Teens and Sleep: The Cost of Sleep Deprivation

It’s a radical thought, but what if the behavior we casually dismiss as “teenage angst” — the moodiness, the constant battles, the sleeping all day, the reckless, impulsive and careless behavior — is not in fact a normal part of being a teen? Or at least, not to the degree we assume it is. What if instead we are doing our teenagers a disservice by writing off as “normal” what are in reality the symptoms of chronic and severe sleep deprivation?

We know that the radical changes that occur in adolescence, including tremendous hormonal shifts and significant brain development, affect teenage behavior. But the physical, mental and behavioral consequences of chronic sleep deprivation are profound, too. With studies showing that 60 to 70% of American teens live with a borderline to severe sleep debt, we need to know how going without their recommended (optimal) nine hours a night affects them.

Sleep deprivation puts teenagers into a kind of perpetual cloud or haze, explains Mary Carskadon, PhD, a professor of psychiatry at Brown University and director of chronobiology and sleep research at Bradley Hospital in Rhode Island. “One of the metaphors I use is that it’s like having an astigmatism. You don’t realize how bad your vision is until you get glasses or in this case, good sleep.” That haze, Dr. Carskadon says, can negatively affect teenager’s mood, ability to think, to react, to regulate their emotions, to learn and to get along with adults.

According to a National Sleep Foundation Study, drowsiness or fatigue is the principle cause of at least 100,000 traffic accidents each year. One North Carolina state study found that 55% of all “fall-asleep” crashes were caused by drivers under the age of 25. Parents shouldn’t let sleep deprived adolescents get behind the wheel anymore than they would if their kid had been drinking.

But while it might pose the most serious risk, driving is not the only danger. After getting between 3 and 4 hours of sleep for several nights in a row, while working on a term paper in his sophomore year of high school, Gabriel Levine went into his kitchen at 3am to get a snack. Instead of slicing through a wedge of cheese he sliced through his thumb clear to the bone, severing a ligament. “It ended up requiring a trip to the emergency room and two surgeries to repair it, and I spent 6 weeks in a cast,” says Levine, now 19 and a freshman in college. Though he says the injury was “absolutely the result of how little sleep I’d been getting by on for months,” he didn’t get any extensions on homework or papers. And because he could only type with one hand, he ended up having to stay up even later to finish his work.

Along with a lack of sleep goes the ability to exercise self-control — over one’s emotions, impulses and mood. Ryan C. Meldrum, PhD, an assistant professor in the Department of Criminal Justice at Florida International University, found a link between short sleep duration, late bedtimes, and poor overall sleep quality and aggression, impulsivity, and being short-tempered.

“There’s a theory that views self-control not as a stable personality trait,” explains Dr. Meldrum, “but as something that is subject to the strains and stressors of the environment that people have to navigate on a daily basis. So imagine that self-control is like a muscle—if we exert a lot of energy and expend a lot of effort we need rest and recuperation in order to restore one’s ability to self-regulate.”

Allison Baker, MD, a child and adolescent psychiatrist, says teens who don’t get the kind of sleep they need in order to be able to self-regulate can actually exhibit many of the same symptoms as kids with ADHD. Signs of sleepiness can include an inability to sit still, to stay on task and to focus. “It’s an easy misdiagnosis to make,” Dr. Baker says.

Research by Dr. Carskadon and several others shows that sleep-deprived teens are far more likely to use stimulants like caffeine and nicotine to get through the day but also to deal with sleep-related negative moods by self-medicating with alcohol. They’re also more likely to engage in unprotected sex and reckless driving than teens who get upwards of 7 hours of sleep a night because they lack impulse control and suffer from impaired judgment that leads to poor decision-making.

As a college student, Carolyn Capputo made the choice to drive knowing she was severely sleep deprived even after she’d fallen asleep at the wheel. Now a number of years out of college, she knows she was lucky she didn’t cause a serious accident, but at the time it just didn’t seem like a big deal. “The summer before my sophomore year in college,” she says, “I’d routinely stay up past 3 am chatting online with my best friend because we missed each other and were still keeping college hours (at least in terms of staying awake). Then I’d wake up at 6:30 in the morning to go to my summer job. I fell asleep driving to work more than once.”

“There is data that shows that because teens are not fully developed in terms of their executive functioning,” says Dr. Carskadon, “even acute short-sleep can lead to risky behavior and poor judgment. The combination of the lack of infrastructure and poor sleep sends them down the wrong path.”

Many of the teens interviewed for this story citied mood as the first thing affected by sleep deprivation. In general, it went something like this:

• “I’m miserable, things get to me more and I’m more fragile.” – Emma
  Levine, a 16-year-old sophomore at The Dalton School in New York.
• “I’m just generally more grouchy and irritable.” – Jake Multer, Emma’s classmate.
• “When I’m tired, everything else seems worse. It’s easy to get depressed.” – Nina Lopez, a junior from Arlington, Virginia.

Some kids can suffer and push through, or have the ability to subsist on very little sleep for long periods and then binge-sleep enough to recharge, so they can get through the next sleep-deprived week. But other kids are not so resilient.

In 2006 the National Sleep Foundation surveyed more than 1,600 adolescents and found that many exhibited depressive symptoms on a frequent if not daily basis. More than half (56%) said that they felt stressed out and anxious. Many reported feeling hopeless about the future. Less sleep correlated with higher levels of depression and in turn, those kids with more depression had problems falling or staying asleep. It’s a vicious cycle — lack of sleep affects mood, and depression can lead to lack of sleep. And multiple studies, including Dr. Meldrum’s, have found that severe sleep debt is linked to suicidal ideation.

In addition, since many mental illnesses first show up in the teenage years, doctors worry that severe sleep deprivation could trigger a serious depression in kids who are already predisposed to it.

Last year Ben Freedman, a 17-year-old junior at Pioneer High School in Ann Arbor, Michigan, suffered what his dad, Jonathan, a professor at the University of Michigan, describes as a pretty bad clinical depression. Ben says the combination of chronic sleep deprivation and stress from an overwhelming academic workload triggered a severe mix of depression and anxiety. “I was way tired out,” he says. “And less sleep put me in a really, really depressed state. I was suffering really badly.” Ben says he was getting 5-6 hours of sleep at the time but his dad says it was less. “Ben took on too many AP courses last year,” says Jonathan. “He and his friends were pulling all-nighters and I as a dad intervened as much as I possibly could. Sleep deprivation and depression go hand-in-hand, and Ben’s kind of a melancholy guy.”

Medication, therapy and changing his sleep habits have all helped Ben feel better, but his dad says convincing Ben that he had to make changes wasn’t easy. “There was a lot of resistance at first. It took a while but eventually he came around and he’s committed to more regular consistent sleep.

Sleep deprivation in teens is not a normal part of growing up. The symptoms and consequences have concrete effects on even the most resilient kids and potentially devastating ones on those who have a predisposition toward mood disorders like depression. In part three of this series on teenagers and sleep we ask the experts — a sleep researcher, psychiatrist, pediatrician and teenager — what steps our kids can take to regain healthy sleep habits given the reality of the obstacles they face.