Elsevier

Sleep Medicine

Volume 8, Issue 6, September 2007, Pages 602-612
Sleep Medicine

Sleep, circadian rhythms, and delayed phase in adolescence

https://doi.org/10.1016/j.sleep.2006.12.002Get rights and content

Abstract

Sleep/wake timing shifts later in young humans during the second decade of life. In this review we describe sleep/wake patterns, changes in these patterns across adolescence, and evidence for the role of environmental, psychosocial, and biological factors underlying these changes. A two-process model incorporating circadian (Process C) and sleep/wake homeostatic (Process S) components is outlined. This model may help us to understand how developmental changes translate to shifted sleep/wake patterns. Delayed sleep phase syndrome (DSPS), which has a typical onset during the second decade of life, may be an extreme manifestation of homeostatic and circadian changes in adolescence. We describe symptoms, prevalence, and possible etiology of DSPS, as well as treatment approaches in adolescents.

Introduction

This review describes changes to sleep/wake behavior during adolescent development and the contribution of the circadian and sleep/wake homeostatic systems to this changing behavior. We also review delayed sleep phase syndrome (DSPS), which may be an extreme manifestation of these changes or may be a distinct clinical entity. Last, we describe approaches to treat DSPS in adolescents. For the purpose of this review, we consider biological adolescence to span the second decade of life.

Section snippets

Developmental changes in sleep/wake (light/dark) patterns

Sleep/wake patterns of developing adolescents are often described in the context of a school year and have been described separately for school (weekday) and non-school (weekend) days. Sleep timing is often quite different during school vacations. Describing sleep patterns during both school and vacation times provides a more comprehensive account of developmental sleep/wake behavior changes, yet few studies have examined vacation sleep patterns.

Table 1 summarizes adolescent self-reported sleep

The circadian timing system

The circadian timing system provides temporal organization for regulatory mechanisms to facilitate adaptive behavior, such as feeding, reproduction, and sleep/wake cycles [23]. These coordinated temporal patterns, or circadian rhythms, are self-sustained and oscillate with a period of about 24 h. The internal mechanism (pacemaker) that organizes these rhythms in mammals has been localized to a small paired nucleus in the hypothalamus, the suprachiasmatic nucleus (SCN; [24]). Biological events or

The homeostatic sleep system

The homeostatic sleep/wake system is thought to be relatively independent of circadian timing. A simple way to characterize the process is that sleep pressure increases the longer one is awake and dissipates as one sleeps. Slow wave sleep (SWS, stages 3 and 4) and electroencephalographic (EEG) slow wave activity (SWA, power in the 0.75–4.5 Hz range) have been used as physiological markers for “sleep pressure.” Thus, SWA is high at the beginning of the nocturnal sleep episode when sleep pressure

Process C

The circadian timing system undergoes developmental changes during adolescence. Although sleep/wake patterns have long been known to delay in adolescents, behavioral factors (e.g., social and scholastic obligations) were assumed to be entirely responsible. The notion that circadian timing may change was noted by Carskadon and colleagues in a study of circadian phase preference in young adolescents [52]. Phase preference, or morningness/eveningness is a behavioral construct related to the time

Delayed sleep phase syndrome (DSPS)

The developmental changes in the circadian and sleep systems we have described may be exaggerated in adolescents who receive a diagnosis of delayed sleep phase syndrome (DSPS). DSPS is a disorder with a typical onset in the second decade of life or earlier [75]. Weitzman, Czeisler, and colleagues [76], [77] first described delayed sleep phase insomnia as a distinct syndrome characterized by a cluster of features including a chronic inability to fall asleep and wake at a desired clock time,

Conclusions

Developmental delays in sleep/wake behavior across adolescence are associated with extrinsic and intrinsic factors. Investigations of circadian timing mechanisms and homeostatic sleep processes may provide insights into biological underpinnings of behavioral changes. Future research is needed to identify whether DSPS is an exaggeration of a typical developmental delay or whether the pathophysiology of DSPS has other pathways. Furthermore, efficacy studies of chronotherapy, phototherapy, and

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