CME Article
The sleepy adolescent: causes and consequences of sleepiness in teens

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Summary

The majority of adolescents do not obtain the recommended amount of sleep, resulting in significant daytime sleepiness. For most adolescents, insufficient sleep results from the interaction between intrinsic factors such as puberty and extrinsic factors such as school start times. Insufficient sleep and sleepiness impact all areas of adolescent functioning, including academic, psychological and behavioural, which underscores the importance of evaluating sleepy adolescents. While polysomnography is required for the diagnosis of certain sleep disorders, causes of sleepiness are generally best identified with a detailed sleep history and daily sleep diary. The management of sleep problems in adolescents involves treating any underlying sleep disorders, increasing total sleep time and improving other environmental factors that impact sleep. Recognition and management of insufficient sleep and sleepiness is important for the health and functioning of adolescents.

Introduction

Due to the interaction of physiological and social factors, adolescence is a period of development characterized by insufficient sleep and sleepiness. One recent study found that 45.7% of adolescents report daytime sleepiness at least once per week.1 Additionally, studies have shown that when adolescents and children sleep for the same number of hours per night, adolescents report higher rates of sleepiness during the day.2 While the majority of adolescent sleepiness is accounted for by insufficient sleep, a number of intrinsic factors also may lead to a complaint of daytime sleepiness. In order to shed light on ‘the sleepy adolescent’, this review will describe adolescent sleep needs, discuss the causes and consequences of insufficient sleep and sleepiness in adolescents, and describe how to assess for and differentiate between sleep problems.

Section snippets

Adolescent sleep needs

Longitudinal studies of sleep needs through puberty have demonstrated that adolescents require >9 h of sleep at night, with some adolescents also requiring additional sleep during the day.2, 3 Using a laboratory-based protocol, adolescents were put on a fixed 10-h schedule and allowed to sleep as much as they wanted. Results were that sleep need did not change from ages 10 to 17; that when well-rested, adolescents needed 9.25 h of sleep per night; and that at mid-puberty there was an increased

Insufficient sleep

The most common cause of daytime sleepiness in adolescents is insufficient sleep. Clinically, an adolescent with insufficient sleep will typically report a late bedtime and early wake time on school days, with significant oversleep at the weekends (sleeping >2 h later on weekend mornings compared to weekday mornings). Insufficient sleep results from the interaction of extrinsic factors (e.g. homework, time with friends and early school start times) and biological factors (puberty).

Activities, employment and academic demands

Participation

Consequences of insufficient sleep and sleepiness

Regardless of the cause of insufficient sleep, sleepy adolescents experience a number of negative consequences, including academic difficulties, mood disturbances, increases in risk-taking behaviours and drowsy driving.6, 8, 40, 41, 42

History and sleep diary

A detailed clinical sleep history is the first step required in differentiating between insufficient sleep, inadequate sleep hygiene and other sleep disorders. Along with a basic sleep schedule (bedtime, wake time and total sleep time), clinicians should enquire about all aspects of the adolescent's sleep and daytime functioning. Questions about sleep scheduling should focus on the consistency of a bedtime routine, typical bedtime and wake time (for both weekdays and weekends), and time spent

Conclusion

Adolescence is a time marked by physiological, social and psychological changes. While some adolescents may be considered moody or lazy, in fact they simply may be sleepy. Insufficient sleep, the most common cause of adolescent sleepiness, is typically the result of the interaction between puberty and academic, social and extracurricular demands. The interaction between these two arenas results in adolescents who do not get enough sleep at night and are sleepy during the day. Insufficient sleep

Practice points

  • The interaction of intrinsic and extrinsic factors predisposes adolescents to obtain insufficient sleep and to be sleepy.

  • Insufficient sleep is the most common cause of sleepiness in adolescents.

  • Sleepiness can affect academic, behavioural and psychological functioning.

Educational aims

  • To describe the causes of adolescent sleepiness.

  • To identify the sleep disorders common to or emerging in adolescence.

  • To describe the consequences of adolescent sleepiness.

  • To describe how to assess for sleep problems and insufficient sleep in adolescents.

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