• Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

    The Sleepy Adolescent: When to Worry

    The Sleepy Adolescent: 

    When to Worry
    Many families notice that when their perky elementary school aged child hits puberty and adolescence, they often get very sleepy.  By the time our children hit high school they often become very hard to wake up in the morning, sleep long hours into the morning if allowed to, and seem to drag themselves through the day.
    What’s going on?
    The first thing to say is that this is exceedingly common.
    An interesting article from the University of Michigan documents that in college about 70% of students get less sleep than they should and half go about the day groggy.

    No one who has been adolescent or whose child is an adolescent should be surprised.

    There are several theories about why so many adolescents go about the world looking exhausted, dragging their bodies from class to class at school, from room to room at home, staying up late, and able to sleep ’til Noon.

    Three Theories on Why Adolescents are Tired
    (spoiler: no one really knows why they are)

    A common theory proposed, but not yet proven, is that adolescents are tired because of the physical drain on the body.  The combination of rapid growth, big swings of new hormones, the impact of stormy emotions all make this a plausible possible cause.

    Another very reasonable theory is that adolescents are tired because they are so busy.  After many hours of intensive high school classroom work, followed by many hours of grueling sports practices and games, plus the extra hours of working on the school paper, in the band, and/or the school play, it would be more shocking if your adolescent can’t open their eyes.

    Altered Biorhythms
    A third, intriguing theory has to do with actual observations that the internal clock changes during puberty in many adolescents.  The clock seems to shift several hours backward, to that the 5th grader who gets tired at 8:30 PM and is ready to get going at 6:30 AM suddenly wants to stay up until 1AM every night, and yearning to stay in bed until Noon.   Not because of wear and tear, or hormones, but because their inherent, structural, circadian clock is reset.  Those holding to this theory have been proposing that high school should start at Noon and end at 7PM.  Perhaps a good plan for the students, but not the staff.

    How to Know, What to Do, When to Worry

    We are frequently asked when to worry about your tired adolescent?  When to know that the tiredness might indicate a problem like low thyroid levels, anemia, or some hidden illness?

    It turns out that many conditions like hypothyroidism and anemia often present with few other symptoms and so there is a lot of overlap between the healthy adolescent who is simply tired and the adolescent with a health problem, but some clues can help.

    First, those with a medical problem can have other symptoms- changes in stool patterns, paleness, unsual rashes, unexplained fevers, for example.

    Second, those with a medical problem tend to get worse over time, while the healthy tired adolescent tends to be about the same week after week, month after month.

    For most adolescents who have no other symptoms, and who drag through the day with no worsening, testing will reveal they have no underlying conditions.

    But if the lethargy gets worse over time and if other symptoms appear, it’s time to call us.

    How Much Sleep is Needed?

    Everyone appears to have a number of hours each day we need to sleep.  Ongoing failure to get this sleep has an impact on both mind and body.  The impact on the mind is experienced as slower thinking, deterioration in being able to complete complex tasks, and decreased comprehension.  For the body, the impact worsens the longer the sleep deprivation continues, with some data suggesting that very serious health consequences follow many years of sleep deficits.

    The problem is that each person has a different number of hours for optimal sleep.   For some age groups the average is about 8 hours a night, but some may need as few as 3 or 4 hours a day, and others 10 or 12.  There are no tests to measure what your, or any specific person’s needed hours are.
    We have often seen adolescents who only sleep 6 hours a night, only to find out one of their parents sleeps about 5 a night and all are well rested on waking, a hint that the adolescent does not need 8 hours.

    Perhaps an indication about whether one is getting adequate sleep is indeed how they wake up and feel in the morning, and how that compares to mornings over the years.  A person who has tended to wake up ready to go who then, after sleeping less, struggles to wake up, could be someone who has started sleeping few hours than they need.

    The main point is that although it is tempting to say the tired adolescent is not getting enough sleep, and that is often the case, we cannot assume that is the case, a careful consideration of trends and current nature and timing of the tiredness can help sort this out.

    1.  Sleep is an essential, getting too little can cause trouble with thinking and with physical health.  Lots of adolescents get too little sleep, but for each individual adolescents, it is not always so easy to find out if they are sleeping enough.

    2.  Seeing a bright-eyed grade schooler transform into a sluggish adolescent is a common happening.   This is a common and harmless occurrence for the vast majority of adolescent.  Some think this is due to the impact of the physical changes of puberty, some of the hormonal shifts, and some because of a tremendously demanding work schedule.  It happens a lot, but on one knows why for sure.

    3.  There are health problems that can cause adolescents to lose energy.  These conditions typically, but not always, also cause other symptoms, such as weight gain in hypothyroidism, and paleness in anemia, and changes in appetite and mood in depression.   And, untreated, the lethargy caused by medical conditions tends to worsen over time.  Although this is not proof, the tired adolescent who has no other symptoms, and whose tiredness does not worsen, likely is well.

    4.  If all seems well, trends are stable, no other symptoms are present, it is reasonable to observe, but if any questions come up, we are happy to have you call to ask.

    To your health,
    Dr. Arthur Lavin 

    *Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person’s particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

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