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Extract 1 - Patterns of Sleep and Sleepiness in Adolescents - Extract

Adolescents experience significant changes in sleep patterns due to various factors, including academic demands and physiological processes, leading to increased sleepiness and mood issues. Research indicates that many adolescents do not get enough sleep, which can result in impaired performance, increased risk of substance abuse, and mood disturbances. The document emphasizes the need for better understanding and education regarding adolescent sleep needs to mitigate these issues.

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9 views4 pages

Extract 1 - Patterns of Sleep and Sleepiness in Adolescents - Extract

Adolescents experience significant changes in sleep patterns due to various factors, including academic demands and physiological processes, leading to increased sleepiness and mood issues. Research indicates that many adolescents do not get enough sleep, which can result in impaired performance, increased risk of substance abuse, and mood disturbances. The document emphasizes the need for better understanding and education regarding adolescent sleep needs to mitigate these issues.

Uploaded by

martina.chiani.24
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Extract 1

Patterns of Sleep and Sleepiness in Adolescents

Among the multiplicity of changes that accompany adolescence are


alterations in sleeping and waking patterns [1]. These changes arise from
a number of sources: changing academic demands, expanding social
opportunities, altered parent-child relationships, involvement in part-time
jobs, increased access to drugs and alcohol, etc. Also important among
factors resulting in changing adolescent sleep patterns are physiological
processes [2]. Very few studies have directly examined specific factors
that might influence the development of adolescent sleep patterns. As will
be shown below, empirical studies may call into question the conventional
wisdom. For example, it is a common perception and also a societal
expectation that adolescents do not really need as much sleep as
preadolescents. Our sleep laboratory data, however, suggest that older
adolescents may actually have a physiological need for more sleep than
preadolescents, not less. The cultural patterns in North America that
promote shortened nocturnal sleep in teenagers conflict with the
physiological imperatives requiring increased nocturnal sleep. Thus,
adolescents may become increasingly at risk for excessive sleepiness,
dysphoric mood, or even catastrophic accidents as a result of excessive
daytime sleepiness [3].
Several major trends emerge from the various survey studies. First, self-
reported nocturnal sleep time declines across the adolescent span.
Second, bedtimes during high school grow later and rising times earlier.
Furthermore, teenagers show increasingly large variations between
weeknight and weekend sleep schedules. The Strauch and Meier [I7] data,
for example, showed that weekend sleep times averaged about 30 min
less than weeknight sleep time in the 10- to 14-year-olds, and the
difference increased to over 2 h by age 18 years.
The timing of sleep on weekdays versus weekends also shows
progressively greater variability across the second decade. For example,
our survey of young adolescents [8] showed about an hour's weekend-
weeknight difference in 10-year-olds, increasing to about 90 min at age
13. More recently, we have found rise time reports in high school students
to average approximately 3 h later on weekends than on weekdays. In
college freshmen, bedtimes and rise times both slide to later times on
weekdays as well as weekends [18].
By far the most striking conclusion from the available information about
adolescent sleep is that many adolescents do not get enough sleep.
School schedules require waking up earlier and earlier, while academic
work loads, social obligations, and work patterns obligate staying up later
and later. Compressed between these daily bookends is an increasingly
narrow window for sleep. What happens when sleep is chronically below
Extract 1

an optimal level? In one experiment, we looked at this issue in a group of


10 college students [28]. To study their response, we brought them into
the sleep laboratory for 10 nights. On the first 3 nights, we allowed them
to sleep 10 h; then we reduced their sleep window to 5 h a night for the
next 7 nights. The effect across the 7 days following short sleep was
additive; that is, the students got progressively more sleepy every day.
One student actually became very sleepy on the day after the first short
night and was extremely sleepy for the final 5 days. The 'twilight zone'
refers to a state of sleepiness associated with impaired performance. All
but 1 of the subjects in this sleep restriction study [28] were in the
'twilight zone' at some point, most for significant portions of every day.
The pattern that we see emerging from all this information is a twofold
process that results in a significant level of daytime sleepiness in
adolescents. First - whatever combinations of factors may be involved -
there is a trend for shorter and shorter sleep times across the adolescent
span. In addition, puberty produces daytime sleepiness, even when sleep
time does not change. Insufficient sleep, therefore, exacts an extra
penalty during adolescence.
It is important to realize that excessive sleepiness is a potentially serious
problem. The scope of the problem has been paradoxically unrecognized
in part because adolescent sleepiness is so widespread and obvious that it
almost seems to be normal. Yet its consequences, if often subtle, are very
real and when a teenager is excessively sleepy, he or she has an
increased vulnerability to a number of poor outcomes. Excessive
sleepiness, as mentioned above, is associated with performance failures
and lapses. Such lapses impact unfavorably on learning and potentially
catastrophically on such activities as automobile driving. The sleepy
teenager is also at potentially greater risk to abuse drugs in an attempt to
increase alertness by self-medication with caffeine and more potent
stimulants. We have also noted evidence that increased alcohol use is
related to insufficient sleep in teens, at least in the context of our high-
work group. The relationship of alcohol and insufficient sleep may be
particularly hazardous for teenagers, due to the well-known tendency for
adolescents to engage in experimentation with alcohol and other risk-
taking behaviors. In this context, sleepiness may reduce an adolescent's
safety margin for such experimentation [3].
Other areas of a teenager's daily life may also be impaired by the
consequences of insufficient sleep. We are just beginning to obtain
evidence that moodiness in adolescents is related to sleep patterns. In a
recent study of sleep restriction in high school students [36], we asked 13
boys in 9th through 12th grades to reduce their sleep by 2 h a night over
5 consecutive nights. Each evening, they completed a mood checklist
(based on the scale of Lubin et al. [37]) as part of a daily
sleep/wake/activity diary. The checklist included three scales (positive,
Extract 1

negative, depressed). At the end of each week, the students also filled out
the Adolescent Depressive Mood Scale of Kandel and Davies [38]. The
positive and negative daily mood scales and the weekly Adolescent
Depressive Mood Scale all showed significantly dysphoric changes during
the period of reduced sleep. Although only a small preliminary study, this
finding suggests that a portion of the moodiness of adolescents may be a
consequence of insufficient sleep. To the extent that such mood changes
interfere with the teenager's ability to cope with daily stresses, poor
sleep/wake patterns may represent another serious threat to an
adolescent's well-being. Furthermore, chronic mood changes due to
chronic insufficient sleep may impair the teenager's relationships with
peers and with adults.
Another potentially serious complication of the typical trend for later
bedtimes in older adolescents is development of the Delayed Sleep Phase
Syndrome (DSPS), which appears to be caused by a defect in the brain's
clock mechanism that sets the timing of virtually all of the body's
biological functions [39]. In susceptible individuals, this clock can get set
incorrectly at a position that causes biological functions (including sleep)
to occur later than desired. Retiring and arising at late hours can initiate
the appearance of this malfunction. The teenager with DSPS is not
necessarily lazy or school phobic or acting out, but is utterly unable to fall
asleep before 5:00 or 6:00 a.m. and impossible to wake up before 2:00 or
3:00 in the afternoon. Such a pattern is clearly untenable for a school-
aged adolescent and requires special therapy through a sleep disorders
center.
No studies have looked at the possibility that preventive measures can
alter patterns of sleep and wakefulness during adolescence. In terms of
intervention, there are a few clinical studies in adolescents with DSPS
showing successful results of chronotherapy [40, 41]. In terms of
insufficient sleep, it is clear that the excessive sleepiness related to
insufficient sleep can be eliminated by extending sleep at night [10, 42,
43]. The latter experiments were all conducted in laboratory settings and
showed improved physiological alertness and performance with extended
sleep. Translation of this approach to the everyday lives of teenagers may
be more problematic. Perhaps the most useful approach may be one that
combines education of children, parents, teachers, and paediatricians
about the fundamental principles of proper sleep hygiene. The first goal of
such a program might be to disabuse people about the notion that
teenagers need less sleep.
Source:
Carskadon Mary, A. (1990). Patterns of Sleep and Sleepiness in
Adolescents. Pediatrician (17), 5-12.
Extract 1

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