AAP: Insufficient sleep among adolescents a public health issue

Recent data show the potential role of later school times as a means to reduce adolescent sleepiness, according to a technical report published in Pediatrics.

The report, which includes relevant data that has been published since the last report from the AAP on adolescent sleepiness, expands on the extent of sleep restriction and emphasizes the importance of recognizing insufficient sleep as a public health issue that directly affects pediatric practice.

Evidence of short sleep durations, daytime sleepiness and excessive caffeine use indicate adolescents are sleeping fewer hours than needed. Middle- and high-school students not getting enough sleep is a chronic problem worldwide, according to Judith A. Owens, MD, FAAP, director of sleep medicine at Children’s National Health System, and colleagues. Further, restricted sleep has been linked to alarming health and behavioral outcomes, such as increased risk for car crashes, delinquent behaviors, depression and psychological stress.

A combination of biological processes, modern lifestyles and social obligations decrease the opportunity for adolescents to obtain adequate sleep.

Recent study findings indicated adolescents accumulate sleep-wake homeostasis, a process that accounts for greater pressure to sleep as one stays awake longer, at a slower rate than other age groups.

Nighttime screen use and social networking, which have significantly increased in the 21st century are external factors that contribute to insufficient sleep among adolescents.

Going to bed later and waking later on weekends than on weekdays is a response to insufficient weekday sleep and reflects the biology of circadian rhythm, according to researchers.

Data from the National Sleep Foundation’s 2006 Sleep in America poll indicated almost all adolescents had at least one media electronic device in their bedroom. Several studies have demonstrated that electronic exposure at nighttime potentially disrupts sleep. Use of multiple electronic devices at the same time has been linked to less sleep at night and increased sleepiness during the day.

Earlier data suggested peer-to-peer interaction did not significantly affect school-night bedtime but did significantly affect a teenager’s sleep on the weekends. These findings may no longer be true with the advancement of social media, according to researchers.

Another potential detrimental effect of electronics is the light they produce, which may disrupt circadian rhythms by suppressing melatonin. This may lead to difficulty falling asleep at a reasonable time, according to the AAP.

Regarding school start times, a small but increasing number of school districts have delayed school start times in response to research about the prevalence of insufficient sleep among adolescents. Students who attended schools with later start times reported later rise times, more total sleep on school nights, less daytime sleepiness, less tardiness, fewer attention/concentration difficulties, and better academic performance compared with children who attended earlier-starting schools.

Caffeine use among children and adolescents has been understudied, according to researchers, but current research raises important questions about the relationship between caffeine use and sleep patterns during the developmental period. Higher caffeine intake as early as 12 years of age was associated with shorter sleep duration, increased sleep onset latency, increased wake time after sleep onset, and increased daytime sleepiness.

Further, increased caffeine use often coexists with other behaviors that negatively affect sleep, such as late-night technology use.

The causes and consequences of sleep loss are closely intertwined in complex ways, the researchers point out. Sleep problems both increase risk for depression and are a predictor of relapse. Recent data show addressing insomnia greatly improves treatment of depression.

“Adolescent sleep loss poses a serious risk to the physical and emotional health, academic success, and safety of our nation’s youth… Pediatricians have the opportunity to make significant inroads into addressing the health risk that sleep loss presents through screening and health education efforts,” the researchers concluded.

Disclosure: The researchers report no relevant financial disclosures.

See more from Back-to-School Resource Center 2014