Concerned that 60% of U.S. middle-schoolers aren’t getting their minimum 8 hours of sleep? Or that 70% of high-schoolers aren’t getting their 8 hours? We probably should be. But more concerning is how often healthcare providers overlook the impact of sleep deprivation on students' mental health.
Researchers Sound AlaRM: Time For Providers, Parents To Wake Up
This is certainly a concern for University of South Australia sleep experts Dr. Alex Agostini, and Dr. Stephanie Centofanti, whose research paper serves as a rigid reminder about the intrinsic link between sleep – and sleep deprivation – and mental health for teens.
How many teens? Among American high school students alone, that 70% represents nearly 11 million teens. That is a lot of groggy students.
With that in mind, Agostini says it's imperative that parents and providers be aware of the bi-directional relationship between sleep and mental health, particularly for students during their formative teenage years, when they experience such a wide range of physical, social, and developmental changes.
Without at least eight hours of nightly sleep, says Agostini, teenagers are “less able to deal with stressors, such as bullying or social pressures, and run the risk of developing behavioral problems, as well as anxiety and depression.”
And yet, the CDC reports, the percent of students getting fewer than eight hours escalates from 59.7% in ninth grade to 76.6% for seniors. For many of those students, the reported sleep duration during an average school night is even more alarming:
Less than 4 hours: 6.3%
5 hours: 10.5%
6 hours: 21.9%
7 hours: 30.1%
8 hours: 23.5%
9 hours: 5.8%
10+ hours: 1.8%
The news is worse for female students, who are more prone to insufficient sleep than their male counterparts, 71.3% to 66.4%.
By race and ethnicity, American Indian and Alaskan Native students get the most sleep; Asian students the least.
"If sleep drops to less than six hours a night, research shows that teens are twice as likely to engage in risky behaviors such as dangerous driving, marijuana, alcohol or tobacco use, risky sexual behavior, and other aggressive or harmful activities," says Agostini.
Technology In Bedroom Is The Biggest Culprit
The CDC notes that poor sleep quality often results from poor sleep hygiene, bad sleep environment (such as too warm, too cold, too noisy, or cell phones in the bedroom) or sleep disorders. Meanwhile, a report by the American Psychological Association indicates that one-third of teens blame stress for sleeplessness. And while acknowledging multiple contributing factors, Centofanti attributes technology as perhaps the greatest factor for later bedtimes for teenagers.
"Whether it's texting friends, playing games, or watching videos, using technology late into the night is one of the most common disruptors of good sleep,” says Centofanti says. “Overuse of technology can also contribute to mental health issues likely to increase anxiety.”
In fact, according to a 2016 survey by the Journal of Pediatric Nursing (JPN), 97% of adolescent respondents used some form of technology before sleep. A similar 2014 poll by the National Sleep Foundation found that 96% of teens between the ages of 15 and 17 bring some form of technology into their bedrooms – and that adolescents average nine hours of screen time per day.
"Not only can technology use make us feel anxious and awake, but the blue light emitted from technology inhibits the production of the sleep hormone melatonin to delay the natural onset of sleep,” explains Centofanti. “This is problematic because teens already have a biological tendency to want to stay up late and sleep in.”
Day Or Night? 'Blue Light' Plays Tricks On Teens
Blue light, however, is not all bad. Among its many important health benefits are heightened alertness, memory, cognitive function, mood, and good vision. Common sources of blue light include fluorescent and LED lights, flat screen LED televisions, computer monitors, smart phones, tablet screens – and the sun.
The National Sleep Foundation, however, cautions against too much of a good thing – that common blue light sources such as smartphones, tablet screens, computers monitors, LED lights and television screens, and some e-readers all emit a short-wavelength blue light that is very similar to sunlight. In addition to making people more alert, blue light deceives the body into thinking it’s still daytime, thus disrupting a person’s natural sleep-wake cycle.
This is bad news for children and adolescents, scientists say, is that their age group is particularly susceptible to the effects of blue light because their eyes let in more light.
Tired Teens Tied To Depression, Dangerous Behavior
The consequence of too much technology in the bedroom, in most cases, is quite predictable. The JPN, for example, blames frequent nighttime phone calls on students waking too early, waking unrefreshed, and general daytime sleepiness.
The effects of inadequate sleep on the mental health of teens is particularly distressing, according to a 2015 report in the Journal of Youth and Adolescence, citing a survey of nearly 30,000 Virginia high school students which indicated that each hour of lost sleep increases the likelihood of:
Feeling of sadness and hopelessness by 38%
Suicidal thoughts by 42%
Suicidal attempts by 58%
Substance abuse by 23%
In addition to poor mental health, diminished attention, behavioral issues, insufficient sleep is also known to contribute to poor and dangerous decision-making.
Consider, for example, national Youth Risk Behavior Surveys of more than 50,000 high school students between 2007 and 2013, which drew direct correlations between students who got less than seven hours of sleep on school nights and injury-related risk behaviors such as:
Infrequent bicycle helmet use
Infrequent seatbelt use
Riding with a driver who had been drinking
Drinking and driving
Texting while driving
Research suggests that 20% of American youth suffer from some form of mental illness. Yet the World Health Organization (WHO) says that although half of all mental health conditions begin by age 14, most of those cases go undetected and untreated.
"Emotional disorders can profoundly affect areas like schoolwork and school attendance," WHO reports. "Social withdrawal can exacerbate isolation and loneliness. At it worse, depression can lead to suicide" - the third-leading cause death among teens aged 14 to 19.
What Can You Do? Here Are Some Ideas
So, what can be done to reverse these trends? A greater awareness of sleep-related issues and symptoms by the medical community would be a good start.
"Many ... physicians will encounter young people who might present with complaints or conditions that have some relation to poor sleep and/or fatigue," reports the Royal College of Physicians in London. "If sleep is not first considered by the physician, this is likely to remain unrecognized and consequently result in ineffective treatment strategies if the underlying problem is not addressed."
However, the report advises: "Improved recognition ... and the assessment of sleep in routine clinical practice can help to identify and manage problems before longer-term consequences develop. The use of simple screening tools can help and there are a number of online resources that can guide both the clinician and patient."
The National Sleep Foundation suggests that teens and their families work together to to put together a social media plan that balances limited "screen time" with family time, schoolwork, exercise - and sleep. "Teens do best when they are given the chance to participate in creating their own guidelines," NSF advises.
Suggested topics of discussion should include:
Mutually agreed upon screen curfew
Nighttime alternatives to screen time, such as reading, writing, music, podcasts or projects
Routine, age-appropriate bedtime that allows for 8 to 10 hours of sleep
Location of smartphone charging stations (outside of the bedroom)
Good sleep hygiene (cool, dark, quiet bedroom)
Avoiding large meals and caffeine before bed
Talks with teen: Listen to teen's concerns about missing out on nighttime social media updates - and find workable solutions
Are You Losing Sleep Over Your EMR Software?
In cases like sleep-deprived teens, having an awareness of the problem is often half the battle. The other half is knowing how to respond. This same principle applies to EHR/EMR software for your behavioral health practice.
Is your software doing everything it should for your practice? Is it fully integrated and interoperable with state submission reports that are specific to behavioral health practices in your state? If not, this might be the time to do something about it.
At InSync Healthcare Solutions, our mental health EHR software is customized to meet the specific needs of mental health and substance abuse providers at inpatient and outpatient facilities.
For a closer look at a system that fully integrates EHR and practice management and streamlines practice and provider workflow efficiencies, schedule a demonstration today and a specialist will create a custom video demo for your practice specialty.