How do sleep problems in young people affect mental health?

Any parent who has seen a child through adolescence knows sleep is a major battleground. When they're babies, they wake every five minutes through the night and leave you so exhausted you can hardly function. When they're toddlers they're up at 5am, bouncing on your bed and demanding to play with you; by the time they're seven, they're stamping their feet and arguing their case for being allowed to stay up later. But suddenly, apparently almost overnight, they turn into teenagers - and then you can't drag them out of bed in the morning for love nor money.

Or at least, that's the way I remember it. The 21st Century, it would seem, has seen all our thinking on teenage sleeping habits turned on its head.

Sleep troubles on the rise

Insomnia is undoubtedly common, affecting as many as one in three adults. But while we may not think of it as a problem for young people, NHS data shows the number of children referred for sleep problems has increased ten-fold in the last decade. Over the same period, the number of prescriptions for melatonin tablets given to people under 55 has also increased 10-fold. Melatonin is a hormone produced naturally in our brains. Its main aim is to regulate our natural waking and sleeping cycle, or body clock. It's not licensed in the UK for under-55s, but trials are ongoing.

Anyone who has suffered from insomnia will confirm that lack of sleep can wreak havoc with your ability to concentrate - but is this rise linked to the increase rates of diagnosis of depression among young people too? One in ten 15- to 16-year-olds suffers from depression, and between one in 12 and one in 15 self-harm. And if so, which is the consequence and which is the cause?

Links between sleep problems and mental health issues are well proven - but the chicken-and-egg debate continues. We know one of the common symptoms of depression is disturbed sleep. A couple of decades ago, there was much scientific interest in the impact of personal and home problems on sleep among teenagers - sleep problems caused by depression. But we are also becoming increasingly aware of a knock-on effect of sleep deprivation on mood - depression caused by sleep problems.

A similar circular argument applies to obesity. We know there's a link. We know you're more likely to suffer from conditions like obstructive sleep apnoea if you're overweight. But there's also good evidence that poor sleep can contribute in turn to obesity, in youngsters as well as adults.

Sleepy time tabs?

Sleeping tablets are definitely not the answer. In the past, sleeping tablets in the benzodiazepine family were commonly prescribed. Concerns about addiction led to the development of newer drugs called the Z drugs - these were supposed to cause fewer problems, but addiction to, and becoming tolerant of these drugs has also proved a major problem. Even occasional use of sleeping tablets (less than one every three weeks on average) has been linked to a higher risk of dying. This may be down to factors such as drowsiness and confusion increasing the risk of falls and accidents. The simple truth is, doctors don't know exactly why they pose such a risk, but we know they do.

What's to blame?

There seems little doubt that technology has to take at least some of the blame where sleeping problems among teenagers are concerned. The more time young people spend on their phones, tablets and computers, the worse their sleep. There is even a 'dose-response' - the bigger the bedtime dose of technology, the bigger the impact; the more devices they used, the greater the problems with sleep and so on. The link holds true for a wide variety of electronic devices, including mobile phones, MP3 players, tablets as well as TV and computers.

The blue light emitted from these devices is known to interfere with melatonin production. But other habits linked to computer use probably also play a part. The more time youngsters spend on technology, the less time they're running around outside - and there is good evidence that regular physical exercise improves sleep. If you're an already-exhausted teenager, exercise is unlikely to be appealing - and the more likely you are to resort to energy or other high-caffeine drinks, which can also disrupt your sleep

How can we break the cycle?

If your teenager is struggling to sleep, you'll need tact, discretion and a very thick skin to broach the subject. But simple steps can make a big difference:

  • Have a sensible conversation. Your youngster, if they're anything like mine, would have you believe that there are only two opinions in life - their opinion and the wrong opinion. But surveys suggest they pay more attention to your opinion than you might think. You might want to write down your points beforehand to avoid getting into a slanging match
  • Negotiation is key. 'I'm your mother/father and I know best' isn't productive and it isn't effective. There is good scientific evidence for the value of sleep on academic performance and mood, and equally well proven evidence for the suggestions below. You know your youngster better than any doctor - work out what matters to them and how you can make improvements without making them feel you're ruining their lives
  • Keep caffeine to a minimum. Caffeine is great for keeping you awake while you're studying for exams, but it's the last thing a youngster with insomnia needs. Energy drinks are particularly high in caffeine, but colas, coffee, tea and chocolate all contain caffeine
  • Set a screen curfew. It would be a brave parent who tried to ban the average teenager from social media completely, but negotiate a cut-off time for all electronic devices with screens in the bedroom. As a compromise, settle on a CD player or radio, which at least doesn't emit blue light
  • Eat early. Eating too late at night (and that includes snacks) can disrupt sleep
  • Routine rocks. Going to bed at a regular time and winding down before bed (a warm bath rather than a horror movie) sends subconscious messages to your brain
  • Bedrooms are for sleeping. Make sure your young person's bedroom is quiet and really dark - as well as banning electronic devices, use thick lined curtains and no digital clocks. If they have the same bed they've been bouncing on since they were five, try and invest in a comfortable mattress.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

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