Adolescent Sleep Needs

Teens need more sleep than adults. Even with more than 9 hours of sleep a night many teens struggle with drowsiness, especially early in the day. This problem has gotten worse in recent years, as culture pushes kids to delay bedtimes, while high school start times have been pushed earlier. Many adolescents report sleeping 7 hours or less on weeknights rather than the 8 or 9 hours they need to be alert during the day.

As children grow up, they spend less time in REM and slow-wave sleep and more in Stage 2 sleep.  A transition to a more adult sleep architecture is a hallmark of the transition from childhood to adolescence.

The sleep-wake cycle shifts during adolescence. Scientists have found changes in both the homeostatic and circadian systems as kids to grow into adolescence. The sleep pressure grows more slowly during the day, resulting in greater alertness in the evening. And the Dim Light Melatonin Onset, measurable in blood tests, takes place at roughly 8:30 PM in younger kids and 9:30 in adolescents. As a result, teenagers have a natural tendency to fall asleep later and wake up later. When this pattern occurs in mature adults it is sometimes diagnosed as Delayed Sleep Phase Syndrome (DSPS). In some sense, it is normal for teens to have DPSD. What is a disorder for adults is normal for adolescents. This shift sometimes lasts into a person’s 20s.

However, the problem is not so much the shift in the sleep timing, but the total amount of sleep that the kids are getting. Psychosocial and environmental conditions make it easier for adolescents to delay bedtimes. Sports, homework, jobs, socializing contribute to a busy schedule that leave little time for sleep. Modern electronics and entertainment systems keep minds occupied when they should be sleeping. Combining work and school is also a challenge for teens, often to the detriment of their sleep lives. Research shows that working more than 20 hours a week during the school year is associated insufficient sleep and exercise.

Academic studies have attempted to get some data on teens, but like other sleep studies they are subject to suspicion because of low sample sizes, the subjective nature of sleep quality, and standardization in reporting. It appears that 10% to 15% of adolescents have insomnia. This is actually lower than any age group in adults. There is some evidence of heritability, with mothers being the family member that most often shares insomnia. However, scientists all agree that sleep disorders are not as simple as genetic.

Many sleep experts are calling for revision of school start times. They want schools to start later in the morning and run later in the afternoon, to accommodate the delayed sleep cycles of teens.  Here is an op-ed in the New York Times advocating such a change: ( http://www.nytimes.com/roomfordebate/2011/09/26/should-the-school-day-be-longer/let-students-sleep) Chronotypes are biological and not easily changed.  School times are social constructs. When the Minneapolis School District adjusted high school schedules 1.5 hours later, a study concluded the change brought "significant improvements in sleep time, attendance, and fewer symptoms of depressed mood."

Many teens try to catch up on their sleep on weekends, and to some extent this works. But irregular sleep schedules also pose problems. Delaying weekend bedtimes and rising times for several hours can disrupt the normal sleep cycle much the way jet lag affects long-distance travelers.

Learning

Sleep is important in helping humans learn and remember things. Both declarative memory and procedural memory are enhanced by sleep and new learnings are made permanent during sleep. Declarative memory refers to memory of facts and procedural memory is acquisition of skills.

Research has shown that sleep is especially important in teens. Long-term memory formation and acquisition is better if the brain is well rested. This is especially important in adolescents who are engaged in the project of learning (both schoolwork and developing social and emotional intelligence).

Other sleep disorders

Kleine-Levin Syndrome most often strikes males in their adolescent years.  Snoring and apnea are less common than in adults, but rates are on the rise, especially with rising obesity rates in kids. It is estimated that 12% of children snore regularly. Many kids have their tonsils and/or adenoids removed and that eliminates or reduces the snoring.  Apnea rates are less than 3%, although also tending upward with increasing obesity.

The CPAP machines used to treat apnea have low enough usage rates in adults (they are uncomfortable), but even lower adoption rates in teens.  The still maturing nervous system is more affected by the cut-off in oxygen sleep-disordered breathing brings and so apnea can cause irreversible cognitive problems.

ADHD is common in children and interacts with sleep patterns.  The stimulants given to treat ADHD often alleviate insomnia.  And diseases seen in adults such as depression and eating disorders also affect teens and their sleep.

Treatment and Behavioral Patterns

Teens with insomnia (primary insomnia) are treated the same way as adults. Education and behavioral modification is the first approach to the problem (before drugs.) This means sleep hygiene, stimulus control, sleep restriction therapy, and relaxation techniques.

Rip Van Winkle The FDA has not approved any sleeping pills (insomnia medication) for children or teens. That doesn’t mean medicines are not used. Experienced pediatricians and psychiatrists sometimes deem it wise to prescribe sleeping aids off-label for children. They usually do so as part of an overall sleep strategy that includes behavioral modification. The fact that children have different sleep architectures from adults (longer time in Stage 3) and generally smaller bodies (resulting in dosing challenges) means doctors have to be careful with medicines and cannot simply use the same regimens they apply to adults. As with adults, doctors weigh the teenage patient’s overall health and other conditions when determining a regimen. When the patient has sleep onset insomnia, a fast-acting drug with a short half-life might be used. Sleep insomnia (more often seen in the elderly than in young people) is frequently treated with longer half-life drugs.

Another big problem seen in teens is drowsy driving. Young people fall for this much more than more experienced drivers. The National Highway Safety Administration estimates that more than 1500 Americans under age 21 are killed because of car crashes due to drowsy driving every year. A study found teens who haven't been sleeping enough take more risks than they would otherwise.

Adolescents may also suffer from sleep disorders, just like people of any age range. Narcolepsy typically first appears between the ages of 10 and 20. Mood disorders often begin in adolescense, and sleep problems are often a problem. Insomnia can also be a warning sign for depression in later life.

Adolescents may also be more affected by caffeine and nicotine than adults so that an equal amount of these stimulants consumed could lead to more insomnia.  While a middle-aged parent may not feel jittery after two cups of coffee, the same two cups can substantially alter their teenage child’s behavior. A high portion of adolescent insomnia seems to be due to hyperarousal. The kids are "wired" and may grow out of it, or may learn to live with it.

State of Teen Sleep

Cross-sectional studies suggest widespread insomnia among US teens. A minority, but a substantial minority (about a quarter) of adolescents report chronic insomnia, even after kids with psychiatric disorders are not counted. The effects of chronic sleep loss are more than just fatigue; people can’t learn as well when they have accumulated sleep debt — school performance suffers.   (A survey of Dartmouth College students showed sleep distrubances was listed as a major factor in poor academic performance. And this despite kids and young adults notoriously underestimating their daytime sleepiness. Other evidence that too much sleep lowers test scores.

The Youth Risk Behavior Surveillance System found in 2009 that only 31% of American high school students got 8 or more hours of sleep on school nights. American teens experience a decline in sleep duration of about 45 minutes between the ages of 13 and 19. Although part of this is due to normal maturation – adults sleep less than children – social and lifestyle pressure may also play a role.

This is not a problem unique to any culture. Studies have shown significant percentages of teens report insomnia and daytime sleepiness in Japan, China, the United States, and Spain.

Consequences of insufficient sleep in adolescents include missed school, sleepiness, tiredness and decreased motivation, and difficulties with self-control of attention, emotion and behavior. Sleep loss interferes with daytime functioning. Weight gain and increased risk for diabetes also result from short sleep.  Many of the negative stereotypes of teens - apathetic, moody, tired – can be aatributed to insufficient sleep. It is also known that sleep deprived adolescents tend to indulge in more risky behavior such as smoking, drinking, and fighting.

The U.S. government's Health People initiative has established a goal of increasing the percentage of teens who get adequate sleep on school nights. According to the Youth Risk Behavior Surveillance System 30.9% of high school kids got at least 8 hours per night in their 2009 survey. The goal is to increase this to 33.2% by 2020.


Related: Persistence and Change in Symptoms of Insomnia among Adolescents

Exercising, sleep-EEG patterns, and psychological functioning are related among adolescents.

Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions

Sleep-deprived teens take more risks

 

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