Clinic consultation

“Asking them to get up at 7 a.m. is like asking adults to start work at 4 p.m.”

In an office somewhere deep in the gut corridors of London’s Royal Brompton Hospital in Chelsea, sleep consultant Dr Alanna Hare peaks at her computer, examining the nighttime patterns of one of her youngest patients, the patient X, who likes so much nowadays is an erratic and dissatisfied sleeper. According to a 2022 study by YouGov, half of Britons believe they don’t get enough sleep – with one in eight sleeping less than six hours.

“Okay, he works in IT, his schedule is busy, he sits in front of his screen most of the time, and his main problem is both falling asleep and staying asleep. It’s been going on since many months and it’s incredibly distressing for him,” Dr. Hare says. “Of the many sleep conditions I treat, the one we most associate with psychological distress is insomnia.”

In fact, insomnia can be so distressing that Dr Hare says first visits with new patients can be “really very emotional, with people sharing how awful it has been for them”. Consultations become less tearful as time passes and treatment can take place. “I tell them, I can fix it for you, and I can do it in about six to eight weeks. Their relief, she says, is palpable.

Sure, conditions like sleep apneanarcolepsy and night terrors are no picnicbut there’s something about insomnia, his endless dry, smirking stare, that buries itself deep within those who suffer. The YouGov study found that 53% of women and 45% of men across the UK believe they don’t get enough sleep, with the average rest period being seven hours. The NHS recommends everyone spend seven to nine hours a night.

Dr Hare sees teenagers coming to the clinic and being kept awake all night by their phones (Picture: Royal Brompton)

In modern life, there are many reasons why people don’t close their eyes enough. Our bodies need light to keep us awake and darkness to promote the production of melatonin (our natural sleep hormone) so it’s likely we’ve been struggling with sleep since the invention of the light bulb. But today, everything is lit, and our phones ensure that we are constantly drinking more of this light into. In the evening before going to bed, and very often in bed we scroll or give in to Netflix insidious efforts to watch a whole series. In this context, sleep is something we have to fight hard for.

But it’s not just adults who suffer. Insomnia can be particularly distressing for teenagers, whose lives are already in perpetual change as they struggle to deal with the myriad pressures of school, developing social lives and physical changes. Painful also for parents who have to suffer vicariously because of their restless children. And while adults might find themselves, at least in theory, in a better position to discipline themselves against screen time, children are less so.

Dr. Hare sees more and more young people taking up this position. A study by NHS Digital, published in 2021, found that 28.7% of children aged 6 to 10 had trouble sleeping three or more nights in the previous week. Problems falling asleep, waking up at night or waking up early were even more common among older children, affecting more than a third (38.4%) of 11- to 16-year-olds and the majority – 57.1% – of youth. aged 17 to 23. The research concluded that the The Covid pandemic had sparked an epidemic of sleep disorders.

Reports have also suggested a sharp increase in the number of young people admitted to hospital for sleep disorders, with admissions for conditions such as insomnia nearly doubling in the seven years to 2020.

This hits close to home – in my own family, we’ve had sleepless nights for the past few years. Although my 16 year old daughter found that her sleep had improved during the lockdown, she is struggling again as she started college and returned to life post-pandemic. “I’m exhausted all the time,” she said I. “I go to bed at 10 a.m., 11 a.m., put my phone on airplane mode, but I’m still awake at two, three in the morning. And if I sleep, I keep waking up. At seven in the morning, when I have to get up for college, I just want to stay in bed. I just want to sleep.”

During the pandemic, many teenagers have struggled, with hospital admissions surging (Picture: Royal Brompton)

As a parent, it’s scary to watch your child struggle with sleep (and the aftereffects of too little). To date, my daughter has briefly experimented with sleep apps, and even more briefly with meditation – “boring” – and was prescribed several courses of melatonin, each time at a higher dosage, but she insists that it does not work. Or it doesn’t work long enough.

“That’s why the market for sleep products is so huge,” says Dr. Hare. “When you’re so desperate, you spend any amount of money on anything that promises to give you some kind of sleep, even if it’s just a small amount.” The sleep market is expected to be worth $585bn (£510bn) by 2024. In addition to the range of pills offered, there are specialty pillows, mattresses, eye masks, skin care lines, bath salts, lavender pillow sprays. There is soothing music and wind chimes. But does it all work? “No,” Dr. Hare replies. “That’s what’s frustrating, especially for specialists, we see people spending all that money on something that just doesn’t work.”

When I talk to Dr Hare about my child’s sleeping habits, she suggests, like many, that she does not suffer from insomnia – as many parents in a similar situation might assume – but that it is simply disturbed sleep because she goes to bed too late. , wakes up too early, eats badly and spends a lot of time on his devices. She compares this to another patient who came to the clinic for an overnight observation: “Her phone, which she had placed on her bedside table, was vibrating with new messages every half hour, and so of course her sleep. was interrupted. The data was useless.

Safer Features

A significant proportion of teenagers sleep with their phones by their bed (a 2019 study by online safety organization Digital Awareness UK found that almost half – 42% – of students kept their phones next to their bed at night and 23% check their mobile device more than 10 times per night). Parents Who Have Tried Intervention Tend to Get a Closer Look at What Addiction Really Looks Like: you don’t remove a child’s phone without protest, and immediate withdrawal symptoms.

In addition to technology, there are other, more physiological reasons why children and teens may have trouble sleeping. Dr Mike Farquhar, sleep medicine consultant at Evelina London Children’s Hospital, explains that children are ruled by the schedule of an adult world, not by what is most compatible with children’s circadian rhythms, which dictate that they tend to feel tired later. and they need to sleep later and longer.

“A teenager’s biological clock works differently,” he says. “Asking a child to wake up at 7 a.m. is like asking the rest of us to start work at 4:30 p.m..” There are ongoing campaigns to change school hours to reflect this – the less tired a student is in class, the better their performance – but change is slow to come.

Lots of people are spending money on fixes that don’t work (Picture: Royal Brompton)

At the Evelina, Dr. Farquhar sees many children with extreme cases. The most common incidents of insomnia are most likely not insomnia at all, but rather, he says, “typical developing teenagers who just haven’t established the right habits or the right behaviours”.

If it’s part of a teenager’s makeup, how do you deal with it? The good news is that expensive drugs are not the way to go. On the contrary, talk therapy is. The current “gold standard” of treatment offered in most sleep clinics is cognitive behavioral therapy for insomnia (CBTi).

As with classic CBT, it involves cognitive restructuring to help change inaccurate and unhelpful thoughts, as well as an attempt at specific appraisal. why the patient might experience insomnia. Is there a predisposition, a precipitant – excess stress, say, or bereavement – ​​and what are the perpetuating factors?

Sleep clinic patients are encouraged to keep a sleep diary and limit their time in the bedroom so that bed means sleep rather than the frustrations of not being able to doze off, and to experiment with relaxation techniques muscle or counting down from 1,000 in sevens, “all of which,” says Dr. Hare, “are helpful in helping to calm a busy mind.”

More Way of life

Once a patient has had a consultation, new sleep schedules are recommended if necessary, in an effort to establish a routine. “If you find that you don’t fall asleep until about 1 p.m., don’t go to bed at 10 p.m.,” Dr. Hare says. Going to bed when you’re more likely to fall asleep can help address some of the fears and concerns about insomnia that keep you awake afterwards.

However, the ultimate goal in any patient is to achieve balance. “In a healthy patient, these methods will ensure that they begin falling asleep at around the same time each night and wake up the same way each morning. The more balance we find, the faster we develop a healthy sleep pattern.”

Again, this might be easier to affect in adults than in young people: the teenager who stays up late to revise, or because he hangs out late with friends at parties, will find it difficult to establish this balance. “Adolescents certainly have to be ready to commit,” says Dr. Farquhar, “but each of them has the resources to make lasting change when they want to and when they’re ready.”

Back at the Royal Brompton, Dr Hare points to his screen. Patient X’s sleep improved significantly after eight weeks of CBT. “That’s not to say they won’t ever have problems again, because we all have them, but once that initial worry is gone and the circadian rhythm is restored, then they can stop worrying, stop trying and let it be.” be”.

“Oh,” she adds, as a final thought, “don’t use the word ‘insomniac’ in your article. They are simply people suffering from insomnia. There is a remedy, they can get better and they will get better sleep. We all can.