Dr. Jessica Rubinstein explains why other health issues in teens — headaches, depression, anxiety — can often be tied to sleep deprivation, and how parents can help turn that around.
Many of your patients are teenagers. Do they mention having a problem with sleep?
Sleep has become a major complaint. When one of my teenage patients complains about headaches, fatigue, stomachaches, depression or anxiety, I ask them about their sleep habits. Do they have trouble falling asleep? Do they nap in the afternoon? Are they waking up in the middle of the night?
Kids have told me they wake up in the middle of the night to text their friends. As I tell their parents, it is not a good idea for their children to have phones, laptops or TVs in their bedrooms — partly because they should know what the child is doing on the internet and partly for sleep hygiene. However, there is also a biological reason why teenagers have problems with sleep.
What is the biological reason?
During adolescence, the circadian rhythm or sleep-wake cycle changes. The brain produces melatonin, the hormone that makes us sleepy, later in the evening. As a result, teenagers aren’t feeling sleepy at 9-10 p.m., eight to nine hours before they have to wake up and go to school. So they’re sleepy during the day, which causes some of them to take a nap — and also interrupts their sleep cycle.
On weekends, teenagers typically go to bed later and then sleep late. Patients often tell me they have the most difficult time falling asleep on Sunday and Monday nights. All of this is totally biologic.
Do environmental factors also play a role?
Yes, beginning with electronic devices. We know that the blue light from a computer screen suppresses the secretion of melatonin. Kids often tell me their phone is in the bedroom because they use it as an alarm clock. What’s surprising is that parents typically go along with this.
Other factors include caffeinated drinks, which are widely available today; academic pressures, which now begin during middle school; and jam-packed schedules, including extracurricular activities and homework. We know about the increasing stress levels among area teenagers from Emerson’s 2014 Youth Risk Behavior Survey, which also revealed that 71 percent of high school students are getting seven hours of sleep or less. It’s not enough for healthy growth and development; the American Association of Pediatrics recommends they get between 8.5 and 9.5 hours.
Do you have suggestions for parents?
I encourage parents to consider if their kids have too much going on; take a look at their activities and the impact of, for example, taking multiple honors and advanced placement classes. You can only take so many classes when you have an hour of homework for each one every night.
I suggest that parents take on one factor at a time — maybe getting their teenager to stop napping and perhaps get some exercise instead. Then take on their caffeine intake. Finally, I would ask parents if they are modeling good behavior themselves. How much do they work? Do they allow themselves enough downtime?
What if parents have a hard time disciplining their teenagers about sleep?
If that’s the case, I would ask that they look at the health implications of sleep deprivation. People who get inadequate sleep are more likely to be overweight, partly because they have more hours in the day to consume calories. And when you’re tired, you don’t have good impulse control, so you can easily overeat.
Those who are fatigued are prone to get in car accidents, which is dangerous and a clear public health issue. Being a nuisance to your child — making them change behavior so that they get enough sleep — could be a lifesaver in the long run.
