2023 Volume 55 Issue 6 Pages 413-420
A Japanese phrase, “Asa-okirukotoga-dekinai” is described as difficulty in morning awakening in the international classification of sleep disorders, version 3. This symptom is common among adolescents worldwide, with 40-90% of adolescents reporting complains of it. Difficulty in morning awakening is reported to be associated with school tardiness/absence, poor academic performance, nocturnal media usage, delay in bedtime, smoking, drinking, depressive conditions and sluggish cognitive tempo. The need for differentiation among allergic rhinitis, atopic dermatitis, long sleeper, obstructive sleep apnea syndrome, delayed sleep-wake phase disorder, sleep debt/insufficient sleep syndrome, idiopathic hypersomnia and psychiatric disorders is demonstrated in the literature. “Asa-okirukotoga-dekinai” is one of the major manifestations of orthostatic dysregulation, which is a common disease in the pediatric population in Japan. However, according to the English version of the clinical guidelines for this disease, “Asa-okirukotoga-dekinai” in orthostatic dysregulation is described as difficulty in getting out of bed, instead of difficulty in morning awakening. Care plans for adolescents with difficulty in morning awakening are summarized, and six future problems on difficulty in morning awakening have been demonstrated, including the sophistication of sleep education, social enlightenment on the importance of sleep in a sleep deficient society, interventions involving smoking/drinking cessation guidance and nocturnal media usage guidance, and research on sleep inertia/sleep drunkenness as well as on biological markers.
