Sleepless youth and teens

Adapted from an article in the TOI:

Anand, a young computer science student, noticed he was tired even before the day began. Tossing and turning for hours at night, the 18-year-old would finally drift off around 5 or 6am, only to miss his 9am classes. His memory dulled, assignments piled up, and grades tanked. “I’d be wide awake when I needed to be sleeping, and then utterly exhausted when I had to be alert and learning. It felt like I was fighting my own body,” he recalls. Anand was eventually diagnosed with Delayed Sleep Phase Syndrome (DSPS), a circadian rhythm disorder that throws the body’s internal clock out of sync.

Sleep disorders like DSPS, Night Shift Work Disorder, and other circadian rhythm disturbances are on the rise among adolescents and young adults. “Urban lifestyles are a perfect storm for sleep disorders,” says Dr Dnyaneshwar Jadhav, professor of neurology at Ashok One Hospital. “There is late-night device use, academic demands, and irregular meal timings — often dinners as late as 9 or 10pm — that disrupt natural sleep cycles, unlike the West where meals are eaten between 5 and 7pm, aiding better sleep,” he adds. Youngsters also tend to indulge in late-night snacking while studying or scrolling on their phones.

Dr Nishtha Dalwani, consultant psychiatrist at Ashok Hospital, recalls how one of her patients, 16-year-old Sabira, slept 12-13 hours a day, yet woke up drained. Once a top guitar-strumming student, her school absences mounted, music faded, and vibrant social life withered. After thorough evaluation, including a detailed sleep history and overnight polysomnography, Sabira was diagnosed with mild depression and a circadian rhythm sleep disorder. “Her internal clock, which regulates the sleepwake cycle, was misaligned with the environment outside, causing her body to want to sleep at odd times and struggle to feel truly rested,” she says.

To help reset her body clock, Sabira was put on a short course of antidepressants and melatonin around 9pm to nudge her sleep cycle back on track. She was told to stick to a fixed sleep schedule, even on weekends, and soak up bright morning light to signal daytime to her brain. Her routine also changed: no screens before bed, no daytime naps, caffeine and heavy meals out, and a calming wind-down ritual in a dark, quiet room.

NIGHT STUDY, EARLY CLASSES

Academic pressures further rob youngsters of sleep. Dr Nishtha cites a 2021 study in Kochi, published in the International Journal of Contemporary Paediatrics, reporting a 5.7% DSPS prevalence among adolescents. Another study by Verma et al. (2002) in the International Journal of Behavioral Development highlights how India’s late-night studying and early school hours amplify DSPS. Sujata Jayprakash, Counsellor at Raahat suggests a later start at school can help. “School timings force kids to wake early, cutting sleep short. In metros, shifting school start times, as done in California, could help.”

Japan offers a glimpse of innovation. Sunao Uchida, a certified physician with the Japanese Society of Sleep Research, describes a study at an elementary school. “Sixth-graders tested naptime’s impact on concentration, combining it with math tests over seven months. The results showed improved focus. Although its scientific rigour may not meet the highest standards, the content is compelling. Such initiatives are being trialed across Japan,” Uchida told TOI .

The crisis isn’t limited to teens, though reasons for pre-teen sleep disorders are different. Many studies have shown paediatric obesity can trigger obstructive sleep apnea (OSA), a disorder characterised by recurrent upper airway obstruction that disrupts ventilation and sleep. Dr Siddhant Lalwani, paediatric pulmonologist and sleep specialist at Bharati Hospital, Pune, treated a six-year-old boy with severe OSA — linked to obesity and enlarged adenoids — whose oxygen levels dropped dangerously low during sleep. “He now sleeps well with the help of a CPAP (continuous positive airway pressure) machine, which we’re increasingly using even in infants as young as six months. Poor sleep in kids is not just about daytime drowsiness, it’s tied to longterm risks like hypertension, metabolic disorders, and poor academic performance,” he says.

Dr Remy Kottadayil, from Shalom Hospital’s department of sleep medicine in Mira Road, says sleep disorders don’t discriminate by age, adding, “From toddlers to college students, hormonal shifts and lifestyle choices like staying up until 4 or 5am wreak havoc on sleep cycles.”

Dr Anuradha, ENT surgeon at Ruby Hall Clinic, Pune, reports a sharp post-Covid rise in sleep-related breathing disorders among children, often due to enlarged adenoids swelling from infections, allergies, or poor hygiene. “Cases have surged in the last four to five years, especially among kids aged five to eight. I recently treated a four-year-old who had never breathed properly through his nose, couldn’t hear, and was falling behind in school. Timely surgery transformed his life in just two weeks,” she says.

BLUE LIGHT TO BLAME

Blue light from screens is a major reason for disrupted sleep, notes Dr Mathew. “It delays circadian rhythms, especially in kids and teens who ideally need 9-11 hours of sleep for growth,” he says. God has amazingly made sunsets yellower, and sunrise bluer. But man is just beginning to understand the power of this and how we are wired to react to different colours differently.

Just four consecutive nights of five-hour sleep can impair performance similar to a 0.06% blood alcohol level, affecting judgment, motor skills, and reaction time. Post-Covid, Dr Vinita observes a 30% surge in sleep complaints among young patients, with one in five reporting insomnia or sleep anxiety. “Digital learning, stress, and less physical activity are key drivers,” he adds.