President's Blog - February 2017

Insufficient Sleep in Teens

Dr. Judith OwensInsufficient sleep in teens has evolved as a global epidemic that poses multiple risks to the health, safety and well-being of adolescents, and has been recognized as a serious public health issue by the American Medical Association, the American Academy of Pediatrics (AAP) and the U.S. Centers for Disease Control and Prevention. The term “deficient sleep” has been used to characterize unhealthy sleep in teens as including both daily sleep amounts insufficient to meet developmentally-appropriate sleep needs and/or sleep timing which conflicts with normal changes in adolescent circadian rhythms.

Consequences range from inattentiveness, reduction in executive functioning and poor academic performance to increased risk of obesity and cardio-metabolic dysfunction, mood disturbances which include increased suicidal ideation, a higher risk of engaging in health risk behaviors such as alcohol and substance use, and increased rates of car crashes, occupational injuries and sports-related injuries.

Early school start times for both middle and high school students have been identified as one of the most pervasive and important contributors to deficient sleep in teens. Due to circadian-based developmental changes in sleep timing, the average adolescent has difficulty falling asleep much before 11pm. Wake times required by early start times not only do not allow teens to obtain the recommended 8-10 hours of sleep “to promote optimal health” (American Academy of Sleep Medicine, 2016), but also result in misalignment with circadian rhythms: imagine having to wake up and function at 3am every day! In addition, early forced wake times selectively rob teens of REM sleep, critical to memory consolidation and learning of new information. Despite this, in 2011-12, less than 1 in 5 middle and high schools in the US started at the time recommended in the 2014 AAP policy statement of 8:30am or later.

There has been a growing movement over the past decade to change this situation, often spearheaded by grassroots community advocates, parents and school administrators who recognize that the evidence supporting later school start times is extensive and compelling. Healthy start times are associated with more sleep, less daytime sleepiness, better school performance and attendance, less depression symptoms, fewer visits to school health centers and lower rates of car crashes in teens, among other benefits. While recognizing that there are many practical and logistical challenges that communities face in changing school start times (child care for younger siblings, parent work schedules, after-school employment, traffic flow, sports schedules and costs related to busing), an increasing number of schools in rural, suburban, large metropolitan and inner city areas have successfully surmounted these barriers, and almost none of the well over 1000 schools and districts that have made the change have gone back to the original bell times.

It is our responsibility as sleep medicine professionals to get involved and to encourage and assist our local school schools and school districts. Educating yourself and then your community about the consequences of deficient sleep in adolescents and the benefits of healthy school start times is the first step in moving the issue forward.



Dr. Judith Owens