleep.
It’s best to rule out a sleep disorder or impediment before assuming that your teen is practicing bad sleep hygiene. A sleep study, at home or in a lab, is a good place to start. If the study doesn’t uncover any abnormalities, and yet getting to sleep or staying asleep is a problem for your teen, he or she may have Primary Insomnia, which I call “ADHD-related insomnia.” If that’s the case, you should talk to your prescriber about medication. This is a tricky business, and may require the help of a sleep specialist or a psychiatric prescriber.
7 Rules for Sound Rest
- Teach from early childhood that sleep isn’t a waste of time, but a crucial task of the day.
- Cut off caffeine after 2 p.m. While caffeine often has a paradoxical impact on ADHD kids (it is, after all, a stimulant), it can increase the tendency toward insomnia, especially if your child is taking Adderall, Vyvanse, or methylphenidate.
- You can’t run a sleep deficit and pay it off later. So, to the extent possible, regulate teen sleep/wake cycles seven days a week. There will be exceptions, but the rule should always be to keep bedtime and wake-up times consistent. You can push back those times by a couple of hours during the summer, but try to readjust at least two weeks before school starts.
- Expect homework to be done before recreational activities begin in the evening, and avoid the habit of doing homework right before bedtime.
- Bedrooms are for sleeping. The brain associates behaviors and environments, and your teen should walk into his or her bedroom and think, “I need to sleep,” not “Let’s play ‘Call of Duty’” or “Time for homework.” Teens hate this, but it’s better to do all non-sleeping tasks elsewhere.
- End screen time about an hour before bed. Teens will protest mightily, but there are two reasons for this. First, most media activity (TV, video games) is exciting and engaging. That’s the last thing you need before bed. In addition, the blue light from devices prevents the release of melatonin, a hormone that promotes sleep. A book or podcast is better. If your teen listens to anything, he needs to shut it off after an hour. Audio material stimulates the brain after sleep is initiated.
- Equip bedrooms with light-blocking shades, unless you live in the exurbs, and don’t have a yard light on the bedroom side of the house. When you pull the shades down, the room becomes nearly black.
Wes Crenshaw, Ph.D., is a member of the ADDitude ADHD Medical Review Panel.