If your teen just won’t engage in coming up with a solution, and is chronically sleep deprived and feeling awful, you may need to look for an alternative school that starts later; a school that’s more amenable to her phase-delayed life can give your teen the extra sleep time needed to live more successfully. Changing schools may seem extreme, and your teen may object strenuously, but if it’s the only way to carve out more sleep time, it’s a step you should consider seriously. Discussing a school change with your teen can alert her to the seriousness of the situation and motivate her to engage consciously in the treatment program, send a clear message to her that you care and that you’re willing to help—that you’re a supporter, not an adversary—and give your teen hope that she can feel better. You can also work to get your teen’s current school to start later in the morning. (See Chapter 13 for more on this topic.)

Putting It All Together

If your teen’s circadian clock is in need of normalizing, you may be ready to put into practice one or more of the treatments I’ve just described. So I’m going to take you through my typical treatment process—which includes using a light box, taking melatonin, and regulating the weekend wake-up time—so that you can see for yourself how it works. (Chronotherapy is pretty straightforward, but it takes several consecutive days to complete and is used only when time and motivation permit.) By addressing your teen’s sleep problems early, with the kind of treatment I recommend, you can avoid getting into an extreme situation that may cause a lot of harm.

A Case History

Carson came to see me during the summer before his junior year in high school. On the small side for his age, he had a history of attention deficit hyperactivity disorder (ADHD), for which he was taking Ritalin, and depression, which had improved since he had transferred a few months earlier to a new school that he enjoyed much more. His pediatrician had referred him to my office because he was having great difficulty falling asleep and greater difficulty waking up in the morning. He often awoke with a headache and also coughed a lot when he



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