Adolescents who are lethargic, cranky and forgetful may have chronic sleep deprivation

Adolescents who are lethargic, cranky and forgetful may have a common ailment: chronic sleep deprivation. But some tired teens may actually have a medical condition such as depression, insomnia, narcolepsy or sleep apnea, warns a new report in Pediatrics.

"For reasons that have to do with both biology and behavior, many young adults don't get the sleep they need. So our take-home message is that teens need more sleep," said lead author Richard Millman, M.D., professor of medicine at Brown Medical School and director of the Sleep Disorders Center of Lifespan Hospitals, a Rhode Island sleep research and treatment center that is one of the largest in the country.

"Physicians also need to be on the alert," Millman said. "While most teens are tired because they are sleep deprived, chronic drowsiness may, in some cases, be symptoms of an underlying sleep disorder."

The Pediatrics report is a first, merging a review of more than two decades of basic research with clinical advice for physicians. It represents a joint effort of the American Academy of Pediatrics (AAP) and the National Center on Sleep Disorders Research (NCSDR), part of the National Heart, Lung and Blood Institute within the National Institutes of Health.

A joint committee formed by the AAP and the NCSDR wrote the paper. This 10-member committee includes three other Brown Medical School faculty: Mary Carskadon, Ph.D., director of the Bradley Hospital Sleep and Chronobiology Research Laboratory; Judith Owens, M.D., director of the Pediatric Sleep Disorders Clinic at Hasbro Children's Hospital; and Suzanne Riggs, M.D., director of the Division of Adolescent Medicine at Hasbro Children's Hospital. Bradley and Hasbro are leading institutions for child and adolescent health care in New England and serve as teaching hospitals for Brown Medical School.

The report summarizes key research findings on teens, young adults and sleep.

The paper notes, for example, that adolescents aged 13 to 22 need nine to 10 hours of sleep each night. It also discusses the hormonal changes that conspire against them. When puberty hits, the body's production of sleep-inducing melatonin is delayed, making an early bedtime biologically impossible for most teens. At the same time, the report notes, external forces such as after-school sports and jobs and early school start times put the squeeze on a full night's sleep.

The result: A "profound negative effect" on mood, school performance and cognitive function. Studies also show that young people between 16 and 29 years of age were the most likely to be involved in crashes caused by the driver falling asleep.

"Sleep deprivation is a major adolescent health issue," Millman said. "But pediatricians and parents may see only fatigue and not a more dangerous medical condition."

But how can physicians tell the difference between a typically tired teen and one with a serious health problem? A physical exam can point up large tonsils or other causes of sleep apnea. But Millman said that the most effective diagnostic tool is a rigorous pediatric sleep history. Physicians, he said, should ask patients about insomnia, excessive daytime sleepiness, disordered breathing and other problems. These questions can point up chronic medical or psychiatric conditions that require treatment.