Sleep Loss and Risky Behavior in Teens

Teenagers notoriously exhibit sleep patterns characterized by staying awake later at night and sleeping in later in the morning (when possible) than children and adults.

Yet, while research shows that this change in the teenage sleep cycle is largely a physiological and not a behavioral phenomenon, total sleep quantity is in itself an important determinant of teenage behavior.

Lack of sleep is correlated with risky behavior

A research study including over 20,000 7th and 8th graders compared self-reported sleep duration with self reported risky activities such as antisocial behavior, drug use, sensation seeking, and gang activity. There was a strong correlation between reported sleep duration of less than 7 hours and the prevalence of these behaviors. The data showed that there was an even stronger correlation between getting less than 5 hours of daily sleep and the presence of risky behaviors among the surveyed middle school students. 

Another study from George Mason University in Fairfax, VA evaluated the correlation between sleep habits and the self reported psychosocial/emotional issues of over 27,000 8th graders, 10th graders, and 12th graders. The findings of the study showed that for each hour less of continuous sleep, there was a correlated increase in the prevalence of serious emotional issues, including depression, a sense of hopelessness, drug use, suicidal ideation, and incidents of attempted suicide. 

Both studies used 9 hours as the recommended and ideal sleep duration for teenagers, a number that only 3% reported in one study, and approximately 15% reported in the other study. The majority of participants of each study reported less than 7 hours of sleep per school night.

Why does lack of sleep have such a strong effect on teenagers? 

There are a number of possible contributing factors that can explain the relationship between lack of sleep and psychosocial issues among teenagers. 

Lifestyle factors may impact sleep duration 

Issues that impact sleep may include a lack of parental supervision, excessive teenage burden of responsibility, and late night recreational activities. Any of these issues can lead to high-risk teen behaviors, even without the additional variable of sleep deprivation. 

Emotional distress impacting sleep duration 

While insomnia is not commonly reported among young adults, it has been reported, particularly in association with stress and anxiety. When insomnia itself is the reason for lack of sleep, then the physiological effects of sleeplessness are expected to impact daily well-being. Because insomnia may be related to a number of origins, including emotional distress, it is possible that the psychological cause of insomnia itself can contribute to the risk behaviors noted among teens who lack adequate sleep.

Lack of restorative sleep 

The lack of adequate sleep itself may cause emotional distress, whether the cause of sleep deprivation is social, emotional, or even physiologic. The physiologic response to lack of restorative sleep may interfere with self-control and mood, contributing to high-risk behaviors and major mood alterations.

How often do you ask your young patients about how much sleep they get? Is sleep duration an important subject of discussion in a routine physician visit?

References:

Winsler A, et al. Sleepless in Fairfax: the difference one more hour of sleep can make for teen hopelessness, suicidal ideation, and substance use. J Youth Adolesc. 2015 Feb;44(2):362-378.

Owens J, et al. Association between short sleep duration and risk behavior factors in middle school students. Sleep. 2016 Sep 9. pii: sp-00109-16.