The Sleepy Teenager
When asked, many of the college students I teach at the University of Michigan freely discuss their jam-packed agendas of classes, activities, and pursuits that leave little time for sleep. And while many of my young charges have no idea who Edna St. Vincent Millay was, let alone are able to quote her rhyming words about burning the candle at both ends, they enact a Millay-esque lifestyle on a regular basis.

"You go to class all day, and then you may be involved in some clubs or extracurricular activities, then you get home and you have homework to complete, and then you want to spend time with friends. It's a hectic schedule. The more work, the more stress, the less sleep," a 19-year-old psychology major recently told me.

Her story is not an uncommon one. American teens and young adults sleep less than ever, increasingly attempting to erratically catch up on these losses in ways that often baffle and upset their parents and teachers.

Indeed, some colleges, like Brown University, have stopped 8:00 am classes after studies of their students' sleep habits demonstrated a median bedtime of 2:00 am. The educational day at Brown now begins at 9:00 am to better accommodate these students' sleep patterns, according to leading sleep researcher and Brown psychology professor Mary Ann Carskadon.

The June 2005 issue of Pediatrics featured a report by the American Academy of Pediatrics' (AAP) Working Group on Sleepiness in Adolescents and Young Adults. It is a superb comprehensive and scholarly overview of the problem's causes, consequences, and treatment strategies. One of the most striking findings, however, is that this insidious problem often begins long before the freshman year at college. Sleep research data indicate that adolescents and even young adults under 21 still require 9-10 hours' sleep a night. But since the 1980s, the average sack time for both college and high school students has diminished to 6-7 hours nightly.

"By adolescence, most parents have given up trying to control their kids' sleep patterns, which can help things spiral out of control," said Dr. Jodi Mindell, a professor of psychology at St. Joseph's University and author of A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Youngsters who are aged 9-10 years tend to sleep, on average, for about 10 hours on school nights and usually not more (and many times a lot less!) on weekends. But teenagers typically begin to enjoy sleeping in on the weekends. This trend increases during the high school years. As teens also develop a yen for late-night activities, their sleep debt increases daily. Developmental changes in circadian rhythms, endocrine and neurobehavioral systems, not to mention busier schedules, earlier start times for school, and parental supervision, also contribute to the problem of a teenager's getting less sleep. Regardless of the causes, however, this scenario often proves far more serious than a mere yawn or a brief encounter in slumber land.

"We have pretty good evidence that staying up late all night and then trying to catch up with an erratic schedule of naps quickly creates a situation called sleep-delayed insomnia. This is the kiss of death for mood regulation," explains Dr. John Greden, chairman of psychiatry and director of the Depression Center at the University of Michigan.

Dr. Mindell adds, "We do know that college kids are not getting enough sleep and that that this affects their moods negatively. It also interferes with their ability to problem-solve, make decisions, and do their schoolwork. There is excellent evidence that sleep-deprived adolescents are at higher risk to engage in risky behaviors such as drinking and driving, unsafe sexual activity, and so on."

Summertime can be even worse in terms of good sleep hygiene for teens. Once school has let out, students no longer have to get up early for classes and may be working late evenings or just enjoying the summer with their friends, often staying up later and waking up later. As a result, one of the most difficult periods of adjustment for good sleep habits starts when the school year begins and a more rigid schedule returns.

The AAP committee report gives some good advice on how adolescent and young adult health professionals can begin to address this problem by taking a sleep history called the "BEARS" ( Table ). Discovering the answers to these questions will help lead you down the right path when considering how to manage those sleepy teens who make it in for a clinical visit, and may help you detect a potentially reversible process.

Also very beneficial, the AAP Working Group concluded, is good, old-fashioned pediatric anticipatory guidance for the adolescent or young adult "on the importance of age-appropriate sleep needs and the detrimental effects of sleep loss on performance and overall health."