Many of us have terrible sleeping patterns, often as a
result of staying up late for assignments, parties or just not realising it’s
so late. This may have been especially true throughout fresher’s week and the
first few weeks of lectures at university. It can be very easy to get into this
habit, and it only takes a couple of late nights in a row to really throw your
body clock out of touch with the rest of the world!
This is a problem that is very concerning to those who are
aware, however very few people are aware of the current lack of sleep being
attained by many adolescents. To be clear, I refer to adolescents as those who
have started/ gone through puberty but are not yet full adults (i.e. 14-21 year
olds).
One often
cited study found that over 45% of adolescents in the USA have inadequate
sleep (less than the recommended 8.5-9.5h per day on a regular basis). This
lead to 15-52% of students reporting excessive sleepiness, frequent daytime
sleepiness, oversleeping and sleeping during class, depending on the study. That’s
pretty bad, but what are the consequences of a lack of sleep?
First, those with high scores for sleep deprivation were
more likely to report feeling sad, depressed and there are associations with
suicidality. Some studies
indicate that over 70% of those with high sleep deprivation scores also
reported feelings of sadness, depression and even suicidality. It has also been
shown that it leads to impaired concentration. One study found
that even one night with no sleep in a fully rested adolescent lead to
significantly reduced cognitive processing speed and increased reaction time
responses. It may not, therefore, be a surprise that improving sleep by delaying school start times
by 1 hour significantly improved mood, tardiness, academic performance (especially
in morning classes) and also led to a 16 % reduction
in adolescent car crash rates within one year.
If that isn’t a good enough reason to sleep better. There is
also evidence
to suggest that getting more sleep could help prevent obesity in adolescents.
This finding is still present even when most confounding variables are
accounted for, including caloric intake and physical activity (although lack of
sleep had an unhealthy impact on both of those). In a best cause scenario
(increasing sleep from 7.5 hours to 10 hours) this could reduce the proportion
of adolescents who are overweight by 4% (or 500,000 Americans).
Circadian Rhythms
Aside from social and work obligations, there are also biological reasons why you will want to sleep and eat at the right times. We have specialised cells that act as a network of body clocks in the brain, these are tuned to the day/night cycle and control our hormone levels throughout the day. See my previous post for more information, but essentially this bundle of cells called the suprachiasmatic nucleus receives input from a specialised cell in the retina that detects ‘blue light’ which indicates day time. The more blue light, the brighter the daytime it is and stops us from producing the sleep hormone melatonin, this makes sure that we start feeling sleepy and alert at the right time. These not only ensure that we are alert and sleepy at the right times, but they also prepare our organs for the right functions at the right time.
These rhythms are entrained by the day/night cycle but are
endogenously generated, as removing the day/night cycle has little effect on
daily activities. In the case of humans, our natural circadian rhythm (Latin
for approximately daily) is about 24.12 hours in the absence
of a day/ night cycle, pretty good if you ask me. Despite this, adolescents
experience a shift towards a ‘night owl’ like sleeping pattern (or chronotype),
so why is that?
Many people would attribute this change in sleeping patterns
to lifestyle; staying up and playing video games or mindlessly browsing the
internet, but this does not explain it entirely and teens have been staying up
late for generations (although it has gotten worse in recent years). This means
that, while increased screen time before bed is probably worsening the
situation, there are more physiological reasons as well.
In the scientific community, the role of biology in this
problem is being acknowledged more and more. These pass times may just be ways
of occupying the time while we wait to get sleep (although engaging in
stimulating activities such as video games clearly won’t help!). However, this
phenomenon is seen cross-culturally, so lifestyle cannot be the only answer. So what does science have to say about this?
The phenomenon of delayed circadian phase (later bed times)
is seen cross-culturally and cross-species. It has been shown that this
occurs in every country measured so far (16 countries in 6 continents from
pre-industrial to modern).
Figure 1 Regardless of region or socioeconomic status, adolescents gradually go to bed later and later, leading to inadequate sleep for multiple years during the weekday. |
In laboratory conditions, where schedules are regulated in a
way that allows for plentiful sleep, this shift towards a later bed time is
still seen (typical delay between 1-3hrs). A similar delay is seen in
Rhesus monkeys, rodents and many other animals.
Puberty, sex hormones and sleep
As with most problems that teenagers go through, it all
starts with puberty. As previously
mentioned, the circadian rhythm relies on hormones to exert its effects. Hormones
are wonderfully complicated things, especially when it comes to puberty. What we do know, is that the shift in bed time or circadian
phase nicely coincides with puberty across many species. Although there are
problems with translating findings to do with puberty from rapidly developing
animals like rodents to humans, that this is found in so many species (from
amphibians and fish through to apes and humans) suggests it is a fairly
important factor. Also, in species where puberty onset differs between genders,
so is the delay in circadian phase
(in humans girls go through puberty first and the phase delay also occurs in
girls first).
We also
know that removal of the sex organs in rodents removes this shift, and that
restoring the levels in sex hormones induces the circadian phase shift. But let’s
not dwell on that thought for too long. Sex hormones (well actually just oestrogen,
as testosterone is converted to oestrogen before entering the brain) have a huge
impact on the development of the brain throughout adolescence, which
undergoes huge changes
in order to become a fully adult brain (which I hope to cover one day). It
would make sense that these changes also occur in the suprachiasmatic nucleus
(where circadian rhythms are controlled in the brain) which would lead to
altered circadian rhythms.
Mechanistically, the field is less certain about how
this happens, as with much of neuroscience. One possibility could be changes in
how sensitivity we are to light during the evenings and the mornings at that
age. It has been shown
that adolescents are more sensitive to evening light and less sensitive to
morning light. The most convincing evidence
for this comes from a study that tried to use morning light exposure to try and
shift the circadian phase back towards a more regular schedule. The study found
no evidence that this was possible, even at the highest light intensity. The
focus of this study was to study the phenomenon of ‘weekend social jet lag’ in
adolescents and young adults. Typically, during the week adolescents follow a
schedule in which they stay up late, but then wake up early for school,
producing chronic sleep restriction. On the weekends, when they have the
opportunity to recover sleep, they continue to stay up late, exposing
themselves to evening light, and then they sleep in and lose several hours of
exposure to morning light. This weekend light schedule drives their circadian
rhythms to become even more delayed, so that by Monday morning they are
completely out of synchrony with the school schedule and the cycle continues.
This highlights the impact that light from electronics
during the evenings may be having on adolescent and adult sleeping patterns. By
enhancing our exposure to light during the evenings, our brains don’t realise
that it is late and so we stay up late and shift our sleep cycles back. We then
miss out on light exposure during the mornings because we slept in and our
sleep cycle remains shifted.
Why does this shift occur in the first place?
It’s all very well and good saying that this happens, it’s
quite easy to see for yourself that young people stay up late. But now that we
know what happens and a little but about how, why does this happen at all?
Because it is seen in so many species; it’s reasonable to
assume to sort of evolutionary purpose, some sort of mechanism that enhances
the chances of survival for an adolescent. This is where we start having to
become a little more speculative, as is often the case when trying to explain
the evolution of a behaviour in humans. In many fish and amphibians, juveniles
and adolescents have a diurnal circadian rhythm (active during the day) whereas
the adults are nocturnal (active at night in case you didn’t know…). This is
likely to be because they eat different foods and the best time for eating them
differ between adults and adolescents. It also means that the youngsters spend
less time around the adults, which can have the propensity to eat their young
in times or hardship!
Heading up the evolutionary tree, mammals are much less
likely to resort to cannibalism, but the theme of avoiding adult contact
remains. In rodents and
monkeys, the adolescents often stay up later and rise later than the more
dominant adults in order to ensure that they are feeding/ foraging at different
times of the day. It is often the case that adults will see the adolescents as
competition and will feel the need to assert their dominance. It is possible that this is conserved in
humans to some extent and adolescents stay up later than their parents in order
to carve out some time for themselves, outside of the control of adults.
What can be done about it?
Now you know the what, the how and possibly the why. But
what can be done to improve the amount of sleep that adolescents get? One way
might be to move bed times earlier. This could work a little, but only small
(about 15 minutes per night) gains have been found. Another method
that hasn’t really translated into improved sleep are education programs.
While knowledge about sleep hygiene can be improved by these programs, they
rarely lead to real world changes, which may be due to the method of delivery,
content and lack of engagement and recognition of the problem by the adolescents
or any other reason you can think of.
What does seem to work is allowing adolescents to recover at
the weekends, and many adolescents do this by themselves. Another important
factor is changing school start times. One study (mentioned
previously) found that delaying school start time by half an hour (to 08:30) increased
average sleep duration by 45 minutes, reduced the number of students getting
less than 7 hours sleep by 79.4% and
almost quadrupled the amount of students getting at least 8 hours of sleep per
night. This significantly improved mood, fatigue, attendance and grades.
Another study, this time in US military
recruits undergoing Basic Combat Training, had two groups; one with a
customary sleep regimen (20:30 to 04:30) while the other had a delayed sleep
regimen (23:00 to 07:00). The delayed sleep group gained approximately 31mins
extra sleep/night on average, which resulted in significant improvements
marksmanship, mood and were 2.3x less likely to report occupationally
significant fatigue (ie fatigue that would affect their performance).
While no studies so far have measured whether reducing
electronic screen time before bed actually leads to improved sleep duration, it
makes a lot of logical sense. By exposing ourselves to less light at night time,
our brain is more able to recognise that it is night time and tell itself to go
to bed. A lot of the time, I find myself
on my phone/laptop at a normal time and then don’t realise how late it has gotten.
To help with this I found an app for my phone
and laptop that filters out blue light
(unnatural to be seen in the evening) and dims the screen in accordance with
sunrise and sunset in your area. It takes about 2 minutes to set up and,
anecdotally at least, it seems to work (oh and they’re both free and have no
ads so what do you stand to lose?).
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