Sleep Deprivation and Adolescents

Introduction
We can go longer without food than we can without sleep. Yet in our modern culture, it seems sleep is no longer a required activity. Students wake early to attend school, then postpone sleep for the priorities of homework. Adults find no respite once their schooling is complete, our preoccupation with productivity makes sleep the seeming refuge of idlers. Caffeine encroaches more and more into our diets, offering an easy pick-me-up to keep us going long after our bodies cry for rest. Does the devaluation of sleep offer us more time to get what we need done? Perhaps. However, long-term sleep deprivation may be harming our society, and ironically our productivity, without us even realizing it.

Sleep is a basic human need, a fundamental drive which cannot be ignored without repercussions. Sufficient sleep lets us think more clearly, accomplish complex physical and mental tasks more completely and more consistently, and keeps us more emotionally stable. Insufficient sleep slows our cognitive processes, decreases the ability to concentrate, and can result in short-term memory loss and reduced learning ability (NIH, 1997).

This report seeks to answer the fundamental question:

What are the long-term effects of sleep deprivation, and what are the repercussions of sleep-deprivation in adolescents?
In order to provide a satisfactory answer, three supplementary questions must be posed:

1. What are the functions of sleep, and what are the psychological and behavioral outcomes of short-term and long-term sleep deprivation?

2. How much sleep do adolescents require, how much are they getting on average, and what is the end result? What are the causes of sleep deprivation in adolescents, and hence, does sleep deprivation pose a tangible risk?

3. If adolescents are not getting enough sleep on average, what could be done to change the situation?

Note: Due to space constraints, this paper will not include information or research pertaining to clinical sleep disorders, instead focusing on the sleep habits and patterns of normally functioning adolescents.

Adolescents have complained for decades about their desire for more sleep, and current research is showing just how essential adequate rest is for both teens and adults. Research shows that not only do many adolescents not get enough sleep, but that the consequences can be more dire than a couple yawns during breakfast. Inadequate sleep patterns in young adults is now being linked to low grades and poor school performance, negative or hostile moods, increased possibility of drug use, and increased risks of injuries or death (Wolfson and Carskadon, 1998).

Are our sleep-sick youth simply doomed by biology to sleepy days, or is it the fault of our current societal systems? Would changing our school and work clocks to coincide closer to our own internal clocks actually help rather than hinder our driving productivity? We may pay a higher price to our alarm clocks than we realize.

I - What is the function of sleep?
In order to understand sleep deprivation in any of its forms, it's important to understand the nature and functions of sleep itself. Scientific excursions into the field of sleep research are a relatively modern concept, which seems unusual considering we spend a third of our lives asleep. One of the most important discoveries was that although to all external observers it appears as if a sleeping subject is completely inert, an electroencephalograph (EEG) measurement tells a different story. Our brains are deceptively active while we sleep. By the late 1930's, EEG measurements were well-established instruments of scientific investigation, and through EEG measurements of brain wave patterns during sleep, it was found that sleep can be divided into five stages, each with distinctly different types of brain activity (Hobson, 1989).

Fig 1 : The stages of the sleep cycle are repeated several times during sleep, each time ending with more time spend in REM sleep. It is important that these patterns continue for full and healthy rest, and sleep deprivation disrupts these natural cycles. (sleep-deprivation.com, 2005)

The fifth stage of sleep is accompanied by rapid flurries of the eyes and eyelids, and as such, is known as Rapid Eye Movement (REM) sleep. Stages I-IV (which occupy the first 50-70 minutes of sleep) are classified as non-REM sleep, with stage IV being what we know as �â'¬Å"deep�â'¬ï¿½ sleep. During REM phase sleep, the brain is a frenetic source of active brain waves, which is not so surprising considering it is during REM phase sleep that we dream. Each phase of sleep is important to rejuvenating the body, however REM sleep is associated with short-term to long-term memory transference, and deep cognitive restorative functions (Martin, 2004).

While the properties of sleep are still being researched and understood, it is easier to see what going without sleep does to the body, than exactly how sleeping helps individuals. Short-term sleep deprivation, such as staying up all night for only one night, can often be seen in college students after a term paper is due: very low alertness levels, yawning and drooping eyelids, combined with an inability to focus or concentrate (Martin, 2004). Moods take a dive, and the ability to accomplish tasks effectively or interact with others is substantially reduced. The short-term sleep deprived subject is in sore need of a long weekend.

Long-term sleep deprivation, however, is no less harmful both physiologically and psychologically. Sleep loss over long periods of time (one or more hours a night over many nights) causes many of the same problems as short-term deprivation, except since the effect is less pronounced, most people only have a vague realization of the problem.

II - What are the reasons for deprivation?
There are myriad reasons why sleep deprivation can occur, ranging from working late, to stress, to simple illness. However, the human tendency to work during the day and sleep at night is at its core a function of our circadian rhythms (the internal 24-hour cycle or biological clock), and it can be theorized that modern sleep deprivation would not be as prevalent without artificial light. Electric lighting allows us to artificially bypass our natural circadian rhythms, our day and night cycles have the ability to become blurred, and we can stave off our natural times of sleepiness, despite the fact that rest is still needed.

With the advent of artificial lighting, the work day has become nearly as long as we can stand it. The circadian rhythm of adolescents is different than that of adults, and because there is less public knowledge of adolescent sleep needs, these rhythms can be easily thrown off balance. Teens tend to stay up late working on homework, or are simply unable to sleep at predetermined bedtimes, then are forced to wake up long before their natural needs for rest have been satisfied. Since there has been so little verifiable scientific research done on the large-scale long-term effects of sleep deprivation, society's march towards sleepless nights and unprecedented working hours has continued unabated.

Ignoring medical conditions which may interfere with sleep, sleep deprivation in adolescents is generally characterized by too much schoolwork, early school start times, and the natural inclination of adolescents to stay up late. These and other factors such as sports and after school jobs often work to create an unhealthy environment for restful sleep. Teens are also at high risk for drug and alcohol experimentation, substances which often have detrimental effects on sleep.

III - How much sleep do adolescents really require?
Only recently has research been seriously undertaken regarding the sleep habits and needs of adolescents. Researchers have identified changes in sleep patterns, sleep/wake systems and circadian timing associated with the changes during puberty. These changes contribute to excessive sleepiness which can have negative effects on many adolescents, including increasing their risk of injury or poor academic performance (Carskadon, 1999).

Scientists hypothesize these that sleep related problems in adolescents are due largely to conflicts between physiologically-driven sleep needs and patterns, and the behavioral and social factors that influence their sleeping habits.

Key changes in sleep patterns after the onset of puberty are as follows:

--Adolescents require at least as much sleep, if not more, as they did as pre-adolescents (approximately 8.5 to 9.25 hours per night).�â'¬ï¿½ (NSF, 2000)

--Sleepiness during the day increases, even when an adolescent's schedule allows for necessary, natural amounts of rest.�â'¬ï¿½ (NSF, 2000)

--Adolescents sleep patterns undergo a phase delay (that is, a tendency toward later times) for both sleeping and waking. Current studies suggest that the average high school student's natural time to fall asleep is 11:00 pm or later.�â'¬ï¿½ (NSF, 2000)

These physiological changes are then compounded by the hectic weekly schedules which are now the social norm. Most school-age adolescents do not get sufficient sleep, especially during the week. Adolescents have irregular sleep patterns; their sleep habits during the work week are much different from their habits over weekends, Survey data shows that average total sleep time during the school week decreases from 7 hours, 42 minutes in 13 year olds to 7 hours, 4 minutes in 19 year olds (Wolfson and Carskadon, 1998). 15 percent of adolescents said they slept 8.5 or more hours on an average school night, 26 percent of students reported sleeping 6.5 hours or less each school night. This means that only 15 percent of adolescents are getting an adequate amount of sleep each night, and this number is even lower in average high school students.

Data on average sleep habits is difficult to analyze due to the fact that adolescents have irregular sleep patterns; sleep schedules during the school week end up much different than those over the weekend. This is to some extent a direct consequence of their average weekday sleep loss. Students stay up late during the week working, then are forced to wake up earlier in the morning than is naturally acceptable for their sleep cycles.

Psychosocial patterns such as these create fundamental differences in both the timing and quantity of sleep. One study of more than 3,000 adolescents showed the average increase of weekend compared to weekday sleep, among ages 13-19, to be one hour and fifty minutes (Wolfson and Carskadon, 1998). The average sleep time discrepancy in 18 year olds was found to be more than two hours, which could significantly affect academic habits. As well, 91 percent of high school students surveyed said they went to sleep after 11:00 pm on weekends. Another 40 percent reported going to bed after 11:00 pm on average school nights. Though the natural tendency during (and post) puberty is to go to sleep around 11:00, waking up at 7:30 or later is rarely an option, which contributes to daytime sleepiness.

These irregular sleep schedules can contribute to a shift in sleep phase, in other words, a tendency towards morningness or eveningness. Significant discrepancies between weekdays and weekends may also create problems falling asleep at night or awakening in the morning, as well as fragmented, poor quality sleep (Carskadon, 1999).

IV - What serious problems does this effect pose?
Besides days filled with yawning, scientific data on adolescents confirms that long-term sleep deprivation can have serious detrimental effects. Research shows that excessive sleepiness is associated with a variety of psychological and physiological effects contributing to lower health and higher risk.

Insufficient sleep in adolescents as well as adults is linked to increased risk of injuries or death, especially in drivers. Drowsiness and fatigue have been identified as a principle causes in over 100,000 traffic crashes each year, one-sixth of all traffic accidents in the US are believed to be attributed to attention lapses by drivers, with fatigue and general sleep loss a significant factor in the chances of a lapse occurring (NIH, 1998). One study found that drivers age twenty-five or younger cause more than 55 percent of fall-asleep crashes, and that young drivers on average were five to ten times as likely to crash at night than in the morning. The same lapses and symptoms of sleepiness associated with driving accidents also contribute to non-traffic injuries, such as handling dangerous chemicals or hazardous equipment. Anne Williamson (2005), a sleep researcher from the University of New South Wales, indicated that lack of sleep increases risky behavior much the way drugs and alcohol affect similar judgements.

As previously stated, sleep deprivation in adolescents has a tendency to result in lowered grades and poor academic performance. The majority of high school students who described themselves as having lowered scholastic performance, and were earning C's or below in their high schools, also reported getting less sleep than they presumed they needed. They also noted having later bedtimes and more irregular sleep habits on average, than students with notably better grades and academic habits (Wolfson and Carskadon, 1998).

One symptom of general sleep deprivation both adults and adolescents can agree upon is that less sleep will affect your mood. Adolescents with even moderate sleep debt will begin to show signs of unusually negative moods, and are more likely to become angry, sad, or afraid for little reason. Female high school students who went to bed on weekends two or more hours after their peers reported feeling more depressed than those who did not postpone sleep (Wolfson and Carskadon, 1998). Studies also show sleep deprivation may create difficulty in controlling emotional or behavioral problems in adolescents (Dahl, 1999). Certain indications of excessive sleepiness, such as an inability to focus, impulsivity, and problems staying still or completing tasks, resemble the symptoms associated with ADHD. A study of students in transition from middle to high school found that misbehavior and aggressiveness was closely linked to shorter sleep times and later initial bedtimes (Wolfson et al., 1995).

In my own investigation of adolescent sleep deprivation, I simulated the high school or college experience of studying late, as many students indicated that on weeks with large tests or term papers, they got four or less hours of sleep for an extended period of time, often several days. I deprived a group of high school adolescents comprising various ages of all but four hours of sleep per night for a maximum of five nights. Most of the group lasted a realistic maximum of only three days, each day becoming progressively less coordinated, more irritable, and less able to focus on repeated tasks. All members of the group reported having felt similar reactions on several occasions that year, along with many times over the course of their schooling (See Appendix B for further information).

Teens who get less sleep than they need also have a higher likelihood of drug use (Carskadon, 1990). This is not limited to stimulants, alcohol use is also more prevalent among teens who report getting less sleep than their peers. Alcohol can facilitate �â'¬Å"unrestful�â'¬ï¿½ sleep; sleep which has an inhibited REM phase and therefore leaves users exceptionally tired even after a night of sleeping. Stimulants such as caffeine or nicotine over long periods of time not only create a dependency on the substance in order to �â'¬Å"wake up,�â'¬ï¿½ but can also significantly affect the quality of sleep. Caffeine is in fact a psychoactive drug, though we rarely realize it, and the rate at which teens are becoming dependent on caffeine during their days is an alarming indication of underlying sleep problems.

V - What can be done to alleviate the problem?
The consequences of sleep deprivation in adolescents is especially important to understand because the symptoms are closely tied to key elements of human development during adolescence. Many sleep researchers are now saying intervention to improve sleep patterns in adolescents is critical to their development psychologically and socially. Groups such as the National Sleep Foundation (http://www.sleepfoundation.org) are working to increase awareness of the sleepiness in our society, and are now working to help schools, parents, and adolescents to improve their sleep habits and alleviate sleep deprivation.

The largest public effort to help with sleep deprivation in adolescents needs to start in the public schooling system. Suggestions include:

§ Educating teachers, school health providers, and other school officials about adolescent sleep needs and patterns, as well as the signs of excessive sleepiness and alertness difficulties posed by sleep loss.

§ Integrating sleep-related education in public school curricula as required sub-courses, so students can learn about the and benefits of healthy sleep, and the consequences of sleep loss. These could also be integrated into biology, health, or psychology courses. In addition, driver's education courses should cover the effects of sleep deprivation on driving, the prevalence and prevention of sleep-related accidents. (In fact, drowsy driving has begun to be integrated into drivers education classes and pamphlets due to new legislation.)

§ A restructuring of school schedules to better accommodate adolescent sleep needs, behaviors, and circadian rhythms. One favorable approach is to start daily high schools and middle schools later in the day, when students are more likely to be alert and ready to learn. Several school districts in the U.S. have adopted later start times due to sleep deprivation studies; many more are considering doing so (NSF, 2000).

Preliminary findings in studies conducted by the University of Minnesota show that high schools which developed later start times had students who reported they felt more rested and alert throughout the day, especially during their first one or two periods (Wahlstrom and Freeman, 1997). Additionally, students in a nearby high school district whose schools delayed their start times, reported less erratic sleep, higher grades, and less feelings of depression. It was also noted that students found little conflict with the later start times and extracurricular activities. Teachers reported that their students appeared more active and alert, as well as substantially improved student behavior and general attendance (Wahlstrom and Freeman, 1997).

This is not to say that later start times are a foolproof solution. In some Minneapolis high schools, student mood appeared unaltered, and conflicts with extracurricular activities and student jobs were more pronounced, due to the later start times and therefore later end times (Wahlstrom and Freeman, 1997). School start times are early so that students (and their parents) can go to work or participate in extracurricular activities such as daylight athletics during the 9-5 weekday schedule. A change in school start times, without a change in the schedules of many other time-scheduled activities, results in well-rested students who may not have time for a needed job or after-school activity.

Adopting later times is a complex system for any school district, and is composed of many more factors than just the schools. The shift in bell schedules results in a need for school buses, food services, and faculty to adjust their own schedules to the district's, which is not always met with warm reception. Parents trying to transport their children in the morning may find themselves strapped for time as their child's school starts closer to their work. If later school start times become normal behavior for public school districts, the rest of the affected community will have to agree and cooperate for the entire system to function.

VI -- Implementing social change
Federal policies are key to significantly influencing social change. Efforts towards these policies can be spearheaded by state or district medial societies, public health department, social service agencies, or other governmental organizations. One key policy is legislation to encourage starting high schools no later than 9:00 am, as well as appropriations to help with any increased district costs related to changing school start times (See Appendix A, Z's to A's Act). This would directly affect sleep schedules by giving high school students more time to sleep according to their natural circadian rhythms.

Other policies include the previously mentioned integration of sleep related material into mandatory school curricula, in grades K - 12. Also, more detailed child labor laws might take into account the requirements of sleep in minors, and these requirements could be integrated into work schedules for adolescents. Federal programs to educate adults such as teachers, caregivers, and parents about the necessities of proper sleep habits in adolescents could easily help with deprived teens, though all federal policies require adequate funding and it has often been economic concerns which have postponed sleep-related legislation. With further funding, sleep deprivation education and prevention services, as well as research programs into the nature and benefits of sleep in all age groups, could likely break new ground in this field. It is important to note however, that further funding might take away from other federal programs delegated towards adolescent needs, and therefore be more detrimental than beneficial.

Finally, it is important to note that the simplest and most cost effective method of correcting and preventing long-term sleep deprivation is parental intervention. Though parental influence over sleep habits generally diminishes during high school, adolescents of middle school age need bedtime restrictions which help balance their circadian rhythms. A consistent sleep schedule will encourage good sleep habits on through high school and college, not to mention a parent's influence over whether a child is using caffeine, alcohol, or other sleep altering substances.

Conclusion
Research into sleep deprivation in adolescents is fairly modern, but there has been enough research done to give at least a partially answer to the question: What are the long-term effects of sleep deprivation, and what are the repercussions of sleep-deprivation in adolescents?

Research has shown that sufficient sleep is fundamental to our daily health, and the long term deprivation many people experience is harmful, even though the effects may be less than obvious. Insufficient sleep makes us irritable and more depressed, it damages our ability to solve problems and concentrate to the full extent of our abilities. Overall, it harms our developing youth.

The long-term effects of sleep deprivation have so far been identified as lower alertness levels overall, increased feelings of depression, unusually negative or aggressive moods, inability to focus and/or concentrate, and a higher risk of dangerous behaviors. These are especially important when relating to adolescents, as their circadian rhythms make them particularly susceptible to sleep deprivation in both short and long-term. The repercussions can be dire according to relatively preliminary research, with reduced academic performance and increased feelings of depression key consequences found from modern study. Repercussions also include an increased chance of risky behaviors, such as drug use, which can lead to a circular cause and effect relationship between sleep deprivation and unhealthy behavior.

In an increasing amount of research, it has now been shown that the majority of U.S. students suffer from some form of regular sleep loss or erratic sleep habits, and the world average isn't so much better. Yawning adolescents trudge to school, many unaware of the fact that their sleep habits may be unhealthy. Sleep deprivation causes adolescents problems in school, and later problems at home as bedtimes may not coincide with their developing sleep interests and needs. Its effects create caffeine addicts and drowsy drivers, and has been seen to correlate with adolescent depression, but hope may be on the way.

Research groups looking into sleep habits and sleep deprivation in adolescents are working to change the current schedules teens must abide by. Using new knowledge, they hope to alter the way both teens and adults look at sleep, and how much sleep we truly need, considering the most recent studies show we need more sleep than most of us get. My own research imitating a college study week supported the notion that although sleep is a commodity many students try to do without, it is necessary for proper and healthy daily living. Now it seems we are paying more for our fast-paced progress, along with our hectic work and school schedules, than we truly bargained for.

Will our alarm clocks change to suit our natural biological rhythms? For the time being, many sleep deprived adolescents are left to dream of the eight-hour night.

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