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After Michelle Trudeau's story The Other Big Deficit: Many Teens Fall Short On Sleep aired on Morning Edition on Monday, we asked listeners to submit questions on teens and sleep. We received dozens of questions and posed some of them to a panel of sleep experts. Their responses, edited for brevity and clarity, are below.
Helene Emsellem, neurologist at George Washington University and medical director of the Center for Sleep and Wake Disorders
Question from Rowan Rose: I have two teens who have difficulty sleeping, and I worry that they have developed bad sleep habits they might never grow out of. Should they take sleep meds?
EMSELLEM: One of most important things to understand is that the changes in biological rhythms are not changeable with a drug. If an adolescent's biological clock says they won't get sleepy until midnight, a sleeping pill may do absolutely nothing. It could also complicate matters by leaving them hung over the next day. The best you can do is regiment a routine and give them a comfortable sleep environment.
Melinda Miller: I am a teacher in Indiana who just listened to this piece with a class of seniors. My students are wondering, what are some safe suggestions for them to be more alert and ready to learn at the start of their school day, which is 7:35 a.m.?
EMSELLEM: Food, light and exercise are cues to brain that it's morning and it's time to synchronize the clock, so try to get all of those before school starts. But in the end, the real problem is that school starts too early. A start time of 7:35 is incompatible with the sleep-wake schedule and circadian rhythms of adolescents.
Amanda Russ Daquelente (high school teacher): Should I punish my students for sleeping in class, or should they just suffer the consequences of missing notes and directions?
EMSELLEM: First and second period teachers are always challenged with being incredibly interesting to keep kids engaged. Bit it's very difficult to punish students for falling asleep. They already do pay a price, but punishing kids beyond what they miss is brutal.
Jennifer Beaton: In high school I sacrificed sleep in order to stay on top of class work and extracurriculars. I'm worried my chronic sleep deprivation during such a critical period of neural development took a toll on how my brain forms memories or recalls information. What kind of damage did I do to my brain, and is it permanent?
EMSELLEM: Fortunately, adolescents are resilient. There's no evidence that suggests you would have done any long-term harm. But this idea of sacrificing sleep for academics is an oxymoron. We learn during sleep, so we need to sleep to learn.
RH: This past week I was informed by one of my 15-year-old son's teachers that he sleeps through tests, quizzes and lectures the entire day — he just falls asleep with his head up. He goes to bed at 9:30 p.m. and wakes up at 6 a.m. He doesn't have any electronics in his room except a radio. Should he be tested for sleep apnea or narcolepsy? Should I let him drink popular energy drinks?
EMSELLEM: So this adolescent is getting about nine hours of sleep... I think he needs an evaluation by a primary care doctor. He could have a variety of medical issues, so a general check-up would be best. If you don't get an explanation from primary care, then consider a sleep consultation. And you could use sleep logs to find if this is truly what's happening. Energy drinks may improve his ability to stay awake. But I wouldn't drink more than one energy drink. And he shouldn't have one after 2 p.m. or it could interfere with his sleep.
Amy Wolfson, professor of psychology and associate dean for faculty development at College of the Holy Cross
Several listeners asked: Wouldn't it help to have school begin and end later in the day?
WOLFSON: Yes. Adolescents need 9.2 hours of sleep, and due to the circadian phase delay, the time they go to bed hovers around 11 p.m. So that means it's difficult to start school before 8:30 or 9 a.m.
Steve Meyer: Even if school starts later, do students need to wake up at normal times to allow their minds and bodies to "warm up"?
WOLFSON: No. Research has found that when you delay start time for middle or high school, adolescents literally add sleep based on the time delay of school. They don't stay up later in the evening. And they don't need more time in the morning to "warm up" – they just need more time to sleep.
Mark M: We try to get our elementary school children in bed by about 8 every night, and as a reward to be cooperative, we offer a half-hour of TV. We believe that the shows we let them watch relax them, but I have heard advice not to let kids watch TV before bed. I would appreciate expert comments on the relaxation and reward of TV vs. excitement of TV before bedtime.
WOLFSON: In terms of sleep, I don't know of research of benefits of TV before sleep. Most research says that watching TV or being on a computer in hour before trying to sleep for an adult or child is not conducive to sleeping. The American Academy of Pediatrics recommends 1 to 2 hours of TV a day, and the TV shouldn't be in the bedroom. A striking finding from the 2011 National Sleep Foundation Sleep in America poll was that 18 to 20 percent of 13 to 18-year-olds and 19 to 29-year-olds admitted that at least a few times a night, they're awakened by or awake to use text messaging, phone or e-mail. That is clearly not conducive to sleep.
Laura Ingram Ryan: How do sleep deprivation and other aspects of typical teen life (caffeine, junk food, hormones, questionable choices) affect each other? What kind of problems would be helped by teens getting better sleep?
WOLFSON: On caffeine, we know it is stimulant and it makes it more difficult to fall asleep. We did a study where we found that 95 percent of 9 to 12 graders at one high school were using caffeine. And many of them tied their use to increasing energy and handling daytime sleepiness. This is a new field: looking at caffeine and sleep.
As for junk food, there is a relationship between inadequate sleep and weight gain. It seems to be stronger in younger children, but regardless of age, you make poorer decisions when sleepy, so you might be more likely to pick junk food.
Stephanie Crowley, a psychologist and sleep researcher at Rush Medical College
Travis Wald: What is the most efficient way to sleep? How can a busy person get the most benefit from sleep while taking up the least amount of time?
CROWLEY: This is the million-dollar question! I'd like to encourage people to think about this question another way: how to make the most of your day when you're awake. If you are obtaining an adequate amount of sleep at night on a regular basis, then a busy person can be far more efficient with the time they have during the waking day to get things done. You will be able to think more clearly, make decisions more decisively, and overall be more productive with a good night's sleep. So, my suggestion is to figure out how much sleep you think you need to function and feel your best (everyone is different), and try to get this sleep on a regular basis.
Chris Comstock: Does the eight hours of sleep have to be contiguous, or are six hours plus a two-hour nap later just as good?
CROWLEY: If you don't have trouble falling asleep at night and if this type of sleep schedule works for you, then it is fine. The timing of the nap, however, is important: It should be in the middle of your waking day. For example, if you go to bed at midnight and wake up at 6 a.m., then nap between about 2 and 4 p.m. This way, you shouldn't have trouble falling asleep when you want to.
Celeste Wise: Does 3 mg of melatonin an hour before the desired bedtime help [teens or adults] sleep better?
CROWLEY: Melatonin can make a person sleepy and, if taken 30 minutes to an hour before bedtime, can help some people sleep. Because melatonin is not regulated by the FDA, it is important to buy melatonin from a reputable company. At this time, I remain cautious when recommending melatonin to healthy adolescents, as there is some concern about it possibly delaying sexual maturation, especially when taken in high doses.
Wendy Brown: Are there long-term health risks to chronic sleep deprivation?
CROWLEY: The short answer to your question is, yes. Mounting evidence shows that short sleep is associated with an increased risk for obesity, potentially leading to chronic diseases such as Type 2 diabetes in both children and adults. Chronic short sleep is also associated with an increased risk of heart disease, high blood pressure, depression, and anxiety.