Sleep, circadian rhythms, and delayed phase in adolescence
Introduction
This review describes changes to sleep/wake behavior during adolescent development and the contribution of the circadian and sleep/wake homeostatic systems to this changing behavior. We also review delayed sleep phase syndrome (DSPS), which may be an extreme manifestation of these changes or may be a distinct clinical entity. Last, we describe approaches to treat DSPS in adolescents. For the purpose of this review, we consider biological adolescence to span the second decade of life.
Section snippets
Developmental changes in sleep/wake (light/dark) patterns
Sleep/wake patterns of developing adolescents are often described in the context of a school year and have been described separately for school (weekday) and non-school (weekend) days. Sleep timing is often quite different during school vacations. Describing sleep patterns during both school and vacation times provides a more comprehensive account of developmental sleep/wake behavior changes, yet few studies have examined vacation sleep patterns.
Table 1 summarizes adolescent self-reported sleep
The circadian timing system
The circadian timing system provides temporal organization for regulatory mechanisms to facilitate adaptive behavior, such as feeding, reproduction, and sleep/wake cycles [23]. These coordinated temporal patterns, or circadian rhythms, are self-sustained and oscillate with a period of about 24 h. The internal mechanism (pacemaker) that organizes these rhythms in mammals has been localized to a small paired nucleus in the hypothalamus, the suprachiasmatic nucleus (SCN; [24]). Biological events or
The homeostatic sleep system
The homeostatic sleep/wake system is thought to be relatively independent of circadian timing. A simple way to characterize the process is that sleep pressure increases the longer one is awake and dissipates as one sleeps. Slow wave sleep (SWS, stages 3 and 4) and electroencephalographic (EEG) slow wave activity (SWA, power in the 0.75–4.5 Hz range) have been used as physiological markers for “sleep pressure.” Thus, SWA is high at the beginning of the nocturnal sleep episode when sleep pressure
Process C
The circadian timing system undergoes developmental changes during adolescence. Although sleep/wake patterns have long been known to delay in adolescents, behavioral factors (e.g., social and scholastic obligations) were assumed to be entirely responsible. The notion that circadian timing may change was noted by Carskadon and colleagues in a study of circadian phase preference in young adolescents [52]. Phase preference, or morningness/eveningness is a behavioral construct related to the time
Delayed sleep phase syndrome (DSPS)
The developmental changes in the circadian and sleep systems we have described may be exaggerated in adolescents who receive a diagnosis of delayed sleep phase syndrome (DSPS). DSPS is a disorder with a typical onset in the second decade of life or earlier [75]. Weitzman, Czeisler, and colleagues [76], [77] first described delayed sleep phase insomnia as a distinct syndrome characterized by a cluster of features including a chronic inability to fall asleep and wake at a desired clock time,
Conclusions
Developmental delays in sleep/wake behavior across adolescence are associated with extrinsic and intrinsic factors. Investigations of circadian timing mechanisms and homeostatic sleep processes may provide insights into biological underpinnings of behavioral changes. Future research is needed to identify whether DSPS is an exaggeration of a typical developmental delay or whether the pathophysiology of DSPS has other pathways. Furthermore, efficacy studies of chronotherapy, phototherapy, and
References (109)
- et al.
Sleep characteristics of adolescents: a longitudinal study
J Adolesc Health
(1993) - et al.
A marker for the end of adolescence
Curr Biol
(2004) The organization of the human circadian timing system
Prog Brain Res
(1992)- et al.
A human phase response curve to light
Neurosci Lett
(1991) Changes in sleep cycle patterns with age
J Psychiatr Res
(1974)- et al.
A model of human sleep homeostasis based on EEG slow-wave activity: quantitative comparison of data and simulations
Brain Res Bull
(1993) - et al.
Age-related change in the relationship between circadian period, circadian phase, and diurnal preference in humans
Neurosci Lett
(2002) - et al.
Delayed sleep phase syndrome in adolescents
J Adolesc Health Care
(1988) - et al.
Prevalence and patterns of problematic sleep among older adolescents
J Am Acad Child Adolesc Psychiatry
(2000) - et al.
Altered phase relation between sleep timing and core body temperature rhythm in delayed sleep phase syndrome and non-24-hour sleep–wake syndrome in humans
Neurosci Lett
(2000)
The effects of chronic, small doses of melatonin given in the late afternoon on fatigue in man: a preliminary study
Neurosci Lett
Effects of melatonin on human mood and performance
Brain Res
Development of sleep patterns in early adolescence
J Sleep Res
Annual and weekly changes in the sleep–wake rhythm of school children
Sleep
Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children
Sleep
Do many adolescents sleep poorly or just too late?
Sleep Res
Sleep habits and disorders in Finnish schoolchildren
J Sleep Res
Patterns of sleep and sleepiness in adolescents
Pediatrician
Changing sleep patterns in adolescents
Sleep Res
Impact of part-time employment on adolescent sleep patterns
Sleep Res
Sleep and risk-taking behavior in adolescents
Behav Sleep Med
Sleep schedules and daytime functioning in adolescents
Child Dev
Sleep–wake patterns in the high-school-to college transition: preliminary data
Sleep Res
Sleep and the teenager
Sleep Res
Evidence for the validity of a sleep habits survey for adolescents
Sleep
Sleep questionnaire in adolescents
Sleep Res
Sleep need in adolescents: a longitudinal approach
Sleep
Life between clocks: daily temporal patterns of human chronotypes
J Biol Rhythms
The impact of school daily schedule on adolescent sleep
Pediatrics
Estimating dim light melatonin onset (DLMO) phase in adolescents using summer or school-year sleep/wake schedules
Sleep
Circadian rhythms: basic neurobiology and clinical applications
Annu Rev Med
Light suppresses melatonin secretion in humans
Science
Sensitivity of the human circadian pacemaker to nocturnal light: melatonin phase resetting and suppression
J Physiol
Phase-dependent effects of room light exposure in a 5-h advance of the sleep–wake cycle: implications for jet lag
J Biol Rhythms
Adaptation of human pineal melatonin suppression by recent photic history
J Clin Endocrinol Metab
The dim light melatonin onset as a marker for circadian phase position
Chronobiol Int
The endogenous melatonin profile as a marker for circadian phase position
J Biol Rhythms
Comparisons of the variability of three markers of the human circadian pacemaker
J Biol Rhythms
Stability of melatonin and temperature as circadian phase markers and their relation to sleep times in humans
J Biol Rhythms
Entrainment of human circadian rhythms by light–dark cycles: a reassessment
Photochem Photobiol
A phase response curve to single bright light pulses in human subjects
J Physiol
Light exposure induces equivalent phase shifts of the endogenous circadian rhythms of circulating plasma melatonin and core body temperature in men
J Clin Endocrinol Metab
Failure to identify pubertally-mediated melatonin sensitivity to light in adolescents
Sleep (Supplement)
Entrainment of the human circadian system by light
J Biol Rhythms
A two process model of sleep regulation
Hum Neurobiol
Timing of human sleep: recovery process gated by a circadian pacemaker
Am J Physiol
Sleep deprivation: effect on sleep stages and EEG power density in man
Electroencephalogr Clin Neurophysiol
Electroencephalogram power density and slow wave sleep as a function of prior waking and circadian phase
Sleep
Cited by (782)
Temporal pathways between circadian rhythm, depression and anxiety in the transition from adolescence to early adulthood
2024, Journal of Affective DisordersSleep-Related Problems and Pediatric Anxiety Disorders
2024, Psychiatric Clinics of North AmericaThe Impact of the Double School Shift System on Lifestyle Behaviors Among Mexican Adolescents
2024, Journal of Adolescent HealthSleep spindles in adolescents with major depressive disorder
2024, Journal of Affective DisordersCurrent Considerations in the Diagnosis and Treatment of Circadian Rhythm Sleep-Wake Disorders in Children
2023, Seminars in Pediatric Neurology