When sleep deprivation is just a way of life.

Recently, I have been thinking about teen sleep. It dawned on me that most of my teen clients have some type of sleep disturbance that is impacting their mental health. Studies show that the average US teenager loses about 90 minutes of sleep from 6th to 12th grade¹. The lack of sleep impacts cognitive functioning, mental health, physical health, emotional functioning, risk of illness, and more². When bringing up these points to my clients, they understand the value of sleep but struggle with the multiple systems at play: “I have to wake up so early for school”, “I need to tiktok before bed”, “I can’t shut my mind off”, “I try to go to sleep early, but I just can’t fall asleep.” When we start to problem solve solutions, most of the time, my teens have great ideas on how to solve their sleep woes. They will tell me things like:

• “I need to create a bedtime routine”
• “I need to try to sleep before midnight”
• “I know…I need to turn off my phone at least an hour before bed” (sometimes accompanied by an eye roll)
• “I need to take Melatonin”
• “I heard about these sleep meditations…maybe those could help”
• “I need to stop taking these two hours naps when I get home from school”

Despite my teens ingenuity, follow through is where it all falls apart.

The forces that contribute to the struggle of my teens to get a good night sleep are HARD to overcome. Yet, because the strategies are so simple, my teens feel silly for not being able to make the changes. I wanted to understand the forces or systems that get in the way of teen sleep a little bit better. To be honest, I knew I could name them but I felt like I didn’t fully understand enough. I proposed to my teens that we learn together. We would both do research outside of session and teach each other what we discovered. Through that process the next series of blog posts were born! Taking some editing liberties, I am summarizing what me and my clients discovered together into three buckets: Teen biology, social forces, and teen psychology. Essentially the biopsychosocial framework of teen sleep.

Biology of Teen Sleep

Much to the surprise of my clients, teens need on average of 8-10 hours of sleep a night, but the average US teens gets about 6.9 hours of sleep a night^1,2.  Said another way, the average US teenager suffers from chronic sleep deprivation. Even though the sleep needs of teenagers do not change much from their younger selves, their brains are changing which impact major aspects of their ability to get a good night sleep.

Circadian Clock and the Sleep/Wake System

Sleep is regulated by two different processes in the brain³. The first is our Circadian biological clock which basically tells our body what time zone and schedule we are operating under. Our circadian clock is always updating every 24 hours with new data that comes from our previous 24 hours. Our circadian clock is why we feel jet lagged when we travel to a different time zone. The parts of the brain that control the circadian rhythms needs to update before we feel back to normal.

The second part of our brain that regulates sleep is the parts of our brain that control the sleep wake system³. How long can we stay awake before getting sleepy and how fast do we fall asleep once we’re in bed. For example, babies nap all the time because they have small wake windows before the sleep pressure overwhelms them and they need to sleep.

During puberty both processes change. Sleep pressure decreases and circadian rhythms change³. So if a teen used to sleep at 9pm, they will naturally stay awake longer as puberty progresses in their teen years. On top of that, the amount of time that it takes to fall asleep can increase. When my teens tell me, I’m just not sleepy earlier and then I toss and turn trying to fall asleep…they are not wrong.

As sleep pressure changes, circadian rhythms change. Circadian rhythms sensitivity to light also increases during teen years⁴. Light is an important signal in melatonin production. Melatonin is a hormone that is rises before sleep and is nearly absent during wake periods⁴. The hormone signals to the circadian clock that it is time for sleep. However, light suppresses melatonin production. Light as little as 200 lux, which includes the light from our devices⁴.

Swimming Upstream

“Highschool is hard enough…and my body is lit working against me!” The long and short of it is that the biology of teen sleep does not fit in modern society. In order to make it work, teens have to teach their brains to rewire based off of their needs. The good news is we know it is possible. The systems that regulate teen sleep in the brain rely on feedback from the teens external environment which means if teens change their environments and schedules, they can rewire their brain. Just looking at the biology of sleep alone makes some of the sleep recommendations make more sense. Sleep routines, minimal light exposure, turning off devices, minimizing naps, and even some Melatonin supplementation all target teaching the teen brain their desired circadian rhythm and attempt to manipulate the sleep/wake system.

Learning more about their brains helped take some of the blame and pressure off most of my clients. Armored with knowledge, the conversations quickly turned to the social systems that were making it hard for my teens to sleep the way their bodies wanted to. School start times, activities, social media and technology, homework, and more. In my next post I will explore more of the social systems that have come up in conversations with my teens that are getting in the way of their much needed sleep.

References

1. Tarokh, L., Saletin, J. M., & Carskadon, M. A. (2016). Sleep in adolescence: Physiology, cognition and mental health. Neuroscience and biobehavioral reviews, 70, 182–188. https://doi.org/10.1016/j.neubiorev.2016.08.008
2. Bruce, E. S., Lunt, L., & McDonagh, J. E. (2017). Sleep in adolescents and young adults. Clinical medicine (London, England), 17(5), 424–428. https://doi.org/10.7861/clinmedicine.17-5-424
3. Illingworth G. (2020). The challenges of adolescent sleep. Interface focus, 10(3), 20190080. https://doi.org/10.1098/rsfs.2019.0080
4. Crowley, S. J., Acebo, C., & Carskadon, M. A. (2007). Sleep, circadian rhythms, and delayed phase in adolescence. Sleep medicine, 8(6), 602-612.