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Adolescents and SleepDavid Y. Huang, M.D.Tallahassee Pulmonary Clinic, P.A.

April 8, 2010

Goals

• Provide scientific and medical background regarding adolescents and sleep

• Allow the community’s educators to look at innovative ideas regarding better sleep for our adolescent students• Provide sleep education in schools

• Improve opportunity for students to get adequate sleep each night

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Disclosures• I am a Sleep Medicine Physician

• I am 6’ 4”

• I am married to a beautiful wife and am the father of 4 children

• 9th grader at Sail

• 2 sons in middle school

• Daughter in elementary school

• I am a Leon County Taxpayer

• I receive no compensation for being here today

• I am not affiliated with the Leon School Board, SAC, or DAC

• I realize that these are tough times for all county school budgets

• I am a concerned citizen of Leon County and am an Advocate for the 5,000 high school students in Leon County

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Terminology

• Adolescent: 13-22 years old

• Teenager: 13-19 years old

• Insufficient sleep syndrome =

Chronic sleep deprivation

• Insomnia = difficulty initiating or maintaining sleep = DIMS

• Delayed sleep phase syndrome = DSPS (going to bed very late and sleeping very late)

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Sleep Needs Vary as We Age -Ideal Sleep Times

Newborns/Infants (0 - 12 months): 10.5 - 18 hours

Toddlers/Children (12 mo - 12 years): 10 - 13 hours

Adolescents 8.5 - 9.5 hours

Young Adults 7 - 9 hours

Older Adults 7 - 8 hours

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Adolescents Experience a Shift to a Later Sleep-Wake Cycle

• The biological clock of children shifts during adolescence, which drives them to a later bed time (11:30 pm or later) and a natural tendency to wake up later in the morning. Bright light at night can worsen this problem.

• This delayed sleep onset (delayed sleep phase) can place them in conflict with their schedules – particularly early school start times.

Whose Fault Is It?

Thomas Edison The Light BulbThe Big Three

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Adolescent Sleep-Wake CycleAdolescent - Delayed circadian phase

Alert in the eveningDelayed sleep onset

Morning sleepiness and difficulty awakening from sleep

Childhood circadian phase

Normal sleep time

Later Sleep-Wake Cycle

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Adolescent Sleep-Wake CycleLater circadian melatonin phase

Alert in the eveningSleep onset insomnia

Morning sleepinessdifficulty awakening from sleep

Delayed sleep time and reduced sleep duration ▬► during the school week

Normal circadian melatonin phase

Normal sleep time

Restricted sleep time with delayed phase

NL sleep time with delayed phase

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Sleep Time

School start times

Social pressures

Substance abuse

Hormonal influence, obesity

Genetic predisposition

Delayed sleep phase

Insufficient Sleep Syndrome

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Trying to Get Enough Sleep

Late bedtime

Difficultyinitiating sleep

Afternoonnapping

Sleep restricted during school

week

Problem withdaytime alertness

Sleep restricted during school

week

Sleep longer onweekends

Problem withdaytime alertness

AdolescentViciousCycle

Graphic courtesy of Helene Emsellem, MD, George Washington University.

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Consequences of Sleep Deprivation

• Impaired cognitive, social and behavioral performance.

• Poor athletic performance, poor school performance, lower grades

• Tardiness and absence from school

• Difficulty remaining alert, difficulty being able to focus and concentrate (worse ADHD)

• Irritability, impaired mood, and depression.

• Increases in substance abuse and in obesity

• Drowsy driving, injury, and possibly death.

• How many hours of sleep do the Rickards basketball players get each night?

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Drowsy Driving and Auto Accidents

• The peak age for fall-asleep driving accidents is 20 years old

• Drivers under 30 account for 2/3 of drowsy-driving crashes.

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Circadian Rhythm Disorders

• Delayed sleep phase syndrome*• Advanced sleep phase syndrome• Irregular sleep-wake disorder• Free running sleep disorder • Shift work disorder• Jet lag disorder

* Very common in adolescents

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Treatment of Delayed Sleep PhaseSyndrome with Bright Light

ExposureGoal of treatment is to shift circadian

melatonin phase and bedtime to an earlier time

Evening reduced exposure to light

Morning exposure to bright light

- Normal sleep

- Restricted sleep with delayed phase

- Delayed sleep phase syndrome

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Treating Adolescent Delayed Sleep Phase Syndrome

• Bright light exposure in the morning• Darkness in the evening• Cognitive Behavioral Therapy

• Learning the importance of sleep• Resetting habits and associations

• Pharmacologic treatment in the evening• Melatonin• Hypnotics

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Advocacy Issue: Sleep Curriculum

• Educators, parents, and many health care providers receive little training about the physiology and importance of sleep.

• Very few schools offer information regarding sleep to their students or include sleep education in the health or science curriculum.

• We must teach our adolescents the importance of getting sufficient sleep!

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Advocacy Issue: School Start Times

• Symptoms are worst in the morning.

• Students are often living with the consequences of sleep deprivation throughout the day.

High school and middle school start times tend to be early - interrupting adolescents’ sleep patterns - and making it difficult to wake up and be alert.

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Positive Outcomes from Minnesota Schools – After Change to 8:40 Start

Time• Teachers report more alert students.• Students report less sleepiness and better

grades.• Fewer students are seeking help from school

counselors or nurses. • Parents report more “connect time” and their

teens are easier to live with.• Tardiness and sick days declined.• JAMA article on Later HS Start Times, June 2009

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Helping Schools Become Sleep-Friendly

• Many high schools across the country are establishing later start times to get in sync with a teen’s sleep schedule

• Several studies cite the positive outcomes of “sleep-friendly” high school start time policies.

• Early Bird Gets the Bad Grade - NY Times, 2008

Dim the Lights and Say Noto TV and Computer after 8

pm

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What’s Next - Innovative Ideas for Better Sleep

• Time to digest this information (short time)

• Add sleep education to student curriculum and parent curriculum

• Change standardized testing from 8 a.m. to 10 a.m. for high schools and middle schools

• Set up a task force or committee to evaluate the optimal school start times

• Invite Ronnie Youngblood to be on the committee

• Decide where this falls on the priority list of funding

• Can Leon County be a leader re school start times22