A look at adolescent sleep needs
Waking up to the unique sleep needs of adolescents
Teenagers generally require 8.5 to 9.5 hours of sleep per night.1 The National Sleep Foundation (NSF) 2006 Sleep in America Poll revealed that adolescents report sleeping 7.6 hours on school nights, even though they feel that they need an average of 8.2 hours of sleep for optimal daytime function.2
More than 50% of teenagers feel sleepy during the day.2 Only approximately 20% of all surveyed adolescents (6th- to 12th-graders) report an adequate amount of nightly sleep (=9 hours per night); among high school students (9th- to 12th-graders), the percentage decreases to 9%, suggesting that sleep deprivation is more common in older adolescents. Interestingly, 90% of parents believe that their adolescent gets enough sleep on most school nights.
Adolescent sleep physiology
Circadian rhythms organize the timing of various biologic processes, including sleep regulation. Light is the main environmental stimulus that synchronizes the intrinsic human circadian period to the 24-hour day. Melatonin, a hormone secreted by the pineal gland, induces evening drowsiness and also maintains the inherent sleep-wake cycle. Light blocks the secretion of melatonin; therefore, light exposure at bedtime can delay sleep initiation. Advanced Tanner stage has been associated with a delay in melatonin secretion in adolescents aged 11 to 14 years.3 In addition, adolescents seem to have a longer circadian period (24.3 hours), and difficulty entraining their sleep-wake cycle to the 24-hour solar day causes circadian phase delay or a "night owl" tendency to stay up late at night.4 This circadian alteration during adolescence has been observed across various cultures throughout the world and even across several mammalian species.5
Sleep-wake homeostasis refers to the buildup of "sleep drive" throughout the day. A prolonged period of wakefulness increases the intrinsic need for sleep, or sleep pressure. Taking a nap in the afternoon affects sleep homeostasis by decreasing this drive to sleep, thereby delaying sleep onset at bedtime. Adolescents with more advanced Tanner stage have a slower accumulation in sleep pressure compared with younger, less mature adolescents.6 This pubertal decrease in sleep drive may promote delayed sleep initiation in teenagers.
 Figure 1: Adolescent sleep need. Adolescents may accrue a 2-hour sleep debt each school day. Data from the National Sleep Foundation.2 |
Sleep behaviors
Based on the 2006 NSF poll, most adolescents (97%) have an electronic device in their bedrooms.2 Seventy-six percent of adolescents report watching television within an hour of bedtime. One study found that among adolescents aged 12 to 18 years, 82% watched television and 55% used their computers after 9 PM.8 Other nighttime activities include watching DVDs, cell phone use, and playing video/computer games. It has been hypothesized that adolescents experience an exaggerated response to the circadian phase-delaying effects of nighttime light exposure; therefore, light stimulation associated with use of electronics close to bedtime may exacerbate their natural night owl tendency.5
 Table 1: Caffeine content chart |
Other activities that keep teenagers up at night include evening homework, extracurricular activities (eg, athletics), jobs, and socializing. Adolescents who work 20 or more hours per week attain less sleep, tend to oversleep more on school days, and report increased use of caffeine, alcohol, and tobacco compared with adolescents who work fewer than 20 hours per week.12 Parental influence on setting bedtimes dramatically decreases as adolescents get older. Adolescents who have a curfew get to sleep earlier, wake up earlier in the morning, and have less daytime sleepiness.
MORE ARTICLES IN THIS ISSUE
Young boy suffering from a rapidly spreading rash
You are called to the emergency department to evaluate a 2-year old boy with a fever for 5 days and a rapidly spreading rash on his face, arms, and legs for 2 days. The rash was made up of 3-mm to 6-mm diameter elongated vesicles on a red base. He is irritable and not eating well. There was another child at his day care with a similar rash, and his mother is worried that his 8-month old brother will develop the same illness.
Physicians missing blood pressure checks in kids
Many physicians are not monitoring children's blood pressure during ambulatory or preventive care visits as recommended by the American Academy of Pediatrics (AAP) and the National Heart, Lung, and Blood Institute (NHLBI).
A girl with abnormal movements and emotional lability puzzles doctors
While on the inpatient pediatric service, you receive a call from the emergency department (ED) about a 6-year-old girl who has abnormal movements and emotional lability. When meeting the child and her mother, you discover that the illness began about a week before presentation, when the child was sent home from school because of headache and vomiting.
Quality care measures for children proving difficult to quantify
Born almost 3 years ago, the set of federal measures for quality care for children in Medicaid and CHIP is being slowly pushed out of infancy; however, states are having difficulties gathering and reporting data, which may keep some of the measures aspirational for some time.
ONDCP paying attention to prenatal exposure to opioids
The nation's drug czar's office highlighted the issues around the increased use of opioids by pregnancy women at a recent meeting, held just across from the White House.
Childhood obesity a risk for developing gallstones
Children who are overweight or obese, especially girls, face an increased risk for developing gallstone disease compared with their normal-weight peers, according to research by Kaiser Permanente Southern California.
The importance of being an "intrusive" parent
Intrusive parents may not effectively prevent every risky or dangerous behavior by every teenager, and dangerous drugs and guns are but 2 of the possible risks, but intruding is the first step.
The risks of heavy backpacks on schoolchildren
Schoolchildren with heave backpacks risk back pain and pathology.
IUDS, implants best birth control choices for teenagers
Long-acting reversible contraception (LARC) is the best choice for preventing unintended pregnancies, rapid repeat pregnancies, and abortions among sexually active adolescents and should be the first-line recommendation by health care providers, according to the American College of Obstetricians and Gynecologists.
Warning on SimplyThick now includes infants of any age
The US Food and Drug Administration (FDA) cautions that SimplyThick, a brand of thickening agent added to breast milk or formula for premature babies, has been linked to necrotizing enterocolitis (NEC) in a full-term infant.
The new drugs leading to substance abuse
Synthetic cannabinoids and cathinones have become drugs of abuse for adolescents and young adults. Research suggests that there is potential for great harm with chronic use.
Children with arthritis face elevated cancer risk
Children diagnosed with juvenile idiopathic arthritis (JIA) have triple the risk for cancer, and the findings hold for those who were never treated with biologic therapies for JIA, according to a new study.
Iron indices evaluated as tools for differentiating infection
Greek researchers conducted a study in 69 children with febrile illness who were admitted to a hospital with a diagnosis of a bacterial or viral infection to assess established iron indices in acute febrile infections and to explore whether serum iron distribution differs depending on whether the infection is bacterial or viral.
Pets can affect risk of infant respiratory infections
A study in Finland found that infants who had contact with dogs in their first year showed fewer respiratory tract symptoms or infections.
How oral health affects academic performance
Tooth pain, dental disease, and poor access to dental care adversely affect how children perform in school and are associated with increased school absences and missed parental days of work.
About Epstein-Barr virus-associated infectious mononucleosis
Although the Epstein-Barr virus causes most illnesses presenting as mononucleosis, clinicians should be able to recognize and consider alternate differential possibilities.
