Excessive sleepiness in teenagers - What are the causes and what to do?

Adolescents and young adults (13–22 years of age) are often excessively sleepy.

This excessive sleepiness can have a profound negative effect on:

- school performance
- cognitive function
- mood
- increased incidence of automobile crashes

Excessive sleepiness - What are the causes?

The main reason adolescents don’t get enough sleep is that they simply don’t make enough time for it, because of early school hours, homework, part-time jobs, and other demands. The typical high school student falls asleep at 11 or later. One reason is that many teenagers cherish the late night as one of the few times they have all to themselves.

The “BEARS” screening is divided into 5 major sleep domains and provides a comprehensive screen for the major sleep disorders affecting children in the 2- to 18-year age range. Each sleep domain has a set of age-appropriate “trigger questions” for use in the clinical interview.

“BEARS”: A Sample Sleep History

B = Bedtime problems (Do you have any problems falling asleep at bedtime?)
E = Excessive daytime sleepiness (Do you feel sleepy a lot during the day? In school? While driving?)
A = Awakenings during the night (Do you wake up a lot at night?)
R = Regularity and duration of sleep (What time do you usually go to bed on school nights? Weekends? How much sleep do you usually get?)
S = Sleep-disordered breathing (Parent: Does your teenager snore loudly or nightly? Patient: Has anyone ever told you that you snore loudly at night?)

An algorithm can be used for diagnosing and treating sleep disorders. One sample assessment tool is shown below. Treatment should be directed at any potentially reversible process.



Excessive sleepiness - what to do?

- Adjust the lighting. As bedtime approaches, dim the lights. In the morning, expose your teen to bright light.

- Agree on a schedule, and stick to it. Tough as it may be, encourage your teen to go to bed and get up at the same time every day — even on weekends.

- Stop long naps. If your teen is drowsy during the day, a 30-minute nap after school might be refreshing. Be cautious, though. Too much daytime shut-eye might only make it harder to fall asleep at night.

- Set limits on electronic devices. Take the TV out of your teen's room, or keep it off at night. The same goes for your teen's cellphone, computer and other electronic devices.

- Relax. Encourage your teen to wind down at night with a warm shower, a book or other relaxing activities. Discourage stimulating activities — including vigorous exercise, loud music, video games, television, computer use and text messaging — an hour or two before bedtime.

- Limit the caffeine.

References:

Excessive Sleepiness in Adolescents and Young Adults. PEDIATRICS Vol. 115 No. 6 June 1, 2005 pp. 1774 -1786, (doi: 10.1542/peds.2005-0772), http://bit.ly/IcRr00

The Sleepy Teenager< - Harvard Health Publications http://hvrd.me/IcSJYO

Teen sleep: Why is your teen so tired? - MayoClinic.com http://mayocl.in/IcSZXV

Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

For people with congestive heart failure, a hot dog can trigger a trip to the hospital due to excessive salt

The average daily salt intake in America is one and 1/2 teaspoon a day. This is 3,400 milligrams of sodium a day, or 1,100 milligrams more then the recommended maximum.

For people with congestive heart failure, a salty hot dog can trigger a trip to the hospital.

The experts say the new target for sodium intake should be set at 1,500 milligrams daily.

In a previous study, reducing dietary salt by 3 gm per day (1200 mg of sodium per day) was projected to reduce the annual number of new cases of coronary heart disease by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. Such an intervention would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.

77% of the salt in the American diet comes from processed food. Only 6% is shaken out at the table, and only 5% is sprinkled during cooking.

Once people cut back on salt -- whether or not they know they are doing it -- they begin to prefer less salt in their food. This happens in a matter of weeks.

For example, alarmed by high death rates from strokes, Portugal plans to decrease salt in bread, blamed for high blood pressure. Portugal has one of the highest mortality rates from strokes in Europe - double that in Spain and 3 times that in France. http://is.gd/ndNv

The daily salt intake in Portugal is a staggering 12.3 grams (ranging from 5.2 to 24.8 gm) http://is.gd/ndQq

References:
Americans Need Help Shaking The Salt Habit - Shots - NPR Health News Blog.

"Cutting Salt as Good as Quitting Smoking"

3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death

"Food is risky. You can choke on a hot dog, be poisoned by a pizza or die slowly from years of eating too much" - The Economist, 2014 http://buff.ly/1k0lKBY

Image source: Wikipedia, GNU Free Documentation License.

Excessive Internet use may be linked to depression

Excessive Internet use may be linked to depression. Spend a day offline and connect with friends and family.

Twitter comment by @MiriamETucker: But they're all online!

Your Internet use could be telling you something about your mental health. If you keep up with friends via Facebook or spend more time chatting online with strangers than with family, it might be time to disconnect the computer for awhile — and check in with yourself.

The researchers analyzed internet use and depression levels of 1,319 Britons aged between 16 and 51. An online questionnaire was used to measure participants' Internet use, the functions for which they used the Internet, and their depressive tendencies. Of these, 1.2 percent were "internet addicted."

"Excessive internet use is associated with depression, but what we don't know is which comes first -- are depressed people drawn to the internet or does the internet cause depression?"

Using the Web to replace your usual social circle could be a red flag. Instead of spending hours on message boards, pick up the phone and call someone.

Twitter comments:

@BiteTheDust (Robbo) re: internet and depression.... if you skype someone is that using the phone or using the internet? just asking :)

@amacdt Especially if you use video skype - it's a tough one. I find that I really enjoy talking to people with video

References:

The relationship between excessive Internet use and depression: a questionnaire-based study of 1,319 young people and adults. Morrison CM, Gore H. Psychopathology. 2010;43(2):121-6. Epub 2010 Jan 23.

Study links excessive Internet use to depression. Reuters.

http://www.360-5.com

Image source: Wikipedia, public domain.