In September 1880, Arthur’s Home Magazine published an anonymous short essay titled, “On Getting Up in the Morning.” As the author writes, “When a man was once rallying another on his weakness in this respect, he said: ‘Why don’t you make up your mind to do it?’ The reply was: “Make up my mind to it! Oh, that is easy enough; I have done that a hundred times; but what I can’t manage is to make up my body to it.”
So how can we “make up our body to it” in the morning – or those of our young family members? This is a constant tension in the relationship between me and my child with a disability. We both want her to be independent, but as I watch the clock tick ever closer to the time she needs to leave for work or school, I become ever more tempted to walk into her room, flick on the lights, and announce that it is time to get up. During high school, she unsuccessfully tried the wake-up light alarm clock as well as a more traditional clock radio with both music and static (when it’s not actually set on a station). When I search the internet for “getting up in morning”, I am awarded with many published lists from sites as diverse as Huffington Post, Buzzfeed, and webmd.com. Most such articles pitched to the general public don’t acknowledge the co-occurrence (often labeled “comorbidity”) of insomnia with anxiety, depression, schizophrenia and other mental disorders. In fact, 40% of people with insomnia have a psychiatric diagnosis (Ford & Karmerow, 1989). In some instances, this may be because antidepressants such as fluoxetine (Prozac) can create insomnia as a side effect. (McCrae & Lichstein, 2001).
What advice can we learn directly from published research? One study (Dewald-Kaufmann, Oort, & Meijer, 2014) with a sample of Dutch adolescents, mostly girls, found that gradually advancing bedtimes by 5 minutes every evening until up to an hour earlier than usual, along with sleep hygiene advice, led to fewer sleep problems and depressive symptoms among adolescents who had been suffering from insufficient sleep as compared to adolescents who received no instructions about their sleep. However, that result begs the questions of whether adolescents or even adults outside of an experiment could tear themselves away from their phones, friends, homework, or computers any earlier, though the gradual five minute increments seems a brilliant, almost unnoticeable strategy. In the experiment, the recommended sleep hygiene rules included:
However, because the same adolescents both changed their personal sleep start times and were taught the sleep hygiene rules, we cannot disentangle the effects of the changed sleep schedule from those of the sleep hygiene rules. Was it the advancing bedtimes that worked or was it the improved sleep hygiene? Are all the sleep rules necessary or only one or two? In fact, researchers did not check whether participants even followed the sleep hygiene rules.
So what is the take-away from this interesting yet imperfect study? First of all, there was no harm done to the adolescents after making these sleep changes, at least as reported by the experimenters. Of course, in our daily lives, an unfinished homework assignment might be problematic. However, most importantly, we learn that extending sleep by about an hour and teaching some basic sleep hygiene may improve adolescents’ sleep and reduce their symptoms of depression.
Dewald-Kaufmann, J. F., Oort, F. J., & Meijer, A. M. (2014). The effects of sleep extension and sleep hygiene advice on sleep and depressive symptoms in adolescents: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 55, 273-283.
Ford, D. E., & Kamerow, D. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA, 262, 1479-1484.
McCrae, C. S., & Lichstein, K. L. (2001). Secondary insomnia: Diagnostic challenges and intervention opportunities. Sleep Medicine Reviews, 5, 47-61.