Behavioral insomnia

[Mouse75]

We have a 18 year old who has been to counselors, doctors, psychiatrists, and a sleep lab and they have come up with depression (which they put him on prozac) but are taking him off now, and they have come up with behavioral insomnia or delayed sleep syndrome.  He missed most of his Junior year of high school because he could not fall asleep at night and then slept the day away.  We are trying hard to get things on the right track this summer but seems to be staying the same.  He found a weekend job at the animal shelter but can't get up to go.  This is only his 2nd weekend and he can't get up.  He wants us to treat him like an adult but that is hard for us when he sleeps through most everything.  He has always been a good kid and very well liked.  This just started about a year ago in May.  Any thoughts to what we can do to help or discipline him to start taking things into his own?

[Mouse75]

Thank you very much for your response.  The doctor took him off of Prozac and we think that has helped some.  It seems that it is just his sleep now and that it depends who he is with and what is going on the next day so we will be taking your advice because that is just what his doctors and consolers have recommended.  Please keep us in your prayers.  Especially that he makes it through his Senior year.  His dad has made a contract for him, so hope that helps him stay on track.

[Kitty506]

When I was in high school and the first part of college I was very much like that. I'd stay awake until 4, 5 in the morning and then get up at 7 for school. I was always tired and depressed (I find they go hand in hand -- if you don't get enough sleep it will make you anxious and depressed, and if you are depressed or anxious you often have trouble sleeping) and I was even in therapy for a short time for the depression.

Now, even today I'm a night owl (now I get to bed by 11:30 or midnight, wake up at 6:30-7), but since the depression has gone away it's been easier for me to sleep at night and since I've been sleeping I feel less anxious and depressed.

So first it's important to make sure any signs of depression or anxiety are treated, but in the meantime, set up a schedule in which he should be sleeping -- no computer, no video games, nothing but a dark room and a bed and maybe a book to read. When I was an insomniac I'd stay up all night on my computer and it DID NOT HELP. Removing those distractions with calming alternatives is helpful though.

The other thing I've read about is that caffeine and sugars can keep people up at hours they should be sleeping and groggy during daytime hours. So keeping him on a nice balanced meal will also help regulate his body.

Lastly, it may just be that the changes his body is going through are affecting his sleeping patterns. He may just grow out of it naturally. I think part of my sleep regulation is due to growing up.  

[Mouse75]

We did get our sons sleep study done and nothing came back wrong.  His Doctor thinks it is Delayed sleep phase syndrome or behavioral insomnia.  So we are trying to make a contract with him to see if we can get things going in the right direction.  This behavioral is not necessarily his fault but they think he needs more CBT to correct it.  I also just read something on cortisol imbalance and was wondering some about that.  I think I might have to check into that some.  Later

[Jason Greenberg, Ph.D.]

I have read your post as well as the exchange you've had with wishforchange.  I will first say that depression can cause day-night sleep reversal, making it difficult to say how much the sleep issues are related to the depression and how much they are a result of DSPS.  Second, I notice that you mention that he is not able to get to his cognitive behavioral therapy as much as he should.  Given that he has depression in addition to the unclear sleep issue, I would assert that regular treatment, at least once a week, would be warranted.  Even if his sleep problem is not depression-related, if he is depressed he is likely going to have difficulty motivating himself to stick to a behavioral plan to address his sleep problem.  Consistent psychotherapy will help support the plan while addressing the depression  (I have to admit though, given the numerous professionals that you have enlisted to help your son, with rather nonspecific results, as well as the recent development of this sleep problem, I ask myself what role the upcoming changes in his life -- graduating high school and moving onto the "next phase" of his life -- are having on his mood and sleep) .

[wishforchange]

Thank you I did get your note, although I rarely read my notes, so was lucky I did this time!  You're welcome.
Currently still thinking along the lines of what you can't change (for now) you can work with.  Any chance of him having home tutoring whilst he is in this state, to get him through school to graduate?  With all the input from the doctors, psychologists etc. there may even be funding for this in your area - don't know where you live.  If you can push the case that this is a real problem which has been assessed and attempts at treatment given from several professionals, it may be that he qualifies for help at home with his studies.  Just an idea.  Yes I know it is not solving the problem and he is missing out on school life, but at least his education will be provided for.  
I really hope he makes it through school and gets over this or learns to cope with it.  Sleeping so much?...still wonder if there is something going on medically.
Let us know how he gets on.

[Mouse75]

I am new at this and am not sure you received my note.  Thank you for your input.  My son is at normal weight.  He has had his general health checked and they did not come up with anything.  He is such a good person that it is hard for me to think it is all just behavioral but they say that with DSPS it can change the way people behave.  He goes to Cognitive Behavioral therapy and has for about 10 months but maybe doesn't get in as often as he should. (Lots of patients).  We'll keep praying that something comes out of this.  He will be a Senior this fall and he says he wants to graduate with his class.  

[wishforchange]

Hello.  
If this is entirely a sleep idiosyncracy then maybe a way around it would be for him to look into night work, so he can do what he is comfortable with and sleep in the day to work at night.  
Regarding his medication, I agree that Prozac may not be the best treatment for a sleep disorder, if that is what he has.  Has he been assessed for narcolepsy?  Also how is his weight, if he is overweight this can be a causative factor of sleep apnea, where people go without breathing on and off through the night.  This leads to very broken sleep and consequent daytime fatigue.  Just double check with the sleep lab that all ground has been covered.
He is also still a teenager, and be it he is 18 teenagers are notorious for sleeping badly, and lots.  
Something is not clear, how long has he been like this?  You talk about him missing school, and later about this only going on for a year.  If it is a recent development then I would be more tempted to look for organic causes, but if he has always been like this it may just be his natural rhythm, and any job where he can work the hours he prefers to be awake would be good eg. night security, health care assistant, call centre handler etc.  
Get his general health checked eg. blood count for anaemia, thyroid, adrenal funcion, liver and kidney profile, just to ensure there is nothing going on here.
Regarding counselling, that is something obviously related to his feelings and issues, and of course any depression or anxiety will affect sleep.  But as you have not here mentioned any obvious issues which may be affecting him, and even his doctors are now reconsidering the diagnosis of depression, this just leads me to question his general health again.
There is an expert who answers on this forum, who may have other answers.  My background is in Psychology and nursing, amongst other things, so I come perhaps from a slightly more medical perspective.  I am not trained as a counsellor, but hope my input has offered you at least some ideas.