The Causes of Circadian Rhythm Sleep Disorders in Adolescents

Zixiang Xu

RCF Dongba high school, Beijing, China

Keywords: Circadian Rhythm Sleep Disorders, Adolescents, Sleep Hygiene.

Abstract: Circadian rhythm sleep disorders (CRSD) are increasingly prevalent among adolescents, with significant

impacts on their physical and psychological health. The present paper discusses three broad etiologies of

CRSD in adolescents, namely irregular eating habits, nicotine exposure, and excessive electronic device use.

Unusual dietary patterns like night eating and skipping breakfast disrupt the body's internal clock and cause

delayed sleep-wake phase disorder. Nicotine from active smoking and passive smoke exposure induces

circadian disruption through action on neurotransmitter mechanisms, with an effect of sleep fragmentation

and disrupted timing of sleep. Electronic device use over several hours prior to bedtime also disrupts

melatonin release through the induction of blue light exposure, leading to increased sleep onset latency and

compromised sleep quality. These create circadian misalignment and sleep deprivation, which are the basis

of the need for specific treatments against healthier sleeping habits and reversing the impact of CRSD for the

well-being of adolescents.

1 INTRODUCTION

Circadian rhythm sleep disorders (CRSD) are

epidemic around the world because of their extreme

prevalence (Kim et al. 2013). CRSD affects over 3%

of adults, and 10% of adults and 16% of adolescent

sleep disorder patients could be experiencing this

disorder. CRSD can be confused easily with

insomnia. In addition, statistics in the China National

Mental Health Development Report (2019–2020)

show that there are nearly 30 million Chinese

teenagers with mental illness, among which the

detection rate of depressive disorder is 24.6%. Of all

the teenagers who have emotional disorders, more

than 90% also suffer from CRSD. CRSD and

depression go reciprocally, and chronic sleep

disturbance can cause hippocampal atrophy and

immune dysfunction. Regardless of whether it is a

mental or physical issue, the impact of CRSD cannot

be exaggerated. Given its influence on teenagers in

particular, information regarding CRSD's etiology

and prevention is of maximum global interest to the

younger population.

Of the many factors causing CRSD in teenagers,

three of them are of utmost importance. First, diet

plays a vital role when it comes to circadian

entrainment. Irregular timing of meals and negative

dietary habits can destroy peripheral clocks'

synchrony, subsequently causing sleep pathology.

Specifically, skipping breakfast and nighttime

snacking can have a great effect on the circadian

rhythm and result in bedtime delay (Hu et al. 2020).

Consuming some types of drinks, like coffee or

functional drinks, has caffeine intakes that also

generate circadian disruption through both

caffeine's stimulating effect and its prolonged half-

life. Second, secondhand smoking among

adolescents can negatively impact sleeping quality

through the stimulating effects of nicotine. Finally,

overuse of electronic devices, particularly prior to

bedtime, has been commonly accepted as a major

sleep disruptor by virtue of the blue light emissions

and the general cognitive stimulation it causes. The

aim of this article is to try to examine the three key

causes of CRSD in teenagers and their impacts on

sleep regulation at the physiological and behavioral

levels. More effective actions towards healthy

sleeping habits promotion based on knowledge

about these causes are developed, and the negative

implications of CRSD for adolescents' well-being

are reduced.

Xu, Z.

The Causes of Circadian Rhythm Sleep Disorders in Adolescents.

DOI: 10.5220/0014487300004933

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Biomedical Engineering and Food Science (BEFS 2025), pages 307-311

ISBN: 978-989-758-789-4

307

2 CIRCADIAN ENTRAINMENT

THROUGH EATING HABITS IN

ADOLESCENTS

2.1 Irregular Eating Times Such as

Late-Night Snacking and Breakfast

Skipping

Irregular meals, particularly those eaten in the

evening, tend to desynchronize the body clock. The

circadian system is dependent on stable meal times so

that it may control physiological activities, and dinner

can disrupt the process and induce sleep disturbances.

Skipping breakfast also disrupts the circadian system

and is generally followed by evening snacking.

Evening dining and breakfast skipping both lead to

DSWPD. An experiment examined the effect of late-

night feeding on physiological processes and

gastrointestinal microbiota in male Wistar rats with

the aim of investigating abnormal food intake patterns

such as meal skipping and nocturnal food intake. The

rats were assigned to four groups: standard three-meal

diet (BLD), dinner meal skipping with nocturnal food

intake (BLN), breakfast meal skipping with nocturnal

food intake (LDN), and free-feeding (FF). Late-

night eating, particularly the LDN pattern, led to

increased body weight, hepatic lipid accumulation,

systemic inflammation, and significant alterations in

gut microbiota. Importantly, LDN feeding caused a 4-

hour phase delay in the expression of key clock genes

in peripheral tissues, indicating a profound

misalignment of the circadian rhythm. These findings

highlight how irregular late-night eating, especially

skipping breakfast, disrupts circadian regulation and

contributes to metabolic disorders (Ni et al. 2019).

The breakfast skipping is also prevalent among

adolescents; nearly 44.9% of participants (n =

71,390, 8-18 years) in South Australia (public)

schools are reported to be involved in such an issue:

17.4% reported sometimes skipping, 18.0%

reported often skipping, and 9.5% reported always

skipping breakfast (Sincovich et al. 2022). The

prevalence of Iranian students is 21.6%, and out of

322 records, 24 articles remained for meta-analysis

in this research (Ghafari et al. 2017). Similarly,

approximately 41.6% of adolescents are reported to

eat after 10 p.m. in a Turkish study; 32.7% reported

occasionally eating in the middle of the night, and

7.3% reported usually eating (Tuncay & Sarman

2024). Coincidentally, breakfast skipping and

late-night eating both present high rates among

adolescents globally. Adolescents highly follow the

LDN pattern, referring to skipping breakfast and

eating late at night, contributing to adolescents with

DSWPD along with other physiological

dysregulation.

2.2 Dietary Content Such as Caffeine

Caffeine is a central nervous system stimulant that

can significantly impact sleep quality. Its half-life can

last several hours, meaning that consumption,

especially in the evening, can delay the onset of sleep

and reduce total sleep time. Adolescents who

consume coffee or other caffeine-containing

beverages close to bedtime are at higher risk of

developing sleep disorders. As reported by the

Washington Post in 2015, global daily coffee

consumption reaches two billion cups; the

consumption among adolescents is undoubtedly high

as well. Indeed, coffee has some appealing qualities

that make it inevitable to consume. Studies have

shown that caffeine helps learning and memory in

tasks where passive information is presented,

improves performance on tasks that rely on working

memory to some extent, and in small doses can

reduce anxiety levels and increase pleasure (Fiani et

al. 2021). Consequently, consuming caffeine

products can help adolescents to reduce pressure

easily and to increase their passive learning efficiency

and effectiveness. In addition, due to the pressure

coming from different sources, the students in

puberty have to face the pressure of study, busy

tackling the heavy assignments. Consuming coffee is

an option to maintain the study state. Adolescents

may also consume some kinds of beverages, such as

cola sodas and energy drinks, which also contain

caffeine. According to the Brazilian Caffeine Content

Table (BraCaffT), brewed coffee and instant coffee

(diluted) both contain an average of 36 mg of caffeine

per 100 mL, cappuccino has 32 mg/100 mL, energy

drinks average 30 mg/100 mL, and cola soda contains

9 mg/100 mL (Rocha et al. 2022). Due to the irregular

intake of caffeine, the sleep-wake time can be delayed

and result in CRSD. Limiting caffeine intake,

particularly in the late afternoon and evening, can

help improve sleep quality and align circadian

rhythms more effectively.

BEFS 2025 - International Conference on Biomedical Engineering and Food Science

308

3 SECONDHAND SMOKE

EXPOSURE AND SMOKING

PREVALENCE AMONG

ADOLESCENTS

3.1 Secondhand Smoke Exposure

among Adolescents

Nicotine is a potent neuroactive substance that works

primarily by acting on nicotinic acetylcholine

receptors (nAChRs) in the central nervous system.

Nicotine's mechanism of action involves multiple

neurotransmitter systems, particularly the dopamine

and glutamate systems, which play key roles in

reward, motivation, and addiction. As a neuroactive

substance, nicotine may result in circadian

disturbance; a study presents several drugs, including

nicotine, that can lead to drug-entrained anticipatory

activity. In this study, female Wistar rats were

exposed to constant dim light to eliminate external

time cues and subjected to rate-limited feeding to

prevent meal entrainment (Gillman et al. 2019). Rats

received daily injections of nicotine,

methamphetamine (MA), or fentanyl at fixed 24-hour

or 31-hour intervals. The experiments demonstrated

that nicotine, like MA and fentanyl, induced

anticipatory wheel-running activity preceding the

injection, with activity persisting for 24 hours after

the final injection, suggesting a drug-entrainable

circadian oscillator. Notably, rats were entrained only

to the first nicotine injection of the day, mirroring the

importance of the "first cigarette" in nicotine

dependence and relapse. These findings highlight the

role of nicotine in modulating circadian rhythms and

suggest that drug-entrained anticipatory activity may

contribute to craving and relapse in addiction,

offering potential targets for therapeutic

interventions. Therefore, whether secondhand

smoking exposure or smoking, which generates

nicotine intake, would lead to drug-entrained

anticipatory activity, resulting in an irregular sleep

schedule.

Secondhand smoke contains numerous harmful

chemicals that can irritate the respiratory system

and disrupt normal physiological functions.

Exposure to secondhand smoke, especially in

confined environments like homes or vehicles, can

lead to increased alertness and difficulty in falling

asleep. This is because of the effect of nicotine and

other poisons in tobacco smoke, which may disrupt

the normal sleep-wake cycle. Another study

revealed that the prevalence of Japanese

adolescents' exposure to secondhand smoke

declined but was persistent from 2008-2017

(Kuwabara et al. 2023). Adolescents were exposed

to SHS anywhere in 2008 at a prevalence of 51.0%,

at home at a prevalence of 37.2%, and at public

places at a prevalence of 36.5%. By 2017, these

rates declined to 36.3% for any setting, 23.8%

indoors, and 27.0% outdoors. Although the rate

decreased, nearly one-third of the adolescents had

been exposed to SHS in 2017, reflecting the

ongoing public health burden of SHS exposure

among Japanese youths. The exposure to SHS on a

large scale leads to passive absorption of nicotine

on a large scale during adolescence. Sleep

disturbance aside, secondhand smoke is a major

causative factor for respiratory disease,

cardiovascular disease, and generally compromised

health in adolescents. Secondhand smoke exposure

reduction is important in improving sleep quality as

well as general health.

3.2 Smoking Prevalence among

Adolescents

Youth smoking is a major public health issue. Despite

the decrease in tobacco consumption, the majority of

adolescents still smoke due to peer pressure,

marketing, or autonomy. Studies proved that

Japanese youth smoking prevalence decreased

significantly from 5.2% in 2008 to 1.8% in 2017,

indicating a positive trend towards tobacco control.

SHS exposure was still common, however, with

36.3% ever exposed to SHS anywhere, 23.8% ever

exposed at home, and 27.0% ever exposed away from

home in public places in 2017. SHS exposure was

also, in this study, strongly associated with smoking

behavior since adolescents who were exposed to SHS

had higher odds of smoking, and the risk was higher

with higher frequency of exposure. It means that

limiting the exposure to SHS, especially indoors and

out of the home, is paramount to further reduce the

incidence of smoking among youths and to support

the protection of their health (Kuwabara et al. 2023).

Smoking causes immediate nicotine intake into the

body, a stimulant that can destroy the quality of sleep.

Nicotine withdrawal during nighttime sleeping can

cause disturbed sleeping as well as waking up earlier

than usual in the daytime. Adolescent smokers are

also prone to risk of sleep onset latency, decrease in

total sleeping time, and prevalence of chronic

sleeping disorders. The habit of smoking not only

affects immediate sleep quality but also has long-term

health implications, including increased risks of

The Causes of Circadian Rhythm Sleep Disorders in Adolescents

309

respiratory diseases, cardiovascular issues, and

compromised lung function. Addressing the smoking

prevalence among adolescents is essential to mitigate

both short-term sleep disturbances and long-term

health risks.

4 OVERUSE OF ELECTRONIC

DEVICES

4.1 Blue Light Interference

The blue light emitted from electronic devices

disrupts the secretion of melatonin, a hormone crucial

for regulating sleep-wake cycles (Minich et al. 2022).

Melatonin is a hormone secreted by the pineal gland

that plays a crucial role in regulating the body's

circadian rhythm (biological clock). Its secretion is

influenced by light exposure, with blue light in the

visible spectrum (wavelengths around 460-480 nm)

having the most significant impact. When the retina

detects blue light, it transmits signals via the optic

nerve to the suprachiasmatic nucleus (SCN) in the

brain, which then inhibits the synthesis and release of

melatonin by the pineal gland. This means that

exposure to blue light at night (such as from

electronic device screens and LED lighting) reduces

melatonin secretion, making it more difficult to feel

sleepy, thus affecting sleep onset and quality. Studies

have shown that using electronic screens for more

than an hour can significantly lower melatonin levels.

In particular, using electronic devices before bedtime

delays the melatonin secretion peak, leading to

difficulty falling asleep (Minich et al. 2022). In

contrast, avoiding blue light or using dim, warm-

colored lighting can effectively reduce melatonin

suppression, helping the body naturally transition into

sleep.

4.2 Increased Cognitive Stimulation

Stimulating content from electronic devices, such as

engaging videos, interactive games, or social media,

can increase brain activity and excitement. This

heightened state of alertness makes it harder to relax

and transition into sleep, further contributing to sleep

disturbances. Since the stimulatory contents of

electronic devices can significantly stir the brain

activity and excitement, using electronic screens for

more than an hour happens frequently in adolescents,

leading to a lower melatonin level. Studies show a

strong negative correlation between screen time and

sleep, with computer use having the most significant

impact (94% of studies), followed by unspecified

screen time (91%) and video gaming (86%), both

linked to sleep disturbances. Mobile device use (83%)

also strongly disrupts sleep, likely due to its

accessibility and interactive nature. While television

use (76%) had the least impact, it still contributed to

shorter sleep duration and delayed bedtime. These

findings highlight the pervasive role of screen

exposure in reducing sleep quality among adolescents

(Hale & Guan 2015).

The study, based on a survey of 776 adolescents

in grades 6 to 9, found that widespread use of social

media and electronic devices is significantly

associated with reduced sleep duration, particularly

among teens who use phones and computers in their

bedrooms. Sleep-deprived teens (≤6 hours) were

more likely to experience difficulties falling asleep,

waking up in the morning, daytime drowsiness, and

reduced energy compared to those with adequate

sleep (≥9 hours), and they also reported more

emotional issues such as irritability and sadness.

The study also revealed that sleep duration

gradually decreased with age, with 6th graders

sleeping significantly more than 9th graders. The

research indicates the high level of association

between sleep deprivation among teenagers and

social media usage and device use, which calls for

early learning regarding healthy sleep and screen

time and parental involvement in enforcing proper

bed times to enhance the quality of sleep among

teenagers (Hale & Guan 2015). Overuse of

electronic devices is most likely to result in late

bedtimes. Exposure to screens prior to sleeping will

most probably extend the wakefulness period,

decreasing the overall sleeping time and

interrupting the normal sleep pattern.

5 CONCLUSION

Circadian rhythm sleep disorders (CRSD) among

teenagers are mainly brought about by three reasons:

irregular meal times, exposure to nicotine, and

overuse of electronic media. Irregular meal times, like

eating late at night and skipping breakfast, interfere

with the internal clock of the body, causing delayed

sleep-wake phase disorder (DSWPD) and metabolic

dysregulation. Caffeine consumption, primarily in

coffee and energy drinks, also increases sleep

disturbance by prolonging sleep latency and

decreasing sleep. Secondhand smoking and smoking

introduce nicotine, a drug that affects the circadian

BEFS 2025 - International Conference on Biomedical Engineering and Food Science

310

rhythm by generating drug-entrained anticipatory

activity, resulting in disrupted sleep patterns and non-

restorative sleep. Also, overreliance on the use of

electronic devices, particularly during late-night

hours, affects the production of melatonin with

exposure to blue light, thus delaying sleep initiation

and lowering sleep quality. Besides, psychological

arousal resulting from watching such content on

electronic media also increases alertness and prevents

adolescents from sleeping. In most cases, they induce

generalized circadian desynchronization and sleep

loss in adolescents, which requires focused

interventions towards improved sleep practices and

prevention of the long-term health effects of CRSD.

REFERENCES

Fiani, B., Zhu, L., & Musch, B. L., et al. 2021. The

Neurophysiology of Caffeine as a Central Nervous

System Stimulant and the Resultant Effects on

Cognitive Function. Cureus 13(5): e15032.

Ghafari, M., Doosti-Irani, A., & Amiri, M., et al. 2017.

Prevalence of the Skipping Breakfast among the Iranian

Students: A Review Article. Iranian Journal of Public

Health 46(7): 882–889.

Gillman,A.G., Rebec,G.V.,&Pecoraro, N. C., et al. 2019.

Circadian entrainment by food and drugs of abuse.

Behavioural Processes 165:23–28.

Hale,L. & Guan,S. 2015. Screen time and sleep among

school-aged children and adolescents: a systematic

literature review. Sleep Medicine Reviews 21: 50–58.

Hu,J., Li,Z., &Li,S., et al. 2020. Skipping breakfast and

physical fitness among school-aged adolescents.

Clinics 75: e1599.

Kim,M.J., Lee,J.H., &Duffy,J.F. 2013. Circadian Rhythm

Sleep Disorders. Journal of Clinical Outcomes

Management 20(11): 513–528.

Kuwabara,Y., Kinjo,A., &Kim,H., et al. 2023. Secondhand

Smoke Exposure and Smoking Prevalence Among

Adolescents. JAMA Network Open 6(10): e2338166.

Minich,D.M., Henning,M., &Darley,C., et al. 2022. Is

Melatonin the "Next Vitamin D"?: A Review of

Emerging Science, Clinical Uses, Safety, and Dietary

Supplements. Nutrients 14(19): 3934.

Ni,Y., Wu,L., &Jiang,J., et al. 2019. Late-Night Eating-

Induced Physiological Dysregulation and Circadian

Misalignment Are Accompanied by Microbial

Dysbiosis. Molecular Nutrition & Food Research

63(24): e1900867.

Rocha,P.L.A., Lima,A.L.C., & Saunders, B., et al. 2022.

Development of a Caffeine Content Table for Foods,

Drinks, Medications and Supplements Typically

Consumed by the Brazilian Population. Nutrients

14(20): 4417.

Sincovich,A., Moller,H., &Smithers,L., et al. 2022.

Prevalence of breakfast skipping among children and

adolescents: a cross-sectional population level study.

BMC Pediatrics 22(1): 220.

Tuncay,S. & Sarman,A. 2024. Late-night eating and

inactivity: Links to depression and suicide risk in

adolescents living in Turkey. Journal of child and

adolescent psychiatric nursing 37(3): e12474.

The Causes of Circadian Rhythm Sleep Disorders in Adolescents

311