He Can't Fall Asleep. It May Not Be Defiance.

Puberty tends to push the internal clock later while school pushes the wake time earlier. Some late bedtimes are a body-clock mismatch, some are insomnia, and some are neither.

This is Part 4 of a five-part series on sleep and mental health. The other parts cover Less Time in Bed, More Consolidated Sleep, The Harder You Try, the Further It Gets, You’re Not Weak. It May Be Rebound, and Sleep Was the First Thing to Change.

Your teen cannot fall asleep until very late. In the morning, alarms fail, tempers rise, and school feels impossible. It can look like refusal. Sometimes a later body clock clashes with an early school clock. Sometimes the bigger problem is too little chance to sleep. Insomnia, substances, mood symptoms, or another sleep disorder may also play a part. This article helps parents sort those patterns without making a home diagnosis. Start with a short record of school days and free days. Protect enough sleep and involve your teen in the questions. If sleepiness makes driving unsafe, stop there. Arrange another ride and seek help for the pattern.

Key takeaways

• Puberty tends to shift sleep later, but a late bedtime is not automatically a disorder.
• Delayed sleep-wake phase disorder, or DSWPD, is a persistent timing problem that impairs required-day function. Sleep is usually better on the person’s preferred late schedule.
• A two-week pattern is more useful than one bad night or one tracker score.
• Light and melatonin can move timing in different directions depending on when they are used. This is why the article gives no universal time, dose, or light prescription.
• If your teen is sleepy, they should not drive. Arrange another ride.

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Two clocks, one school bell

Think of two clocks. One is inside your teen. The other hangs over school, practice, work, and the bus. Puberty tends to move the internal clock later. School often moves the required wake time earlier. When the bell follows the school clock, a teen can be asked to wake during what their body still treats like night.

That image has limits. The inner clock is not fixed. Every late bedtime is not a disorder. Schoolwork, sports, gaming, substances, medicine, noise, caregiving, and family routines can change sleep. A parent cannot reset a teen by force. Ask, “What pattern are we seeing, and what would help safely?”

What DSWPD is, and what it is not

DSWPD is a body-clock disorder. Sleep and wake times are late compared with the times the person must follow. The pattern is fairly stable. It lasts for months and causes real problems with school, work, mood, relationships, or safety. Sleep is often easier and more complete when the late schedule is allowed. Current standards also ask the care team to consider other disorders, medicines, substances, and too little chance to sleep.1, 2

Sleeping at 2 a.m. is not a diagnosis. A teen who sleeps well from 2 a.m. to 11 a.m. on vacation may have a delayed clock. They may also be recovering from months of short school-night sleep. A teen who still lies awake for hours on their preferred schedule may have insomnia too. A teen whose sleep moves later every day needs a check for a different body-clock disorder. A teen who sleeps far less and feels unusually energized needs a prompt check for mood activation.

Normal teen biology matters. In a long-term study, sleep timing and the biological night shifted later across the teen years. The amount of change varied widely.3 A small lab study also found that sleep pressure built more slowly in later-pubertal teens than in younger teens.4 Those studies help explain why “go to bed earlier” can fail. They do not prove that biology explains every late night.

Who this evidence fits

Direct trials were small. Most studied teens with DSWPD or a strong late pattern; some included young adults. Results may not fit a normal late preference, one bad week, shift work, pregnancy, major illness, or unsafe housing. ADHD, autism, mood, and medicines may change care. One standard plan is not proven.

The first sorting question: timing, chance to sleep, insomnia, or something else?

Ask what happens on both required days and free days.

With normal evening preference, timing is later, but sleep and daytime function remain mostly adequate. With insufficient sleep, school nights are short because the teen does not have a long enough chance to sleep. Free-day catch-up may be large. With DSWPD, late sleep is fairly stable, required mornings are impaired, and sleep improves on the preferred late schedule. With insomnia, sleep stays difficult despite a suitable chance to sleep. These patterns can overlap.

Difficulty waking has other explanations. Snoring, gasping, breathing pauses, uncomfortable legs, pain, reflux, medication effects, depression, anxiety, trauma, narcolepsy, another illness, and substance use can all matter. Housing noise, shared rooms, family work schedules, and caregiving are real sleep conditions, not failures of will.

A sudden change deserves special care. Much less sleep without expected tiredness is one key clue. Fast speech, rising or irritable energy, unusual confidence, risky behavior, or psychosis add concern. This differs from being exhausted but unable to sleep. Contact a doctor promptly. Use emergency help if behavior is dangerous or the person cannot stay safe.

A two-week pattern, not a nightly trial

A brief sleep log should help the teen and care team see a pattern. It should not become surveillance. With your teen’s agreement, record school and free days for 7 to 14 days. Note when they entered bed, tried to sleep, think they fell asleep, woke, and got up. Add alarms and naps. Also note caffeine or other substances, medicines or supplements, major evening light, and next-day alertness.

Estimates are enough. Do not turn on a light to record a number or question your teen each morning. If parent and teen remember a night differently, keep both views. The difference can help the care team.

Actigraphy is a movement monitor worn for several days. The American Academy of Sleep Medicine gives it a weak nod for children with body-clock disorders. The evidence in children is very limited.5 It can help show timing. It cannot find every period of sleep, measure sleep stages with perfect accuracy, or make the diagnosis by itself.

A consumer tracker can offer clues, but it is not a diagnostic sleep study. Devices and their math change. If the score raises conflict or worry, return to function, safety, and the simple log.6

A sleep specialist may measure dim-light melatonin onset, a body-clock marker. A sleep study is not routine for simple DSWPD. It may help when breathing, movement, or unusual night behavior raises concern. A daytime test is used for suspected narcolepsy or severe sleepiness after enough sleep is shown.

What the care evidence supports

The answer is careful. The AASM suggests well-timed melatonin for selected children and teens with DSWPD. It also suggests light after waking with a behavior plan. These are weak suggestions, not strong rules. Certainty was moderate for youth without mental-health conditions and low for those with them. Certainty was also low for light plus behavior care.1

One small trial placed 49 teens in a six-session thinking and behavior program with bright light or on a waitlist. Sleep, daytime function, and diagnostic status improved more with the active program. Yet the study could not tell which part led to the gain. It might have been light, scheduling, thinking skills, therapist attention, or the mix. Follow-up included only a small treated group.7

Another trial included 60 teens and young adults in four morning light and activity groups. It found no clear edge for one group on any outcome. More than one third asked for more care by three months.8 That null finding matters. A teen who does not improve with a simple light or activity plan has not failed.

A 2026 Finnish trial adds another limit. It studied 176 community teens who tended toward later rhythms. They did not have confirmed DSWPD. Bright light, personal coaching, their combination, and active sleep information did not overcome the late rhythm. Coaching added about 23 minutes of sleep after care and 33 minutes at one year versus information alone.9 The result supports checking sleep amount and staying power, not bedtime alone.

Most results came from teen reports or sleep diaries. Everyone knew which care they received. Those results still matter because the problem includes felt sleep and daytime function. Lab measures answer different questions. A 2026 lab test used a body-clock marker and actigraphy in 40 teens. Later evening room light plus a shorter chance to sleep weakened the shift from a brief morning-light plan. It sometimes sent the clock later. The test could not separate evening light from sleep loss. It also did not test long-term care.10

Together, the findings support a matched plan, not a brighter lamp or earlier alarm for everyone.

Light is a timing signal

Teen lab work shows that light can move the body clock earlier or later. The direction depends on body timing.11 Well-timed light after waking may move timing earlier. Bright evening or night light can move it later. Mistimed light can make the delay worse.

This is why there is no clock time, lux level, device, or session length for everyone. Outdoor light after waking and a calmer, dimmer evening may help. Strong light care needs a doctor’s review. This is vital with eye disease, a light-sensitive medicine, or bipolar risk. Watch for headache, eye strain, nausea, irritability, agitation, or unusual energy.12 Tanning lamps are not treatment devices.

Do not make the phone the villain. Ask separate questions: Is light reaching the eyes late? Is the content exciting or upsetting? Are notifications waking the teen? Is use displacing the chance to sleep? Is the phone also needed for safety, disability access, homework, or social support? A shared change that answers the actual problem is more useful than a moral argument about screens.

Melatonin is not a simple bedtime switch

Melatonin is both a body-clock signal and a product sold in many forms. When it is used matters. More is not always better. Discuss the goal, timing, exact product, other medicines, and next-day effects with the teen’s doctor or pharmacist.

In the United States, melatonin is a dietary supplement. It is not an FDA-approved pediatric medicine for DSWPD. “Dietary supplement” does not mean no rules exist, but supplements do not receive the same premarket approval as prescription drugs.13

Product quality varies. A 2023 study tested 25 melatonin gummies sold in the United States. Twenty-two did not match their labels closely. The measured amount ranged from 74% to 347% of the label among products that contained melatonin, and one had no detectable melatonin.14 A larger 2025 survey tested 110 U.S. products marketed to children. Measured content ranged from none to more than six times the label amount.15 These are market snapshots, not tests of every product or clinical harm. They show why the exact product matters.

Short-term use is not the same as proven long-term safety. A 2023 systematic review of 22 randomized trials found more non-serious adverse events with melatonin, but serious-event data were sparse. Evidence about puberty and bone health came from only four small observational studies and was too limited for a confident conclusion.16 The honest message is not that melatonin harms puberty. It is that indefinite safety has not been established.

Next-day drowsiness, headache, dizziness, agitation, interactions, and secure storage need attention. U.S. poison surveillance found many unintentional child exposures as use grew. Most reported poison-center cases were asymptomatic, and most young-child emergency visits did not lead to admission, but hospital and intensive care cases occurred.17, 18 Store melatonin like medicine, out of sight and reach. Do not treat gummies like candy.

Why later school starts matter, and what they cannot do

Teens ages 13 to 18 are generally advised to get 8 to 10 hours of sleep each day.19 An early bell can make that chance hard to protect. A 2022 review covered 28 school-start studies and more than 1.7 million youth. Later starts were linked with longer sleep and less negative mood. Evidence for other results was thinner or mixed. Many studies watched real-world change rather than assigning start times.20

The AASM supports middle and high school start times of 8:30 a.m. or later.21 The AAP issued a similar policy in 2014. Its pages also say policy statements expire after five years unless reaffirmed, revised, or retired, and this review did not locate an explicit reaffirmation.22 A current AAP family page still supports later starts.23 That distinction matters when describing policy status.

A later start can reduce a structural mismatch. It does not diagnose DSWPD or fully treat it. School conversations should focus on observed function, attendance, safety, and what support is feasible. Do not promise a schedule change, legal accommodation, or a particular school plan.

The teen-family job box

Your teen’s role

• Describe the pattern honestly, including school days, free days, substances, medicines, and what feels hardest.
• Choose one goal, such as safer mornings, enough sleep, better attendance, or less conflict.
• Say when they are too sleepy to drive or do another risky task.24

Your family’s job

• Treat the pattern as a health and timing question before calling it defiance.
• Protect enough time to sleep and help with safe rides.
• Support the agreed plan without nightly grading, threats, or tracker surveillance.

What neither of you has to do

• Win an argument about blame.
• Force sleep, run home chronotherapy, or copy an adult sleep-restriction plan.
• Guess a melatonin dose or light schedule from the internet.

When the plan needs professional help

Get help when the pattern lasts, function falls, safety is at risk, or another disorder may be present. Get help for any timing plan that needs personal instructions.

What to do this week

Observable target: Compare sleep timing, total time to sleep, wakeability, and alertness on required and free days.

Baseline: Aim for 7 to 14 days. On a low-capacity week, record three school days and two free days.

First actions:

1. Ask your teen to choose one goal and agree on what the log will include.
2. Protect a real chance to sleep. Do not move wake time earlier while sleep onset stays very late.
3. Make a drowsy-driving backup plan before it is needed.

Time needed is about two minutes in the morning and two minutes in the evening. Materials can be paper, a private note, or the worksheet in the companion toolkit. People needed are the teen and one supportive adult. If the week falls apart, restart with the next school day without blame. At the review, decide together whether to continue, simplify, adapt, or seek more help.

How to measure real-life progress

An earlier bedtime is not the only goal. Track total sleep, ability to wake, daytime alertness, attendance, mood, driving safety, family conflict, and whether the plan can last. Also track burden. A plan that takes over family life may need adaptation even if a clock number moves.

Do not judge the plan from one morning. Do not use a consumer score as the final outcome. Ask whether the teen is getting enough sleep and functioning more safely over time.

Words you can use

Parent: “I want to understand the pattern before we call it a behavior problem. Would you help me track school days and free days for two weeks?”

Teen: “I can record the basics, but I do not want my tracker checked every morning. I will tell you if I am too sleepy to drive.”

Care team: “We brought the sleep log, all medicines and supplements, and our main goal. Could you help us sort a late body clock from sleep debt, insomnia, and another disorder?”

School team: “We are not asking you to diagnose a sleep disorder. We want to share the pattern and discuss what support may work while the health review continues.”

Access at three levels

Start today: Use the free log and make a ride backup. Change no medicine and begin no intensive timing protocol.

Lower-cost support: Ask a child health clinic, school health office, community health center, or insurer about a sleep check. Ask about behavior care, telehealth, language help, and transport. If a digital program is offered, ask if it was studied in teens with this problem. Ask who checks it, what data it keeps, and its cost. Age limits and access vary.

Formal care: A child sleep doctor or body-clock specialist can check a lasting late pattern. A child mental-health expert may be needed when depression, anxiety, trauma, ADHD, autism, substance use, or mood activation is part of the picture. A pharmacist can review melatonin, sedating products, stimulants, and drug effects.

Care must fit real life. Shared rooms, night work, rural travel, shared custody, disability, religious schedules, sports, and limited internet can change what is possible. Ask what is essential and what can adapt.

Coordination plan

Agree on one goal, one baseline, and one first step. Name who owns each task. The teen might own the log. The parent might own the ride plan and visit. The care team owns diagnosis and any melatonin or strong light directions. Choose a review date. Share only what the plan needs. Keep private teen-doctor time when it fits. Get more help for drowsy driving, a sharp change in mood or energy, breathing concerns, sleep attacks, or major loss of function.

When to get help

Emergency help now

Call 911 for immediate danger, inability to stay safe, seizure, severe breathing trouble, inability to awaken, suspected overdose, or dangerous psychosis or mania. For suicidal or emotional crisis support in the United States, call or text 988 or use 988 chat. If danger is immediate, call 911. For a suspected poison exposure, call Poison Control at 1-800-222-1222. If the person has collapsed, had a seizure, has trouble breathing, or cannot be awakened, call 911.25, 26

Prompt clinical evaluation

Seek prompt care for falling asleep while driving, a near miss, sudden sleep attacks, cataplexy, progressive daily drifting, prominent snoring or gasping, sudden onset, marked decline, dangerous substance use, worsening depression, or much less sleep with unusual energy, fast speech, risky behavior, hallucinations, or paranoia.

Routine troubleshooting

Ask for review when the goal is unclear or the log feels like too much. Also ask when family conflict rises, access blocks the plan, or a fair care plan brings no real gain. A lack of response is useful information. It is not proof of poor effort.

Frequently asked questions

Does sleeping well on vacation prove DSWPD?

No. It is a useful clue because the teen may sleep better at a preferred late time. It can also mean they are repaying sleep debt. Compare timing, sleep amount, and function on school and free days. Then let a care team check the full pattern.

Should I take the phone away at night?

Not as a one-cause fix. Separate light, content, alerts, lost sleep time, safety, and needed phone uses. Agree on the smallest change that fits the real problem. A phone rule cannot replace enough time to sleep or a sleep check.

Can we try melatonin on our own?

This article gives no dose or time because the body-clock goal and product matter. Discuss the exact product, timing, drug effects, next-day drowsiness, safe storage, and review date with the teen’s doctor or pharmacist.

Is a consumer sleep tracker enough to diagnose the problem?

No. It may show a rough timing pattern, but it cannot diagnose DSWPD or replace a health history. Devices and their math differ. Use a simple log and real-life function. Bring tracker data only if it helps and does not raise conflict.

Will a later school start fix DSWPD?

Not by itself. Later starts can give more time to sleep and reduce the gap between a teen’s clock and an early bell. They do not prove the diagnosis or address insomnia, substances, mood symptoms, breathing problems, or every timing factor.

If your teen is sleepy, they should not drive. Arrange another ride.

This article is for education and is not a diagnosis or an individual treatment plan. Sleep problems can have more than one cause. A qualified clinician can help you choose care that fits your health, medicines, schedule, and safety needs. Do not start, stop, taper, or change a prescription medicine based on this article.

Tools you can use

The core page gives the essential action and safety boundaries. These tools may be linked as a separate companion resource. They are original and do not reproduce a proprietary scale or diagnostic criteria.

Tool 1: Two-week teen-parent sleep log

Agreement before starting

• The purpose of this log is: ____________________
• The teen chooses where the log is kept: ____________________
• People allowed to see it: ____________________
• We will not use the log for punishment, minute-by-minute checking, or morning arguments.
• We will review it on: ____________________

Low-capacity version: Complete three required days and two free days. Estimates are acceptable. Do not wake the teen to collect data.

Tool 2: Body clock, opportunity, insomnia, or something else?

Tool 3: Shared plan with teen choice and consent

• One goal the teen chooses: __________________________________
• Baseline period: __________________________________
• One first action: __________________________________
• Teen owns: __________________________________
• Parent or caregiver owns: __________________________________
• Clinician or school owns: __________________________________
• Information the teen agrees may be shared: __________________________________
• Information that remains private unless safety requires otherwise: __________________________________
• Review date: __________________________________
• Continue, simplify, adapt, or get more help if: __________________________________
• Stop and seek help if: __________________________________

Tool 4: Light-dark household plan without a prescription

Choose one item from each side only if it fits the teen’s safety, disability, school, and household needs.

This is not a light-treatment prescription. A clinician must choose the timing, intensity, device, and duration of intensive treatment. Stop and ask for review if headache, eye strain, nausea, marked irritability, agitation, unusual energy, or another concerning change appears.

Tool 5: School conversation guide

Bring facts, not a demanded diagnosis.

• “We have observed this pattern across school and free days: ____________________.”
• “The main safety or function problem is: ____________________.”
• “Clinical assessment is planned or underway with: ____________________.”
• “What attendance, health-office, workload, transportation, or schedule supports are feasible while we evaluate this?”
• “Who needs which information, and how can we protect the student’s privacy?”
• “When will we review whether the support helped?”

This guide does not promise a legal accommodation, a 504 plan, or a change in school start time.

Tool 6: Melatonin questions and safety card

Bring the exact bottle or clear photos of every panel.

• What problem are we trying to change: sleepiness, sleep onset, or body-clock timing?
• Does the history support DSWPD, insomnia, insufficient sleep, or another problem?
• How does biological timing affect the plan?
• What evidence applies to this teen’s age, diagnoses, and medicines?
• What product-quality feature should we look for?
• What interactions and next-day effects matter?
• When should the teen avoid driving or another risky activity?
• How will we store the product securely?
• What is the review date, and what would make us stop or revise the plan?

No dose, clock time, or titration schedule is supplied by this toolkit.

Tool 7: Drowsy-driving plan

• Teen’s no-penalty phrase: “I am not safe to drive.”
• First backup ride: __________________________________
• Second backup: __________________________________
• School, practice, or work contact if the trip is canceled: __________________________________
• Place the car keys when driving is unsafe: __________________________________
• Clinician to contact after a near miss, sleep attack, or repeated drowsiness: __________________________________

If your teen is sleepy, they should not drive. Arrange another ride.

Tool 8: A morning routine that avoids punishment

1. Use the agreed alarm and support level.
2. Keep the first question practical: “Are you safe to drive, and what support do you need?”
3. Use ordinary light and movement only within the shared plan.
4. Avoid a lecture, sleep-score review, or consequence discussion while the teen is barely awake.
5. Revisit the plan at the scheduled review time, not during the morning crisis.

Protecting enough sleep remains essential. This routine is not permission to keep forcing an early wake while sleep onset stays extremely late.

Tool 9: Clinician referral and red-flag checklist

Bring to routine or prompt assessment

• A 7 to 14 day log with required and free days
• Medicines, supplements, energy products, nicotine, alcohol, and cannabis information
• Snoring, gasping, leg discomfort, nightmares, unusual behaviors, sleep attacks, or cataplexy
• Mood, anxiety, trauma, school refusal, ADHD, autism, and recent functional change
• Work, sports, custody, caregiving, housing, noise, and transportation constraints
• The teen’s goal and consent preferences

Seek prompt assessment for a progressive daily drift, sudden sleep attacks, cataplexy, marked decline, witnessed breathing pauses, drowsy-driving near miss, dangerous substance use, worsening depression, or possible mood activation.

Use emergency help for immediate danger, inability to stay safe, seizure, severe breathing trouble, inability to awaken, suspected overdose, or dangerous psychosis or mania. Use 988 for U.S. crisis support and 911 for immediate danger. Call Poison Control at 1-800-222-1222 after suspected ingestion; call 911 for collapse, seizure, breathing trouble, or inability to awaken.

Related reading

• Less Time in Bed, More Consolidated Sleep
• The Harder You Try, the Further It Gets
• You’re Not Weak. It May Be Rebound
• Sleep Was the First Thing to Change
• Melatonin: a Clock Signal, Not a Sleeping Pill
• When Sleep Steals Focus: A Practical ADHD Sleep Plan

References

1. Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders. Journal of Clinical Sleep Medicine. 2015;11(10):1199-1236. doi:10.5664/jcsm.5100. PMID 26414986. PMCID: PMC4582061. 2. American Academy of Sleep Medicine. International Classification of Sleep Disorders, Third Edition, Text Revision. 2023. Official ICSD page. Accessed August 31, 2026. Full criteria require licensed access. 3. Crowley SJ, Van Reen E, LeBourgeois MK, et al. A longitudinal assessment of sleep timing, circadian phase, and phase angle of entrainment across human adolescence. PLoS One. 2014;9(11):e112199. doi:10.1371/journal.pone.0112199. PMID 25380248. PMCID: PMC4224451. 4. Jenni OG, Achermann P, Carskadon MA. Homeostatic sleep regulation in adolescents. Sleep. 2005;28(11):1446-1454. PMID 16335485. PubMed. 5. Smith MT, McCrae CS, Cheung J, et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2018;14(7):1231-1237. doi:10.5664/jcsm.7230. PMID 29991437. PMCID: PMC6040807. 6. Khosla S, Deak MC, Gault D, et al. Consumer sleep technology: an American Academy of Sleep Medicine position statement. Journal of Clinical Sleep Medicine. 2018;14(5):877-880. doi:10.5664/jcsm.7128. PMID 29734997. PMCID: PMC5940440. 7. Gradisar M, Dohnt H, Gardner G, et al. A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. Sleep. 2011;34(12):1671-1680. doi:10.5665/sleep.1432. PMID 22131604. PMCID: PMC3208844. 8. Richardson C, Gradisar M, Barbero SC. A randomised controlled trial of bright light therapy and morning activity for adolescents and young adults with delayed sleep-wake phase disorder. Sleep Medicine. 2018;45:114-123. doi:10.1016/j.sleep.2018.02.001. PMID 29680419. PubMed. 9. Kuula L, Pesonen AK. Toward Earlier Bedtimes: Randomized Trial of Multi-Method Interventions in a Community Cohort of Adolescents. Journal of Adolescent Health. 2026;78:854-864. doi:10.1016/j.jadohealth.2025.12.247. PMID 41697175. ClinicalTrials.gov NCT02964598. 10. Monterastelli AJ, Misiunaite I, Eastman CI, Crowley SJ. Late evening room light and sleep restriction reduces the ability of bright morning light to phase advance adolescents’ circadian clocks. Scientific Reports. 2026;16:10276. doi:10.1038/s41598-026-37985-y. Full text. 11. Crowley SJ, Eastman CI. Human adolescent phase response curves to bright white light. Journal of Biological Rhythms. 2017;32(4):334-344. doi:10.1177/0748730417713423. PMCID: PMC5972384. 12. American Academy of Sleep Medicine. Bright Light Therapy. Updated May 6, 2021. AASM Sleep Education. Accessed August 31, 2026. 13. U.S. Food and Drug Administration. Dietary Supplements. Official FDA page. Accessed August 31, 2026. 14. Cohen PA, Avula B, Wang YH, et al. Quantity of melatonin and CBD in melatonin gummies sold in the US. JAMA. 2023;329(16):1401-1402. doi:10.1001/jama.2023.2296. PMID 37097362. PMCID: PMC10130950. 15. Pawar RS, Coppin JP, Khanna S, Parker CH. A survey of melatonin in dietary supplement products sold in the United States. Drug Testing and Analysis. 2025;17:1176-1185. doi:10.1002/dta.3823. Publisher page. 16. Händel MN, Andersen HK, Ussing A, et al. The short-term and long-term adverse effects of melatonin treatment in children and adolescents: a systematic review and GRADE assessment. eClinicalMedicine. 2023;61:102083. doi:10.1016/j.eclinm.2023.102083. PMID 37483551. PMCID: PMC10359736. 17. Lelak K, Vohra V, Neuman MI, Toce MS, Sethuraman U. Pediatric melatonin ingestions, United States, 2012-2021. MMWR Morbidity and Mortality Weekly Report. 2022;71:725-729. doi:10.15585/mmwr.mm7122a1. Corrected report checked. 18. Freeman BE, et al. Notes from the field: emergency department visits for unsupervised pediatric melatonin ingestion, United States, 2019-2022. MMWR Morbidity and Mortality Weekly Report. 2024;73. doi:10.15585/mmwr.mm7309a5. PMID 38451863. 19. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for pediatric populations: a consensus recommendation of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine. 2016;12(6):785-786. doi:10.5664/jcsm.5866. PMID 27250809. PMCID: PMC4877308. 20. Yip T, Wang Y, Xie M, Ip PS, Fowle J, Buckhalt J. School start times, sleep, and youth outcomes: a meta-analysis. Pediatrics. 2022;149(6):e2021054068. doi:10.1542/peds.2021-054068. PMID 35593065. PMCID: PMC9665092. 21. Watson NF, Martin JL, Wise MS, et al. Delaying middle school and high school start times promotes student health and performance: an American Academy of Sleep Medicine position statement. Journal of Clinical Sleep Medicine. 2017;13(4):623-625. doi:10.5664/jcsm.6558. PMID 28416043. PMCID: PMC5359340. 22. Adolescent Sleep Working Group, Committee on Adolescence, Council on School Health. School start times for adolescents. Pediatrics. 2014;134(3):642-649. doi:10.1542/peds.2014-1697. Formal current policy status not verified through the cutoff. 23. American Academy of Pediatrics. Healthy Sleep Habits: How Many Hours Does Your Child Need? Updated August 7, 2026. HealthyChildren.org. Accessed August 31, 2026. 24. National Highway Traffic Safety Administration. Drowsy Driving. Official NHTSA page. Accessed August 31, 2026. 25. 988 Suicide & Crisis Lifeline. Get Help. Official 988 page. Accessed August 31, 2026. 26. America’s Poison Centers. Poison Help. Official Poison Help page. Accessed August 31, 2026.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, available 24/7. En español: marque 988 y oprima 2. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.