Wake-up call: Teens running on too little sleep

When Judith A. Owens, MD, MPH, went to a local high school earlier this year to talk about the importance of getting a good night's sleep, she was dismayed to find a coffee concession in the lunch room. "Ostensibly, it's for the teachers," said the associate professor of pediatrics at Brown Medical School, Providence R.I. "But I don't think it sends the right message. Kids need to understand that caffeine is a drug, and it's not a substitute for sleep."

Dr. Owens, who specializes in sleep medicine, is part of the growing chorus of alarm about the fact that many teenagers do not get adequate rest and this shortcoming is not good for them. To address the problem, parent groups across the country are increasingly lobbying for later school start times, and physicians are raising their index of suspicion regarding teen sleep issues.

"Adolescents don't get enough sleep, and there's a price that they pay for that," said Carl E. Hunt, MD, director of the National Center on Sleep Disorders Research at the National Institutes of Health. "Sleep needs to be part of our health care information that we discuss with our adolescent patients."

The American Academy of Pediatrics, in conjunction with NCSDR, published a technical report in the June Pediatrics urging physicians to quiz teen patients about how much and how well they sleep, counsel them about good sleep hygiene and be alert to the possibility of sleep disorders. The rationale for focusing physician attention on sleep matters is a result of mounting evidence that documents the significant impact sleep loss has on overall health as well as the ability to study, participate in extracurricular activities and drive safely.

"Those aged 13 to 24 are just so sleep-deprived, it's ridiculous," said Richard P. Millman, MD, lead author and professor of medicine at Brown. "Kids are falling asleep in class. A lack of sleep is increasing motor vehicle accidents. This is a major issue."

A difficult problem to solve

But understanding the health importance of sleep is only half the battle. Translating that recognition into good medical care is another.

The authors admit that their paper is only a first step in raising awareness among physicians who care for teens. Tools to better address sleep deficiencies and disorders are expected to come later. For example, the specifics of how to question and counsel teens on this topic are not entirely clear. Experts do suspect, though, that such conversations will need to be more detailed than those conducted with adults.

"It's not enough to ask how much sleep adolescents get," said Ronald E. Dahl, MD, one of the paper's authors and professor of pediatrics and psychiatry at the University of Pittsburgh School of Medicine.

Many experts also note that this issue is far more complicated than simply telling teens to go to bed earlier. They say they are battling against a combination of ever-earlier school start times and an adolescent physiology that makes it inherently difficult for teens to get to sleep early.

"Adolescents have a shift in sleep rhythm, but school start times are too early," said Dr. Millman. "It makes it absolutely impossible."

Physicians who care for children agree that adolescents need more sleep but were not sure what they could do to change the situation.

"In theory, it's a great idea," said David Marcus, MD, a pediatrician from Boca Raton, Fla., and father of four -- including one in high school. "In reality, it's difficult to correct because school days start at 7:30. I don't know how you get them more sleep. I don't even have any solutions for my own child, who is always up doing projects."

Even if it is possible, teens may not perceive sleep as high priority.

"I'm perfectly happy to get in a nap," said Elliot Weinstein, MD, a pediatrician from Rancho Cucamonga, Calif. "The older kids are not quite as receptive."

Adolescents may also be copying the sleep patterns of their parents.

"Many parents are equally sleep-deprived," said Kingman Strohl, MD, professor of medicine and director of the Center for Sleep Disorders Research at Case Western Reserve University in Cleveland. "Parents may have sleep disorders or may have done the same thing as teenagers."

A study in the same issue of Pediatrics, however, did suggest one solution, though somewhat imperfect. Teens could compensate for the sleep lost during the week, by sleeping more when they have a chance.

Researchers linked the start of the school year with a loss of two hours of sleep per night during the week but a gain of around half an hour per night on the weekends.

"Sometimes we push our children to do a lot of extracurricular activities on the weekend," said Margarita Dubocovich, PhD, lead author on that paper and professor of molecular pharmacology and biological chemistry at Northwestern University Medical School in Chicago. "Maybe they should be allowed to sleep."