Polysomnography I - Normal

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

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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
• 9th 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

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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)

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Sleep Needs Vary as We Age -Ideal Sleep Times
Newborns/Infants (0 - 12 months) 10.5 - 18 hours
Toddlers/Children (12 mo - 12 years) 10 - 13 hours
Adolescents 8.5 - 9.5 hours
Young Adults 7 - 9 hours
Older Adults 7 - 8 hours
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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 (1130 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.

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Whose Fault Is It?

• Thomas Edison

The Light Bulb
The Big Three
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Adolescent Sleep-Wake Cycle
Adolescent - Delayed circadian phase
Childhood circadian phase
Morning sleepiness and difficulty awakening from
sleep
Alert in the eveningDelayed sleep onset
Normal sleep time
Later Sleep-Wake Cycle
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Adolescent Sleep-Wake Cycle
Later circadian melatonin phase
Normal circadian melatonin phase
Morning sleepinessdifficulty awakening from sleep
Alert in the eveningSleep onset insomnia
Normal sleep time
Delayed sleep time and reduced sleep duration
?? during the school week
Restricted sleep time with delayed phase
NL sleep time with delayed phase
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Insufficient Sleep Syndrome
Social pressures
Delayed sleep phase
Sleep Time
School start times
Genetic predisposition
Substance abuse
Hormonal influence, obesity
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Trying to Get Enough Sleep
Late bedtime
Sleep restricted during school week
Afternoon napping
Problem with daytime alertness
Problem with daytime alertness
AdolescentViciousCycle
Sleep restricted during school week
Sleep longer on weekends
Difficulty initiating sleep
Graphic courtesy of Helene Emsellem, MD, George
Washington University.
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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?

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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.

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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
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Treatment of Delayed Sleep PhaseSyndrome 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
- Delayed sleep phase syndrome
- Restricted sleep with delayed phase
- Normal sleep
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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

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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!

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Advocacy Issue School Start Times
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.

• Symptoms are worst in the morning.
• Students are often living with the consequences
  of sleep deprivation throughout the day.

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Positive Outcomes from Minnesota Schools After
Change to 840 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

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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

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Dim the Lights and Say Noto TV and Computer
after 8 pm
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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