By Rafael Pelayo, M.D.
As teenagers return to school, the nightmarish reality of increased homework along with more social demands may make getting a full night sleep just a dream. They may feel trapped for time and feel forced to sacrifice their sleep. Teens may model themselves on their sleep-deprived parents and peers and think they are supposed to get less sleep as they mature. Yet science confirms that making healthy sleep a priority will help teens and their families in many ways. Alternatively, sleep deprivation is associated with serious problems including irritability, learning difficulty, motor vehicle accidents, and increased risk of suicide.
For a maturing teenager, developing an autonomous lifestyle is a matter of choices. When they make a decision, they must weigh what is in it for them. Making sleep a priority is a lifestyle choice that quickly pays off. Thousands of Stanford University students have learned the benefits of better sleep. Better sleep helps young people learn more efficiently and improves their mood and athletic performance. Sleeping well simply makes life more fun. A few years ago, the National Sleep Foundation surveyed adolescents. They reported that 25 percent of teens admitted to falling asleep in class at least once a week. This astounding number was largely ignored or at best elicited a national yawn. The assumption is that the teenagers are falling asleep because they are bored or disinterested in the class. Parents usually are not notified when their teenagers falls asleep in class. In contrast, children in elementary school do not routinely fall asleep during class and if they do, parents can expect prompt notification. This must change. Was elementary school more exciting than high school? No, that is not the reason. It is a misconception that boredom causes sleepiness. Boredom just unmasks sleep deprivation. The real difference between these age groups is that younger children have set bedtimes and are forced to get more sleep. This is why they can stay awake easier even if they are sometimes bored. Younger children, despite their parents' wishes, do not usually sleep in on weekends. They have no need to catch up on sleep. Teenagers, on the other hand, on weekends often sleep in much more than even their parents do. That is a key difference.
Sleeping in on weekends may be one of life's small luxuries, and for many adults it is. However, when it comes to teenagers, sleeping in on weekends may be the first sign of an emerging sleep problem. Adolescents are typically very sleep deprived during the school week. Parents realize this and may even feel guilty about how over-worked their child is. Parents and teens may think that sleeping in on weekends is normal. It may be common, but it is not normal. Think about it, does your body need more calories on weekends than on weekdays? Why should you need more sleep on weekends? Nobody should ever wake up feeling tired. We do not leave fine restaurants feeling hungry, so why should we wake feeling tired?
It is another common misconception that a person can make up five days of partial sleep deprivation over just a two-day weekend. Neuroscience teaches us that the brain does not work that way. Sleep relies on a biological rhythm that predicts dawn and dusk. Since the advent of electricity in our modern society, "dawn" is effectively whatever time light hits your eyes upon awakening. The brain will then anticipate that "dawn" will occur near that same time the next day. This mechanism may help us adjust to the change of seasons. To the brain it makes no sense that "dawn" occurs for example at 7 a.m. Monday through Friday but at noon on Saturday and Sunday.
Compounding this problem is that adolescents may need more sleep than prepubescent children. It is not surprising that some teenagers gravitate to stimulating substances such as cigarettes and caffeinated beverages.
We have long known that sleep can affect classroom behavior and mood in children. There is solid emerging data that sleep deprivation is associated with suicide ideation and suicidal behavior. A study of over 8,000 teenagers in Korea found that about 20 percent of them felt sleepy in the daytime and were getting only seven or less hours of sleep on school nights while they habitually slept in more than two hours on the weekend. These teenagers were much more likely to have suicidal behavior. A study in 2012 of over 6,500 teenagers in the U.S. found that sleep problems predicted suicidal behavior independent of depression or substance abuse.
This effect is not limited to adolescents. A meta-analysis of over 140,000 adults and teenagers confirmed that suicidal behavior is 2-3 times more likely in people suffering from sleep problems. Again, these findings were independent of depression. A possible explanation for this problem comes from a 2013 study using fMRI technology, which demonstrated imbalances in brain regions of adolescents with sleep disturbances which were associated with more risk-taking behavior. The last thing we need is for our sleep-deprived teen drivers to take more risks!
So how can we help our teens sleep better? It begins by helping teens make sleep a priority during the school week. In my experience, teenagers will often go to sleep past their parents on school nights even though they may be in their rooms much earlier. Many teens spend more time awake in their bedrooms than sleeping in them! Parents, do not go to sleep before your teenager. You did not do it when they were in elementary school, so why do it now? They are still children.
Teens may complain they cannot go to bed earlier because they have too much homework. Part of the problem that is not acknowledged is that many teens have converted homework into a social activity. Our teens have never lived in a world without the Internet or cell phones. They will often text or IM each other as they are doing homework. We all know it takes longer to reach decisions by committee. Therefore, the homework time is dragged out and sleep time is reduced.
Too many families start their days with arguments about getting up in time to go to school and end their days with arguments about bedtime. What a horrible way to start and end the day. Teens can learn how getting better sleep is the easiest way to improve their lives. This can be taught in their health classes. Do not accept waking up tired or sleeping in as normal. My wish for all teenagers and their families this coming school year is more sleep and less homework. We can always dream.
Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.
Rafael Pelayo, M.D., is a pediatric neurology-trained sleep medicine specialist and clinical professor at the Stanford Center for Sleep Sciences and Medicine. This Center is the birthplace of sleep medicine and includes research, clinical, and educational programs that have advanced the field and improved patient care for decades. To learn more, visit us at: http://sleep.stanford.edu/.
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Lee, YJ et al. "Insufficient sleep and suicidality in adolescents." Sleep. 2012 Apr 1; 35(4):455-60.
Park, JH et al. "Associations between non-restorative sleep, short sleep duration and suicidality: findings from a representative sample of Korean adolescents." Psychiatry Clin Neurosci. 2013 Jan; 67(1)28-34.
Pigeon, WR et al. "Meta-analysis of sleep disturbance and suicidal thoughts and behaviors." J Clin Psychiatry. 2012 Sep; 73(9):e1160-7.
Telzer, EH et al. "The effects of poor quality sleep on brain function and risk taking in adolescence." Neuroimage. 2013 May 1; 71:275-83.