More on sleep in adolescents

This is the third part of the series on the topic, from April 01, 2006...

This being the National Sleep Awareness Week and in the heels of the recent study on sleep of adolescents, it is not surprising that this issue is all over the media, including blogs, these days.

I have covered this issue a couple of times last week, e.g., here, here and here. Recently, Lance Mannion wrote an interesting post on the topic, which reminded me also of an older post by Ezra Klein in which the commenters voiced all the usual arguments heard in this debate.

There are a couple of more details that I have not touched upon in the previous posts.

First, lack of sleep can lead to obesity and even diabetes, as the circadian clock is tightly connected to the ghrelin/leptin system of hormonal control of hunger, feeding and fat-deposition.

Second, lack of sleep discourages excercise. Put these two pieces of data together, and you get a national epidemic of obesity, not just a bunch of sleep-deprived children.

Third, lack of sleep has a well-documented effect on mood. No, teenagers are not naturally that moody - at least not all of them. They are just barely "functional" (instead of "optimal") and walk through life like zombies because they are operating on 4-8 hours of sleep instead of 9 hours (optimal for teens, it goes down to about 8 for adults). Of course they are moody.

Fourth, chronic sleep deprivation can have long-term consequences, ranging from psychiatric diseases to cancer. Remember that teens in high-school (and college students are faring worse!) are constantly jet-lagged!

There is even a hypothesis floating around that sleep-delay in adolescence may affect the onset of picking up smoking.

Fifth - and I did not think of this although it is obvious - teenagers above a certain age, still in high school, are allowed to drive. If they are driving themselves to school at 6 or 7am, when their circadian clocks think is it 3 or 4am, it is as if they are driving drunk. There is actually a scale devised by one of the sleep researchers that tells which time of the night corresponds to what number of bottles of beer. Driving at 4am (or driving a ship, like Exxon Valdese, or operating a power-plant, like one in Chernobyl) is the equivalent of driving drunk - way over the legal limits. Teenagers driving at 7am are equally "drunk".

One of the reasons for the resistance to healthy inititiatives to change school-start schedules stems from the fact that the world is organized by adults and adults want to have the world run according to schedules that fit their moods and are unwilling to change it - they may not know that teens feel differently, or they defend their preferences nonetheless.

A large proportion of adults in this country still subscribe to barbaric notions that sleep is a shameful activity, a sign of laziness, and that teens need to be tortured in order to "steel" them to grow into "real men". This has roots all the way back to the Puritan so-called "work-ethic" which is really a "no fun for anyone" punitive ethic long ago shown to be physically and emotionally debilitating.

When I was a kid, back in old now-non-existent Yugoslavia, most schools in big urban areas worked in two shifts. All the kids started school at 8am and ended at 1:15pm for one week, then started at 2pm and ended at 7:15pm the next week, and so on...

If a school had, let's say, twelve classes of the seventh grade, six of those would be in the A-shift and the other six in the B-shift. Each shift had its own complete set of teachers, assistants, nurses...everything except the one shared Principal and the school psychologist.

The time between 1:15pm and 2pm was for supplementary classes (either for those who needed extra help, or for those preparing for Math Olympics and such) and clubs. That was also time for kids from two shifts to meet and get to know each other (it is amazing how many kids from opposite shifts started dating each other after the year-end Big Trip to the Coast - me included). There was no such thing as the American hype for high-school competitive sports, which I still find strange and curious after 15 years in this country.

Thus, you get to sleep in for a week (but miss out on afternoon activities), then have to get up relatively early for a week but have the afternoon free to galivant around town. Nobody there understands what's the American fuss over kids being home alone - of course they are home alone, cleaning the house, fixing meals, doing homework and BETTER be getting to school on time!

Teachers were pretty understanding about sleeping types. I do not recall ever having a big test, quiz or exam being given at the extremes of the day (around 8am or around 7pm). As an owl myself, I was much more likely to raise my hand, participate in discussions, or volunteer for oral examinations during the week when I was in school in the afternoon, and that was fine with most of my teachers.

Transportation was not an issue. Most kids lived close enough to their neighborhood school to walk. For those who lived a little farther away - hey, no problem, that's Europe, so Belgrade has a huge and pretty efficient public transportation system. I do not remember ever seeing any of my friends ever being dropped off to school by a parent driving a car! Or being brought to or picked up from school by a parent beyond fourth grade at all - period. And the minimum driving age being 18, nobody drove themselves to school either.

In rural areas, there was no need for two shifts - something like 9am-2:15pm was good enough to accomodate all of the kids.

I do not think that this kind of system can be implemented in the USA. It relies on an efficient public transportation which, with exception of a few oldest East Coast cities, is practically non-existent. American cities have been built for cars.

But some things can be done.

First, swap the starting times so elementary kids go to school first, middle school next and high school last (e.g., around 8am, 8:30am and 9am respectively). Studies show that teens do not go to sleep later if their school starts later. Some cynics claim that is what teens will do. But they do not. Actually, they fall asleep at the same time, thus gaining an additional hour of sleep.

Teens are almost adults. The current generation of teens, perhaps because of a closer and tighter contact with their parents than any generation before, is the most serious, mature and responsible generation I have seen. Give them a benefit of the doubt. Just because you were into mischief and hated your parents when you were their age does not mean that today's kids are the same.

Second, start the school day - for all kids every day - with PE (or some kind of excercise), preferably outdoors, as both exposure to daylight and the excercise have been shown to aid in phase-shifting the circadian clock.

Third, let them eat breakfast afterwards (sticking to a meal schedule also helps entrain the clock). Follow up with the electives which kids may be most interested in. By the time they hit math, science and English classes around 11 or so, their bodies are finally fully awake and they can understand what the teacher is saying, and do the tests with a clear mind instead of in a sleepy haze.

Do not permit any caffeine to be sold in schools. Advise parents not to allow TV or any other electronics to be in kids bedrooms. Let them enjoy those activities in the living room. Bedroom is for sleeping, and sleeping alone. A book before bed is fine, but screens just keep them awake even longer.

Finally, rethink all those extra activities you are forcing the teens to do: sports, art, music, etc. In teen's minds, the day does not start with the beginning of school in the morning. We may think that we are at work most of our day. Teens do not - they consider their day to begin at the time schoolday is over. Their day begins in the afternoon. School is something they have to deal with before they can have their day. Realize this and give them time and space to do with their day what they want. Do not push them to do things that you think they'll need to get into Harvard. Let them be - leave them alone. Then they'll go to sleep at a normal time.

Concern for our kids' physical and mental health HAS to trump all other concerns, including economic costs, cultural traditions and adult preferences. We have a problem and we need to do something, informed by science, to fix the problem. Blaming the messenger, proposing to do nothing, and, the worst, blaming the kids, is unacceptable.