#90 - Treating Teen Sleep: Lesson 3

So many people have heard about Melatonin.

They’ve heard that the bright light from screens can suppress melatonin (that is actually true).

They’ve also heard that melatonin can help you sleep - that is also true.

However, there are two different ways melatonin improves sleep.

And when it comes to treating teenagers’ sleep, melatonin works in a very different way than it does for kids and adults.

Endogenous vs Exogenous Melatonin

So here’s the first confusing part.

If bright screens suppress our melatonin levels, then that suggests that we have melatonin within us.

Then how come there are also bottles on store shelves that say ‘Melatonin’?

Do pharmaceutical companies ‘milk’ humans of their melatonin and squeeze it into capsules for adults and chewable gummies for kids?

To all the conspiracy theorists out there - the answer is ‘No’ (but I’m guessing anything I say won’t convince you otherwise…).

The melatonin on shelves is a synthesised version of the melatonin within us.

But first, it’s important to understand endogenous melatonin (ie, the melatonin within us) - because teenagers’ melatonin differs to everyone else’s.

The Melatonin Wave

Melatonin is like the vampire of bodily hormones.

It is usually produced in our bodies when the sun sets. It’s peak production should occur around midnight. It then retreats when the sun rises. These 3 concepts describe the circadian rhythm of melatonin.

But the circadian rhythm of melatonin is different in teenagers.

The rise in their melatonin levels happens much later in the evening. And if they are allowed to sleep-in (as good vampires do), then their melatonin is still present when the sun has risen.

This delay in the timing of a teenager’s melatonin rhythm is one of many expressions of an overall delay in a teenager’s circadian rhythm.

This is why they also have a delay in the timing of their body temperature, appetite, reflexes, and of course - sleep.

But you can actually use synthesised melatonin that’s sitting on the shelves to help move the teenager’s circadian rhythm to an earlier time.

Doing so means they will fall asleep earlier - and wake up easier in the morning.

Behavioural vs Biological Time

Most bottles of melatonin on the shelves will have something like the following in their instructions:

“Take 30 min before bedtime”

That instruction can actually work for some people’s sleep.

But for a teenager with a delayed circadian rhythm - this instruction alone will not work.

The interaction between exogenous melatonin (think of ‘external’ when you see the ‘exo’ at the front of ‘exogenous’ - so this is external melatonin - the stuff on shelves) and a teenager’s endogenous melatonin (the natural hormone released in their body) doesn’t care about this thing called ‘Bedtime’.

Melatonin cares more about the time at which a teenager falls asleep.

That’s because ‘bedtime’ is a behaviour - and falling asleep is more influenced by ‘biology’.

So a teenager needs to take melatonin in relation to the time that they fall asleep.

The time at which teens fall asleep is something we researchers call ‘Sleep Onset Time’ or (SOT).

SOT can change from night to night for a teen.

So it’s important to find the teenager’s average SOT (using something like our sleep diary).

Most wearables should also be good at detecting SOT too. I’ve been testing out the Polar watch devices (these were invented around 30 years before the FitBit) - and I’ve noticed a +/- 5min margin of accuracy around sleep onset time.

Melatonin Therapy

There is so much that needs to be said - and taught - about using melatonin to help teenager’s fall asleep earlier.

I know a lot of people like ‘Sleep Tips’ - as if fixing sleep is as simple as reading a few dot points. But here’s several dot points to get a bigger picture of treating teen sleep:

• We’ve learned that teenagers with a delayed circadian rhythm have lost a lot of hope by the time they find us.

• They truly want their sleep to change - but their confidence in health professionals and techniques is pretty low (we’ve measured this - Micic et al., 2019).

• Get Bright Light Therapy wrong - or Melatonin Therapy wrong - and you can easily lose them to all future attempts to fix their sleep.

• This is why is takes me several hours to teach health professionals how to do Melatonin Therapy.

• And this is why those in my clinic do 400 hours of training under my supervision.

• You have to get it right.

• You have to know what type(s) of melatonin can be used.

• You have to know how much melatonin to use.

• You have to know when the teenager needs to take melatonin at night (or the wee hours of the morning). It’s different for each teen.

• And the timing of when a teenager takes melatonin is never the same - it changes every night.

If you’re reading this and you’re a teenager - or a parent of a teenager - I can start you off with some suggestions - but keep in mind, these ain’t Sleep Tips …

What To Do?

Here’s some things you can begin doing in the next 24 hours:

• Harm Minimisation - teenagers with a delayed circadian rhythm will fall asleep very late at night. Fill that time by occupying your mind. Whilst reading a book and/or listening to music are the best (Eggermont & van den Bulck, 2006), our analysis of data from 10,000s of teenagers suggests watching TV is less harmful than interactive technologies (eg, social media; Bartel, Gradisar & Williamson, 2015) and lying in the dark ruminating (Hiller et al., 2014).

• Do Your Own Research - search for a Sleep Disorders Unit affiliated with a hospital near you, and find out if they have a health professional who is able to treat a teenager’s sleep problem. If you find someone, continue your research and find out:

  • how many teens they have treated?

  • over how many years?

  • and what their success rate is?

  • For example, we’ve seen hundreds of teens over the years; we’ve been doing this since the early 2000s; I’d estimate our success rate (defined as improving a teen’s sleep) to be ~75-85% … we actually have the scientific proof for this (Gradisar et al., 2011, Sleep; Richardson et al., 2018, Sleep Medicine).

I’m a parent of a teenager who has been fighting the battle against a delayed circadian rhythm for years.

As a parent, I know how tough this is - how their ‘personality’ is so different in the morning compared to after dinner.

My son is in the ‘home straight’ of his final year in high school. I’m pretty confident that if I wasn’t one of the world’s leading experts in treating teen sleep, that he would have dropped out of high school a year or two ago (just like one of his mates).

Every week I help teenagers at my sleep clinic. But there are not enough hours in the day or week to be able to individually help the estimated 100,000s of poor sleeping teens around the world.

That’s why I’m now focused on training people to do what I do.

We’ve got a growing community of professionals at WINK, and many of them are soon to be trained in how to do Melatonin Therapy, Bright Light Therapy, and other techniques to help teens sleep.

Look out for them - and their WINK certifications - at our Find-An-Expert page.

Hopefully there will be a WINK Teen Sleep Practitioner near you soon …

• Prof MG

p.s. Sign up in the next 24 hrs to our free weekly newsletter and you’ll find out what type of melatonin you should use - and which one you shouldn’t … don’t worry. If you bought the one you shouldn’t we will tell you how you can still use it …