Insomnia and its negative consequences for health and functioning of adolescents

The most common sleep symptoms reported by adolescents involve insomnia; with large epidemiologic studies indicating one in four teenagers can be affected. Most of the evidence from cross-sectional studies indicate that adolescents with insomnia report more depression, anxiety, irritability, anger, inattention, conduct problems, drug and alcohol use, increase in fatigue, headache, backache and abdominal pain. However there have been very few longitudinal studies to clarify the cause and effect relationship between psychosocial symptoms and insomnia in the context of a precise diagnosis of insomnia.

A study in the Journal of Adolescent Health March 2008 looked at a large community sample of adolescents (11 – 17 years) prospectively over 12 months asking about a diverse range of psychological, interpersonal and body functioning.

The study confirmed that insomnia is not only common but also chronic with 46% of teenagers reporting symptoms and almost 25% meeting the definition for clinical insomnia.

(For the purpose of this study clinical insomnia was defined as difficulty initiating sleep, difficulty maintaining sleep and non-restorative sleep causing significant distress or impairment.)

The authors concluded that there is a strong reciprocal relationship between insomnia and psychosocial effects (ie such as depression, anxiety, irritability, anger, inattention, conduct problems, drug and alcohol use as well as an increase in fatigue).

In that, chronic insomnia in teenagers predicts an increase in negative psychosocial symptoms and in turn having these negative psychosocial symptoms increase the risk of future chronic insomnia.

Roberts et al Chronic Insomnia and its Negative Consequences for Health and Functioning of Adolescents

Journal of Adolescent Health 42(2008) 294-302

Adolescent insomnia as a risk factor for early adult depression & substance abuse

In a study published in the medical journal titled “Sleep” adolescent insomnia was investigated as a risk factor for early adult depression and substance abuse.

In this study a US nationally based population sample of 4,494 adolescents participated, aged 12 to 18 years with a median age of 15.83. These adolescents were then contacted 6 to 7 years later with 3,582 now young adults responding, aged 18 to 25 years with a median age of 21.25 years.

Results from the study found insomnia symptoms were reported by 9.4% of the adolescents.

Cross-sectionally, adolescent insomnia symptoms were associated with significantly increased use of alcohol, cannabis, use of drugs other than cannabis, depression, suicide thoughts and suicide attempts.

The study concluded that:

  • adolescents with insomnia symptoms have significantly higher occurrences of mental health problems than adolescents without insomnia symptoms

  • 6 to 7 years later when the adolescents with insomnia symptoms were young adults, they were found to significantly be more likely to develop mental health problems such as depression, anxiety disorder & suicide when compared to the adolescents without insomnia.

The study concluded, insomnia symptoms during adolescence were a significant risk factor for depression diagnosis in young adulthood.

Brandy M. Roane, MS; Daniel J. Taylor, PhD. Dept of Psychology, University of North Texas, Denton, TX.

Published in SLEEP, Vol. 31, No. 10, 2008

Adolescent sleep, school start times, and teen motor vehicle crashes

There is considerable evidence that a majority of adolescents do not get enough sleep for optimal functioning during the day. It is also clear that driving while drowsy is a serious traffic safety problem, especially among young drivers. Both social and biologic pressures appear to cause a shift in sleep patterns during the transition to adolescence, with the result that adolescents stay up progressively later as they progress through high school. Therefore, early school start times for adolescents decrease their sleep, which increases their daytime sleepiness, which may, in turn, increase their odds of crashing their vehicles while driving.

Previous research has indicated by starting the school day 1 hour later, adolescents were able to sleep more and proved to have a positive effect on academic performance. It was hypothesised starting school 1 hour later may also have an effect on motor vehicle crash rates where teenagers are the drivers. In this study, the sleep habits and motor vehicle crash rates of 9,966 adolescents from a single, large, county-wide, school district in Kentucky, were assessed by questionnaire. The questionnaire was given in April, 1998 and then given again in April 1999, when the school start-time was delayed by 1 hour.

The results from changing the high school start time to 1 hour later in the morning, showed the average hours of nightly sleep increased by 50 minutes and catch-up sleep on weekends decreased. The percentage of students who got at least 8 hours of sleep per weeknight increased significantly from 35.7% to 50.0%, and the percentage who got at least 9 hours of sleep increased significantly from 6.3% to 10.8%.

Significantly the average crash rates for teen drivers in the study county in the 2 years after the change in school start time dropped 16.5%, compared with the 2 years prior to the change. The study concluded later school start times increase the sleep of adolescents and decrease their risk of motor vehicle crashes.

This data is consistent with the idea that allowing adolescents to sleep more on school nights by delaying the start of school not only results in them sleeping more, but also may have a measurable positive effect on their driving safety.

Danner F, PhD & Phillips B, MD

Journal Clinical Sleep Medicine, 2008 December 15; 4(6): 533–535

National Youth Risk Behaviour Survey

The US Centers for Disease Control & Prevention conducted its National Youth Risk Behaviour survey in 2007. This survey of more than 12,000 teenagers assessed a range of health risk behaviours in adolescents. Regarding sleep, the survey asked teens: “On an average school night, how many hours of sleep do you get?” The responses were divided into two categories: 8 hours or more were considered sufficient sleep, and fewer than 8 hours were considered insufficient sleep.

More than two thirds of teens surveyed, 68.9%, said they received fewer than 8 hours of sleep on an average school night.

Of the 11 health risk behaviours that the survey examined, 10 of them were more likely to occur in teenagers who reported insufficient sleep during the school week.

Lack of sleep in teens was associated with a greater risk of:

  • Feeling sad or hopeless

  • Drinking alcohol

  • Smoking marijuana

  • Having seriously considered suicide

  • Smoking cigarettes

  • Engaging in sexual activity

  • Participating in a physical fight at least once

  • Using computers for 3 hours or more per day

  • Not exercising for 60 minutes on 5 of the past 7 days before the survey

The National Youth Risk Behaviour survey concluded teenagers who reported sleeping fewer than 8 hours on school nights were more likely or significantly more likely to engage in these risky behaviours than teens who sleep 8 hours a night or more during the school week.

For teenagers whose brains are still developing (and whose social and emotional skills are also) the challenges of sleep deprivation is particularly serious.

2007 National Youth Risk Behaviour Survey

The US Centers for Disease Control & Prevention

Teenage sleep & the intrusion of digital technology in the bedroom

For most teenagers, digital technologies have become a persuasive part of life with a subsequent impact on a range of social behaviours including pre-sleep behaviour and sleep quality.

In the mid school year, 316 teenagers with a median age of 17.3 years from 4 metropolitan Australian schools volunteered to complete an omnibus questionnaire which included measures of sleep habits and use of digital technologies.

The results found that:

  • only 25% of teenagers reported sufficient sleep on school nights

  • girls compared to boys were less likely to play electronic games, listen to music and watch TV but more likely to talk on the phone

  • a high number of teenagers reported daytime sleepiness, and fell asleep in the following situations: 27% watching TV, 25% on a bus or a train, 20% reading a book, 20% in a class, 18% studying, 7% at the movies, 6% working on the computer, 5% playing video games, 3.2% during a conversation & 3% fell asleep doing a test.

The researchers concluded almost 50% of Australian teenagers in the present study reported before falling asleep on school nights that they either sometimes or always played an electronic game, watched TV, listened to music or talked on the phone.

A sizeable percentage also reported insufficient sleep and daytime sleepiness. The authors suggested that sleep may be unnecessarily shortened in a substantial number of students during a school day where alertness and peak academic performance are required.

Lushington K, Wilson A, Dollman J, University of South Australia. Declan K, University of Adelaide. Martin J, Women and Children's Hospital, Adelaide.

Published in SLEEP, Vol 32, Abstract Supplement, 2009

Texting linked to sleep problems

Exhausted college students should consider their smartphone habits, according to a new study that links heavy texting with sleep problems.

The study attempted to determine what psychological effect the reliance on smartphones had on students, by asking more than 80 1st year university students:

  • how many texts they send and receive on an average day

  • how well they sleep

  • how they feel about their social lives

  • how well they do academically at university

Data from the American College Health Association shows that 40% of students feel rested only two days a week. 70% of university students get less than 8 hours of sleep a night.

The study determined that “heavy texters” (those who send more than 100 messages a day), are most likely to suffer from sleep problems and feel burnt out.

The study also examined the effects of sending text messages while stressed — and discovered it only makes matters worse for sleep-deprived students, who suffer from the lack of non-verbal cues and gestures that help conversation flow in face-to-face meetings.

The researchers suggested that the link between sleep loss and texting might because students feel compelled to answer their messages at all hours, or because they sleep with the phone’s sound on, and the noise wakes them in the middle of the night.

The evidence from the study concluded that among first-year students, those who sent the most text messages had the poorest sleep habits and lowest levels of emotional wellbeing.

Murdock K, Washington and Lee University,Virginia

Published in Psychology of Popular Media Culture

Risk behaviors and negative health outcomes for adolescents with late bedtimes

Late bedtimes in adolescence may be a serious risk factor for later poor health and functional outcomes.

The current study sought to extend existing research by examining whether late bedtimes in adolescence predicts poor outcomes in young adulthood. Data from wave 2 (1996) and wave 3 (2001–2002) of the nationally representative sample of US youth (National Longitudinal Study of Adolescent Health) was used to examine the longitudinal relationship between late bedtime, and several risk behaviors and negative health outcomes following 3,843 adolescents into young adulthood.

At wave 2 the mean age was 16 with 52.1 % female. At wave 3 the mean age was 21.8.

It was found late bedtime was associated with 1.5 to over 3 times greater odds of involvement in risk behaviors and negative health outcomes, including emotional distress, suicidality, criminal and violent activity, and use of cigarettes, alcohol and illicit drugs.

In longitudinal analyses, late bedtime assessed at wave 2 predicted a number of serious health outcomes at wave 3, with late bedtime in adolescence associated with around 1.5 greater odds of involvement in health jeopardising behaviors such as criminal activity, alcohol abuse, cigarette use, illicit drug use and emotional distress in young adulthood.

There was also a dose effect, such that the later the bedtime in adolescence, the greater the risk of involvement in risk behaviors in young adulthood.

This research suggests that late bedtime in adolescence predicts multiple serious risk behaviors and health outcomes in young adulthood.

E. L. McGlinchey, Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center and A. G. Harvey, Department of Psychology, University of California, Berkeley.

Published in the Journal of Youth Medicine, March 2014