Adolescent Insomnia and Depression

There is growing research that sleep problems are even more likely to be a cause of adolescent depression than a symptom of depression. The same is true for anxiety disorders. ‍

This comes from a great review article of the existing literature on adolescent insomnia and depression in the Journal Nature. ‍

Some of the key points from the article are as follows: 

There are normal changes in sleep as children become adolescents, which can sometimes lead to insomnia in adolescents:  
-The need for slow wave sleep falls compared to children
-In response to sleep deprivation, there is a lowering of “sleep pressure”—meaning it’s easier for adolescents to stay up later and ignore sleep queues. 
-The adolescent “clock” or circadian rhythm, is set to 24.2 hours, which allows for a natural drift later and later. Treatment wise, this means we must focus on resetting it each day, so it doesn’t drift into later bedtimes. This is true until age 21, when it starts to reverse again. 
-Despite the fall in factors that lead to sleep onset as teens get older, the duration of sleep that adolescents need across this age range stays constant. 

There is an optimal amount of sleep that most adolescents should strive for: 
The optimal sleep duration for most adolescents is 9-9.3 hours. Large studies point towards getting less, or more, than this can lead to “next day depressed mood” (which is not the same as clinical depression, but which may portend it). 

The above changes in sleep patterns as children become adolescents can lead to issues with insomnia in the face of societal demands, such as early school start times.
-Despite all of the evidence pointing towards later school start times being more beneficial for adolescents, most schools start by 8am, which doesn’t give adolescents with late bedtimes nearly enough time to get win their 9-9.3 hours per night. 

Does “catching up on sleep” on the weekends fix the deficits in sleep some teenagers have?
Research shows that catching up on weekends doesn’t undo the deficit incurred over the 5 day school week, and sleeping in also further disrupts the sleep cycle teens need to try to get back to (earlier bedtimes to accommodate the earlier school times). 

When is adolescent insomnia considered a clinical condition? 
When their insomnia leads to significant drops in performance across social and/or academic domains (causing tardiness to school, interfering with after-school activities, missing get togethers with friends) it meets criteria for “delayed sleep-wake phase disorder.” 

How do we treat delayed sleep-wake phase disorder in adolescents? 
‍We have a researched list of treatment options here, and if you feel those ideas haven’t worked for you or your child, please feel free to reach out to us to make an appointment by calling or texting 610-999-6414.
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The article goes on to discuss many factors implicit in adolescent insomnia and their roll in the development of depression: 
-Many studies show that sleep deprived adolescents have a more difficult time feeling a positive emotion (happiness, excitement, enthusiasm) during a positive experience. 
-Emotion regulation is imparted in sleep deprived adolescents, which leads to more intense negative reactions in response to stressors. 
-There is evidence that adolescents with early insomnia (insomnia that occurs when they are laying in bed and trying to fall asleep for the first time that night) have a higher tendency towards negative rumination during these periods of the day. 
-There is some bi-directionality at play: studies show that adolescents who prefer evening wakefulness have a higher chance of developing depression and adolescents with depression often prefer evening wakefulness. 
-Adolescents who sleep in regularly will miss more school and also miss the early morning light— in other words, they have a higher chance of missing chances for connectedness to peers, bright light, and more physical activity— all of which are protective against depression. 
-There are also hormonal factors at play— delayed sleep onset can be from and lead to issues with normal melatonin fluctuation. This can have downstream effects and lead to other changes in the brain that may lead to depression. 
-There is evidence that shows distinct similarities in the negative ruminations in adolescents with insomnia without depression and the daytime ruminations/negative thinking in adolescents with depression.