Sleep: What can it tell me about my teen? Kristen C. Stone, PhD Assistant Professor (Research) Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Brown Center for the Study of Children at Risk Department of Pediatrics/ Women & Infants Hospital

In teens, biological sleep regulation conflicts with adult regulation of society. Often, the results are irregular and restricted sleep schedules for teens.

If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made. Rechtschaffen

Sleep is a symptom of caffeine deprivation. ~Unknown

Two Process Model of Sleep Regulation Borbély (1982) Sleep Drive Circadian Rhythm

Sleep Drive in Adolescents Across adolescence, sleep drive accumulates more slowly; older teens can stay up later than youngsters (Jenni, Achermann, & Carskadon, 2005) The speed at which sleep drive decreases at night does not change with puberty (Jenni, van Reen, & Carskadon, 2005).

Circadian Timing in Adolescents The older the adolescent, the later the circadian timing: a biological propensity to phase delay (Carskadon, Acebo, & Jenni, 2004)

Circadian alertness in teens Carskadon & Acebo, 2002

Homeostatic alertness (Sleep Drive) in teens Carskadon & Acebo, 2002

Adolescent Sleep Schedules SCHOOL NIGHT BEDTIMES: year olds PM (Carskadon, 1990; Link & Ancoli-Israel, 1995; Manber et al., 1995; O'Brien & Mindell, 2005; Wolfson & Carskadon, 1998) – Parents influence (Carskadon, 1990) > 50% of 10-year-olds parents set their bedtimes. 19% of 13-year-olds parents set their bedtimes. 5.1% year-olds – Activities (Carskadon, ). Homework Sports, musical groups, clubs, service groups Part-time jobs (>50%) TV, video games, computer, texting (more devices in BR = less sleep)

School Start Times High school rise time on school days = 6 am with a tendency for girls to rise slightly earlier (Carskadon, 1990; Link & Ancoli-Israel, 1995; Manber et al., 1995; Sleep in America Poll, 2006; Wolfson & Carskadon, 1998) Students aged years: time spent in bed on school-nights 9 hours (Carskadon, 1990; Manber et al., 1995) year-old students: time in bed 7.5 hours (Carskadon, 1990; Link & Ancoli-Israel, 1995; Manber et al., 1995; O'Brien & Mindell, 2005; Wolfson & Carskadon, 1998)

How much sleep do adolescents need? 9.2 hours regardless of developmental stage (Carskadon et al., 1980) 90% obtained less than 8 hours of sleep on school-nights (O'Brien & Mindell, 2005) Teens lose about 1.5 hours of sleep per night or about 7.5 hours per school week. – Start school day with residual sleep pressure – Accumulate a large sleep debt

How well do sleepy teens perform?

Outcomes in adolescent sleep restriction studies Cognitive performance declines Verbal creativity decreases (Randazzo et al., 1998) Visual vigilance declines (Sadeh, Gruber, & Raviv, 2003) Other studies show minimal differences (Carskadon et al.,1981; Fallone et al., 2001) Teens with better grades (Bs or higher) report more sleep than their peers (Sleep in America Poll, 2006) Teacher-evaluated school performance is worse in sleep-restricted 6-12 year-olds (~6.8 hours) compared with well-slept kids (~10.2 hours & 9.5 hours) (Fallone, Acebo, Seifer, & Carskadon, 2005)

How do sleepy teens feel? Increased negative emotions o Sadness/Depression o Anger o Fear

Can the sleep loss be recovered on the weekend? 2 hour sleep schedule delay on weekends o Increases sleepiness o Worsens mood o Impairs thinking (executive functioning) (Yang & Spielman, 2001)

Summary Biological sleep processes (sleep drive AND circadian timing) change during adolescence: – Sleep drive accumulates more slowly – Circadian phase delays – Both of these changes foster later sleep schedules for teens School start times prevent late rise times for teens Despite early rise times, teens stay up late (10-11 pm); therefore they rarely achieve the 9.2 hours of sleep they need during the school week. To compensate for lost sleep during the week, teens sleep in on the weekend. BOTH restricting sleep and shifting sleep schedules lead to poor daytime outcomes.

Crowley et al., 2010 Okay, so what are we supposed to do? One researchers idea... What the typical teen sleep schedule looks like The intervention group What can we do to help teens prevent circadian shift after the weekend? An afternoon nap?!

How can I help my teen sleep more and at the right times? Later rise times Earlier bedtime Bright light in the morning Dim light (minimal screen time) at night Minimal stimulant use, especially after noon Regular sleep schedules 90-minute afternoon nap on weekends Melatonin prescribed by a sleep specialist in serious cases of delayed sleep phase American Academy of Pediatrics: Sleep-Patterns.aspx Sleep-Patterns.aspx

Do the best you can!

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