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My teen is having more trouble falling asleep at night lately. How can I help?

​Anna Esparham, MD, FAAP, DABMA, DABOIM

Answer

​​​Many teens have a hard time winding down at bedtime. This can prevent them from getting the recommended 8 to 10 hours of sleep they need every night. Not surprisingly, many teens I talk with report difficulty concentrating at school, daytime sleepiness, and fatigue.

Causes of sleep issues in teens

Teens often have more trouble falling asleep than when they were younger. Rapid body changes, especially in adolescence, can disrupt sleep. This happens because the growth phase they're in causes their circadian rhythm—the body's internal clock—to reset, delaying their sleep cycle.

Stress, anxiety, and worry are other common reasons for sleep problems. Teens are dealing with more stress lately, interrupting their rest and recovery at night. Late-night phone and social media use, and sports or other physical activities close to bedtime can also make it more difficult to fall asleep.

Other causes of sleep trouble include health conditions like iron deficiency. Teens who don't have enough of this mineral may have symptoms such as cramps and involuntary movements in their legs that can wake them up from sleep. If your doctor thinks your child may have this issue, they will typically order a hemoglobin, ferritin, and/or iron test panel to check.

Why sleep is so important

Sleep is vital for everyone, especially growing, developing children and teens. Kids who get enough sleep tend to have healthier immune systems, and better memory, school performance, and mental health.

Not getting enough sleep can lead to all sorts of potential problems, such as:

  • Difficulty concentrating,  paying attention, and remembering things

  • Crankiness and low energy

  • Mood changes such as depression

  • High blood pressure

  • Weight problems and obesity

  • Headaches

  • Behavior problems

Lack of sleep can even affect a part of a teen's developing brain that helps control impulses. This may be why sleep deprivation is linked with higher rates of risky behavior​ such as texting while driving, fighting, substance use, and unsafe sexual behavior in teens.

Tips to help your teen sleep better

  • Encourage daily exercise and time outside. Exercise can help your teen sleep better. Kids of all ages need to move throughout the day and get plenty of physical activity. That said, try to avoid sports practices and other types of exercise too late in the evening so there's time to unwind. Spending some time outdoors each day can also support a healthy sleep-wake cycle.​

  • Avoid overscheduling. Having too much on their plate can make it difficult for your teen to get enough sleep. If they are running from one after-school activity to another, they won't be able to finish their homework until later at night. We all need time to relax at the end of the day to help us sleep well.

  • Scale back screens before bedtime. Blue light from phones, computers, tablets, TV, and even nightlights, can trick the brain into thinking that it's daytime. Over time, that can disrupt your teen's natural levels of melatonin, a chemical that tells us we're sleepy. Even just a tiny bit of blue light coming from an electronic device can stop the release of melatonin. Encourage your teen to put all screens away at least an hour before bedtime, and charge devices outside their bedroom overnight. Having screens right there is tempting and sets kids up for staying up too late.

  • Limit late meals & caffeine. Aim to eat dinner a few hours before bedtime, and offer whole foods that are easier to digest. Food sensitivities or substances that cause indigestion may disrupt your child's sleep because of the close relationship between the gut and the brain. It is important to remember that caffeine can stay in the body for more than 8 hours, depending on a person's metabolism. Your teen should avoid caffeine after lunchtime. 

  • Make time to relax. Engage in relaxing activities in the evenings, such as a warm bath with Epsom salts, reading a book that's not on a screen, meditation, stretching, soft music, journaling, or restorative yoga. Activities like these support a healthier sleep cycle.

  • Optimize your teen's sleep environment. Some ideas:

    • Make sure the temperature is cool, but comfortable. A cooler room promotes sleep and reduces sweating and itching.

    • If light bothers your teen, put up heavy or blackout curtains.

    • Create an inviting sleeping space with a comfortable mattress, blankets, and pillows. Encourage your teen to reserve their bed for sleep, and avoid doing homework and other daily activities there. This helps your teen's brain connect laying down in bed with sleep. 

    • If noise outside your teen's bedroom is a problem, turn on a fan, soft music, or nature sounds. Try earplugs to see if they help.

    • Try a soothing scent like lavender. Studies have shown it can help people fall asleep faster.

  • Look into melatonin supplements. Melatonin may help reset your teen's circadian rhythm back so they can fall asleep at a normal time. Typically, melatonin can be given in for a short amount of time (days, not weeks or months) and in very small doses (0.3 to 0.5 mg) about 3 hours before bedtime.

  • Consider therapy. Cognitive behavioral therapy (CBT) can help your teen manage stress and anxiety, nurture their gifts, and achieve a normal sleep-wake cycle. There's even a specialized form of CBT for people with insomnia called CBT-I. Digital CBT-I apps, such as CBT-i Coach, have been shown to be effective for treating insomnia in teens.

Remember

Sleep is important for a healthy immune system, neurodevelopment, cognition, memory, and restoration. If your teen is having trouble falling asleep, contact your pediatrician.

​Anna Esparham, MD, FAAP, DABMA, DABOIM

​Anna Esparham, MD, FAAP, DABMA, DABOIM, is a triple-board certified physician in pediatrics, medical acupuncture, and integrative medicine. She is currently a pediatric headache specialist at a large regional pediatric academic medical center in Kansas City. Within the American Academy of Pediatrics, she is an executive committee member on the Section of Integrative Medicine.

Last Updated
11/15/2021
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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