Factors Affecting Sleep:

SOURCE: http://www.sleepdisordersguide.com/sleep-disrupts.html Environment Mostly, a quiet environment for sleeping is the most preferred. However, some people find a familiar noise e.g. traffic, is comforting when they fall asleep. Again, it is your own preference. Bedroom A cooler bedroom is thought to enable a better environment for sleep as it mirrors the fall in the core body temperature of the sleeper. Hotter environments can lead to a more disturbed nights sleep as it affects the REM sleep and can lead to more awakenings during the night. Please note that the environment can be affected by what the sleeper is wearing, the duvet size and the fluctuating temperature of the sleeper. Mattress Sleeping on a good quality bed and mattress can make all the difference to your sleeping pattern. Second hand or older beds, due to their poor hygiene, can cause sleep disturbance, leaving you feeling tired, irritable and in some cases, unwell. A mattress will absorb a lot of moisture and skin cells over its lifetime, making it a perfect environment for the house dust mite. This is thanks to, on average, an adult perspiring and breathing out around 1/2 litre of moisture every night, as well as shedding about half a kilo of dead skin per year! This is why it is important to not only clean your bedding and mattress on a regular basis, but to also change your mattress and bed about every 10 years keeping your sleeping environment clean, and more importantly keeping yourself healthy. Clutter Free A bedroom that is free of electronic devices is also thought to aid a better nights sleep as the room becomes solely a place that the sleeper enters to sleep. Watching TV in bed is a delay for actual sleep to commence and is thought to steal valuable sleep time. Removing clutter from your room will hopefully help remove the clutter from your mind! Light A dark room is favoured by most to fall asleep in, but a natural light in the morning when you are waking up is thought to make you feel more alert and more willing to get out of bed as it mirrors dawn and the natural process of waking up.

Stimulants Avoiding stimulants such as caffeine, alcohol and nicotine before you sleep can help your body relax quicker as these will stimulate the body rather than letting it unwind. Awake/Sleepy Go to bed only if you are feeling tired and feeling as if you can sleep. If you do find that you go to bed and you cannot sleep, it is better to get up and do a quiet activity, such as reading, for 1520 minutes. This will relax your mind and take away the pressure you may put on yourself to sleep. If you continue to lie there willing yourself to sleep you may only stress yourself further away from sleep. Naps Try not to nap during the day as this will affect your sleeping pattern, and if you cannot keep awake, then nap for no longer than an hour. Baths Having a bath may relax you as water can have a calming effect on us. It is also thought to cause a reactive decrease in our body temperatures which allows us to sleep more readily. Eating & Drinking Try not to go to bed on a full stomach as the body will still be trying to digest the food. Equally, going to bed hungry may disrupt your sleep. Drinking before bed may disturb your sleep as you may need to urinate during the night, so try to avoid drinking about an hour before bed. Smoking Smokers can have quite a hard time of sleeping. Time for which nicotine is actually active in the bloodstream is quite low. So as soon as theyve stopped smoking the reaction of not having nicotine around that time can disturb sleep. Generally their circulatory systems are quite poor so their breathing is disturbed during sleep. The two add up together to not having a good night sleep. Nicotine is can keep you awake. Nicotine also leads to lighter than normal sleep. Heavy smokers also tend to wake up too early because of nicotine withdrawal. Although alcohol is a sedative that makes it easier to fall asleep, it prevents deep sleep and REM sleep, allowing only the lighter stages of sleep. Over-the-counter Medicines Certain commonly used prescription and over-the-counter medicines contain ingredients that can keep you awake. These ingredients include decongestants and steroids.

Many pain relievers taken by headache sufferers contain caffeine. Heart and blood pressure medications known as beta blockers can cause difficulty falling asleep and increase the number of awakenings during the night. People who have chronic asthma or bronchitis also have more problems falling asleep and staying asleep than healthy people, either because of their breathing difficulties or because of the medicines they take. Other chronic painful or uncomfortable conditionssuch as arthritis, congestive heart failure, and sickle cell anemiacan disrupt sleep, too. Menstrual Cycle Hormones Menstrual cycle hormones can affect how well women sleep. Progesterone is known to induce sleep and circulates in greater concentrations in the second half of the menstrual cycle. For this reason, women may sleep better during this phase of their menstrual cycle, but many women report trouble sleeping the night before their menstrual bleeding starts. This sleep disruption is probably related to the abrupt drop in progesterone levels in their bodies just before they begin to bleed. Women in their late forties and early fifties, however, report more difficulties sleeping (insomnia) than younger women. These difficulties may be because, as they near or enter menopause, they have lower concentrations of progesterone. Hot flashes in women of this age also may cause sleep disruption and difficulties. Psychological Disorders A number of psychological disordersincluding schizophrenia, bipolar disorder, and anxiety disordersare well known for disrupting sleep. Depression often leads to insomnia, and insomnia can cause depression. Some of these psychological disorders are more likely to disrupt REM sleep. Psychological stress also takes its toll on sleep, making it more difficult to fall asleep or stay asleep. People who feel stressed also tend to spend less time in deep sleep and REM sleep. Many people report having difficulties sleeping if, for example, they have recently lost a loved one, are undergoing a divorce, or are under stress at work. Lifestyle Factors Certain lifestyle factors may also deprive a person of needed sleep. Large meals or exercise just before bedtime can make it harder to fall asleep. Studies show that exercise in the evening delays the extra release of melatonin at night that helps the body fall asleep. Exercise in the daytime, on the other hand, is linked to improved nighttime sleep. If you arent getting enough sleep or arent falling asleep early enough, you may be over scheduling activities that can prevent you from getting the quiet relaxation time you need to

prepare for sleep. Most people report that its easier to fall asleep if they have time to wind down into a less active state before sleeping. Relaxing in a hot bath before bedtime may help. In addition, your body temperature drops after a hot bath in a way that mimics, in part, what happens as you fall asleep? Probably for both these reasons, many people report that they fall asleep more easily after a hot bath.

SOURCE: http://www.sleepdisordersguide.com/sleep-disrupts.html

Sleep Disorder and Teenagers

http://hubpages.com/hub/Sleep-Disorder-and-Teenagers There is a sleep disorder that affects between seven to ten percent of teenagers called Delayed Sleep Phase Disorder, also known as DNS. Most teenagers outgrow this disorder by the time they reach young adulthood. Less then one percent of adults are believed to have DSP. Often people mistake this sleep disorder for insomnia. Left on their own, people with delayed sleep phase disorder would stay up until very late, sometimes until 4 or 5 a.m. They like to get up very late in the morning or early afternoon. Often they are referred to as night owls. Many teenagers like to stay up late and sleep late in the morning. Sometimes this is because they want to socialize at that time of the day. However, it can also be due to the natural delay in the circadian sleep / wake rhythm at their age of development. Teenagers with this sleep disorder often have a very hard time getting up in the morning for school. Even if they go to sleep at a regular time, such as 11 p.m., they toss and turn for hours like someone with insomnia. They difference is, unlike an insomniac, people with delayed sleep phase disorder have no difficulty staying asleep. They do have a very difficult time getting up early in the morning. Teenagers with this sleep disorder are very tired during the day and may even fall asleep in the classroom. The exact cause of this sleep disorder is not known. It is known for certain that it is a circadian rhythm problem. Treatment for this sleep disorder is available for people that need to get onto a more traditional sleep / wake schedule. The types of treatment include, bright light, chronotherapy, melatonin and over- the-counter prescribed sleeping pills. Bright light treatment for delayed sleep phase disorder uses bright light to trick the brain's circadian clock . Exposure to bright light shifts the circadian rhythm if it is administered within a few hours of the body's lowest temperature at night. Using chronotherapy as a treatment for someone with delayed sleep phase disorder requires a block of time one week long. Each day bedtime is delayed by three hours successively. For example, for someone that falls asleep at 2 a.m. but wants to fall asleep at 11. p.m., their bedtime would move to 5 a.m. on the first day. The next day it would move to 8 a.m. and continue this cycle for a week. A teenager suffering with delayed sleep phase disorder would need a week off from school in order to complete this therapy. Once the desired bed time is reached it is very important to keep a consistent wake up time. There are several treatments involving various drugs that are used to treat delayed sleep phase disorder. Melatonin has been successful in changing the sleep cycle of people with this sleep disorder. Prescription medication such as Ramelteon, and other sleeping pills, have been successful in treating teenagers and adults with delayed sleep phase disorder. If your teenager has trouble falling asleep and always wants to stay up late, be aware of the possibility that a sleep disorder may be present.

Teenagers suffer from sleep disorders resort to alcohol consumption

Written by: David Castillo on June 23rd, 2010

Sleep disorders are common among teenagers in their puberty, and they result to alcohol to get sleep, suggests a new study. Alcohol has pharmacological properties disrupt rapid eye movement and other restorative stages of sleep. Pubertal timing has been found to predict adolescent alcohol use, with early maturing adolescents being more likely to drink, explained Sara Pieters, a doctoral student and a corresponding author of the study. Adolescent alcohol use has also been linked to sleep problems, such as trouble falling asleep, maintaining sleep, and perceived tiredness. This study combines these two separate lines of research by examining the impact of pubertal maturation on the relation between sleep problems and alcohol use. The study obtained data from 431 adolescentsaged 11-14 years oldby way of questionnaire data. The researchers found that puberty has links to sleep-related problems and evening tendencies, like sleeping later. This results in early alcohol abuse for adolescent, who get sleepier with alcohol. Our advice to clinicians would be to better screen for sleep problems when adolescents seem to have other psychosocial or behavioral problems, advised Pieters. To parents it is recommended that they monitor their offsprings sleep, keeping in mind that sleep has an effect on so many other health domains, including risky behaviors such as alcohol consumption. The results of the study will be published in the 2010 issue of of Alcoholism: Clinical and Experimental Research.
SOURCE: http://www.shiftworkdisorder.com/teenagers-suffer-from-sleep-disordersresort-to-alcohol-consumption-101241.html

Parents need to help their teenagers get enough sleep

Written by: David Castillo on August 6th, 2010

Teenagers tend to stay up late hours during the summer. This makes it harder for them to adjust their body clocks when the school year begins. Supposedly, teenagers need eight to nine hours of sleep per night. But, as most parents would know, most teenagers refuse to do so. As a result, they become sleep deprived during weekdays. And the condition worsens as the school year progresses. Due to sleep deprivation, teenagers will underperform in class. Lack of sleep will make them drowsy, while also giving them concentration problems. In addition to that, it also puts them at risk whenever theyre performing daily activities, like driving. The best thing that parents can do to solve this is to develop and maintain a sleep routine for the teenager. Televisions, computers, and cell phones will rob teenagers of sleep time. Drinking coffee will also disrupt their sleep clock. When left unchecked, sleep deprivation can also lead to sleep disorders, like sleep apnea. SOURCE: http://www.podfeed.net/podcast/Tips+for+Parents+with+Teenagers+with+Sleep+Disorders/6423

Adolescents With Chronic Insomnia Report 'Twofold To Fivefold' Increase In Personal Problems
ScienceDaily (Mar. 23, 2008) Chronic insomnia is costing adolescents more than sleep. Its been linked to a wide range of physical, psychological and interpersonal problems, according to public health researchers at The University of Texas Health Science Center at Houston, who completed the first prospective study of adolescents with persistent sleep problems. Documenting a twofold to fivefold increase in personal problems among adolescents with persistent sleeplessness, public health researchers at The University of Texas Health Science Center at Houston say they have completed the first prospective study demonstrating the negative impact of chronic insomnia on 11 to 17 year olds. More than one fourth of the youths surveyed had one or more symptoms of insomnia and almost half of these youngsters had chronic conditions. Findings appear in the March issue of the Journal of Adolescent Health and are based on interviews with 3,134 adolescents in metropolitan Houston. Insomnia is both common and chronic among adolescents, wrote lead author Robert E. Roberts, Ph.D., a professor of health promotion and behavioral sciences at The University of Texas School of Public Health. The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive and substance abuse disorders. Chronic insomnia severely impacts future health and functioning of youths. Researchers measured 14 aspects of personal wellbeing and found that adolescents with chronic insomnia were much more likely to have problems with drug use, depression, school work, jobs and perceived health. The study involved adolescents enrolled in health maintenance organizations who were screened for sleep problems and issues affecting physical health, psychological health and interpersonal relationships at the beginning and end of a 12-month-period. The initial screening was in 2000 and the follow up evaluation in 2001. Almost half of the adolescents who reported one or more symptoms of insomnia during the initial screening had similar issues a year later, Roberts said. Twenty-four percent met the symptom criteria for chronic insomnia as defined by the American Psychiatric Association (APA). Insomnia is considered a psychiatric disorder. The adolescent data was gleaned from Teen Health 2000, a community-based, prospective study of the epidemiology of psychiatric disorders among adolescents, which involved a structured psychiatric interview, demographic data on the youths and the household, as well as queries about stress exposure. Interviews took one to two hours.

The symptom criteria for insomnia, according to the APAs Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, includes difficulty initiating sleep, difficulty maintaining sleep, early morning awakening and nonrestorative sleep over the past four weeks. In the initial screening, 27 percent had one of more symptoms of insomnia, 7 percent had one or more symptoms of insomnia plus daytime fatigue or sleepiness or both, and 5 percent met the DSM clinical diagnosis criteria, which attempts to rule out other psychiatric disorders, as well as the effects of alcohol, drugs or medication, which can be confused with chronic insomnia. Other studies indicate that chronic insomnia among adolescents can be caused by behavioral and emotional issues, Roberts said. Roberts said adolescents with chronic insomnia were more likely to seek medical care. These data suggest that primary care settings might provide a venue for screening and early intervention of adolescent insomnia, he said. Roberts collaborators include Catherine Roberts, Ph.D., Vivian Driskell, Wenyaw Chan, Ph.D., and Hao T. Duong, M.D., all with the UT Health Science Center at Houston. Research was supported by the National Institutes of Health. The study is titled Chronic Insomnia and Its Negative Consequences for Health and Functioning of Adolescents: A 12-Month Prospective Study. SOURCE: http://www.sciencedaily.com/releases/2008/03/080320192339.htm

Adolescent Sleep Needs

"Adolescence is the time of greatest vulnerability from the standpoint of sleep," - William Dement Teens need more sleep as they go through adolescence. Even with more than 9 hours of sleep a night many teens struggle with drowsiness, especially early in the day. This problem has gotten worse in recent years, as teen culture pushes kids to delay bedtimes, while high school start times have been pushed earlier. Many teens report sleeping 7 hours or less on weeknights rather than the 8 or 9 hours they need to be alert during the day. Research suggests that the sleep-wake cycle shifts during adolescence. As a result, teenagers have a natural tendency to fall asleep later and wake up later. Psychosocial and environmental conditions make it easier for adolescents to delay bedtimes. Sports, homework, jobs, socializing contribute to a busy schedule that leave little time for sleep. Modern electronics and entertainment systems keep minds occupied when they should be sleeping. Combining work and school is also a challenge for teens, often to the detriment of their sleep lives. Research shows that working more than 20 hours a week during the school year is associated insufficient sleep and exercise. Recent academic studies have attempted to get some data on teens, but like other sleep studies they are subject to suspicion because of low sample sizes, the subjective nature of sleep quality, and standardization in reporting. It appears that 10% to 15% of adolescents have insomnia. This is actually lower than any age group in adults. There is some evidence of heritability, with mothers being the family member that most often shares insomnia. However, all researchers agree that sleep disorders are not as simple as genetic. Many sleep experts are calling for revision of school start times. They want schools to start later in the morning and run later in the afternoon, to accomodate the delayed sleep cycles of teens. Cross-sectional studies suggest widepread insomnia among US teens. A minority, but a substantial minority (about a quarter) of adolescents report chronic insomnia, even after kids with psychiatric disorders are not counted. Lost sleep accumulates over time; the more sleep debt an individual incurs, the greater the negative consequences. The effects of chronic sleep loss are more than just fatigue; people cant learn as well when they have accumulated sleep debt. Consequences of insufficient sleep in adolescents include missed school, sleepiness, tiredness and decreased motivation, and difficulties with self-control of attention, emotion and behavior.

Treatment and Behavioral Patterns

Teens with insomnia (primary insomnia) are treated the same way as adults. Education and behavioral modification is the first approach to the problem (before drugs.) This means sleep hygiene, stimulus control, sleep restriction therapy, and relaxation techniques. The FDA has not approved any sleeping pills (insomnia medication) for children or teens. That doesnt mean medicines are not used. Experienced pediatricians and psychiatrists may wish to prescribe sleeping aids off-label for children. They usually do so as part of an overall sleep strategy that includes behavioral modification. The fact that children have different sleep architectures from adults (longer time in Stage 3) and generally smaller bodies (resulting in dosing challenges) means doctors have to be careful with medicines and cannot simply use the same regimens they apply to adults. As with adults, doctors weigh the teenage patients overall health and other conditions when determining a regimen. When the patient has sleep onset insomnia, a fast-acting drug with a short half-life might be used. Sleep maintenance insomnia (more often seen in the elderly than in young people) is frequently treated with longer half-life drugs. Another big problem seen in teens is drowsy driving. Young people fall for this much more than more experienced drivers. The National Highway Safety Administration estimates that more than 1500 Americans under age 21 are killed because of car crashes due to drowsy driving every year. Many teens try to catch up on their sleep on weekends, and to some extent this works. But irregular sleep schedules also pose problems. Delaying weekend bedtimes and rising times for several hours can disrupt the normal sleep cycle much the way jet lag can affect long-distance travelers. Adolescents may also suffer from sleep disorders, just like people of any age range. For instance, narcolepsy typcially first appears between the ages of 10 and 20, although the symptoms are sometimes different from those in adults. Mood disorders often begin in adolescense, and sleep problems are often a problem. Insomnia can also be a warning sign for depression in later life. Adolescents may also be more affected by caffeine and nicotine than adults so that an equal amount of these stimulant consumed could lead to more insomnia. SOURCE: http://www.sleepdex.org/adolescent.htm

The Sleepy Teenager

By Kyle P. Johnson , M.D. (This article was first printed in the November 2001 issue of the Harvard Mental Health Letter.) The rapid physiological, emotional, and social changes of adolescence often have disturbing effects on sleep. Teenagers need more sleep than school age children but usually get less, and the shortfall causes many problems. Daytime fatigue and drowsiness may affect schoolwork by reducing concentration and short-term memory. Sleepy teenagers are more easily injured, especially in traffic accidents, and lack of sleep raises the risk of depression and the use of alcohol and illicit drugs. A standard way to measure daytime drowsiness is the Multiple Sleep Latency Test (MSLT). The person taking the test is asked to try to take a nap every couple of hours, and the time it takes to fall asleep (sleep latency) is recorded. Anyone who falls asleep within ten minutes probably has not been getting sufficient sleep at night. It turns out thatby this standard or more informal standardsteenagers ordinarily need eight and a half to nine and a quarter hours of sleep a night to be fully rested. But surveys indicate that during the school week, average sleep time ranges from about seven hours, 40 minutes in 13-year-olds, to barely over 7 hours in 19-year-olds. Only 15% of adolescents sleep as long as eight and half hours on school nights, and 26% say they usually sleep six and a half hours or less. They try to compensate on weekends by sleeping nearly two hours longer on average. The main reason adolescents dont get enough sleep is that they simply dont 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. Another, possibly more important cause is their biological phase delaya tendency to fall asleep and wake up later because of changes that occur at puberty in the internal body clock governing circadian (24-hour) biological rhythms. A common circadian rhythm disturbance is known as delayed sleep phase syndrome (DSPS). Adolescents with DSPS cannot fall asleep until the early hours of the morning and often lie awake in bed for a long time. The problem is especially serious during the school year, when they have to get up early on weekdays and may sleep well into the afternoon on weekends to compensate. Meanwhile, they feel constantly drowsy during waking hoursexcept in summer, when they may sleep from 2 a.m. to noon. If allowed to persist, the syndrome is sometimes complicated by conditioning that associates bed and bedroom with wakefulness. Adolescents

with DSPS are also at risk of developing poor sleep habits, such as staying up into the wee hours of the morning doing homework or playing video games. DSPS often leads to poor schoolwork and family conflict; it may be an unrecognized cause of behavior that looks like adolescent rebelliousness or delinquency. DSPS can also be mistaken for depression. Some teenagers are drowsy during the day even though they seem to be sleeping normal hours. There could be several reasons for this. Sleep can be disrupted by drugs (including alcohol and caffeine), by the rebound effect when a drug leaves the body, and by medical conditions such as chronic pain or gastroesophageal reflux (heartburn). Psychiatric disorders are another cause of disrupted sleep and daytime sleepiness in teenagers. Either insomnia (especially difficulty in falling asleep) or, occasionally, excessive sleep may be a sign of depression in an adolescent patient. Anxiety disorders, post-traumatic stress, bipolar (manic-depressive) disorder, or the onset of a psychosis may also be contributing to the problem. Involuntary limb movements, including restless legs syndrome, are another possible source of unrefreshing sleep. In trying to understand some adolescent sleep problems, it is important to recognize that sleep is not a uniform state. It has a structure sometimes described as sleep architecture, which is most evident in the cycle of REM (rapid eye movement) and non-REM sleep. During non-REM sleep, body temperature falls, breathing and heartbeat are regular, and brain waves are slow and rhythmical. We have little conscious experience at these times. REM sleep begins about an hour and a half after we fall asleep and returns four or five times a night, becoming more frequent toward morning. This state of consciousness is completely different physiologically from nonREM sleep, more closely resembling the waking state. Muscles (except for the eyes and diaphragm) are almost completely paralyzed, but brain activity is at waking levels, and we have vivid dreams. Charting sleep architecture, especially the pattern of REM and non-REM periods, is often useful in diagnosing sleep disturbances and disorders; for example, the REM sleep of many depressed people begins unusually early in the night. Specialists can measure sleep patterns objectively in a laboratory with a polysomnogram (PSG), which records brain waves, body movements, breathing, and heart rate. Two relatively rare but extremely serious causes of sleepiness in teenagers are narcolepsy and obstructive sleep apnea. Narcolepsy is a neurological syndrome that afflicts about 1 person in 2,000. Its chief symptoms, apart from daytime sleepiness, are cataplexya sudden loss of muscle tone (going limp) induced by strong emotionsand sudden attacks of REM sleep in the daytime. Other symptoms are sleep paralysis (inability to move although fully conscious during the onset of sleep or while waking) and hypnagogic hallucinations (dream-like auditory or visual hallucinations at the onset of sleep). These symptoms arise when REM (dreaming) sleep intrudes into waking periods. The diagnosis is made with the help of a polysomnogram and the Multiple Sleep Latency Test. Narcolepsy has a strong genetic component, although scientists have not discovered a consistent pattern of hereditary transmission. In recent research, it has been linked to decreased numbers of the brain cells that produce a substance called hypocretin. But in more than four out of five cases, the disorder is precipitated by sleep deprivation, irregular sleep patterns, head trauma, infections, psychological stress, and other environmental influences.

Obstructive sleep apnea is the repeated interruption of breathing during sleep because the passage to the lungs is physically blocked. Symptoms include loud snoring, mouth breathing, and morning headaches as well as daytime drowsiness. Sleep apnea is diagnosed in the sleep laboratory with the aid of a polysomnogram. The disorder is common in middle-aged and elderly people, and it raises the risk of coronary artery disease, high blood pressure, and stroke. It rarely occurs in adolescents unless they are vastly overweight, have enlarged tonsils, or suffer from a physical malformation such as an unusually small jaw. When physicians or other professionals evaluate sleep troubles in adolescents, they begin with a detailed clinical history of sleep problems in the patient and the patients family, as well as interviews with the patient, family members, and sometimes school staff. They need a careful description of the patients bedtime routines and environment, including middle-of-the-night awakenings, wake-up times, morning routines, daytime alertness, and sleep schedules. It is often helpful to have the adolescent describe a typical weekday, weekend day, and vacation day. The patient should keep a sleep diary for two weeks. Of course, a medical and psychiatric history are also essential, and it is important to know which drugs the patient is taking or has taken in the past. A physical examination is necessary to check for sleep apnea. It may also be useful to have the patient wear a wrist actigraph, a device about the size of a wrist watch that measures and times physical activity in both sleeping and waking hours over a period of several weeks. Physicians will need to call on a sleep medicine specialist if the standard treatments fail, and also in special cases such as suspected narcolepsy, periodic limb movements, or sleep apnea. The key to successful treatment is building rapport with adolescents and identifying their concerns and goals. No matter what the cause of insufficient sleep, education and motivational counseling will help. Beyond that, treatment depends on the underlying cause. Many teenagers will have fewer problems if they are allowed to start school at a time that accommodates their biological tendency to delay circadian rhythms. Several school districts across the country have taken this measure, and systematic studies in Minnesota suggest that it is effective. Adolescents with severe DSPS may need more; well-timed exposure to bright light and doses of the hormone melatonin, which regulates the internal body clock, are often useful. Antidepressants and psychotherapy (including cognitive and interpersonal therapies) are recommended for depression or anxiety. For conditioned (learned) insomnia, useful approaches include behavior therapy and improved sleep hygieneregular exercise, a regular bedtime, avoiding alcohol and caffeine. Stimulant medications, including methylphenidate (Ritalin) and the novel drug modafinil (Provigil), are used to prevent daytime sleepiness caused by narcolepsy. Drugs that suppress REM sleep, such as the tricyclic antidepressants, may be prescribed for cataplexy. Sleep apnea can be treated by the use of continuous positive airway pressure (CPAP) a device that keeps the breathing passage open by pumping air directly into the lungs through a face mask.

SOURCE: http://www.sleepdex.org/s27.htm