Sleeping through the holidays

Last year around this time, my friend Sue called worried about her college-age son Charlie because he seemed to be sleeping away his whole Christmas vacation.

“At first, I thought, OK, he is just catching up because he was up many nights studying for finals. But now two weeks have gone by and he is still sleeping the day away.”

There are a number of reasons that college kids or teens could be sleeping all day. As my friend suspected, we do indeed try to “catch up” on sleep. It seems to work to a certain extent, but we can’t make up for the full amount of sleep lost.

Also, it is difficult to pinpoint exactly what it is that we “lose” when we lose sleep. So Charlie could have been studying (and partying?) very hard before the holiday break and would indeed have the tendency to sleep in.

However, it is doubtful that the catch-up period would last for weeks. Most teens and college kids require nine to nine and a half hours to feel their best. If they curtail their sleep for a few nights, they will usually have long sleep times for one to two nights. If they are chronically sleep deprived, then that period will be extended.

Of course, we must keep in the mind that sleeping for extended periods could be a sign of illness.

Diseases such as mononucleosis or depression can have an insidious onset marked by sleepiness and fatigue.

The sleepy college kid or teen might have developed a primary sleep disorder such as obstructive sleep apnea, restless legs syndrome (now known as Willis-Ekbom disease) or periodic limb movement disorder. Most importantly in this age group, narcolepsy should be considered.

Get some sleep: Is restless legs syndrome real?

The telltale feature of narcolepsy is daytime sleepiness, and it usually occurs in teens and young adults. People can have actual sleep attacks where one minute they are awake and the next they are asleep. They could be driving or talking to someone and without much warning, they fall asleep.

Many times, the sleepiness is not so dramatic; people can have profound sleepiness that impairs their quality of life, but still be able to fight off the sleep attacks.

The other hallmark symptom is cataplexy which is often confused with sleep attacks. In cataplexy, the muscles become suddenly relaxed and people can fall to the ground and seem to faint. Muscle relaxation is a feature of REM sleep and what has happened is that that one aspect of REM sleep has suddenly intruded into the wake state. Cataplexy usually occurs after a person is startled or has a sudden burst of emotion, often a good one such as suddenly finding something very funny. Narcolepsy can, and often does, occur without cataplexy.

Therefore, although the presence of cataplexy cinches the diagnosis, the absence does not rule out narcolepsy by any means. A suspicion of narcolepsy should be investigated with a sleep specialist.

Kleine-Levin Syndrome is another disorder that should be considered if the young person has recurrent episodes of sleepiness and long sleep times. It is a rare and poorly understood disorder marked not only by hypersomnia (sleepiness) but also by megaphagia (overeating) and hypersexuality (usually masturbation).

In the wake periods, there is almost always cognitive and mood disturbance. The episodes last anywhere from two days to four weeks and tend to recur at least once a year, although there is a tendency for them to abate over time. It is much more common in boys and young men than in women, although there is a well described hypersomnia syndrome that can occur during menstruation. The cause of Kleine-Levin Syndrome is unknown and none of the attempts at treatment has given consistent results.

An important question to ask is what time the teen went to sleep. Teens and young adults have a natural shift in their circadian rhythm such that they are naturally sleepy only later in the night, for example, midnight-1 am. And the lifestyle of young people often encourages an even more delayed bedtime.

Therefore, before you assume that your college kid has a sleep pathology that is making him sleep for 16 hours a day, find out when he finally finished gaming and when he stopped texting his girlfriend who is visiting her family in a time zone that is three hours behind.

It turned out that Charlie was sleeping 10 hours a day, from 4 am to 2 pm, which, although on the long side, is still considered well within normal limits. Staying up late, as I said, is a biological tendency that is reinforced and exacerbated by social norms in that age group. The pervasiveness of continual electronics use only makes matters worse.