April 20, 2007, Newsletter Issue #116: Causes of EDS In Adolescents

Tip of the Week

The most common causes of excessive daytime sleepiness in adolescents are:

1. Poor Sleep Hygiene: Insufficient sleep, irregular bedtime and rising time; pushing back bedtime to socialize, watch TV or play computer games, etc. Other problems are vigorous exercise just before bed, smoking, alcohol at bedtime, watching TV in bed.
2. Phase Delay Syndrome: inability to fall asleep until late, sometimes after 3 A.M. Such adolescents have trouble getting up in the morning and tend to build up a sleep deficit which they try to make up on the weekend. Adolescents normally require more sleep (9 hours) than children and adults.
3. Narcolepsy: Although relatively uncommon, the symptoms are regularly misinterpreted. These adolescents tend to fall asleep while doing routine activities, like eating, playing or working in class. These attacks are uncontrolled and may be frequent. When awakened they can be aggressive, confused or verbally abusive. They may experience sudden muscle weakness, particularly when surprised, excited or laughing. Their academic performance is usually affected and they are often labelled as inattentive, lazy or dull.
4. Sleep Apnea: Not uncommon in children, they may snore loudly, drool on the pillow, or have morning headaches. Daytime sleepiness is due to disturbed sleep. These children may exhibit signs of Attention Deficit Hyperactivity Disorder (ADHD).
5. Movement Disorders in Sleep: Restless Legs Syndrome (RLS), Periodic Limb Movements in Sleep (PLMS). These leg twitches are repetitive and may last several seconds. At night they are not recognized by the child but cause fragmented, unrefreshing sleep. They can also occur during the day, leading to a restless child who can´t sit still. These children may also have signs of ADHD.
6. Asthma: Asthma can be predominantly sleep-related. Attacks disrupt sleep leading to daytime fatigue and less frequently daytime sleepiness.
7. Depression: Adolescents may suffer from unrecognized depression which often affects their academic performance. Depressed mood - especially in the morning, daytime sleepiness, lethargy, loss of appetite, poor concentration and irritability may also be signs of depression.
8. Shift Work: Disrupted biological rhythms can affect the quality and duration of sleep. Students who work afternoon or evening shifts can be excessively sleepy during classes, develop mood changes or have cognitive difficulties.

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