Nieman: Let sleeping teens lie

Teenagers need about 10 hours of sleep at night but many don't get that. kasinv / Getty Images/iStockphoto

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Not so long ago, while preparing to give a talk to family doctors, it dawned on me that wellness is a bit like the four wheels of a car. One can argue which wheel matters the most, but they all matter and are closely interconnected.

The four wheels are: how we eat; how we move; how we relax and how we think. Our positive or negative attitude has a huge impact on our wellness and in an era of much more stress, minimal mental resilience in teens is the cause of terrible suffering.

It comes as no surprise that stressed teens, who are too tired to exercise, too addicted to screens, and too busy to sleep, often have very little resources left to function in top gear.

They are also easily attracted to fake food late at night (Buy a burger at a famous drive-through outlet, leave it sitting for a year and see how pristine it looks — it seems to me we are facing not just fake news, but also fake food in increasing measures.)

Most of us know that to say children are not little adults is like saying the sun rises in the east. They are, in fact, unique and their needs are different.

According to Dr. Charles Samuels, an internationally recognized expert in sleep disorders, a past president of the Canadian Sleep Society, and the director for Calgary’s Centre for Sleep and Human Performance (CSHP), Canadian children and youth miss the mark when it comes to maintaining a consistent sleep routine.

During a recent interview with this well-respected expert, he underscored that poor quality sleep and not getting enough sleep can put a child at risk for health issues such as obesity, mood disorders, chronic fatigue, irritability and impaired attention.

Adolescents require stable sleep routines. Between the ages of 14 to 17 years, 10 hours of sleep is ideal.

I have coined two terms for problems in teens not getting enough sleep: The Harvard Factor and the Hollywood Factor (The Harvard Factor refers to teens staying up late to study hard so they can get accepted into top universities; the Hollywood Factor — far more common because it’s way more fun — is the typical teen who tells us there is a huge need to take the latest model of a smart phone to their rooms, because they need it as an alarm clock. Of course, parents find it alarming when they discover the teen texting at two in the morning, wide awake.)

We are talking about behaviours where teens shoot themselves in the foot by skimping on proper sleep.

Dr. Samuels and the CSHP are about to change that by providing something new to Albertans — easy access to a trained behavioural sleep medicine specialist. To facilitate collaboration between doctors, a primary care doctor can refer, but it is not a requirement to be seen at the CSHP. Self-referrals will be accepted. The cost is covered by government funding (Alberta Health).

The program is based on cognitive behavioural methods (CBT) that have been developed and used in other parts of Canada (Toronto Sick Kids Hospital and Dalhousie).

Dr. Katherine Rasmussen, an expert in CBT working at the CSHP, says: “The demand from a younger population continues to increase for our program.” The CBT program includes stimulus control therapy which reduces anxiety and conditioned arousal behaviour at bedtime; it reduces the amount of time spent in bed while improving the quality of sleep; it improves sleep hygiene, pre sleep routines, teaches the importance of minimizing light exposure; helps with getting better at meditation, deep breathing exercises and muscle relaxation and perhaps, most importantly, teaches teens to cope with cognitive distortions (inaccurate thoughts). It is especially useful when depression or stress cause insomnia.

Dr. Samuels correctly states that treating sleep problems in children with medication should be a definite last resort and be done only under close supervision by a physician.

In 32 years of being a pediatrician, I can count the times I prescribed medication for sleep almost on one hand. But sadly, teens self-medicate with a product which is easily available, supposedly used by many teens, which is perfectly safe —because its natural — and most importantly, it is legal: marijuana.

But this natural “safe” chemical interferes with the quality of sleep in that it interrupts various sleep stages. Eight hours of sleep with the “help” of marijuana and eight hours without it is vastly different.

Better Nights Better Days is a Canadian project funded by CIHR and doctors from Toronto and Dalhousie. When visiting http://betternightsbetterdays.ca one will also access YouTube Videos which explain the problem and its solutions in much more detail.

A Sport Canada initiative to help young athletes sleep well that is worth knowing about can be found by visiting www.sportlife.ca/wp-content/uploads/2016/11/Sleep-Recovery-Jan2013-EN.pdf

Dr. Nieman is a community-based pediatrician with 32 years experience. For more on pediatric holistic wellness, see www.drnieman.com

 

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