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Sleep Disorders

Not sleeping at night

03/20/2007

Question:

I`m fifteen years old, and latley I just cant seem to fall asleep or stay asleep. Every night I go to bed at ten o clock, lay there for a couple of hours, and not fall asleep, or if I do fall asleep, its for a short period of time. I`m extremely tired all the time, but still can`t sleep and I dont know why.

It`s kinda weird acually, I am laying there trying to fall asleep, and in my mind, I`m sleeping, but in reality I`m still awake. It`s kinda hard to explain, but for example, the other day, I was laying down with my eyes closed. After about 15-20 minutes, I thought I was dreaming, and something really big hit my head, and I came out of it. It always seems so real, but I`m not quite getting how I could dream if I wasn`t fully alsleep, and still hear and know everything that`s going on around me.

My eyes feel like they`re burning constantly, and I just can`t seem to sleep no matter how hard I try. Do you maybe have any suggestions? at this point, anything will help.

Thank you!

Answer:

It's hard to know exactly what is going on with your sleep without additional information. However, based upon the history you have provided, I can try to address some of the probable issues at hand. Given your age and what appears to be trouble falling asleep at the start of the night, it is likely that you may have a delayed sleep phase.

Teenagers often like to stay up late and sleep in, especially on the weekends. Individuals who tend to stay up late at night, also known as night owls, need to be able to sleep late in order to get enough sleep. However, when they are required to awaken early for school or work, they tend to develop problems with not getting enough sleep. This type of sleep pattern, known as delayed sleep phase, is quite common in adolescents (about 10 times more common than in middle-aged adults). The lack of sleep that results may contribute to daytime sleepiness and poor performance at school or work (when these symptoms occur, it becomes known as delayed sleep phase syndrome). This problem is being increasingly recognized in society and some states are now experimenting with a later start time for high school students to see if this will impact behavior and performance.

If present, delayed sleep phase syndrome can usually be treated with behavioral modification and measures to help change the circadian rhythms, also known as biorhythms, which help determine when an individual becomes sleepy. Treatments that can influence the internal clock usually include appropriate timing of light exposure and, in certain cases, the use of melatonin or similar types of agents. Despite fairly effective therapies, some individuals have a hard time adjusting their internal clocks and have to adjust their work or school schedule to match their sleep schedule (i.e. only taking afternoon and evening classes).

In your case, trying to make sure you get plenty of exposure to bright light early in the daytime and avoiding it late in the afternoon/evening may help advance your circadian rhythms to help you get to sleep sooner. In addition, avoiding any kind of stimulant late in the day (i.e. no caffeine after lunch, no evening exercise) may make it easier for you to fall asleep. Some additional recommendations you might consider to try to improve your sleep include the following:

1) Maintain a regular wake time, even on days off school and on weekends.

2) Keep a regular schedule. Regular times for meals, medications, chores and other activities help keep the inner clock running smoothly.

3) Avoid napping during the daytime. If you do nap, try to do so at the same time every day and for no more than one hour. Mid-afternoon (no later than 3 PM) is best for most people.

4) Do not spend excessive amounts of time in bed. Use your bed only for sleep and times of illness.

5) A relaxing pre-sleep ritual such as a warm bath, light bedtime snack, or 10 minutes of reading may help. Avoid heavy meals before bedtime.

6) Try to exercise regularly. Vigorous exercise should be limited to earlier in the day, at least six hours before bedtime. Mild exercise should be done no more than 4 hours before bedtime.

Additional factors in your history may be important and, if after making the above adjustments you are still having problems, you should probably speak to your Pediatrician. Referral to a Sleep Specialist may be needed to determine the exact nature of your problem and how best to manage it. I would not recommend you start taking any over-the-counter sleep aids until you have undergone some form of an evaluation.

I’m not sure what to make of your complaint of feeling like you got hit in the head while attempting to sleep. This could represent a dream intrusion on early sleep, a migraine headache type of problem or something else. Further history would be helpful to decide if any additional evaluation is needed.

If you would like further information about sleep and sleep disorders, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you. The website Sleep Education.com also contains a list of accredited Sleep Centers and may also provides plenty of good consumer friendly information. Good Luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University