a teenage girl in her bedroom, using a smartphone and laptop

DEAR MAYO CLINIC: For the past few weeks, my 13-year-old daughter has had trouble falling asleep at night. She’s in bed at a reasonable time, but can’t seem to fall asleep until after midnight. What could cause insomnia in someone so young? Should I make an appointment for her see her doctor?

ANSWER: Many children your daughter’s age have trouble falling asleep easily at night. The reason for this often can be traced back to habits a child has developed that interfere with good sleep. Less often, it may be due to a sleep disorder.

Before
making an appointment with your daughter’s health care provider, make sure her routines
are sleep-friendly. One of the best ways to ensure healthy sleep is setting a
consistent wake-up time and sticking to it. The wake-up time doesn’t have to be
exactly the same time every day, but it should be within a one-hour window. It
may seem helpful to let her sleep in on the weekends, but this actually disrupts
her internal clock. That makes it much tougher to get back into a weekday sleep
routine on Monday. Sleep deprivation then worsens during the week.

It’s also important to consider
your daughter’s use of electronic devices before bedtime. Many tweens and teens
have smartphones, tablets and TVs in their bedrooms. They keep their cellphones
close by at all times. These devices can make it hard to disengage from
stimulating activities.

Have your daughter turn off all electronic
devices at least 30 to 60 minutes before bedtime. This gives the brain time to
relax and wind down, making it easier to fall asleep. I strongly recommend that
all electronics be kept out of a child’s bedroom. It is best for cellphones to
be shut down and stored in another room at night. Understandably, this can be
difficult to do given how attached people are to their electronics. It’s ideal
that the entire family be good role models and also consider doing the same.

Another important approach is to
reduce the amount of time in bed at night lying awake. If your daughter is
awake in bed for longer than 15–20 minutes during the night, encourage her to
go to another room; stay in a sitting up position; and do “boring things,” such
as listening to light music or practicing relaxation skills. She should try to
go back to bed when she starts to feel sleepy, such as head bobbing or heavy
eyes. This will help increase the likelihood that her bed and bedroom become
more associated with sleep.

Avoiding food and beverages that
contain sugar at least two to three hours before bedtime also is important. Try
reducing caffeine use throughout the day, and preferably avoid caffeinated
drinks past 3 p.m. Daily exercise and other physical activity can aid sleep,
but have her finish those activities at least two hours before she goes to bed.
Also, even if she is sleepy during the day, encourage her not to nap. Naps do
more harm than good when it comes to getting good sleep because they often make
falling asleep at night harder.

For some children, when they lie
down at night worries and concerns creep into their minds, making it hard to
relax and fall asleep. To help clear her mind, it may be useful for your
daughter to take a few minutes before bedtime to write down anything that’s on
her mind or tasks she needs to do. Once they are on paper, sometimes children are
better able to let their concerns go and get to sleep more easily.

Although uncommon, the source of your daughter’s problem could be a sleep disorder related to the workings of her internal clock. The most common such problem for children your daughter’s age is called “delayed sleep phase syndrome.” Children who have this sleep disorder are “night owls.” According to their internal clock, their day is longer than 24 hours. As a result, they tend to fall asleep at progressively later and later times each night, and then have difficulty waking up in the morning.

Too little sleep can make it hard for a child to concentrate and pay attention at school. It also can lead to mood swings and irritability, and can increase a child’s tendency to have accidents. Therefore, it’s important to address your daughter’s sleep problem. Have your daughter try to change any habits that may interfere with her sleep. While this may take some time and practice, it’s not uncommon that sleep can improve within a couple of weeks of sticking to these healthier habits. If those changes don’t help, make an appointment to have her see her health care provider. — Dr. Craig Sawchuk, Psychology, Mayo Clinic, Rochester, Minnesota

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