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Jeff Deitz, M.D.

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Children's Sleep: Time For A Wake-Up Call

Posted: 12/11/2011 10:36 am

Except for a handful of forward-thinking school districts, the continuing resistance to starting high school later to accommodate the biological time clocks of teenagers speaks to the attitudes of the adults in charge of our children. How can it be that despite overwhelming evidence that sleep deprivation in teenagers is every bit the public health menace that cigarette smoking is, school administrators have abided the status quo?

Sleep researchers have convincingly demonstrated that, on average, teenagers need nine hours of sleep and that their brains are programmed for them to stay up later than adults. Sleep researchers have also convincingly demonstrated that, on average, adults need eight hours of sleep. Not getting enough sleep is as pervasive in today's culture as was consuming two or three packs per day of Lucky Strikes in the 1940s, 50s and 60s.

In reaction to a July 2010 Wall Street Journal article reporting the salutary effects of starting first period later at a Rhode Island prep school, several commenters decried what they termed the coddling of a generation and giving in to spoiled brats' laziness -- precisely how depression was depicted four decades ago -- rather than responding to a biological imperative. School boards and superintendents, whose reputation and ranking depend on how many advanced-placement tests their students pass, have not come to grips with the toll that sleep deprivation takes on the developing adolescent brain.

Sleep is essential for sustained focus, concentration, and attention, the brain circuitry of which is the same in children and adolescents as it is in adults. The prefrontal cortex, center of complex reasoning, signals the striatum, a deeper brain structure which modulates activity and attention to novel stimuli, which connects to an even deeper area called the thalamus, which relays sensory input from the body and regulates alertness and sleep. Sustained attention requires that these three brain structures, known as the CST system, cooperate, a function of the brain neurotransmitters norepinephrine and dopamine. Sleep deprivation not only reduces CST function, it alters CST norepinephrine and dopamine levels. Amphetamines, the mainstay of treatment for inattention, stimulate CST circuitry artificially by either mimicking dopamine at nerve cell endings or stimulating dopamine's release. However, clinical experience shows that amphetamines interfere with sleep and in excess act like cocaine, which can overexcite nerve cells to the point they self-destruct. Prolonged amphetamine abuse can produce a syndrome that looks like schizophrenia.

Clinically, every psychiatric disorder I treat in adolescents is worsened by getting too little sleep. Well over half the teenagers who come to me with attention symptoms are sleep deprived. While CST malfunction is not caused by sleep deprivation alone, and amphetamines have a role in medicine's pharmacopeia, my experience is that medicating the inattentiveness and cognitive impairment of sleep-deprived youngsters with amphetamines -- teenagers today bum Adderall from each other like cigarettes -- is like trying to paralyze the tail that wags the dog, or like treating a smoker's hacking with codeine-containing cough suppressants while failing to address the lung disease.

What's at issue here is an attitude change with respect to sleep behavior. Change is hard. Change requires self-reflection; there is no way around it. Facing sleep deprivation head-on means that the adults in charge of our teenagers acknowledge and deal with their own sleeping habits, including maladaptive sleep behaviors like the widespread use and abuse of sleeping pills and alcohol at bedtime; like stimulant and caffeine dependence and abuse during the day; like snoring and obstructive sleep apnea and the toll snoring takes on sleep-partners and relationships; like arguing at bedtime, as well as a host of unattended mental and physical disorders -- depression, obesity and diabetes for instance -- that disrupt sleep patterns.

Years ago, senior physicians rationalized the hundred-plus hour work weeks they demanded of their bleary-eyed trainees saying, "Four hours of sleep were good enough for me." Now that we know how many preventable mistakes were caused by secondhand sleep deprivation, medical trainee's work-weeks have been scaled back to no more than eighty hours.

I am not advocating we lower academic standards; far from it. However, as a physician who cares deeply about the health and welfare of teenagers, I feel it is essential we give adolescents the opportunity to get the sleep needed for optimal brain function. These are the facts: well-rested adolescents significantly outperform their sleep-deprived counterparts academically; their moods are better; their graduation rates are higher; they watch less television; they do more homework; and they are involved in fewer car crashes.

High school should start at 8:45 a.m., or better at 9 o'clock. The successful grassroots campaign of Wilton, Connecticut's League of Women voters, which moved their high school start time 50 minutes later, proves that logistical complications like busing schedules and after school activities, often cited as obstacles to change, can be overcome when the community is involved and motivated.

It's only a matter of time until the family of someone killed when a teenager falls asleep at the wheel brings action for reckless endangerment. School board members and superintendents need to wake up now, before they receive the subpoena.

 
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11:54 AM on 01/03/2012
A well-designed and well documentat.Felicitări article.
Romeo - Nicholas + ASiIiVro
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mrsL
marriage & motherhood with mirth and grace
02:50 PM on 12/22/2011
This is another reason to home school through high school. We start at 10 and we're done by 5. That's still plenty of time for him to socialize with friends, take drum lessons or even work a job.
11:07 AM on 12/15/2011
My school district is one that actually just switched to a later start time for the high schools a few years ago. At first many of the students, myself included, weren't strong supporters of the later start because it results in a later end time, less time to work jobs, and later running extra-curriculars. However, after participating in the later start for a few years, I'm glad we have it. With the way us teenagers function, most of us would stay up late doing homework regarless of school start-time. By pushing the start time back an hour, most students actually will be getting an extra hour or so of sleep.
10:17 PM on 12/14/2011
Fantastic article!
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TheGloriousHand
Student of the Serpent, the Light-bearer, Liber.
12:06 PM on 12/14/2011
From kindergarten to 9th grade I went to a (horrible) private school where classes started at 9am. Even though I hated that school, I was at the top of my class.
For 10th through 12th grade, my parents finally let me go to 'normal' public school. I loved it (mostly), but classes started at 7:15am. I went from being an A+ student for most of my life, to As and Bs in 10th, to having a very...alphabetical transcript for my last years of school.

And then there was that insomnia diagnosis, which seems to be more of a finicky later-than-average sleep cycle, as I still don't get sleepy till about 2-3am sans sleepy pills (those are awful).

Come on, schools, there's always room for improvement!
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valeskas
catlover/book lover democrat
10:09 AM on 12/14/2011
Parents should take away the cell phones at night, so the kids can get to sleep. Every evening at 8.00 pm, my daughter takes away the cell phone from my grand daughter, it was a huge difference in her sleep. She was not disrupted from any of her friends, because she did not have her phone. The computer is in the living room, so now she goes to sleep when she needs too.
03:56 PM on 12/16/2011
That is a great idea. I am fresh out of college and I don't remember how many times I was interrupted by late calls on my phone. I finally had to shut it off at night so I could get the sleep I needed.
12:39 AM on 12/14/2011
Um, /please/ do. I'm in my grade 12 year of high school, and granted, my cruddy sleep schedule is probably because of the I.B. program I'm in, but the toll 3 hours of sleep takes on the body is just not fun. I get up at 6 everyday, school starts at 7, and for me, ends at 5. By the time I get home it's around 6pm. Add in afterschool activities (which are required for CAS), eating and cleaning up. I don't sleep till about 3am, 2 if I'm lucky, and on the days big essays are due, I don't sleep at all. Now throw in insomnia. So to all those people who are saying, suck it up, it's a lot harder than it seems.
11:17 PM on 12/13/2011
My school starts at 7. I get up at 530 every morning. And I suffer from insomnia. Coincidence? I think not.
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08:09 PM on 12/13/2011
I've spent many years working in sleep medicine. I often find that when pediatric patients come in and the parents are complaining about their child's sleep pattern, there is either nothing wrong or the issue is the parent. The parent is usually the problem with healthy toddlers. But with the teenage patients, I see a lot of parents complaining that their child doesn't fall asleep at "bedtime" and is difficult to wake in the morning.

A quick look at weekday vs weekend sleep schedules usually shows that the teen falls asleep maybe 60-90 minutes later on weekends and sleeps in an extra hour or so. It doesn't help to give a child an earlier bedtime or to turn off the TV if the child is going to lie in bed for an hour after lights out. In fact, doing that only reinforces insomnia. Lying in bed when you can't fall asleep will only make matters worse.

It isn't laziness or bad parenting. Not every teen will fall into the average pattern, but for the most part, they need the sleep and it is often pushed to a later bedtime/wake time.
08:03 PM on 12/13/2011
I have to say, all those that comments with "when I were young, I got up early and ....etc" reminds me of this awesome sketch by Monty Python:
http://www.youtube.com/watch?v=13JK5kChbRw

I also got up early to go to High School, school started at 8 and I had a 30 minute bus ride to get there, and at 15 minute bike ride to get to the bus, but that does not mean that I think that the teenagers now should suffer and not benefit from the new knowledge we have.
I believe that we should ALWAYS benefit from the new knowledge, otherwise we would still die of the most general diseases that are now cured with penicillin etc.
04:26 PM on 12/13/2011
I have worked in a large metropolitan school district for 40 years, advocating to my employer that high school should start later. The main objection comes from teachers who like to have their afternoons off and do not want to work until 4 or 5 p.m. Teachers' unions stand by their teachers, in the face of evidence that a later schedule would improve learning. No further comment necessary.
07:12 PM on 12/13/2011
or MAYBE you should just put them to bed early! novel concept I know....
12:12 AM on 12/14/2011
Did...you even...read the article?
Inform yourself before you try to add your input. You insult yourself, it's sad really.
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PhoenixLady
10:04 AM on 12/14/2011
Obviously you did NOT read the article...so maybe you should hold off on giving uninformed advice. Just saying...unless you think you know much more than a Doctor.
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AKQueenie
No such thing as coincidence, just synchronicity.
02:21 PM on 12/13/2011
I see that a lot of people here are describing this time change as coddling, or spoiling our kids. I think that the school boards made school start so early because parents of said kids have to get up early to go to work. So why do your children? Are you afraid they won't get them selves up at 9am and get to school on time? After 9 hours sleep, Im sure they will wake up bright eyed and bushy tailed ready to learn! I, along with many classmates, practically slept my morning classes away with my 5-6 hour sleep per night.

I don't know about you, but I would do anything to have this next generation "wake up" to real life. It's not all music videos and touch screens. It's so much more then that, and I would love for them to learn about it now. Why wait?
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AKQueenie
No such thing as coincidence, just synchronicity.
02:14 PM on 12/13/2011
10am-5pm. I can't believe how early I started school. That was the main reason I hated school....the early hours...
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12:06 PM on 12/13/2011
I can't believe people's attitudes about this!! Maybe we should stop coddling all those namby pambies who don't want to be around second hand smoke or those whiny kids who are just being coddled with annoying and expensive car seats.
The idea that early school "trains" kids to be up early is absurd. When they aren't adolesents anymore, they will be going to bed earlier, waking up earlier and requiring less sleep.
I'm guessing those of you who claim adequate sleep for kids is coddling also think that kids today are lazy and over medicated, but don't understand that lack of sleep is often the cause of that. Oh, you probably complain about kids being overweight. Guess what? Lack of sleep increases the gut hormone grehlin which tells us to eat more.
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07:58 PM on 12/13/2011
Letting them go through puberty must be considered coddling them! I've given up thinking that the average American can recognize scientific advancement as a good thing that *should* lead to changes. Much better to just go along with the idea that we'd all be ok if we just "suck it up."
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Fromageball
10:18 AM on 12/17/2011
Many people seem to think that they can pick and choose which scientific findings they want to "believe in" so people thinking we are coddling teenagers by allowing them to get the sleep they need does not surprise me.
04:49 AM on 12/13/2011
Why even waste time going to school if you like to sleep in, just sleep all day and party all night. Will make it better for the kids that really want an eduction and a future. The sleep-ins can get on welfare and the ambitious kids can pay for it, see it all works out. This is AMERICA
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07:51 PM on 12/13/2011
Yes, because America is #1 in all educational areas and we haven't spent decades debating how to get test scores up.
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PhoenixLady
10:07 AM on 12/14/2011
Here's yet another person who has NO use for facts science or actually reading the article. How "ambitious" of you.