Young adults’ sleep issues often helped by light therapy

But one reader told the Star her 20-year-old son’s sleep issues go far beyond the ordinary and he can’t fall asleep until the wee hours of the morning — sometimes until 5 a.m. or 7 a.m. That is, after “tossing and turning” for hours each night, she wrote in an email.

Once he does fall asleep, his mom wrote, her son doesn’t wake up until 2 p.m. or 3 p.m.

His mom asked the Star to find out: “are there any tests that can figure out what the problem is?”

There are tests, experts have told me, but they are more of a last resort, rather than a starting point. Sleep issues, defined as insomnia, or difficulty getting to sleep or staying asleep, are usually a symptom of another root cause that when identified by first talking it out with a physician are often solvable, the experts said.

Restless legs syndrome, pain, sleep apnea or medications may be the culprit, according to Brian Murray, director of the Sleep Disorders Clinic and head of Neurology at Sunnybrook Health Sciences Centre. Often, he said, behavioural reasons, such as staring at a tablet and giving your retinas and thus, your brain, a blast of light before bed, could be an underlying cause.

Fixes could include developing better sleep behaviours, such as limiting light before bed, avoiding naps throughout the day and exercising in the mornings, which helps train a normal circadian rhythm and exposes you to light at the appropriate time, Murray said.

It’s rare, he said, to rely on sleeping pills or medication to treat a sleep issue because they are more like Band-Aids, fixing a problem superficially, rather than resolving it.

As far as the 20-year-old is concerned, Murray said, it sounds like he has a “phase delay.”

Colin Shapiro, a University of Toronto professor of psychiatry and ophthalmology, called it a “body clock issue.” Shapiro, director of Youthdale Child and Adolescent Sleep Clinic, a clinic in downtown Toronto that evaluates sleep problems in young people, said it’s like the clock that controls the sleep-wake cycle is “living in Vancouver while they’re living in Toronto.”

There are plenty of teens who make a conscious decision to stay awake into the wee hours, he said, but this biologically driven timing misalignment occurs in about 7 per cent of the young adult population.

Often, he said, it’s caused by an abnormality in the secretion of melatonin, a hormone that controls the human circadian rhythm system. Under normal circumstances, the suprachiasmatic nucleus, a tiny region in the brain right behind the eye, secretes melatonin when the eye begins to sense it is getting dark outside. Melatonin sends its chemical message to the rest of the body, telling it to prepare for the night’s rest.

Shift work, or a plane trip to a far flung destination, such as Tokyo or Sydney, Shapiro said, can disrupt the body clock, signalling for melatonin to be secreted at inappropriate times. Likewise, those with a malfunctioning body clock may send out the hormonal signal late in the evening, postponing the cascade of physical changes that can induce sleep.

Most people begin to secrete melatonin around 7 p.m., Shapiro said.

The clock issue may or may not dissipate with age, Shapiro said, but for those who suffer from it, it can wreak havoc on their lives, as they struggle to get enough rest before exams or competitive sporting events. “It can really ruin their lives,” Shapiro said.

The good news is that 95 per cent of the time, it’s fixable, he said.

Murray, Sunnybrook’s head sleep physician, said he diagnoses this “phase delay” by having detailed discussions with his patients, first ruling out other potential medical causes that could be underlying the apparent clock issue.

To treat this mistiming, he said he prescribes light therapy, where patients sit before a bright light for prescribed periods of time, as it is the most “powerful” way to retrain the body’s internal clock.

Shapiro said that sometimes he brings his subjects into his lab for a body clock test. While not covered by OHIP, Shapiro said the test gives the most definitive diagnosis of body clock functioning.

For six hours, from 6 p.m. to midnight, subjects sit in a dark room. Once an hour, remaining in the dark, they chew a cotton ball and spit it into a tube.

From the saliva extracted, staff measure the melatonin level and plot it on a graph, to show when it rises. If it rises too late in the evening, that can indicate there’s a body clock problem.

Shapiro also uses light therapy to correct the problem and said that melatonin pills are can be an option too. The results can be dramatic, he said, with young adults becoming better students and athletes overnight.

On many occasions, he said, he’s written notes to universities, telling faculty not to count exam results garnered before the body clock issue was diagnosed.

But it’s an “undertreated condition,” he said, because a lot of sleep clinics don’t recognize the disorder. Or they ignore it, he said. “It’s a shame. It hurts a lot of kids.”