As anyone who has followed my work or seen me speak knows, I am a big fan of sleep.

Not just for myself obviously, but for children and teens. I talk about it all the time.

I tell senior school pupils to get good sleep because that is when their brains are busiest; processing their learning, filing it away and storing memories, and I tell their parents to let them sleep till 10am whenever they can, to make sure they get their full quota of Zzzzz.

If you would like to know more about the overall importance of sleep and teens, then do read one of my other blogs here. There is also good advice from the NHS here.

However sometimes sleep is elusive. It can be hard to fall asleep, or you might wake in the night or far too early every morning. This is unhealthy, and unhelpful to your wellbeing.

What do we need to know about disrupted sleep?

Insomnia in teenagers matters because it is unfortunately associated with a higher risk of anxiety, depression, and other scenarios like substance misuse as they try to self-medicate their problems. This is not to say that these consequences are inevitable just that if we ignore the issues, or they are left untreated for a long time, then these problems are more likely to occur.

Girls (especially ones who have started their periods i.e. gone through that puberty milestone) are much more likely than boys to suffer with insomnia.

It is estimated that up to 1 in 4 16-19 year old teens suffer with insomnia significantly at some point.

How to recognise that it is an issue?

Sadly even healthcare professionals can struggle to recognise insomnia in teens as a clinical issue. This is for many reasons, but as the consequences are so worrying, it can be helpful to know what to watch out for and when  to worry.

It is a problem if; they don't sleep well through the night, can't get off to sleep in less than 30-60 minutes, wake far too early, feel restless at night, have daytime sleepiness, and it affects their ability to do the things they need  (or want) to do such as academic work, or activities. There is an NHS online test you can do, though it is usually used for adults.

And the sooner the insomnia is treated of course, the better the outcome.

Clearly there are social and cultural challenges to our teens getting the sleep they actually need, such as school starting earlier than is healthy for teens or being online with friends late into the night.

Wherever possible we have to create a nightly ‘sleep opportunity’, so that they can try to get the sleep they need. When problems occur even after a good ‘sleep opportunity’ has been consistently created for 4-6 weeks, with protected time, good sleep routine, and healthy sleep behaviours then that is when insomnia may need addressing more formally, by a professional such as a GP.

Differentiating between ‘true insomnia’ and the negative impact of traditional school start times on teen sleep

Because teens are biologically designed to sleep from about midnight till 9 or 10am, worldwide figures show that teens miss out on an average of 1-2 hours nightly of sleep during a school week. This clearly has implications for learning and memory, (and is the reason for international campaigns to start the school day later for all teens) but the early school start can also create a ‘delayed circadian phase’ for many young people- meaning that they regularly struggle to get to sleep, feel unrefreshed and dissatisfied when woken, and have daytime sleepiness during the school day.

Interestingly, home learning during the COVID pandemic created one positive upside in that teens all over the world were able to skip the commute and get more sleep, which was beneficial to them. Sadly COVID also caused much more anxiety and other mental health issues, so better sleep was just a small upside.

Thus one of the best ways to see if your teen has true insomnia is to see if they have these issues in the holidays, when they have a chance to sleep as they were biologically designed to.

If they struggle even then- it’s time to get help.

Do make sure that the healthcare professional you speak to understands that the problem is pervasive and present even in the holidays and is not just ‘sleep restriction’ caused by being up too late gaming or on social media, or ‘delayed circadian phase’ (caused by too early a start to the day) -as it could be easy for the issue to be dismissed as ‘normal teenage sleep issues’.

Specific concerns

It can be helpful to be aware that some symptoms may point more towards a more specific diagnosis, so here is a quick and very general list to consider;

·      Waking very early every morning can be associated with depression

·      Staying awake worrying late at night is often associated with anxiety

·      Restless legs with an inability to fall asleep because of that, and daytime sleepiness can be associated with low iron stores (which can lead to anaemia). Easy to check with a blood test.

·      Struggling to fall asleep and stay asleep can be associated with ADHD.

·      Difficulty falling asleep, restlessness, and anxiety can be associated with autism, cerebral palsy, and foetal alcohol syndrome.

·      Very significant daytime sleepiness will lead your healthcare professional to also consider narcolepsy and sleep apnoea, those these are rare in adolescents.

As you can see, sleep is affected by multiple situations, and it is vital not to ignore poor sleep. It may be that none of these are present, but a proper assessment can help rule them out.

What to do as a parent?

1.     Ask how they are sleeping (not all teens will tell you when they are struggling)

2.     Make sure they know that you value their sleep, and let them sleep later on weekends, or holidays. They need 9-11 hours. This blog explains more about what is normal.

3.     On a school day don’t get them up until they absolutely have to.

4.     Explain why sleep matters for their brain development, as well as for physical and emotional wellbeing.

5.     Encourage use of healthy ways to support sleep such as mindfulness apps, as that can be a useful short term intervention for tricky nights. See this blog for more ideas.

6.     If they seem to have longer term issues with sleep (more than 6 weeks), including when they should be able to relax such as in the holidays, talk to a professional and ask about therapeutic options.

7.     These days we have CBT-I for insomnia, a ‘talking therapy’ which may be done online, and there are sleep experts who can advise, as well as good charities and websites for support and ideas. I particularly rate the Teen Sleep Hub website.

8.     Check out the amazing Top Tips for Parents via Teen Sleep Hub

9.     Get your teen to look at their section designed for teens, and their e-book. They even have a phone helpline! 03303 530 541

10.  Find out if there is a NHS sleep service in your area Your GP could refer you.

In summary

Teen sleep issues are common and should not be ignored if they are persistent and affect their daytime functioning for weeks at a time. Insomnia can be associated with several physical and mental health issues. If their issues with sleep continue in the holidays, it is even more important to seek professional help. You can go to your GP, but also check out good charities and advice websites, as mentioned above. These days the main form of treatment is CBT-I  (a talking therapy) rather than medication, although the latter can be occasionally useful. You are not alone in trying to address this, and lots of help and advice is out there.