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1 Adolescents and Sleep David Y. Huang, M.D. Tallahassee Pulmonary Clinic, P.A. April 8, 2010.

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Presentation on theme: "1 Adolescents and Sleep David Y. Huang, M.D. Tallahassee Pulmonary Clinic, P.A. April 8, 2010."— Presentation transcript:

1 1 Adolescents and Sleep David Y. Huang, M.D. Tallahassee Pulmonary Clinic, P.A. April 8, 2010

2 Goals Provide scientific and medical background regarding adolescents and sleep Allow the communitys educators to look at innovative ideas regarding better sleep for our adolescent students Provide sleep education in schools Improve opportunity for students to get adequate sleep each night 2

3 Disclosures I am a Sleep Medicine Physician I am 6 4 I am married to a beautiful wife and am the father of 4 children 9 th grader at Sail 2 sons in middle school Daughter in elementary school I am a Leon County Taxpayer I receive no compensation for being here today I am not affiliated with the Leon School Board, SAC, or DAC I realize that these are tough times for all county school budgets I am a concerned citizen of Leon County and am an Advocate for the 5,000 high school students in Leon County 3

4 Terminology Adolescent:13-22 years old Teenager:13-19 years old Insufficient sleep syndrome = Chronic sleep deprivation Insomnia = difficulty initiating or maintaining sleep = DIMS Delayed sleep phase syndrome = DSPS (going to bed very late and sleeping very late) 4

5 5 Sleep Needs Vary as We Age - Ideal Sleep Times Newborns/Infants ( months): hours Toddlers/Children (12 mo - 12 years): hours Adolescents hours Young Adults hours Older Adults hours

6 6 Adolescents Experience a Shift to a Later Sleep-Wake Cycle The biological clock of children shifts during adolescence, which drives them to a later bed time (11:30 pm or later) and a natural tendency to wake up later in the morning. Bright light at night can worsen this problem. This delayed sleep onset (delayed sleep phase) can place them in conflict with their schedules – particularly early school start times.

7 Whose Fault Is It? Thomas Edison The Light Bulb The Big Three

8 8 Adolescent Sleep-Wake Cycle Adolescent - Delayed circadian phase Alert in the evening Delayed sleep onset Morning sleepiness and difficulty awakening from sleep Childhood circadian phase Normal sleep time Later Sleep-Wake Cycle

9 9 Adolescent Sleep-Wake Cycle Later circadian melatonin phase Alert in the evening Sleep onset insomnia Morning sleepiness difficulty awakening from sleep Delayed sleep time and reduced sleep duration during the school week Normal circadian melatonin phase Normal sleep time Restricted sleep time with delayed phase NL sleep time with delayed phase

10 10 Sleep Time School start times Social pressures Substance abuse Hormonal influence, obesity Genetic predisposition Delayed sleep phase Insufficient Sleep Syndrome

11 11 Trying to Get Enough Sleep Late bedtime Difficulty initiating sleep Afternoon napping Sleep restricted during school week Problem with daytime alertness Sleep restricted during school week Sleep longer on weekends Problem with daytime alertness Adolescent Vicious Cycle Graphic courtesy of Helene Emsellem, MD, George Washington University.

12 12 Consequences of Sleep Deprivation Impaired cognitive, social and behavioral performance. Poor athletic performance, poor school performance, lower grades Tardiness and absence from school Difficulty remaining alert, difficulty being able to focus and concentrate (worse ADHD) Irritability, impaired mood, and depression. Increases in substance abuse and in obesity Drowsy driving, injury, and possibly death. How many hours of sleep do the Rickards basketball players get each night?

13 13 Drowsy Driving and Auto Accidents The peak age for fall-asleep driving accidents is 20 years old Drivers under 30 account for 2/3 of drowsy-driving crashes.

14 14 Circadian Rhythm Disorders Delayed sleep phase syndrome* Advanced sleep phase syndrome Irregular sleep-wake disorder Free running sleep disorder Shift work disorder Jet lag disorder * Very common in adolescents

15 15 Treatment of Delayed Sleep Phase Syndrome with Bright Light Exposure Goal of treatment is to shift circadian melatonin phase and bedtime to an earlier time Evening reduced exposure to light Morning exposure to bright light - Normal sleep - Restricted sleep with delayed phase - Delayed sleep phase syndrome

16 16 Treating Adolescent Delayed Sleep Phase Syndrome Bright light exposure in the morning Darkness in the evening Cognitive Behavioral Therapy Learning the importance of sleep Resetting habits and associations Pharmacologic treatment in the evening Melatonin Hypnotics

17 17 Advocacy Issue: Sleep Curriculum Educators, parents, and many health care providers receive little training about the physiology and importance of sleep. Very few schools offer information regarding sleep to their students or include sleep education in the health or science curriculum. We must teach our adolescents the importance of getting sufficient sleep!

18 18 Advocacy Issue: School Start Times Symptoms are worst in the morning. Students are often living with the consequences of sleep deprivation throughout the day. High school and middle school start times tend to be early - interrupting adolescents sleep patterns - and making it difficult to wake up and be alert.

19 19 Positive Outcomes from Minnesota Schools – After Change to 8:40 Start Time Teachers report more alert students. Students report less sleepiness and better grades. Fewer students are seeking help from school counselors or nurses. Parents report more connect time and their teens are easier to live with. Tardiness and sick days declined. JAMA article on Later HS Start Times, June 2009

20 20 Helping Schools Become Sleep-Friendly Many high schools across the country are establishing later start times to get in sync with a teens sleep schedule Several studies cite the positive outcomes of sleep-friendly high school start time policies. Early Bird Gets the Bad Grade - NY Times, 2008

21 Dim the Lights and Say No to TV and Computer after 8 pm 21

22 Whats Next - Innovative Ideas for Better Sleep Time to digest this information (short time) Add sleep education to student curriculum and parent curriculum Change standardized testing from 8 a.m. to 10 a.m. for high schools and middle schools Set up a task force or committee to evaluate the optimal school start times Invite Ronnie Youngblood to be on the committee Decide where this falls on the priority list of funding Can Leon County be a leader re school start times 22

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