Dr. Anuj Chandra Joins Group Seeking More Sleep For Adolescents

Tuesday, March 28, 2006

Many of the nation’s adolescents are falling asleep in class, arriving late to school, feeling down and driving drowsy because of a lack of sleep that gets worse as they get older, according to a new poll released today by the National Sleep Foundation (NSF).

Dr. Anuj Chandra of the local Advanced Center for Sleep Disorders was among those comment on the survey.

In a national survey on the sleep patterns of U.S. adolescents (ages 11-17), NSF’s 2006 Sleep in America poll finds that only 20% of adolescents get the recommended nine hours of sleep on school nights, and nearly one-half (45%) sleep less than eight hours on school nights.

What’s more, the poll finds that parents are mostly in the dark about their adolescents’ sleep. While most students know they’re not getting the sleep they need, 90% of parents polled believe that their adolescent is getting enough sleep at least a few nights during the school week.

The poll indicates that the consequences of insufficient sleep affect nearly every aspect of teenage life. Among the most important findings:

 At least once a week, more than one-quarter (28%) of high school students fall asleep in school, 22% fall asleep doing homework, and 14% arrive late or miss school because they oversleep.
 Adolescents who get insufficient amounts of sleep are more likely than their peers to get lower grades, while 80% of adolescents who get an optimal amount of sleep say they’re achieving As and Bs in school.
 More than one-half (51%) of adolescent drivers have driven drowsy during the past year. In fact, 15% of drivers in 10th to 12th grades drive drowsy at least once a week.
 Among those adolescents who report being unhappy, tense and nervous, 73% feel they don’t get enough sleep at night and 59% are excessively sleepy during the day.
 More than one-quarter (28%) of adolescents say they’re too tired to exercise.

Dr. Anuj Chandra of Chattanooga's Advanced Center for Sleep Disorders commented: "People tend to see teenagers staying up late during the week and sleeping late on the weekend, and so they don't think it's a problem. This survey shows that there is a problem and that parents are aware how serious it is. Insufficient sleep is a real problem for teenagers. It's not just part of growing up and having a busy life. Parents need to help their teenagers get enough sleep, because it's very easy for their grades and their health to suffer if they don't get enough sleep."

"Serious health consequences of getting too little sleep or poor quality sleep tend to show up later in life, just like it happens with bad diet and sedentary lifestyle," Dr. Chandra added. "It's so important for parents to help their children establish good sleep habits early. In recent years, we as a society have become much more aware of the health consequences of eating poorly or not getting enough exercise, but most people still don't know that it's the same with sleep. Your body needs good quality sleep just as much as it needs good food and exercise."

The poll also finds that the amount of sleep declines as adolescents get older. The survey classifies nine or more hours a night as an optimal amount of sleep in line with sleep experts’ recommendations for this age group, with less than eight hours classified as insufficient. Sixth-graders report they sleep an average of 8.4 hours on school nights, while 12th- graders sleep just 6.9 hours – 1.5 hours less than their younger peers and two hours less than recommended. In fact, by the time adolescents become high school seniors, they’re missing out on nearly 12 hours (11.7) of needed sleep each week.

“This poll identifies a serious reduction in adolescents’ sleep as students transition from middle school to high school. This is particularly troubling as adolescence is a critical period of development and growth – academically, emotionally and physically,” says Richard L. Gelula, NSF’s chief executive officer. “At a time of heightened concerns about the quality of this next generation’s health and education, our nation is ignoring a basic necessity for success in these areas: adequate sleep. We call on parents, educators and teenagers themselves to take an active role in making sleep a priority.”

Awareness gap between parents and teens about sleep

While nine out of ten parents state their adolescent is getting enough sleep at least a few nights during the school week, more than one-half (56%) of adolescents say they get less sleep than they think they need to feel their best. And, 51% say they feel too tired or sleepy during the day.

Also at issue is the quality of sleep once an adolescent goes to bed. Only 41% of adolescents say they get a good night’s sleep every night or most nights. One in 10 teens reports that he/she rarely or never gets a good night’s sleep.

Overall, 7% of parents think their adolescent may have a sleep problem, whereas 16% of adolescents think they have or may have one. Many adolescents (31%) who think they have a sleep problem have not told anyone about it.

Everyday pressures + nature = less sleep

As children reach adolescence, their circadian rhythms – or internal clocks – tend to shift, causing teens to naturally feel more alert later at night and wake up later in the morning. A trick of nature, this “phase delay” can make it difficult for them to fall asleep before 11:00 p.m.; more than one-half (54%) of high school seniors go to bed at 11:00 p.m. or later on school nights. However, the survey finds that on a typical school day, adolescents wake up around 6:30 a.m. in order to go to school, leaving many without the sleep they need.

“In the competition between the natural tendency to stay up late and early school start times, a teen’s sleep is what loses out,” notes Jodi A. Mindell, PhD, co-chair of the poll task force and an NSF vice chair. “Sending students to school without enough sleep is like sending them to school without breakfast. Sleep serves not only a restorative function for adolescents’ bodies and brains, but it is also a key time when they process what they’ve learned during the day.” Dr. Mindell is the director of the Graduate Program in Psychology at Saint Joseph’s University and associate director of the Sleep Center at The Children’s Hospital of Philadelphia.

It is also important for teens, like all people, to maintain a consistent sleep schedule across the entire week. Poll respondents overwhelmingly go to bed and get up later and sleep longer on non-school nights. However, teens rarely make up for the sleep that they lose during the school week. Overall, adolescents get an average of 8.9 hours of sleep on a non-school night, about equal to the optimal amount recommended per night. Again, the poll finds this amount trends downward as adolescents get older.

Survey results also show that sleepy adolescents are more likely to rely on naps, which sleep experts point out should not be a substitute for, but rather complement, a good night’s sleep. About one-third (31%) of adolescents take naps regularly, and these nappers are more likely than non-nappers to say they feel cranky or irritable, too tired during the day, and fall asleep in school – all signs of insufficient sleep. And, their naps average 1.2 hours, well beyond the 45-minute maximum recommended by sleep experts so that naps do not interfere with nighttime sleep.

“Irregular sleep patterns that include long naps and sleeping in on the weekend negatively impact adolescents’ biological clocks and sleep quality -- which in turn affects their abilities and mood,” says Mary Carskadon, PhD, who chairs the 2006 poll task force. “This rollercoaster system should be minimized. When students’ schedules are more consistent and provide for plenty of sleep, they are better prepared to take on their busy days.” Dr. Carskadon is the director of the E.P. Bradley Hospital Sleep and Chronobiology Research Lab at Brown University.

In terms of overall demographics, there are more similarities than differences among adolescents’ responses to sleep-related questions. Boys and girls have similar sleep patterns. In terms of racial/ethnic comparisons, African-American adolescents report getting 7.2 hours of sleep on school nights, as compared to 7.6 hours reported by Hispanic adolescents, 7.4 hours by other minorities and 7.7 hours by White adolescents.

Other factors affecting adolescent sleep

Caffeine plays a prominent role in the life of today’s adolescent. Three-quarters of those polled drink at least one caffeinated beverage every day, and nearly one-third (31%) consume two or more such drinks each day. Adolescents who drink two or more caffeinated beverages daily are more likely to get an insufficient amount of sleep on school nights and think they have a sleep problem.

Technology may also be encroaching on a good night’s sleep. The poll finds that adolescents aren’t heeding expert advice to engage in relaxing activities in the hour before bedtime or to keep the bedroom free from sleep distractions:

 Watching television is the most popular activity (76%) for adolescents in the hour before bedtime, while surfing the internet/instant-messaging (44%) and talking on the phone (40%) are close behind.

 Boys are more likely than girls to play electronic video games (40% vs. 12%) and/or exercise (37% vs. 27%) in the hour prior to bedtime; girls are more likely than boys to talk on the phone (51% vs. 29%) and/or do homework/study (70% vs. 60%) in that time.

 Nearly all adolescents (97%) have at least one electronic item -- such as a television, computer, phone or music device -- in their bedroom. On average, 6th-graders have more than two of these items in their bedroom, while 12th-graders have about four.

 Adolescents with four or more such items in their bedrooms are much more likely than their peers to get an insufficient amount of sleep at night and almost twice as likely to fall asleep in school and while doing homework.

“Many teens have a technological playground in their bedrooms that offers a variety of ways to stay stimulated and delay sleep. Ramping down from the day's activities with a warm bath and a good book are much better ways to transition to bedtime,” notes Dr. Carskadon. “The brain learns when it's time to sleep from the lessons it receives. Teens need to give the brain better signals about when nighttime starts… turning off the lights – computer screens and TV, too – is the very best signal.”

How parents can help teens get more sleep

Parents can play a key role in helping their adolescents develop and maintain healthy sleep habits. In general, it is important for parents and adolescents to talk about sleep – including the natural phase delay – and learn more about good sleep habits in order to manage teens’ busy schedules.

Dr. Mindell adds that “the poll data suggest that parents may be missing red flags that their teenager is not getting the sleep that he or she desperately needs. Simply asking teens if they get enough sleep to feel their best is a good way for parents to begin a valuable conversation about sleep’s importance.”

NSF urges parents to watch for these warning signs that your child may not be getting the sleep he/she needs:

 Do you have to wake your child for school? And, is it difficult to do so?
 Has a teacher mentioned that your child is sleepy or tired during the day?
 Do you find your child falling asleep while doing homework?
 Is your child sleeping two hours later or more on weekends than on school nights?
 Is your child’s behavior different on days that he/she gets a good night’s sleep vs. days that he/she doesn’t?
 Does he/she rely on a caffeinated drink in the morning to wake up? And/or drink two or more caffeinated drinks a day?
 Does he/she routinely nap for more than 45 minutes?

What’s more, teens often mirror their parents’ habits, so adults are encouraged to be good role models by getting a full night’s sleep themselves. And, NSF offers these ways to make it easier for an adolescent to get more sleep and a better night’s sleep:

 Set a consistent bedtime and wake-time (even on weekends) that allows for the recommended nine or more hours of sleep every night.
 Have a relaxing bedtime routine, such as reading for fun or taking a warm bath or shower.
 Keep the bedroom comfortable, dark, cool and quiet.
 Get into bright light as soon as possible in the morning, but avoid it in the evening.
 Create a sleep-friendly environment by removing TVs and other distractions from the bedroom and setting limits on usage before bedtime.
 Avoid caffeine after lunchtime.

NSF released the poll findings as part of its 9th annual National Sleep Awareness Week® campaign, held March 27-April 2, 2006. For more sleep tips for parents and adolescents, as well as the Summary of Findings for the 2006 Sleep in America poll, visit NSF’s website at www.sleepfoundation.org.

The 2006 Sleep in America poll was conducted for the National Sleep Foundation by WB&A Market Research. Telephone interviews were conducted between September 19 and November 29, 2005, with a targeted random sample of 1,602 caregivers and, separately, their adolescent children ages 11-17 in grades 6-12. Using the targeted random sample, quotas were established by grade and race/ethnicity, with minority respondents being over sampled to reflect equal proportions of respondents by grade, as well as the actual distribution of race/ethnicity based on the U.S. census. The poll’s margin of error is plus or minus 2.4%; the response rate for the survey was 27%.

About the National Sleep Foundation

The National Sleep Foundation (NSF) is an independent nonprofit organization dedicated to improving public health and safety by achieving greater understanding of sleep and sleep disorders. NSF furthers its mission through sleep-related education, research, and advocacy initiatives. NSF’s membership includes researchers and clinicians focused on sleep medicine as well as other professionals in the health/medical/science fields, individuals, and more than 700 sleep clinics throughout North America that join the Foundation’s Community Sleep Awareness Partners program.

NSF’s financial support comes from a variety of diverse sources, including memberships, sales of educational materials, advertising, investment income, individual donations, subscriptions, and educational grants from foundations, federal agencies, and corporations including pharmaceutical and non-pharmaceutical companies. Corporate grants are accepted on an unrestricted basis only. NSF alone determines the ideas and content published or promoted in its educational programs. A list of 2006 contributors can be found on NSF’s website.

NSF does not solicit nor accept funding for its annual Sleep in America polls; NSF polls are developed independently by Foundation staff working with a task force of sleep scientists who provide guidance and expertise in developing the poll questionnaire and analysis of the data. NSF can be found online at www.sleepfoundation.org.

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