About Dr. Helene Emsellem

 

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An interview with Dr. Helene A. Emsellem, M.D., about Snooze...Or Lose! 10 'No War' Ways To Improve Your Teen's Sleep Habits

1.  Is insufficient sleep really having a negative effect on learning in teens or is it just making them feel sleepy?

Sleep is critical to learning new information --- data or motor skills.  I like to think of our brains as multi-sensory digital cameras on 'auto-shoot' all day long.  We are constantly taking snapshots of events around us including not only the visual but our emotions at the time, the smells, the sounds and the tactile sensations.  During the night, especially during REM sleep our brains take all of these billions and billions of pixels of information and figuratively throw them up in the air and try to define all of the possible interactions and relationships.  Information that we are exposed to during the day is laid down into memories and 'learned' at night while we sleep.  I am forever encouraging students to begin reviewing material early for an exam - many days before.  We can't put a tape recorder under our pillows, go to sleep and expect to learn the information BUT if we review information during the day and then get a full night's sleep that night our brains will do an immense amount of background work, translating that information into memories and learned facts. Studies show that after initially teaching a cognitive or motor task there is  improvement (without further practice) when retested after one good night's sleep and even more improvement after the second nights sleep.  Restricting sleep to 6 hours on the night that a task is learned eliminates the positive 'boost' effect of sleep on learning.  Mapping of brain regions activated during a task show the reorganization that occurs in the brain as a task is learned and becomes rote.

2.  How much sleep does an average teenager really need?

Teenagers need more sleep than adults --- it is just a fact.  9.25 hours of sleep is considered to be optimal with a normal range of 8.5-9.5 hours.  Studies show decrements in function when sleep drops below 8 hours per night and the recent Sleep in America Poll results shows a progressive restriction in sleep as our teens get older with a typical 17-year-old high school senior sleeping only 6.9 hours per night.  Cumulatively over just the first month of school that is an enormous sleep debt that cannot be compensated for with a weekend sleep-in and negatively impacting on all aspects of daily functioning.  Many teens also have after school jobs, often driving home late and driving to school overtired in the morning contributing to the elevated risk of fatal accidents in this age group and putting our hardest work 'good kids' at greatest risk.

3.  What makes teenage sleep so special?

With the onset of puberty there are changes in sleep that can be correlated with the physical maturation process.   The teenage brain is thought to be operating on a longer 'internal' day than adults (estimated to be perhaps as long as 24.7 hours) causing a progressive tendency to sleep later.  Teens also accumulate sleepiness slower over the course of the daytime hours than adults and children do '¦. meaning that a teen may be awake later into the evening before they even begin to feel sleepy.  Both of these factors result in a relative delay in the circadian timing of sleep in teens.  A typical teen's internal body clock may be most comfortable with a bedtime of midnight and wake-up between 8:30-9:30 AM.  Interview any first period high school teacher and ask them what percent of the class is awake!  The results will be startling.  Several years ago I was asked to do a sleep presentation for a high school health fair and I was distressed to find that I was assigned first period, which started at 7:35 AM.  It was an enlightening experience --- 3 of the 17 teens in the classroom had their eyes open and heads unsupported --- the remainder were in various states of drowsiness and sleep.

4. Aren't parents too lenient and couldn't this adolescent sleep problem be solved by stricter parents enforcing fixed bed times and consequences?

Although parents can play a supportive role by being good role models themselves, encouraging good sleep hygiene and discouraging activities late in the evening, such as telephones, TVs, and instant messaging that can keep teens up into the wee hours of the night, parents cannot force sleep onset.  The point is well stated by my daughter Elyssa who has repeatedly reminded me that it is not helpful to say 'go to sleep'  Yes we can encourage teens to wind down and be in their bedrooms with quiet reading or music at a reasonable time BUT if their internal clock is set to midnight they are still going to have a hard time falling asleep before that ideal circadian 'window of opportunity' for sleep is reached. 

5.  Isn't staying up late and being tired a rite of passage of adolescence?

NO!  Sleep deprived teens are more likely to be irritable, depressed and even experience suicidal thoughts than well-rested teens.  Sleep restriction has also been associated with impaired learning and poorer school performance, weight gain, acne, poor sports performance, automobile and other accidents and increased risk of substance abuse and risk-taking behaviors. 

6.  Can't teens just nap after school and make up for the missed sleep?

Napping is a double-edged sword.  An afternoon nap will fulfill some of the 24-hour sleep requirement and some teens are just so exhausted when they come home after school, especially if they have had sports practice, club/community service activities or an after school job that they can't stay awake to do their homework without a nap.  BUT napping late in the afternoon or early evening backfires as the nap itself rejuvenates the teen, making it easier to stay awake later in the night.  In the long run a late afternoon nap perpetuates the circadian phase delay in the timing of the sleep schedule and makes it harder to get on track with an early bed time and wake-up time.  Following this train of thought late weekend sleep-ins till 11 AM or later may help alleviate some of the sleep debt but at the same time also reinforce a later sleep schedule.  This defines the teenage vicious cycle of sleep deprivation:  Insufficient sleep, afternoon napping, difficulty initiating sleep and later bedtime, worsening sleep restriction.

7.  What can parents do to help their teens cope?

Understanding the sleep needs of adolescents and the processes underlying the changes in the timing of their sleep is a necessary first step.  Then discussing the issue with your teen during the day at a time when they are well-rested and having them help define a coping strategy is critical.  Focusing on the need to organize their after school time between breaks and studying, incorporating exercise into their daily routine, emphasizing the need for a comfortable sleep-environment (separate from the work and play space) and limiting TV. Phone & cell phone and internet use after a certain time is a good beginning.  Teens who can't fall asleep at the time that you all deem necessary in order to get enough sleep may be frustrated and may need to read with a low-light book light or listen to music (quietly!) with CD or MP3 player.  Relaxation strategies may also be helpful.  Parents need to be good role models and heed their own advice.  Parents can also earn the respect and admiration of their teens if they become active in encouraging a change in the high school start times in their school district.  This can begin by sponsoring a local sleep expert to speak to your child's science class or the PTA.  The National Sleep Foundation has a toolkit available outlining the many successfully strategies that have been used to initiate change.