Sleep patterns of 1920 urban school going adolescents were studied using a sleep habits questionnaire by Bhatia and colleagues (2008). The average age of the participants was 15.1 years and average total sleep time of 7.8 h per day which is much less than the optimal sleep requirement for adolescents. About 41.5 % of the participants went to bed by 11 p.m. and 42.6 % had to wake up by 5:00–6:00 a.m. which shows a similar trend of late bedtime and early rise times as their western peers. Although sleep efficiency was reported to be 92.6 %, only less than half the sample reported that they received refreshing sleep. Another finding that was consistent with the Western literature was that the total sleep time decreased with higher classes and sleep duration of the ninth graders was significantly higher from all the other three classes. This led the researchers to hypothesize that the tenth grade could be the transition point for change in total sleep time. This change in total sleep time was attributed to academic demands of higher grades, especially in India where adolescents face academic challenges from ninth grade onwards and tenth grade is probably the time of stress which is not witnessed in lower grades. Another important observation by them was that sleep debt and daytime sleepiness increased with advancing grades as did daytime napping.

Master K, a young male aged 14 years studying in an urban school in Delhi, was referred by his school counsellor with primary complaints of inattention and declining academic performance. Upon routine detailed work up and comprehensive psychological assessment, he was diagnosed with attention deficit hyperactivity disorder predominantly inattentive subtype. His parents revealed that apart from difficulties in concentration their son also found it difficult to stay awake in class. This was reported by his teachers during the last PTA meeting that his parents attended. Moreover, his parents also reported that he went to sleep late and had difficulty waking up in the morning and almost always woke up with a negative mood. Sleep history and physical examination revealed no history of snoring, normal BMI, no history of RLS and no history of narcolepsy. Sleep log and actigraphy data revealed erratic sleep–wake patterns with a total time difference of more than 90 min of weekend versus weekdays sleep schedule. The average total sleep time was found to be 7 h for the two-week period during which sleep log and actigraphy data were recorded. Master K revealed that he often took a long time to feel alert in the morning, experienced fatigue and fell asleep in the school bus while travelling to the school. At times when his schedule permits he would also take a nap in the afternoon. Upon administration of adolescent sleep hygiene questionnaire, it was found that Master K had maladaptive sleep habits. These maladaptive habits included irregular/late bedtime, watching TV and instant messaging at bedtime, sleeping with his pet dog and a high intake of caffeinated drinks during the day. Paediatric sleepiness scale was also administered and the scores obtained were indicative of excessive daytime sleepiness. Master K’s insufficient sleep was fuelled by his maladaptive sleep habits. Therefore, the cognitive rationale for treatment focussed on the need for sleep education and the role of faulty sleep habits in sustaining sleep difficulties. The treatment regimen consisted of sleep education, sleep hygiene and stimulus control. Initially, master K found it difficult to apply the sleep hygiene rules since he was involved with too many after school activities and found it difficult to manage school work, tuitions and after schools extra-curricular activities. Apart from that it was difficult for him to refrain from spending long hours texting/instant messaging at night as his close peer group would be online during those hours sending him messages. Moreover, he shared a bedroom with his brother who would also stay up late at night playing video games and surfing the net. Follow-up sessions were used to discuss these issues and the sleep hygiene rules were discussed with master K and his sibling. Time management was also discussed with master K and reorganization of extra-curricular activities with an attempt at taking on only so many activities that could neatly fit in his schedule without overburdening him was encouraged. Master K was also taught assertiveness skills such that he could effectively encounter peer pressure of not engaging in social media networking past bedtime. A sleep log was maintained throughout the whole treatment regimen to review his progress. Slowly but steadily there was a change in the average total sleep time which increased to about 9 h which is considered optimal for his age. Master K was also asked to write down the positive changes that he experienced during his daytime functioning as a result of adopting healthy sleep habits. Among the positive changes, he reported less trouble getting out of bed in the morning, feeling refreshed on waking up and not feeling drowsy during the day. He also reported being more alert in class and there were no teacher complaints of him dozing off in class.