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Teenage and adolescent sleeping problems: The connection to addiction

What Do Parents Need to Know about Sleep Problems and Addictions in Teens?

What teenager does not stay up all night chatting or using some social media technology, at least occasionally? Most parents would indicate that their teen child does do this from time to time. But good sleep habits are important and sleep disturbances such as insomnia, or sleep cycle changes, such as being awake at night while sleeping by day are not uncommon.

With the advent of cell phones, tablets, and other technology teens are spending more and more time awake at night in front of the glowing lights of these gadgets. This is getting in the way of their sleep because both mental activity and light exposure promote wakefulness and research suggests that this sleeplessness is not good for us, and nighttime light exposure isn’t either. Nighttime light exposure and poor sleep is associated with poor daytime concentration and learning problems.

The connection between sleep and substance use disorders

There is also a connection between disturbance of nighttime sleep and substance use disorders. Sleep disturbances and mental health disorders are both associated with the risk of developing or exacerbating existing substance use disorders (SUD). As a child psychiatrist, I would say a good 75% of my patients exhibit some type of sleep problem. Some of it is related to that late night technology use and light exposure mentioned above. But a good part of it has to do with the fact that depression, ADHD, anxiety and many other mental health problems include sleep disturbance or insomnia as a symptom.

Assessing risk and causes of sleep problems

Doctors and researchers are still working on understanding how to identify which patients presenting with sleep problems in primary care may be at risk of subsequent substance use problems and how to clinically intervene. However, each of the above mentioned mental health disorders are also associated with a risk for developing substance use problems including:

There are many things to consider when making an assessment of risk. First, almost all addictive substances are associated with some form of sleep disturbance; this is supported by studies examining the effects of alcohol, cocaine, cannabis, opiates and other substances on sleep (Garcia & Salloum, 2015). Several aspects of sleep are compromised in individuals addicted to these substances, ranging from difficulty initiating sleep to difficulty maintaining sleep and hypersomnia or sleeping too much. Furthermore, sleep disturbance can put teens at risk for developing drug use, impede substance use treatment success, and be associated with relapse among individual with preexisting substance use disorders.

Sleep problems can come first

However, sleep disturbance can present as a primary diagnosis in teens and can precede the onset of substance and psychiatric disorders. Teens with childhood insomnia or poor sleep are more at risk for early onset of alcohol and other drug use disorders including binge drinking. Poor sleep has also been associated with deleterious effects on mood, attention, and behavior.

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Some studies have even suggested that poor sleep may cause changes in the natural reward system of the brain and impede sound decision making (Wong, 2009). This has led researchers and doctors to question whether early treatment of sleep disturbance could serve as a preventative intervention for substance use disorders in at least some teenagers. We need to learn more about the relationship between sleep problems and substance use problems and how we can help teens.

Can treating sleep problems help prevent addiction?

Studies have consistently demonstrated that the prevalence of sleep problems is under-reported in teens in both clinical and community samples. By treating sleep disturbances and targeting poor sleepers with additional counseling and education regarding the risk of substance use, clinicians may be able to prevent or delay the adverse effects. At the very least, the presence of insomnia should alert clinicians to the need for further clinical assessment of the teen’s sleep and to conduct an evaluation for drug and alcohol abuse as well as mental health disorders. In addition, it has been found that school hours (early start times) may not be optimal for teen natural sleep cycles and we may be being asking them to wake up during times when they are more deeply sleeping. Some school districts are beginning to change school start times for that reason.

Here is what you can DO as a parent:

1. Observe and note your teen’s sleep patterns.
Parents need to understand their children’s sleep schedule, patterns, and habits so that these can be monitored. If a teen is getting under 8-10 hours of sleep per night on a regular basis they may not be getting sufficient sleep to function their best.

2. Troubleshoot possible obstacles to good sleep.
If children have sleep difficulties or poor sleep hygiene, it is important for parents to talk to them and find out the factors that may be causing the problems. Good sleep habits include limiting nighttime activity and exposure to lights, maintain a regular sleep schedule can be helpful.

3. Educate yourself and your teen about sleep.
Parents could explain the importance of sleep to their children, for example, how sleep may affect the development of the brain and thus self-control and behavior.

4. Set up a sleep schedule and regulate activities.
Parents could also help their children keep a regular sleep schedule and monitor/control their children’s activities before sleep, for example, no video games or texting after a certain time at night.

5. Identify one of two possible sleep issues.
When you monitor the sleep health of your teen, there can be two different issues: sleep difficulty and sleep insufficiency. Sleep difficulty includes problems falling asleep and staying asleep. If they are not getting enough sleep because of nighttime activity or a mental health problem, or any reason—then this results in insufficient sleep. Insufficient sleep is associated with potential learning and behavioral problems if it persists over time.

There are many reasons parents should promote good sleep and it is always good to learn more. The following is a good resource from the academy of sleep medicine.

Reference Sources:Garcia, A. N., & Salloum, I. M. (2015). Polysomnographic sleep disturbances in nicotine, caffeine, alcohol, cocaine, opioid, and cannabis use: A focused review. The American Journal on Addictions.
Wong, M. M., Brower, K. J., & Zucker, R. A. (2009). Childhood sleep problems, early onset of substance use and behavioral problems in adolescence. Sleep Medicine, 10(7), 787-796

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About Dr. Lisa Fortuna, MD, MPH

Lisa R. Fortuna, MD, is board-certified in child and adolescent psychiatry and in addiction medicine, with over fifteen years of clinical experience with children, adolescents, and families. She is currently faculty at Boston University School of Medicine and medical director of Child and Adolescent Psychiatry at Boston Medical Center. She has published highly cited articles in the areas of post-traumatic stress disorder (PTSD), adolescent substance abuse, and Latino and immigrant mental health. She is the author of (with Zayda Vallejo M. Litt), Treating Co-Occurring PTSD and Addiction: Mindfulness Based Cognitive Therapy for Adolescents with Trauma and Substance Use Disorders (New Harbinger, 2015).

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