Category Archives: Media

Sleep & Teens: Get the Facts

Parents face many challenges during their children’s adolescent years, one of them most certainly being the struggle to ensure that their teens are getting adequate sleep. As my oldest is about to turn 13 in a few short weeks, we’ve certainly noticed some changes in her sleep routine and so I thought it would be helpful to review “normal” sleep patterns at this age, some common myths and what we as parents can do to support our teens in establishing and maintaining healthy sleep.

Dr. Mary Carskadon is Professor of Psychiatry and Human Behavior at the Alpert Medical School of Brown University as well as the Director of the Chronobiology and Sleep Research Lab at EP Bradley Hospital. She is an expert on childhood and adolescent sleep and circadian rhythms and has conducted extensive research in the area. She was kind enough to share some of her articles (referenced below) with me and I hope to provide you with an overview of the information.

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To start with, a brief review of adolescents and sleep. There are two main things that influence adolescent sleep patterns. The first involves biological changes that occur during puberty and regulate sleep. Contrary to popular belief, adolescents actually need the same (if not more!) sleep than school-aged children. During puberty, most teens undergo a sleep-wake “phase delay” meaning that their internal clocks become wired to stay awake later and want to wake up later as well. This shift can be as much as 2 hours. This is thought to occur because of a delay in nighttime melatonin secretion through adolescence, thus causing a shift in their circadian rhythm. Another contributing factor is a change in the “sleep drive”. The sleep drive is the pressure we feel to fall asleep. During puberty, this pressure accumulates more slowly, ultimately making it more difficult for teens to actually fall asleep. Subsequently, many teens find it challenging to fall asleep before 11 PM. If we understand that their sleep requirements do not decrease during puberty, you can easily see that if your teenager is required to get up much before 8 AM (which is true for almost every family I know!) that it can become quite easy for teens to become sleep deprived.

The second contributing factor that influences teen sleep pattern are psychosocial factors. Teens have an increasing need for independence and autonomy. Bedtime can be one of the areas in which teens choose to exert that autonomy. Throughout the course of adolescence, your child will likely take more control of setting his/her bedtime. (Interestingly, however, even though older kids took more control of setting their own bed time, these same kids actually required a parent or alarm clock to wake them up in the morning compared to younger kids who woke on their own.)  Additionally, kids at this age face increasing pressures on their time. Between after school activities, sports and maybe even a part-time job, teens are often completing homework assignments late into the night. Finally, the use of technology and its effects on sleep have been well documented. Carskadon summarized this nicely in her article:

The preponderance of studies report shorter, later, and/or more disrupted sleep, as well as such daytime consequences as sleepiness or disruptive behavior, for children and adolescents as TV watching, computer/Internet/electronic games use, or mobile phone use in the evening before bedtime is greater. These activities are arousing in and of themselves and usually more easily accessed by the older adolescents, taking advantage of increased accessibility of technology and of the changes to the sleep regulatory systems that make it easier to stay away later. Indeed, to the extent that the activities involve light exposure—perhaps particularly blue-spectrum light exposure to which the circadian clock may have greater sensitivity—evening light has the phase-specific effect of delaying circadian rhythms, thus pushing sleep timing later.

All of these factors show how adolescent sleep patterns can be disrupted but why is sleep so important? Other than the obvious, that well rested teens tend to be more pleasant to be around and that they will be more focused and attentive at school, researchers have actually found some other important reasons to encourage you to help your teen get the sleep they need. In addition to improved mood, attention, behavior, grades, and health (overweight and immune problems), sleep has the following associations:

  • One study showed that teens whose parents set a bedtime of 10 PM or earlier (compared to after midnight) were significantly less likely to suffer form depression or thoughts of suicide.
  • Another study found that teens who had parents set a bedtime (vs. no bedtime) were more likely to go to bed earlier, get more sleep and reported less daytime fatigue.
  • And finally, a study just published last week in the journal Alcoholism: Clinical & Experimental Research, reported that teens who had trouble falling and staying asleep were more likely to binge drink and drive drunk. Obviously many other risk factors come to play with alcohol use but the study findings were interesting nonetheless.

These studies seem to suggest that having a fixed (parent set!) and earlier bedtime not only helps to counter some of the effects of the circadian phase delay seen in adolescence by providing extended amounts of sleep but that, in fact, the benefits of longer sleep periods go beyond being able to stay awake in class.

So, how exactly do we determine how much sleep our teens need? The topic of sleep requirement and the research surrounding it can be quite complicated. Generally speaking, teens need roughly 8.5 to 9.5  hours of sleep a night. As mentioned previously, contrary to popular thinking, sleep requirements DO NOT go down during the teen years. In fact they remain the same (if not increase). Some indicators of insufficient sleep include, excessive daytime sleepiness, difficulty paying attention, irritability, hyperactivity, mood swings, difficulty getting up in the morning and falling grades.

If sleep need does not decline, we know that due to the circadian shift experienced during adolescence, that teens are naturally inclined to sleep later in the day and the start of their day remains fixed (some schools actually  have middle and high school students starting the day even earlier) then it’s easy to see how teens can become sleep deprived. In fact, in August of 2014, the American Academy of Pediatrics issued a policy statement in support of delayed (no earlier than 8:30 AM) school start times for middle and high school students for precisely this reason. However, not all families have access to schools with later start times. Though later start times make sense in terms of teens’ biologically mediated sleep patterns, they also pose certain problems for districts and families if they are not implemented in a well thought way. Many families have daycare/childcare restrictions and often older teens are responsible for caring for younger siblings after school.

So what’s a parent to do? In addition to encouraging your district to adopting a later start time for middle and high school students, here are some strategies you can use at home to help your teen get better sleep:

  • Work together to set a reasonable bedtime and try to be as consistent as possible (even on the weekends!).
  • Take a look at after school activities and simplify where you can.
  • Try to maximize light in the morning and minimize it in the evening (this can help with the circadian rhythm shift).
  • Avoid late afternoon napping (anything past 4 PM).
  • Avoid caffeine, especially in the afternoon.
  • Encourage a calming, relaxing pre-sleep routine and avoid overly stimulating, high-energy activities before bed.
  • Limit screen time before bed and consider removing electronic devices in the bedroom if they continue to be a problem. Some  teens have a difficult time regulating these things on their own and may need our help to set limits.
  • Create an environment where your teen can wake up as late as possible. If their internal clocks are wired to go to bed between 10 and 11 PM, the only way to give them more sleep is to let them sleep in as much as possible. Simple solutions like showering at night, having their clothes picked out the night before and making sure back packs and all necessary items are ready to go could give them more than 1/2 an hour of additional sleep.

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The ultimate goal would be to have a smooth bedtime routine that allows for enough sleep that your child can either wake up on their own or with minimal intervention. She should be able to get through the day without feeling overly tired and remain attentive in class. If you find your child sleeping until noon on the weekends, that may signal that she isn’t getting enough shut eye on school nights. One final thought would be to model good behavior around sleep. Adequate sleep is an essential ingredient in a healthy lifestyle. Whether we realize it or not, our children look to us to show them the way.


Carskadon MA. Sleep in adolescents: the perfect storm. Pediatr Clin North Am. 2011; 58(3):637–647

Carskadon MA. Sleep’s effects on cognition and learning in adolescence. In Hans P.A. Van Dongen and Gerard A. Kerkhof, editors: Progress in Brain Research. 2011; 190: 137-143

School Start Times for Adolescents. Pediatrics 2014; 134:3 642649

 

 

 

 

 

 

 

Technology for Our Youngest

This weekend’s NY Times article Is E-Reading Story Time, or Simply Screen Time?, again raises the question of how much screen time for our littlest tots is too much?  The article talks about the use of e-readers as a substitute for paper books and whether such early exposure will have a detrimental effect. Despite the fact that the American Academy of Pediatrics advises against screen time for toddlers, for many families, story time is now often on a tablet. While most agree that early exposure to reading provides a myriad of benefits including the development of language and social skills, there is still much debate over how that reading should occur.

 

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The proponents and publishers of e-books claim that the interactivity of such devices actually provides educational benefits rather than serving as mere distractions. On the flip side, some researchers have shown that parents who read conventional books, engage more in “dialogic reading” (the back and forth discussion of the story) that has been shown to be critical in a child’s language development. They contend also that children can become so focused on the technology aspect of the device that parents are constantly having to redirect them back to the story and way from swiping or pushing buttons on the screen. Another concern that was raised was that parents may ultimately end up abdicating their reading responsibilites to e-books and that they merely become the tv babysitters of this generation. In reality, the truth of how digital technology will affect the process of learning to read is largely unknown. These devices have not been around for long enough to know exactly what effect they will have on learning.

For now, here is what the American Academy of Pediatrics recommends:

  • Limit the amount of total entertainment screen time to <1 to 2 hours per day.
  • Discourage screen media exposure for children <2 years of age.
  • Keep the TV set and Internet- connected electronic devices out of the child’s bedroom.
  • Monitor what media children are using and accessing, including any Web sites they are visiting and social media sites they may be using.
  • Co-view TV, movies, and videos with children and teenagers, and use this as a way of discussing important family values.
  • Model active parenting by establishing a family home use plan for all media. As part of the plan, enforce a mealtime and bedtime “curfew” for media devices, including cell phones.
  • Establish reasonable but firm rules about cell phones, texting, internet, and social media use.

I think the issue is complicated. I’m a lover of books and my kids still prefer paper books to e-readers. I have to confess that I actually feel lucky to have had both of my children before the iPad even existed (can you believe it’s only been around since 2010!). I never had to face the decision of whether or not I would distract my 2 year old with a hand-held device. Today’s parents face much greater challenges. Though they may make a commitment to adhere to the AAP recommendations on limiting screen time, it’s all around us. If you’ve ever seen a toddler with a hand-held device you know that it has a stunning capacity to captivate them. And whether, as the article mentions, it’s keeping a 2 year old from jumping in the pool during big sister’s swim lesson or allowing you to make your way through the grocery store, the temptation to whip out a device is strong. I’m not exactly sure what the “right” answer is and as I often say, the answer may look different for different families. Here is what I have found works for us and might be helpful for your family:

 

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  • Hold off for as long as you can. Whether it’s television, an iPad or an iPhone. Once you introduce the device, it’s hard to go back. Despite knowing how challenging it may be, I recommend avoiding the use of technology for kids under age two. It will require more effort and patience, but packing books, blocks, and crayons are great alternatives. By offering these options to our children,  we can promote creativity, self soothing and even patience. As they get older, I like to think of technology time as a treat — special when it’s available, not all the time and even better if it’s shared.
  • We have to walk the walk. It continues to be a challenge for me as well, but how often do we, ourselves, turn to our phones and iPads while waiting for swim practice to be over? It’s tempting to answer a few emails and texts or get some work done but when we turn to our devices the minute we find ourselves idle, we also show our children how to be around technology. I’m not advocating that we never use these opportunities to tackle our to do list or even to simply have some down time but rather, that we be more mindful of the example that we set. I try to carry a book and a deck of cards in my purse most days. The book for me and the deck of cards should one of my children complain of boredom while waiting for the other. I still find myself answering messages and emails but I’m hoping to appreciate more the stillness between waiting times.
  • If there is an opportunity to engage with your child, put away the devices. I don’t mean all the time. But when it’s really not that important, just sit together. I’m sure we’ve all had that experience of watching a toddler try to get the attention of the adult near them to point out a dog or bird, only to find the parent affixed to their self phone. It makes me pause, not only because I see a missed opportunity for that parent to engage with that child but because it makes me wonder how often I have done the same.
  • Find ways to engage with your children using technology. I remember my when my son first started playing games on the iPad, I was very conflicted. On the one hand, I knew that it was fun for him and something he and his friends would talk about and even bond over. On the other hand, I didn’t want the technology to replace face to face interactions and interfere with normal social skills. While I had little understanding of the games he was playing, my husband grew up playing video games and saw it as an opportunity for fun and as a way to spend some time together. So even when they are not in front of a screen they talk about the worlds that they have built, what level they’ll get to next or how many gems they’ve mined. Instead of using technology as an isolating activity, by actively participating with him, my husband has been able to share in the experience with him and it’s something they enjoy together.
  • Don’t be afraid to say no. There is a lot of pressure for kids to engage in technology and it offers some amazingly creative ways to learn (the first time I saw a smart board in my kids’ class rooms I was blown away!). But there is a time and a place for it. I support you in your efforts to provide guidance for your kids surrounding the use of technology.

Whether they are 2 or 12, each age presents its challenges when it comes to technology. It’s hard to imagine that when I was growing up there was no internet let alone cell phones and other digital devices. Our challenge is to embrace all of the wonder and creativity of technology while maintaining our values and helping our children to thrive.