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Understanding the Relationship Between Teen Sleep and Mood

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By Michelle Primeau, M.D.

Next week, I am giving a talk at a high school -- first, during the school day, to the students, and then to their parents (after they get off work). I am so excited/happy/nervous about this opportunity! I am excited and happy because I love sleep (I dedicated my career to it, so obvi). l enjoy getting sleep, and I enjoy talking about it. I enjoy helping other people improve their sleep. But I'm a little nervous about trying to translate this enthusiasm to a group of sleep-deprived teenagers. I remember being one of them myself, and I probably would have fallen asleep during my own assembly!

The invitation to speak arose from a conversation with one of my patients; we'll call her Rachel. Rachel is herself one of the students at the school, and she had come to see us at the Stanford Sleep Clinic. She initially came in complaining of insomnia, and so she saw one of our psychologists. But she had some other components suggestive of a physiologic sleep disorder, as well as mood and attention problems, and so she was sent my way. As a psychiatrist who also practices sleep medicine with a special interest in insomnia and the overlap of mood disorders and sleep disorders, it was a perfect fit. She pursued treatment for the mood issues, and on my end, was diagnosed with obstructive sleep apnea (OSA), and was started on continuous positive airway pressure (CPAP), the preferred treatment for OSA. She uses it nightly, a feat many adults are unable to achieve, and feels remarkably better. We also talked about different tricks to help improve her sleep schedule. What was the result? A night-and-day difference with improved mood, concentration, attention, sleep quality, insomnia -- everything! So much so, she wanted to share it with her classmates. Hence, the talk.

We have all had the experience of losing sleep, for one reason or another. Pretty much anyone will tell you, when they don't get enough sleep, their mood worsens; they are more irritable, anxious, and depressed. Not surprisingly, when scientists experimentally sleep deprive subjects, they find the same thing. In fact, one study that analyzed the impact of sleep deprivation on various areas of functioning found that it caused the greatest impairment in mood, followed by cognitive and motor skills. (Nevertheless, it should not be overlooked that both the cognitive and motor impairment was huge as well!) Partial sleep deprivation in particular had a large effect on mood and cognition, which is important, since this is more typical of how most of us are functioning day-to-day.

Teenagers in particular may be at risk of chronic partial sleep deprivation due to changes that occur in sleep as they go through puberty. Teenagers need to sleep about nine hours, and as they get older, they tend to sleep less. This is not because they need less, but because they are busier with school, jobs, extracurricular activities, and friends. Their biology also will often shift so that they tend to fall asleep later and want to sleep in later, an occurrence that may represent delayed sleep phase syndrome. This may explains why your teenager is so hard to wake up on Saturdays. But this shift to a later bedtime, both of social and biologic causes, in combination with fixed early school times, means that many teenagers are walking around sleep deprived.

Sleep deprivation can trigger irritability, depress mood, increase anxiety, and even increase the risk for suicide. Sleep deficit and disruption often precedes depression, and has also been associated with risk-taking behaviors like substance use. Furthermore, sleep deprivation impacts school performance. In high school and college students, sleeping less than seven hours per night and daytime sleepiness have been associated with lower grade point averages. The CDC reports that only 31 percent of teens get at least eight hours of sleep per night. And this is just teenagers in general, not those like Rachel who have a sleep disorder that impairs sleep quality as well. Oh, and by the way, the same CDC report states that 30 percent of adults sleep less than six hours per night. For the most part, Americans are walking around sleep deprived, and this is a habit we start at a young age.

So, when I give my talk next week, the message I want to get across is of the importance of sleep, both for teenagers and their parents. The symptoms of disrupted or insufficient sleep can have a serious impact on the whole person. But the good news is that we know how to make it better. Now if only I can keep the kids awake for my talk...

Michelle Primeau, M.D. is a psychiatrist and sleep medicine physician at the Stanford Center for Sleep Sciences and Medicine. This Center is the birthplace of sleep medicine and includes research, clinical, and educational programs that have advanced the field and improved patient care for decades. Dr. Primeau's research interests are on the overlap of sleep and psychiatric conditions. She enjoys running, crafting, and getting up at a consistent time every day. To learn more, visit us at: http://sleep.stanford.edu/.

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