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Tiger sits in his room carefully painting a small canvas, his cat curled up on his bed.
“Fort Tiger” reads a hand-drawn shield artwork hung above the 14-year-old’s study desk.
But last year the room became anything but a place of sanctuary and protection.
For six months he struggled to get to sleep before midnight and was waking at odd hours.
The next day felt impossible.
“I’d just try to get up but I couldn’t,” Tiger recalled.
He began many days crying as he again missed another bus to school.
His self-esteem plummeted and his depression and anxiety worsened.
“Like a vicious cycle of not being able to sleep and then having not great mental health, and then the mental health causing me to not get great sleep,” he said.
Something had to change.
For teenagers like Tiger, a lack of sleep and poor night-time routines at a sensitive developmental period are leaving them vulnerable.
Clinical teen sleep psychologist Cele Richardson said poor sleep can be linked to depression, anxiety and eating disorders.
“We are building stronger evidence for the really important role that sleep plays as a risk factor for mental health problems,” Dr Richardson said.
A recent Australian study of more than 500 young people aged 11 to 16 years old, found poor sleep predicted increases in generalised anxiety, social anxiety, depression and eating disorders.
“Sleep disturbance and RNT [repetitive negative thinking] should be targeted simultaneously in the prevention and treatment of social-emotional disorders in adolescence,” the five-year study concluded.
With a perfect biological and psychological storm stealing their slumber, experts are calling for sleep to become a mainstay of teen mental health treatment.
But first, what does good teen sleep look like?
Good sleep is important for all of us, but it’s more crucial to teenagers than any other age group.
And what kids need is a bit different.
About a quarter of Australian 12- to 15-year-olds and half of 16- to 17-year-olds aren’t meeting minimum sleep guidelines on weeknights, leaving them more likely to report symptoms of anxiety and depression.
So what is standing in the way of getting to sleep and staying asleep?
It is less about TikTok and more about body clocks, according to leading Australian sleep psychologist Michael Gradisar.
“There’s this misunderstanding it might be something like social media, it might be technology use because both of those have been linked to sleep and depression, but that’s certainly not the case that we were noticing,” he said.
“They’ve already tried to reduce technology; they have already tried to have the phone out of the bedroom and they are lying there in the dark and they can’t get back to sleep.
“It’s an awful experience for them.”
Studies show device use can result in later teen bedtimes and some apps are certainly more responsible than others for keeping teens scrolling long into the evening.
But the two key factors influencing teen sleep are in fact biological.
“From the course of childhood through adolescence, there’s this kind of ubiquitous delay in our body clock [or circadian rhythm] timing so our body clock drifts later,” Dr Richardson said.
“Teenagers don’t feel ready to go to bed when maybe it’s a socially appropriate time, they often report difficulty falling asleep and they also commonly report real difficulty getting up early in the morning.”
“Sleep pressure” and an out-of-balance body clock set the scene for a “process of repetitive negative thinking”, which could lead to mental health problems, Dr Richardson said.
“Their head hits the pillow, it’s dark, it’s quiet, a lot of thoughts come to their minds and generally this tends to be quite negative in nature,” he said.
“They also start worrying about why it is that they haven’t fallen asleep yet.
“It’s this process of repetitive negative thinking that may be one way in which sleep confers risk for mental health problems in adolescence.”
Circadian rhythm: ‘Dude, what?’
Sleep never came easy to Tiger, who is autistic and has ADHD, but it got harder and harder in his teens.
“I wouldn’t get to sleep until midnight,” he said.
“I would wake up at 3am and then go back to sleep and wake up at seven [o’clock] … eight.
“It wasn’t good. I just felt bad for not getting up when everyone else can get up.”
Fortunately, he got help from a clinical psychologist who prescribed him bright light goggles for an hour each morning.
And he learnt about delayed circadian rhythm.
“Apparently it’s what goes on with teenagers, our body clock like, goes later,” Tiger said.
“It’s like, ‘Dude … what?”
Lights were dimmed in the household in the early evening and bedtime was brought forward.
He started taking prescribed melatonin earlier each night and the interventions worked.
“My mental health has been quite a bit better,” he said.
“Before the treatment, getting out of bed sort of felt like trying to eat soup with a fork. But now it’s like, I got a spoon.”
Some teens have had success using self-directed cognitive behavioural therapy (CBT) to tackle insomnia and repetitive negative thinking via online resources.
Associate Professor Aliza Werner-Seidler from the Black Dog Institute is the developer of Sleep Ninja, a phone app currently used by thousands of teens.
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“The Ninja acts as a sleep coach and guides the young person through developing core skills and strategies — things like regular bedtime and wake times and how to deal with thoughts and worries that keep you up at night,” she said.
“Adolescents are not lazy; they just feel sleepy later and they still need to get up very early for school.
“It’s our role to really help educate … which will put them in a better position for so many other aspects of their lives.”
Parental guidance recommended
Tiger was able to shift his body clock and get a better night’s rest with the help of treatments and strategies from professionals.
Of course, not every teen has access to that — and that’s where parents can come in.
Studies have shown that kids sleep longer if parents enforce bedtime on school nights.
“You’ll get resistance, but at the same time the benefits are going to be just so huge for them,” Dr Gradisar said.
Creating a distraction from ruminative thinking can also help.
“One of our studies showed that listening to a 15-minute mindfulness body scan a night halved the time taken to fall asleep,” he said.
Experts also say letting teens nap is ok if it is less than 20 minutes and not too late in the day.
In Australia, experts have suggested a health campaign targeting sleep — and a focus on educating GPs.
“Some of the research that I have done showed that health professionals only receive a couple of hours of formalised training on sleep through their degrees,” Dr Richardson said.
“I’d really like to see a focus on sleep, so that we can reduce the onset of these mental health problems.
“What I would like to see is that there is a greater knowledge about how to assess and treat sleep problems in young people and for sleep treatments to become … embedded in treatment for young people’s mental health.”
Mental health disorders among young people have soared by nearly 50 per cent in 15 years. The ABC is talking to youth, parents, and researchers about what’s driving this pattern, and what can be done to turn things around.
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