6/11/2020 When Teens Don't Get Enough Sleep | Sleep Deprivation Effects | Child Mind Institute

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Teens and Sleep: e Cost of Sleep

Deprivation
Lack of adequate sleep is linked to moodiness, risky
behavior and injuries
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Juliann Garey

I
t’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 o 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 shi s and signi cant brain development, a ect 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

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to know how going without their recommended (optimal) nine hours a night
a ects them.

Sleep deprivation puts teenagers into a kind of perpetual cloud or haze,

explains Dr. Mary Carskadon, 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.” at haze, she says, can negatively a ect teenager’s mood, ability to
think, to react, to regulate their emotions, to learn and to get along with
adults.

Increased risk of  injuries

According to a National Sleep Foundation Study, drowsiness or fatigue is the
principle cause of at least 100,000 tra c 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.
A er 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. ough 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 nish his work.

Inability to self-regulate

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Along with a lack of sleep goes the ability to exercise self-control — over one’s
emotions, impulses and mood. Dr. Ryan C. Meldrum, 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.

Related: Why Are Teenagers So Sleep-Deprived?

“ ere’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 e ort we need rest and recuperation in order to restore one’s
ability to self-regulate.”

Dr. Allison Baker, 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,” Baker says.

Substance use and risky behavior

Research by Carskadon and several others shows that sleep-deprived teens are
far more likely to use stimulants like ca eine and nicotine to get through the
day but also to deal with sleep-related negative moods by self-medicating
with alcohol. ey’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 su er from impaired judgment that
leads to poor decision-making.

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As a college student, Carolyn Capputo made the choice to drive knowing she
was severely sleep deprived even a er 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. “ e
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). en
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.”

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

Sleep and mood

Many of the teens interviewed for this story citied mood as the rst thing
a ected 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 e 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 su er 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.

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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 a ects
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.

A trigger for mental illness?

In addition, since many mental illnesses rst 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, su ered 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 su ering 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-

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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.”

Related: Teenage Depression and the Immune System

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. “ ere was a lot of resistance at rst. 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. e symptoms

and consequences have concrete e ects 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.

Read More:
How to Help Teenagers Get More Sleep

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SLEEP, TEENAGERS, YOUNG ADULTS

Juliann Garey is a journalist, novelist and clinical assistant professor at NYU. Her work has
appeared in the New York Times, Los Angeles Times and Marie Claire; her novel, Too Bright To
Hear Too Loud To See, was an American Library Association award-winner and NPR Best
Book of the Year in 2013.

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