Sleepless in America

Healthy rest, problem sleep, and the dreams and nightmares therein

Sleep and Teenagers

Teens have life conditions that may lead to sleep problems.

imageOn a recent episode of the MTV series "True Life," a high school student suffering from delayed sleep phase syndrome was followed. She finds it impossible to go to sleep at a regular time, instead staying up until the early hours of the morning and then finding it nearly impossible to get out of bed to go to school. When she does, she is constantly falling asleep and is unable to pay attention to class discussions.

This was an accurate depiction of the problems some teens have related to sleep. Teens tend to have three major sleep concerns. One, they are naturally sleepier than younger children or adults. Two, they tend to get insufficient sleep during the week due to academic, social and recreational demands and try to make up for it on the weekend by sleeping late. Three, they have a delayed sleep phase, meaning they want go to bed later and sleep later than other age groups. Given late night activities such as text messaging and video gaming, this propensity can easily become a full fledged delayed sleep phase disorder in which bed time isn't until 3 or 4 a.m., and the ideal wake up time is pushed to around 12 p.m. This shift in circadian rhythm is facilitated by late night exposure to light, as when looking into a bright computer screen at 2 a.m.

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Teens almost always sleep late on the weekends. Some teens, however, find it almost impossible to get out of bed on any given day due to their sleep difficulties. This can easily result in missing school and becoming truant. Indeed, studies have shown that teens are sleepier than younger children or older adults. Their sleep is shallower and less restorative than the sleep that younger children get. When allowed to sleep as much as they would like, teens average 9 to 10 hrs per night, but few are getting anywhere near this amount. Indeed, as the start of the school day is earlier for high school than middle school, it is often necessary for high school students to get up as early as 5:30 a.m. to get to school on time. In order to get even nine hours of sleep with such a schedule, it would be necessary to go to bed around 8:30 p.m., which is not likely.

Once children become preschoolers, most no longer require naptime, and by nature choose to stay awake. Teens regain the ability to nap and are better able to stay up later than younger children. They are able to over sleep when necessary and regularly do so on weekends and during vacations. Teens also tend to have much more irregular sleep schedules, with greatly different bed and wake up times on weekdays as compared to weekends. This greater flexibility in sleep ability and sleep scheduling can lead to significant disruption of the sleep pattern.

As a result of the miss-match between sleep-need and school schedules, insufficient sleep is common among teens. It is estimated that up to 40% of high school and college students are sleep deprived. This may be an underestimate. There are many reasons for this. At this age there is decreasing control exercised by parents. At the same time academic work increases. Many high school students are taking honors and advanced placement classes, often working at a college level. Young people engage in many more social activities such as sports and school clubs. In addition to doing their home work, they also may have to work long hours to earn money for college. Many college students have to essentially be full time students and full time workers due to the current economic challenges.

The adolescent years are filled with challenges. Teens take on more adult roles while still having many of the needs of children. They experience the rapid physical and emotional changes of becoming young adults. Many have concerns about their future such as going to college, getting a job and having enough money. Sexual feelings are intense during this time and teenagers have to take on more adult decisions regarding sexuality, the use of alcohol and other drugs, and working out their own value systems which may be different from their parents. During this time distrust of parents or authority figures may develop. All of these worries and concerns can cause arousal that interferes with sleep.

As with adults, sleep is often a lower priority for adolescents. This is especially true during the school week when school, homework, sports, after school activities, volunteer work, jobs and socializing seem much more important than sleep. As with adults, few teens can appreciate the benefits of sleep with regard to improved cognitive functioning and mood. If they did, the improved functioning young people would experience might more than off-set the extra time devoted to sleep.

There are a number of concerns related to insufficient sleep that go beyond the cognitive, memory and emotional effects. Increased sleepiness results in increased risk for fatigue-related accidents, especially motor vehicle accidents. Laboratory studies have shown that significant sleep loss results in cognitive impairment equivalent to that caused by alcohol intoxication. Not a good thing for new drivers just learning the rules of the road!

When young people are getting insufficient sleep, there is impairment of the motivation needed to do well in the class room or on the job. Unintended sleep episodes may occur in the form of falling asleep in class or on a job, or behind the wheel of a car. Indeed, students with a C average or below typically report getting less sleep and having a more irregular sleep schedule than students with better grades.

While the above issues are the most common ones for sleep problems among young people, a number of other sleep disorders are also potentially problematic. For example, narcolepsy usually appears in adolescence or early adulthood and about 50% of people with narcolepsy will have some symptoms by age 16. Another significant concern is the impact of the increasing obesity in our society. Obesity can increase the risk for sleep apnea in young people just as it does in older individuals. The long term impact of sleep apnea can have severe implications for health and well being.

In the next post, I will discuss some ways to help teens keep from being sleepless in America.

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John Cline, Ph.D., is a clinical psychologist, Diplomate of the the American Board of Sleep Medicine, a fellow of the American Academy of Sleep Medicine and a clinical professor at Yale University.

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