Why Bipolar Kids Can’t Get Up and Get Going
What Can Be Done About Sleep Inertia?
A good plan of attack would be to discuss the timing of medications with the treating physician. If one or more of the meds is contributing to morning grogginess, than it might help to administer the drug at an earlier time the day before. If anxiety is causing school refusal, the doctor or therapist may ease the fears of the child by helping him or her deal with the anxiety. Cognitive therapy may be particularly helpful.
It is important that parents and teachers recognize that many children with bipolar disorder have co-occurring learning disabilities and executive function deficits, and that these deficits make school embarrassing and dispiriting. Rather than get up and go to school and fail, the youngster may prefer to sleep. Neuropsychological testing will reveal these problems, and the IEP of the student can accommodate these disabilities and make the child or adolescent less anxious.
Phototherapy, or light treatment, may entrain the rhythms and phase shift the dysregulation many of these children have. Some parents have reported that a dawn simulator is helpful in getting their children out of bed.
If the prescribing doctor thinks a trial of melatonin is a good idea, he or she will discuss the timing and dosage. In a pilot study, one of the authors of this newsletter (D.F.P.), found that 3-6 mg of melatonin given approximately 20 minutes before bedtime, not only enhanced the earlier onset of sleep, but in a number of cases abolished sleep-arousal disorders such as night terrors. A more restorative sleep ensued. Since melatonin is known to lower core body temperature, this may explain one of its effects on the regulation of the sleep/wake cycle.
Remember the parents who had to squirt GoGurt in their daughter’s mouth each morning? They told us that they began to give her melatonin each night and she can now get up, get dressed, and eat without the aid of her parents (and Gogurt is no longer the only staple of her morning menu).
Melatonin requires more study, and no one is certain of its long-term effects, nor will it work for everyone. Naturally, much depends on the causes of the sleep inertia.
Until the sleep/wake cycle is regulated (and your child may always be more of an owl than a lark), an accommodation in the school day may have to be made. It might help if the student is allowed a later start, and it would be wise to schedule all academics later in the morning and in the afternoon when he or she would be more cognitively available for learning.