INTRODUCTION

Sleep disorders (somnipathy) have become a common issue among adolescents in recent times but not much awareness have been raised on its prevalence.[1]These disorders are a frequent complaint in routine medical appointments and increasingly, the physician must be able to adequately establish their diagnosis and management, thus avoiding referral to specialist consultations, as well as unnecessary and excessive examinations.[2]. Sleep disorders are mainly divided into dyssomnias, parasomnias and circadian rhythm sleep disorders. Dysomnias are the broad classification characterized by difficulty in getting sleep, remain sleep or excessive sleepiness. Parasomnias involve abnormal movements, behaviours, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep and Circadian rhythm sleep disorders (CRSD), is a family of sleep disorders, which affects (among other bodily processes) the timing of sleep and people affected by CRSD are unable to go to sleep and wake up at the times commonly required such as social needs(i.e waking up to school or going to work).

Adolescence is a transitional stage of physical and psychological human development that generally occurs during the period from puberty to legal adulthood (age of majority). [3]There are more than 100 of sleep disorders but the frequently affected adolescents suffer from insomnia and daytime sleepiness [4]. In contrast with males, females were more likely to report poor sleep health, as reflected by shorter sleep durations on school nights, increased likelihood of sleepiness on school days, and higher hyper somnolence scores.[5]These sleep disorder affected students go on with their daily life and without seeking any treatment for it. These continue to give rise to more serious health problems which may be degrade one’s health drastically. This is due to the low awareness about sleep disorders

Potential Causes for The Onset of Sleep Disorders It was found that worries, anxiety, and depression are frequently quoted reasons for not being able to sleep along with consumption or usage of nicotine, alcohol, and caffeine-containing drinks, as well as illicit drug use, are further possible influences.[6]A systematic review found that traumatic childhood experiences (such as family conflict or sexual trauma) significantly increases the risk for a number of sleep disorders in adulthood, including sleep apnea, narcolepsy, and insomnia.[7] Restless Leg Syndrome is often due to iron deficiency ( low total body iron status) and this accounts for 20% of cases. [8] along with ADHD [9], genetics[10]and medications. [11] Restless legs syndrome (RLS) is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations.[12]

Sleep apnea or sleep apnoea, is a sleep disorder which is characterized by pauses in breathing or instances of shallow breathing during sleep. [13] Alcohol, sedatives and tranquilizers may also promote sleep apnea by relaxing throat muscles. Smokers have sleep apnea at three times the rate of people who have never smoked.[14]. risk factors include being male, excessive weight, an age above 40; large neck size (greater than 16–17 inches), enlarged tonsils or tongue, small jaw bone, gastroesophageal reflux, allergies, sinus problems, a family history of sleep apnea, and deviated septum[15] The most prevalent sleep disorder, insomnia is to have trouble sleeping: difficulty falling asleep, or staying asleep as long as desired. [16] Use of psychoactive drugs (such as stimulants), including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines,methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake and withdrawal effects from alcohol and opiods also lead to insomnia.[17] Pain,[18]dementia[19],ADHD [20] or even traumatic brain injuries[21].Fatal familial insomnia which is genetic has also found to be passed down in family member.[22]

The delayed sleep phase syndrome (DSPS) is a common cause of insomnia in adolescents. In half of adult patients with DSPS the symptoms appeared in childhood or adolescence.[23] Children stay up late and their total sleep time has decreased by 20–30 min[22] Refusal to attend school has also increased recently, which could be partially but not entirely caused by disorders in the sleep–wake schedule[24][25] The syndrome is multifactorial : social, psychological and environmental factors as well as biological factors play important roles in the onset of the symptoms [26] [27]

Adverse Effects And Symptoms of Sleep Disorders

Although there are around 90 distinct sleep disorders, according to the International Classification of Sleep Disorders [28] most are marked by one of these symptoms: excessive daytime sleepiness, difficulty initiating or maintaining sleep, or abnormal movements, behaviours, and sensations occurring during sleep. The cumulative effects of sleep loss and sleep disorders have been associated with a wide range of deleterious health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke. Make you more prone to pimples. Lack of sleep can contribute to acne and other skin problem [29][30].Low sleeping hours can also lead to aggressive behaviour resulting in harsh behaviour with friends and family.[31] The main symptom of sleep loss is excessive daytime sleepiness, but other symptoms include depressed mood and poor memory or concentration[32]

Prevalence of Sleep Disorders in Students

Adolescents are also affected by sleep disorder which may be due to childhood mental problems or physical abuse which may sometimes continue to adulthood without any proper treatment. Daytime sleepiness is was found to be major problem, exhibited by 50% of college students compared to 36% of adolescents and adults.[33] It was also found that 60% of students report that they are tired or sleepy at least 3 days a week in a study[34]Similarly, it was reported that excessive daytime sleepiness was strongly associated with depression than sleep-disordered breathing i,e due to sleep apnea [35].Cultural differences in beliefs of different people about and patterns of sleep, also affect the acquiring rate of sleep disorders .[36] The National Sleep Foundation[37] found that high school students who reported insufficient sleep or daytime sleepiness also reported depressed mood and lower grades, whereas 80% of students who reported getting enough sleep made As and Bs in school. Among college students who carried a full academic load, those who reported poorer sleep quality were likely to perform worse on academic tests.[38]. In contrast with males, females were more likely to report poor sleep health, as reflected by shorter sleep durations on school nights, increased likelihood of sleepiness on school days, and higher hyper somnolence scores.[39] Although reported sleep disorders in adults tend to increase with age,[40] they may also occur among college students frequently enough to warrant screening this population. In addition, sleep patterns or disorders among college students may vary by gender or race/cultural affiliation.[41]Consumption of alcohol and other substance use were also found to be more common in students with sleep disorder symptoms[42]

Treatment :

The most basic treatment maybe to make modifications in one’s sleep hygiene which may help to solve the problem, but medical treatment is often necessary in few cases.[43] Research suggests that acupuncture may be helpful for some sleep disorders. With insomnia specifically, acupuncture was found to be more effective in increasing the sleep quality of individuals who received a diagnosis.[44] In the end, researchers found that melatonin decreased sleep onset latency, increased total sleep time, and improved quality of sleep significantly more than the placebo group. [33]There are several reports of successful use of hypnotherapy for parasomnias [45] [46]specifically for head and body rocking, bedwetting and sleepwalking. [47] Maxillomandibular advancement (MMA) is considered to be one of the most effective surgery available for people suffering from sleep apnea. [48] Bright light therapy [49]and dark therapy or scototherapy [50], is used to advance or delay sleep, depending on how (in which direction) the circadian rhythm needs to be shifted.[51] Some drugs can be prescribed especially for people suffering from sleepwalking, such as a low dose of benzodiazepines, such as clonazepam, and tricyclic antidepressants.[52]

CONCLUSION:

Teens of today’s world are pinned by a huge amount of stress and other factors which often leads to it such as coping with academics, leading an active social life, peer pressures and sometimes addiction to drugs and alcohol. Sleep deprivation and disorder are mostly caused due to various causes socially and in few cases genetically. Sleep disorders may lead to lowering of academic grades, failing social life, imperant complications on the body, lack of concentration and focus and may lead to depression and dependence on drugs for sleep. Dependence on drugs is very dangerous and may lead to heavy complications or even death with its overuse. The prevalence of sleep disorders is very high even among Indian populations but due to the low awareness level given to sleep disorders in the societies and the late-night-life culture among adolescents, many people mostly students get affected by sleep disorders but ignore it and proceed with their routine due to lack of knowledge of treatment for their problems. Therefore, proper sleep management must be taught, importantly to students and awareness, must be raised on sleep disorders and the treatment options available for curing it.

REFERENCES:

1 Crowley SJ, Acebo C, Carskadon MA. Sleep, circadian rhythms, and delayed sleep phase in adolescence. Sleep Med 2007;8:602–12.

2 Nunes ML, Bruni O. Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. J Pediatr (Rio J). 2015;91:S26–35.

3 Macmillan Dictionary for Students Macmillan, Pan Ltd. (1981), page 14, 456. Retrieved 2010-7-15.

4 Recent worldwide sleep patterns and problems during adolescence: A review and meta-analysis of age, region, and sleep Michael Gradisar, Greg Gardner, Hayley Dohnt

5 Ming Xue, Radhakrishnan Varsha, Kang Lilia, and Pecor Keith. Journal of Women's Health. May 2016, ahead of print. doi:10.1089/jwh.2015.5681

6 Stores, Gregory. “Aspects of Sleep Disorders in Children and Adolescents.” Dialogues in Clinical Neuroscience 11.1 (2009): 81–90. Print.

7 Kajeepeta, Sandhya; Gelaye, Bizu; Jackson, Chandra L.; Williams, Michelle A. (2015-03-01). "Adverse childhood experiences are associated with adult sleep disorders: a systematic review". Sleep Medicine 16 (3): 320–330. doi:10.1016/j.sleep.2014.12.013. ISSN 1878-5506. PMC 463

8 "Restless legs syndrome: detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome". American family physician 62 (1): 108–14. 2000. PMID 10905782.^ Cortese, S; Konofal, E; Lecendreux, M; Arnulf, I; Mouren, MC; Darra, F; DallaBernardina, B (2005). "Restless legs syndrome and attention-deficit/hyperactivity disorder: A review of the literature". Sleep 28 (8): 1007–13. PMID 16218085.

9 Cortese, S; Konofal, E; Lecendreux, M; Arnulf, I; Mouren, MC; Darra, F; DallaBernardina, B (2005). "Restless legs syndrome and attention-deficit/hyperactivity disorder: A review of the literature". Sleep 28 (8): 1007–13. PMID 16218085.

10 Lavigne, GJ; Montplaisir, JY (1994). "Restless legs syndrome and sleep bruxism: prevalence and association among Canadians". Sleep 17 (8): 739–43. PMID 7701186.

11 Phillips, Barbara A.; Britz, Pat; Hening, Wayne (October 31, 2005). The NSF 2005 Sleep in American poll and those at risk for RLS. Chest 2005. Lay summary – ScienceDaily (October 31, 2005).

12 Earley, Christopher J. (2003). "Restless Legs Syndrome". New England Journal of Medicine 348 (21): 2103–9.doi: 10.1056 /NEJMcp021288

13 "Sleep Apnea: What Is Sleep Apnea?". NHLBI: Health Information for the Public. U.S. Department of Health and Human Services. May 2009. Retrieved 2010-08-05.

14 Mayo Clinic. "Sleep apnea"

15 "Sleep Apnea Health Center". WebMD.

16 Golub, R. M. (2012). "Insomnia". JAMA: The Journal of the American Medical Association 307 (24): 2653 – 2653. "Insomnia". University of Maryland Medical Center. Retrieved 11 July 2013.

17 "Insomnia". University of Maryland Medical Center. Retrieved 11 July 2013.

18 Ramakrishnan, K.; Scheid, D. C. (2007). "Treatment options for insomnia". American family physician 76 (4): 517–526

19 Gelder, M., Mayou, R. and Geddes, J. (2005). Psychiatry. 3rd ed. New York: Oxford. p. 167,

20 Bendz, L. M.; Scates, A. C. (2009). "Melatonin Treatment for Insomnia in Pediatric Patients with Attention-Deficit/ Hyperactivity Disorder". Annals of Pharma-cotherapy 44 (1): 185–191

21 Ouellet, M. C.; Beaulieu-Bonneau, S.; Morin, C. M. (2006). "Insomnia in patients with traumatic brain injury: Frequency, characteristics, and risk factors". The Journal of head trauma rehabilitation 21 (3): 199–212.

22 Schenkein, J.; Montagna, P. (2006). "Self management of fatal familial insomnia. Part 1: What is FFI?".MedGenMed

23 Takahashi K , Morita N , Mishima K et al. A multi-center study on sleep-wake rhythm disorders in Japan (1): Demographic features . Clin. Psychiatry 1993 ; 35 : 605 614 (in Japanese).

24 Ferber R . Sleep schedule-dependent causes of insomnia and sleepiness in middle childhood and adolescence . Pediatrician 1990 ; 17 : 13 20 .

25 Lahmeyer HW & Lilie JK . Personality affects treatment outcome in phase delayed sleep syndrome . Sleep Res. 1987 ; 16 : 282.

26 Thorpy MJ , Korman E , Spielman AJ et al. Delayed sleep phase syndrome in adolescents. J. Adolesc Health Care 1988 ; 9 : 22 27.

27 Weitzman ED , Czeisler CA , Coleman RM et al. Delayed sleep phase syndrome . Arch. Gen. Psychiatry 1981 ; 38 : 737 746

28 AASM (American Academy of Sleep Medicine) The International Classification of Sleep Disorders. Westchester, IL: American Academy of Sleep Medicine; 2005.

29 Bhate, K. and Williams, H.C. (2013), Epidemiology of acne vulgaris. British Journal of Dermatology, 168: 474–485. doi : 10.1111/bjd.12149

30 Management of Atopic Dermatitis in the Pediatric Population Andrew C. Krakowski, Lawrence F. Eichenfield, Magdalene A. Dohil Pediatrics Oct 2008, 122 (4) 812-824; DOI: 10.1542/ peds .2007-2232

31 Poor sleep as a potential causal factor in aggression and violence Jeanine Kamphuis^,Peter Meerlo, Jaap M. Koolhaas, Marike Lancel

32 Dinges D, Rogers N, Baynard . Chronic sleep deprivation. In: Kryger MH, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elsevier/ Saunders; 2005. pp. 67–76.

33 Oginska H, Pokorski J. Fatigue and mood correlates of sleep length in three age-social groups: school children, students, and employees. Chronobiol Int. 2006;23(6):1317–1328.

34 American College Health Association. American College Health Association: National College Health Assessment II Reference Group Executive Summary Spring 2012. Hanover, MD: American College Health Association; 2012

35 Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, et al. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005; 90:4510–4515.

36 Jenni OG, O’Connor BB. Children’s sleep: an interplay between culture and biology. Pediatrics. 2005;115(1) (suppl P):204–216.

37 National Sleep Foundation. http://www. sleepfoundation. org/atf/cf/%7B120BADF0–669E-46D0-B46B-68D410 B0 40E%7D/Key%20Messages%20and% 20 Talking %20 Points. pdf. Accessed January 3, 2008.

38 Howell AJ, Jahrig JC, Powell RA. Sleep quality, sleep propensity and academic performance preview. Percept Mot Skills. 2004;99:525–535.

39 Ming Xue, Radhakrishnan Varsha, Kang Lilia, and Pecor Keith. Journal of Women's Health. May 2016, ahead of print. doi:10. 1089/jwh.2015.5681

40 Avidan AY. Sleep disorders in the older patient. Primary Care. 2005 ; 32:563–586.

41 M, Tran D, Chakrabarti A, Vasquez A, Gilbert P, Davidson, T. Prevalence of snoring in college students. J Am Coll Health. 2008 ; 57:45–52.

42 Sleep disorders among high school students in New Zealand. Fernando AT¹, Samaranayake CB, Blank CJ, Roberts G, Arroll B Ivanenko A, Massey C (October 1, 2006). "Assessment and Management of Sleep Disorders in Children".Psychiatric Times 23 (11)

43 Cheuk, Daniel KL; Yeung, Wing-Fai; Chung, Kf; Wong, Virginia (2012-09-12). Acupuncture for insomnia. John Wiley & Sons, Ltd.

44 Ferracioli-Oda, E (2013-06-06). "Meta-analysis: melatonin for the treatment of primary sleep disorders". Centre for Reviews and Dissemination. Retrieved 2016-03-08.

45 Graci, Gina M.; Hardie, John C. (2007). "Evidenced-Based Hypnotherapy for the Management of Sleep Disorders". International Journal of Clinical and Experimental Hypnosis 55 (3) : 288–302.

46 Hauri, PJ; Silber, MH; Boeve, BF (2007). "The treatment of parasomnias with hypnosis: A 5-year follow-up study". Journal of clinical sleep medicine 3 (4): 369–73.

47 Hurwitz, Thomas D.; Mahowald, Mark W.; Schenck, Carlos H.; Schluter, Janet; Bundlie, Scott R. (April 1991). "A retrospective outcome study and review of hypnosis as treatment of adults with sleepwalking and sleep terror".Journal of Nervous & Mental Disease 179 (4): 181–241.

48 "Resetting the Body Clock and Other research and insomniac treatment contacts". Flinders University. 2014. p. 1. Retrieved2014-01-17.

49 http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/May/blue-light-has-a-dark-side/ "Blue light has a dark side" online article from the May 2012 edition of Harvard Health Letter Dodson, Ehren R.; Zee, Phyllis C. (2010). "Therapeutics for Circadian Rhythm Sleep Disorders" (PDF: full text).Sleep Medicine Clinics 5 (4): 701–715.

50 Swanson, Jenifer, ed. "Sleepwalking." Sleep Disorders Sourcebook. MI: Omnigraphics, 1999. 249–254, 351–352.

Received on 15.06.2016 Modified on 24.06.2016

Research J. Pharm. and Tech 2016; 9(10):1802-1805.

DOI: 10.5958/0974-360X.2016.00365.6