Perspective: Teenagers and the sleep paradox

Abstract

Study Objectives:

Teenagers experience sleep deficits as they try to manage expectations with school, their social media presence, and increasingly competitive extracurriculars. Late-night screen time is a barrier to sleep hygiene. It is important to acknowledge and understand lifestyle challenges that can prevent teenagers from receiving adequate sleep every night. A teenager perspective on these issues and recommendations can incite better ways to outreach, educate, and support teenagers in maintaining good sleep.

Methods:

We describe what is known and not known about sleep health among teenagers and challenges to maintaining adequate sleep from the perspective of a third-year high school student. We also provide recommendations for outreach to promote early recognition of issues and tools that can support sleep hygiene to reinforce future mental and physical health.

Results:

While teenagers enjoy good sleep, this is limited by heavy loads of homework along with increasingly competitive extracurriculars, keeping up with social and cultural demands, and early school starts. Also, teenagers may not understand what adequate sleep entails and the full impact of sleep on well-being.

Conclusions:

Social media provides a channel to extend outreach to teenagers to communicate the importance of consistent quality and quantity of sleep, increase awareness of sleep tracking tools, and highlight the impact of sleep on mental health. Additionally, better engagement is needed with schools and community to manage academic and extracurricular schedules that allow teenagers to schedule consistent bedtimes and wake times.

Citation:

Ramar S, Lloyd RM Perspective: teenagers and the sleep paradox. J Clin Sleep Med. 2023;19(8):1569–1571.

BRIEF SUMMARY

Current Knowledge/Study Rationale: Teenagers acknowledge the importance of getting 8 hours of sleep; however, they may not know what good sleep entails to maintain wellness. It is important to understand the challenges teenagers face to maintaining adequate sleep including shifts in the circadian rhythm and increasing academic, social, and cultural demands.

Study Impact: We describe a teenager’s perspective on what is known regarding sleep health, challenges teenagers face in maintaining adequate sleep, and recommendations on outreach for early identification of issues and support for sleep health during adolescence. This perspective provides an opportunity for policymakers and community members to take actions that can facilitate overcoming barriers to sleep that teenagers face and promote this important aspect of adolescent health.

INTRODUCTION

The American Academy of Sleep Medicine recommends that teenagers get between 8 and 10 hours of sleep per night to maintain their physical health, emotional well-being, and focus at school.^1,2 Data from surveys conducted in the United States between 2007 and 2013 found that nearly 69% of high school students got 7 or fewer hours of sleep per night; in 2019 that number went up to 75%.³ Estimates place the rate of insomnia among adolescents as high as 23.8%.⁴ As a third-year high school student, I present my perspective on what teenagers know about sleep, challenges to getting adequate sleep, and recommendations to address them. Understanding the challenges to sleep from a teenager’s perspective provides an opportunity for policymakers, providers, and educators to take actions to facilitate overcoming these barriers.

WHAT TEENAGERS KNOW ABOUT SLEEP

Teenagers acknowledge the benefits of good sleep; my peers note improved alertness and performance when they have had good sleep, and they describe difficulties finding motivation during the day, looking for opportunities to nap in a darkened classroom when they have been deprived of sleep. Teenagers hear that 8 hours of sleep are recommended, though they may not understand what that entails.⁵ I recently took a health class where the importance of getting 8 hours of sleep was mentioned; however, the why and how were unclear. My friends and I look forward to sleeping in on the weekends to get us through weeknights of late hours. I now know that this can lead to difficulties with establishing a bedtime to allow for sufficient sleep. I also did not know that good sleep includes 8 to 10 hours of sleep in a 24-hour period without naps, falling asleep within 30 minutes, not waking more than once per night, consistent bedtimes, and feeling rested and energized upon waking.^6,7

Teenagers are adapting to more independence, responsibility, and new social relationships, not realizing that lack of adequate sleep can affect mood, resulting in exaggerated emotional reactions such as anger and frustration.⁸ They face situations and decisions every day where sleepiness could lead to interpersonal conflicts and mental health conditions including anxiety and depression. Lack of adequate sleep promotes impulsive behavior, and studies have found an association between teenagers not getting enough sleep and high-risk behaviors like substance use, drunk driving, risky sexual behavior, carrying a weapon, and failing to use a seatbelt.⁹ Sleep-deprived driving, with decreased reaction time, and dangers multiplied by distractions and less experience with driving to begin with, can be as dangerous as drunk driving.¹⁰ One of the leading causes of injury and death in teenagers are car accidents.¹¹ I believe these negative consequences are not well known among teenagers

WHY CAN’T/WON’T TEENAGERS SLEEP?

Teenagers can sleep well when allowed to sleep on their own schedule; however, increasingly competitive social and cultural demands that reward academic achievement, structured productivity, and extracurricular accomplishments make this difficult. In addition, teenagers often contend with family and job responsibilities and a social media presence to keep up with their peers. While sleep hygiene experts suggest unplugging an hour before bedtime, teenagers find themselves spending nighttime hours jumping from computer screens to phone screens and fueling up with caffeine to keep going, all of which further delay the body’s natural sleep signals.

Studies have found increased sleep deficits in older adolescents compared to younger adolescents, with electronics as the number one reason for sleep loss.¹² I often see late-night social media pings among my peers that are questionably necessitated, a snap of a friend’s bedroom ceiling or part of their face acknowledging that they are still awake too. Perhaps ironically, as we fear falling short with our rigorous high school course load, we also fear not being competent and responsive enough to social media apps and not being in the know for daytime interactions with our peers that feed from social media news, trends, and conversations.

Many of my high-achieving peers chronically deprive themselves of sleep and find satisfaction in saying they stayed up late; it comes with bragging rights. I notice that they miss days of school to cope with sleepiness and other health issues. Persistent delay in sleep leads to insomnia and insufficient sleep syndrome, which can result in anxiety, depression, and suicide.^13,14 There is an emerging epidemic of mental health conditions among young people with an alarming association between sleep deficits and future psychopathology.¹⁵ Adolescents who do not sleep well are more likely to have school absences and show more symptoms of depression.^16,17

RECOMMENDATIONS

Advocacy for later start times continues, and school districts are testing later schedules with positive results.¹⁸ This year my school district shifted the start time to 1 hour later, and I hope this will be implemented more widely. Health care professionals who understand the pressures faced by today’s teenagers can reinforce the benefits of getting adequate sleep and help them plan for balance with social and cultural demands. Teenagers use social media for information on everything from world news to lifestyle hacks.¹⁹ This may be a good channel to further education on how to get consistent quality sleep, as well as to stress the negative consequences of inadequate sleep. Research around the use of social media and sleep is still evolving, and there is some indication of bidirectional association where teenagers may use it as a sleep aid.²⁰ I have found that apps on my phone can schedule silencing notifications and prompt a consistent bedtime routine. Similarly, there are apps and devices that can help teenagers track and actively monitor their sleep.

There is room for further community allegiance to reinforce sleep health for teenagers. Parents and school officials can help with trimming expectations to reduce stressors that interfere with getting adequate sleep. For example, restricted daily hours for extracurriculars and improving alignment of academic deadlines and the schedule of extracurriculars (ie, avoid testing the day after a late-night away game or staggering due dates for big assignments). Outreach through different platforms including social media is important to motivate screening for sleep-related concerns, as early engagement with health care providers can expedite identification of sleep issues and support for sleep health during adolescence, promoting future physical and mental health benefits.

DISCLOSURE STATEMENT

All authors have seen and approved this manuscript. Institution where work was performed: Mayo Clinic. The authors report no conflicts of interest.