I wonder, can we prioritize sleep? I mean this sincerely. Can we really value it? Sleep is one of the essential parts of being human yet unlike some of the other essential things (think food, exercise, oxygen, or shelter) no one seems to give us credit when we sleep. Come about age 11, kids start to be praised for their achievements more than their skills in self-preservation.
Like most busy moms, I speak from an experienced place–I’m up early today after going to bed late last night. With the dog awakening us with vomiting at 2:30am, I clocked in under 6 hours of sleep when the alarm clock broke the silence this morning. Clearly it is our own responsibility to find ways to prioritize sleep. No one will do it for us. So, how we both model sleep and also advise our children as they grow matters. It is well understood that sleep deprivation isn’t good for us. It’s not good for our performance, our driving, our friendships, our mood, or even our waistlines.
In clinic, I ask teenagers what time they go to bed. I ask them if they sleep with their phones, if they wake up to an alarm, and how easy it is to fall asleep. I ask parents and I ask about the little ones, too. But it’s the teens (and parents) I worry about most. Those little 6-month-old-midnight-screamers, they’ll figure it out. The over-subscribed-stressed-out high-(or-low)-achieving teens? They need a little time on this…A study published this month only confirms my concern.
After I ask about bedtime, I ask teens how late they sleep on the weekend. The reason: I want to know about their sleep debt. Sleep debt is the cumulative amount of sleep below what you need. If you needed 8 1/2 hours and you only got 6, you create a 2 1/2 hour sleep debt. It adds up, a lot like any kind of other debt. Fortunately you can pay it back a bit by making up for it with long periods of rest in the future, taking a nap, or long nights of sleep on the weekend. But I wonder how you do all week while tired. The study evaluated this.
Teens’ sleep debt is often high –a 2006 US poll found that nearly 1/4 of all teens fall asleep at school. In one report, only 15% of teens said they got over 8 hours of sleep during the week. If you go to bed around 11pm and school starts at 7am, it’s nearly impossible to get what you need. Teens need about 8 1/2 to 9 1/2 hours a sleep each night. Part of my job as a pediatrician is to help teens understand that their sleep debt is a sign they aren’t getting enough sleep mid-week. And it’s my job to help motivate them to prioritize sleep. That’s the hard part.
Sufficient sleep during adolescence is important for the development of psychosocial functioning, behavioral maturation, and cognition. Dr Kim et al
In my practice sleep debt is nearly universal. Most teens report a fair amount of make-up-catch-up-refill-the-tank sleep on the weekend. Do you? I remember crashing on the weekends in high school, in college, in medical school, and in residency. Since the boys have been around–yes, this period of life is sleep-deprived, too–and it seems there is no time when parenting young children for making up sleep! Sleep deprivation has been a huge part of life for me in completing what I needed to do to succeed professionally. So I’m not a great example. Neither is our American culture in general.
As school starts, I’ll keep talking to teens about prioritizing sleep like they prioritize food, exercise, friendship, sports, or good grades. I don’t know how much good I do, though. Culturally, we seem to have it all a little backwards. We often praise those who perform on 4 hours of sleep. We marvel at surgeons who stay up all night and operate the following day. We commend kids who over-subscribe to activities so that they are left doing homework in the dark. We focus on work ethic. We focus on achievement. We forget to prioritize sleeping and self-care. We don’t praise those kids who sleep 9 hours at night. How do we illuminate the cost of sleep deprivation? Science…
A study in Archives of Pediatrics & Adolescent Medicine found that teens who created a sleep debt throughout the week had a more difficult time performing tests requiring concentration and attention during the week. In a study conducted in Korea, investigators studied over 2600 teens. They found:
- Teens slept an average of 5 hours 42 minutes a night during the week. Let me just say, that’s a failing grade in the sleep department!
- Teens slept an average of 8 hours and 24 minutes on the weekend. They had an average of about 2 1/2 hours of “catch-up” sleep to restore their debt.
- Teens who had increased hours of catch-up sleep on the weekend had more errors on tasks that required their attention.
- More, they found that increased sleep debt predicted poorer performance on tasks demanding attention more than the number of hours of sleep a child got each night during the week.
So asking kids about sleep debt is a good start. It may be a flare that a child will have a harder time in school during the week than we knew. And that they are at risk for other consequences of sleep deprivation.
The solution? You tell me. How do we make sleep enticing enough for teens (eclipsing phone, friends, homework, TV viewing) so that they prioritize 8-9 hours each night? How do we do this ourselves?
Courtney says
I won’t guess how to do it with teens, but here’s how I prioritize sleep with my five-year-old twins.
1. Since we can’t seem to change the time they naturally wake up (6:30am), the way for us to get enough hours is by controlling the bedtime. Since my kids stopped napping, we set bedtime at 6:30pm.
2. We held on to naps until age 5. I chose a preschool that allowed them to nap in the afternoon until that age. (Many preschools seemed to discourage it.)
3. I adjusted my work schedule to be home in time for 5pm dinner.
4. We don’t make a habit of afternoon / evening activities away from home.
Ours is a household that revolves around our kids’ schedule. Probably to the extreme, but we believe it’s worth it.
Yolanda @ One Family Table says
I can’t say I’ve had much luck convincing kids and teens to make sleep a priority. One of the biggest factors I’m noticing is having a TV in the bedroom or losing track of time on the computer/phone. Much like the difficult issue of obesity, it really takes a concerted family effort and cognizant change in lifestyle to protect those valuable hours of sleep. I’ve been experimenting myself with going to bed at the unheard time of 9:30pm. My toddlers can’t seem to fall asleep any earlier than 8:30pm, try as I might to move it earlier. I usually lose track of time and am up until midnight or 1 am. This is a habit from my years in college, med school and residency. There is such a culture behind this whole idea of trying to fit 30 hours into 24 hours. But I’m beginning to feel the sleep debt so much more now and I want to model good sleep habits for my kids as they grow older. Thus the experiment of making myself go to bed at 9:30. We’ll see how this goes!
Lisa K. says
As a teen, I would have asked about treatment options for insomnia. I was well aware of my sleep debt. Unfortunately when ever I was ‘good’ and went to bed early I would lie awake for hours unable to fall asleep. And yet every pediatrician I saw just shrugged it off saying they did not like to prescribe pills for chronic insomnia.
Wendy Sue Swanson, MD says
Hi Lisa,
So sorry you had such trouble sleeping at that age. Insomnia is very common among teens. I see many teens who have trouble falling asleep and then, of course, become very sleep deprived when they have to up and ready for school in the AM!
Although, you’re right, we don’t use a lot of medications in children for sleep, there are many other things I do for teens who have a difficult time getting to sleep. Melatonin is one medication that works very well in children and teens is has a very good safety profile. Often though, sleep disturbance can be a sign of other challenges in life like anxiety, depression, excess stress, etc. I talk a lot about reducing screen time 2 hours before bed, getting exercise daily, working on eating three meals, keeping the same bed time, improving sleep hygiene. Further, some children with ADHD or attention challenges have a very difficult time falling asleep even when not using medications or stimulants. If what I do doesn’t solve the problem, we’re very lucky here in Seattle that we have great sleep experts that can offer referrals. Many of my patients have been seen at the pediatric sleep center and children’s. They work hard to help solve these issues. Sometimes sleep studies are needed for sleep challenges, as well.
There is a lot to discuss and lots to be done for children/teens who have a hard time sleeping. I recommend if you don’t get what you need from a doc, find another one until you can start down the road to the solutions for improved sleep quality!
Bethany says
Thinking back to my own experiences as a teenager, I think convincing a teenager to sleep is less an issue than helping her find the time. I think specifically of my junior year, when I was the most sleep deprived. In my case, I was up a 5:45 to get dressed, eat breakfast and catch the 6:30 school bus (had I not been a tom boy, I would have had to be up earlier). Do some homework on the bus. School started at 7am (finish homework during homeroom and study hall), and final bell rang at 2:15 pm. However, there was a Junior Classical League/Key Club/National Honors Society/Prom Committee/Art Club/Library club/Youth Activism group meeting from 2:30-3:30, then a drama club meeting at 3:30 followed by play rehearsal from 4pm-6pm. Gather up your things, do a little more homework, get picked up by mom/boyfriend/friend at 6:30. Do homework in the car. Dinner, 7-8 (sometimes homework while you eat). Volunteer work for that college application (!) from 8:30-10:30 (which I did instead of a part time job, so I was too broke to have my own car). Do some homework while you “volunteer.” Driven home by a friend (homework in the car), got there 11pm. Do the rest of that homework–Honors English, Latin, Greek, Chemistry, Psychology, AP US History, pre-calculus. If there isn’t a test the next day, quit at 12am. Call boyfriend, flirt for 30 minutes. Bed. Total sleep: 5 hrs, 15 minutes.
11 years later, I have a 2 month old baby. I get more sleep now than I did then.
Bethany says
And I will say this…all of my running around, obsessing over getting into a good school, maintaining a romantic relationship, and being a “good girl” did me a lot less good than some sleep would have.
Carolyn C says
Do sleep specialists work with kids on ADD medications? My daughter, who’s on vyvanse during the day, cannot sleep through the night. We’ve tried adding melatonin, which does help her fall asleep, but she’s unable to stay asleep. Her pediatrician also added guanfacine, which isn’t making any difference either. I feel like we’re hitting a wall and she’s starting to pay the price, but was worried they only focus on apnea, etc.
Freya says
One thing that I seldom see addressed that as a culture we can do to help teens is push back the time school starts. There were some studies showing that, because of a change in their sleep cycles, it is impossible for a lot of teens to fall asleep at 10, which they would need to do if school starts at 7. I know I would try every night when I was a teen and fail every night…it always took me two hours to fall asleep when I went to bed at 10. And this was in the days before cell phones and text messaging and I did not have a computer or tv in my room.
Some districts have experimented with having high school start at 8:40 and have had good results. https://www.cehd.umn.edu/research/highlights/Sleep/
Kathy says
I also think there are many families that have kids ubber-scheduled with activities after school and on weekends. This interferes with kids’ \down time\ so they are forced to try and get that down time later at night. Our kids are still young, but we stick to a approx. 8pm bedtime year-round, no TV in the evening hours, and we have no plans to start scheduling their lives away, that is, until they start wanting those things in their lives…
Kathy says
And I forgot to mention no TVs or computers in bedrooms!!!
Candice says
I have a boy 17 and a girl 14. Girl no problem. She does her homework, is scheduled tightly and self manages her sleep and schedule. When she has a down night with no sports, she relaxes and catches up on facebook after homework. My 17 son exceptional student, sports, high anxiety- we’ve been battling sleep since middle school. Something changed at about 6th grade. Heavy sleeper but is a natural night owl. At 17 there is nothing I can do. I’ve tried all tactics over the years. Privileges, penalties, turning off Internet at 10. He just doesn’t sleep till late. He is straight a’s, Rec sports, great friends, no drugs or alcohol. Just has a different clock. I’ve come to accept it; Which has taken the stress off and the pressure I’d put on him- more harmony is the result. I find it interesting that teens should get 8-9 hours of sleep….how do “they” know? From the entries and articles published on the topic, no teen I know of or read about gets that amount of sleep……
Wendy Sue Swanson, MD says
Candice,
GREAT question. I’m going to check with some sleep experts and get back to you. I simply don’t know how they “know.”