Teen sleep: why they cannot fall asleep, and how to get 8 hours back

Why teens are wired at 11 p.m.

At puberty the internal clock delays: melatonin rises later in the evening, so a teen who is told to sleep at 9:30 lies awake, and then cannot wake at 6:30. Add early school start times, homework, sports, jobs and phones, and the average American teen sleeps under 7 hours on school nights. Sleep loss shows up as irritability, tears, forgetfulness, weight gain, more colds, worse athletic performance and drowsy driving, the leading cause of teen crashes.

What works

1. A fixed wake time every day, including weekends (within an hour); this is the anchor of the clock
2. Bright light within 30 minutes of waking: open the blinds, eat breakfast by a window, walk outside
3. Screens off an hour before bed and all devices charged outside the bedroom; an alarm clock instead of a phone
4. Dim, cool, quiet room; the bed for sleep only, not homework
5. No caffeine after noon, including energy drinks and iced coffee
6. Movement every day, but not vigorous exercise in the last two hours before bed
7. A wind-down routine of 20 to 30 minutes: shower, reading on paper, stretching

Melatonin and sleep aids

Melatonin is a hormone, not a vitamin, and it is unregulated in the United States; gummies often contain far more than the label says. A small dose taken 2 to 3 hours before the target bedtime can help shift a teen’s clock for a few weeks, with our guidance. It is not a nightly habit and it does not fix a phone in the bed. Antihistamines and “PM” products are not sleep aids for teens.

When it is more than habits

Loud snoring or pauses in breathing, restless legs, waking unrefreshed after 9 hours, or a teen who cannot fall asleep before 2 a.m. no matter what may have sleep apnea, restless legs or delayed sleep phase disorder. Anxiety and depression very often show up first as sleep trouble. We screen for all of these at teen well visits.