May 8, 2017

Causes and Consequences of Sleep Deprivation in American Teenagers

By Kris Schanilec

An excerpt from the Fall 2016 edition of NightWalkers, the Foundation's quarterly magazine.

The American Academy of Sleep Medicine (AASM) launched the “Sleep Recharges You” campaign in August 2016 to help teens and families learn the facts about sleep, the benefits it brings to health and wellbeing, and the risks associated with not getting enough.

For teenagers in the United States, the sleep situation is “dire,” according to the AASM. The Centers for Disease Control (CDC) reported in April that 69 percent of teens surveyed said they sleep fewer than eight hours per night, on average (1). Yet the AASM recommends they get eight to ten hours of sleep for optimal health.

In June, the AASM published “Recommended Amount of Sleep for Pediatric Populations,” (2) a consensus statement developed by a panel of 13 sleep experts who reviewed 864 published scientific articles related to sleep duration and health in children. The recommendations align with guidelines previously published by the National Sleep Foundation and are endorsed by the American Academy of Pediatrics.

“Many children are not getting enough sleep,” says Shilini Paruthi, MD, who led the AASM panel. “The evidence is there that sleep deprivation has a huge impact on children’s ability to function, and function well during the day … and it’s preventable.”

Risks Associated with Too Little, or Too Much Sleep

In the consensus statement, the AASM reports the behavioral associations found with sleep deprivation, including attention, behavior and learning problems. Lack of sleep also increases the likelihood of hypertension, obesity, diabetes, depression, self-harm, suicidal thoughts and suicide attempts.

Lack of sleep also significantly increases teens’ risk of drowsy driving accidents, according to the AASM. The National Sleep Foundation likens the functional level of a drowsy driver to someone with a blood alcohol content of 0.8%, which is illegal in most states. And there is such a thing as too much sleep, per the studies reviewed by the expert panel. Regularly sleeping more than the recommended hours may be associated with hypertension, diabetes, obesity and mental health problems, according to the AASM statement.

In contrast, sleeping the recommended number of hours is associated with positive outcomes, such as improved attention, learning, behavior, memory, emotional regulation, quality of life, and mental and physical health.

Parents: Be on the Lookout for Sleep Issues

Families should watch for signs and symptoms of sleep deprivation in their teens. These may include problems with grades, attention and behavior at school – even athletic performance, according to Dr. Paruthi.

“Teens with too little sleep are at higher risk of injuries, and their recovery times from injury can be longer…. Sleep deprivation can also affect interpersonal relationships. Parents may see that children may not be getting along with others as well, or even at home,” she says.

When sleep is lacking, teens and their caregivers can take practical steps to get the right amount (see “How much sleep do children need?” at left below). If problems persist, then it’s time for families to make an appointment with a pediatrician – and if they aren’t getting sufficient answers there, then they should seek help from a board-certified sleep specialist.

“It’s very important that parents and clinicians suspecting sleep disorders take it seriously. Children do get sleep apnea, RLS and insomnia, and these can all be treated, even in children,” says Dr. Paruthi. “RLS is an example. A lot of kids are misdiagnosed with growing pains, and yet there are quite effective treatments.”

School Start Times Are A Factor

One of the drivers of sleep issues in teens is a change in circadian rhythm that typically occurs with puberty and shifts the body clock about two hours later in the 24-hour cycle. Yet even as their bodies crave the late nights, teens may still start school at 7:30 in the morning – or for schools that offer “zero period” classes, as early as 6:30 am.

In 2014, the American Academy of Pediatrics issued a policy statement recommending that middle and high schools delay the start of class to 8:30 am or later to “align school schedules to the biological sleep rhythms of adolescents.”

Some studies have shown a benefit from later start times. In a 2014 study involving eight public high schools in three states, schools that delayed their start times until 8:30 saw improvement in students’ academic performance and attendance. In one school, the number of teen car crashes decreased by 70 percent (3).

But a later start time can pose real challenges for communities – for example, in coordinating with bus schedules and family work schedules. The AASM encourages parents to present the recommendations to their local school boards and work with them to set optimal school start times so that teens can get the healthy sleep they need.

1 Wheaton AG, Olsen EO, Miller GF, et al. 2016. “Sleep Duration and Injury-Related Risk Behaviors Among High School Students–United States, 2007–2013.” MMWR Morb Mortal Wkly Rep. 2016 65(13): 337–41.

2 Paruthi S, Brooks LJ, D’Ambrosio C, et al. 2016. “Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine.” J Clin Sleep Med. 12(6): 785–6.

3 Wahlstrom, K., Dretzke, B., Gordon, M., et al. 2014. “Examining the Impact of Later School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study.” Center for Applied Research and Educational Improvement. St Paul, MN: University of Minnesota.

RLS is believed to afflict an estimated 1.5 million children and adolescents. Visit our website to access resources for teens and kids with RLS.