Teens and Sleep
Hylton I Lightman, MD, DCH (SA), FAAP
A few weeks ago I wrote about babies and sleep. I received numerous requests from parents of pre-teens and teens about sleep.
Sleep is important for our teenagers. Sleep is food for the brain. During sleep, important body functions and brain activity occur. Yet so many teens are sleep deprived. The National Sleep Foundation estimates that 85% of teens sleep less than the minimum 8-1/2 hours needed nightly. The National Heart, Lung and Blood Institute recommends 9-10 hours nightly. Why sleep is important? What can be done to structure the environment for better sleep?
The bottom-line: Sleep is the necessary fuel for brain and overall development.
Sleep is as crucial as a healthy eating regimen and regular physical exercise.
In adolescence, the brain is still developing. The brain’s pre-frontal cortex—responsible for complex thinking and decision making, as well as emotional regulation—is among the last areas of the brain to develop, and undergoes significant maturation during teenage years. This part of the brain is especially sensitive to the effects of sleep deprivation.
There are two main factors that affect how sleepy or how alert a teen is at any given time in a day. The first is the sleep-wake balance: how long it has been since he last slept? If a person stays awake for too long, his will throw off his sleep-wake balance which will make him sleepy.
The second factor affecting his level of sleepiness is his internal body clock. This clock controls the “circadian rhythms” in his body. “Circadian” means to occur in a 24-hour cycle. These rhythms make one feel sleepy or alert at regular times every day. Each person’s internal clock tells his body when it is time to sleep at night and when it is time to be awake during the day. Each person’s body has this natural timing system. When you feel sleepy at night, your circadian rhythms are telling you it is time to go to bed.
Many people feel a mild need for sleep in the afternoon. This need to sleep grows much stronger at night. This set rhythm in the body triggers the urge to sleep at these times of day and occurs no matter how much sleep you got the night before. But there’s also a lack of quality sleep which can make one tired at the wrong times of day. Teens can throw off their body clocks by often staying up late at night. Their internal clocks get more confused when they continually change their sleep and wake-up schedules. Once the internal clocks are not set right, teens can become sleepy when they should be wide awake. Lack of sleep could cause them to fall asleep at school, at work, or, G-d forbid, while they are driving.
The lack of sleep can limit your ability to learn, listen, concentrate and solve problems. You may even forget important information like names, numbers, your homework or a date with a special person in your life. Sleep deprivation can be confused with attention-deficit/hyperactivity disorder (ADHD). Some young people are thought to have ADHD when in reality they are having a problem with their sleep. Both of these problems share many of the same signs. A visit to the pediatrician can help to clarify.
Many factors keep teens from getting enough sleep:
Adolescence and Puberty
The teen’s rapidly changing body is one cause. Puberty ushers in an era of exponential changes which includes sleep. Before puberty, the body makes one sleepy around 8:00 or 9:00 pm. When puberty begins, this rhythm shifts a couple hours later and your body tells you to go to sleep around 10:00 or 11:00 pm. The natural shift in a teen’s circadian rhythms is called “sleep phase delay.” Teens may appear initially to be suffering from insomnia. They will have a hard time falling asleep at the usual time. They still need 8-9 hours nightly. The result: Teens have a miserable time waking up early for school. So your Masmid may be thriving at Mishmar, yet 10-11 hours later, he isn’t bouncing out of bed; some say the need for an alarm clock means he’s not getting enough sleep.
Early Start of School
Because most teens have to wake up early for Minyan and school, it is important for them to go to bed on time. If they go to bed late, they will be unable to get the sleep that they need. This change is a normal part of growing up. With some extra care, teens will quickly adjust to the new sleep schedule of their bodies.
There’s so much competing for our teens’ attention that sleep can be compromised. School is a big one as are the demands made on teens in our world.
Peer Pressure and Smartphones
Yes, peer pressure can cause teens to make poor decisions that will affect their sleep. Staying out too late, drinking, smoking, or using drugs — all of these can disturb sleep patterns. Kids need good sleep in order to have the wherewithal to withstand today’s peer pressure.
Teens may have a wrong view of sleep, seeing it as something that keeps them from the things they want to do. It is something to be conquered. It becomes a contest to try to get by on as little sleep as possible. They rarely consider their need for sleep and how it affects all that they do.
Something we all know but needs to be repeated and repeated – Over 90% of teens use some form of digital technology or social media at night and close to bedtime. The resulting stimulation will of course throw off good sleeping. The light from the device will definitely compromise circadian rhythms.
Teens: I understand that you know all this. You also know that lack of sleep puts you at risk for cognitive issues, i.e., trouble with memory, diminished focus and attention, difficulty learning, poor judgment and decision making, and reduced ability to problem solve; behavioral and social issues; emotional issues; and academic and performance issues. And many of you still don’t allow yourselves the sleep you need! Perhaps this “cool” piece of information will incite better sleep patterns. Lack of sleep can make you more prone to pimples and can contribute to acne and other skin issues. Do you want nice skin? Then, in addition to eating healthy and hydrating properly, get enough sleep and do it consistently.
What if your teen is getting the “right” sleep yet is sleepy during the day?
This can happen. You and your teen should meet with your pediatrician to ascertain the cause.
One reason may be Obstructive Sleep Apnea (OSA). OSA occurs when, during sleep, the tissue in the back of the throat collapses which keeps air from getting in to the lungs. This is not uncommon because the muscles inside the throat relax as you sleep and gravity then causes the tongue to fall back and block the airway. The pauses in breathing disturb your sleep, causing you to be tired the next day. Being overweight can be a factor here.
Other reasons can be narcolepsy, a sleep disorder that causes people to feel severely tired during the day. They may fall asleep suddenly at any time or place. These “sleep attacks” can occur while eating, walking or driving and it begins to affect people when they are between the ages of 15 and 25. Mood swings, not uncommon in teens, may be a symptom here.
What can be done?
The National Sleep Foundation recommends as follows:
- Create a calm atmosphere in the home at bedtime
- Set a regular bedtime
- Teens should have a regular, relaxing routine just before bedtime
- To help them relax, teens should avoid activities that will excite their senses late in the evening. They should find another time for computers, social media and “heavy studying.” No exercising within of 3 hours of bedtime
- No caffeine (including soda and chocolate) after 4:00 pm
- Avoid smoking and drinking. Along with hurting their health, nicotine and alcohol will disturb their sleep
- A regular exercise routine and a healthy diet will help them sleep better at night
- Keep the lights dim in the evening. Open the curtains or blinds to let in bright light in the morning. This helps keep their body clocks set at the right time
- Cooler temperatures are better for sleeping
- If they must take a nap, they should keep it to under 45 minutes
- It can be hard for teens to get enough sleep during the week. They may need to wake up later on weekends. But they should not wake up more than 2 hours later than the time when they normally rise on a weekday. Sleeping in longer than that will severely disrupt a teen’s body clock. This will make it even harder to wake up on time when Monday morning arrives.
Prioritize sleep over late-night studying. This dovetails with helping your children carve out the right schedule that allows for homework, fun and sleep. Parents should teach their children about the importance of sleep and have a conversation with their children. They are likely to be more amenable to sleeping healthy if they understand why sleep is important. More information from National Sleep Foundation can be found here.
A visit to the pediatrician can help elicit what’s causing the lack of sleep. It’s also an opportunity to develop good sleep hygiene. If necessary, the pediatrician will refer to a sleep specialist.
About drowsiness and driving
This a big no-no combination. A brain that is hungry for sleep is going to get sleep, no matter how well-intentioned the driver may be not to give into the drowsiness. More than half of sleep-deprived car accidents are caused by drivers under 25 years of age. The signs of drowsy driving include repeated yawning and blinking, drifting out of the lane, trouble remembering the miles driven and hitting the rumble strip at the edge of the world.
If you exhibit any of these signs, immediately reach out to a parent or friend for help driving. It might help to re-visit the article on Teens and Driving.
Parents: You have a zero-tolerance policy about your teens driving under the influence of alcohol and drugs. Establish the same policy for drowsy driving.
It’s never too late to cultivate good sleep hygiene. The benefits are untold.