It's not just growth spurts, new hairdos and fashion crazes that mark the onset of adolescence. Sleep experts say that changing sleep patterns are markers for adolescence, too. Though teens need more sleep than adults, they are more likely to feel wide awake until late at night and can more naturally sleep later into the morning. Pit this pattern against early school schedules, the desire to load up on courses or activities and a 24/7 world of electronic options and you have a recipe for…

America's Sleepy Teens

The National Sleep Foundation's (NSF) 2006 Sleep in America poll conducted during fall 2005 randomly surveyed 1,602 households across the U.S. The poll, fashioned by experts on adolescent sleep, asked questions of one family member between the ages of 11 and 17 and one parent or guardian in the same household in order to compare their responses.

The findings provide a first-time data-based portrait of America’s adolescents and how they sleep.

Lauren's cram-packed day

When sixteen year-old Lauren gets home from a full day of school, cheerleading practice and a quick bite to eat, she’s full of energy and life. After IM’ing on her computer, talking on the phone and working on some homework, she still feels wired and is reluctant to go to sleep. Because Lauren’s parents are used to seeing their daughter come to life at night, they often have a hard time convincing her to go bed; they can’t really imagine that she is sleep deprived. Yet what they often don’t notice is that Lauren has trouble waking up in the morning, can’t get going until she’s had a cup of coffee, is groggy when she heads off to school, yawns throughout the morning and has difficulty paying attention in many of her classes. Because she manages to stay afloat in school, participates in extracurricular activities and makes time for friends, Lauren is perceived to be an "average" teenager with a busy schedule and little time for sleep. No one realizes that there are two sides to Lauren’s day and personality – at night she’s an energetic teenager who makes time for family and friends; during the day she’s often an irritable, sleepy teen who is struggling to balance her responsibilities.

Like many other adolescents and their parents surveyed in NSF’s 2006 Sleep in America poll, Lauren and her family have been fooled by what Jodi Mindell, associate director of the Sleep Disorders Center at the Children's Hospital of Philadelphia, calls the "trick of nature." According to Mindell, adolescents' circadian rhythms change when they hit adolescence – their brains and bodies are geared to stay awake later and sleep in later, but their school schedules don’t permit this kind of lifestyle. Parents often observe an alert, active teen at night without realizing that many of the signs of sleep deprivation regularly show themselves in the morning. To compound this problem, many parents and teens don’t realize that sleep experts recommend that adolescents get 8.5 to 9.25 hours of sleep every night as a minimum. To this mix of circadian rhythms and additional sleep needs, add in a busy social life, extracurricular activities, sports and a job and the result is that America’s teenagers are constantly fighting against their brains’ and bodies' natural tendencies.

Like Lauren, the majority of NSF poll respondents are not getting the sleep they need, and the consequences are catching up with them in all areas of their lives. For instance, in response to the poll, many teens said they often arrive late for school, fall asleep in class and are too tired to exercise. As they deal with numerous social and academic pressures, the lives of adolescents only become busier as they get older, while sufficient sleep becomes a distant memory for many.

For professionals in the sleep field, the poll results are disturbing – trends indicate that not only are adolescents shortchanging themselves when it comes to getting enough sleep, but adolescents' parents may be in the dark about the "sleep debt" their children may be accumulating. "It is difficult for families to plan for sufficient sleep nowadays," says Mary Carskadon, a sleep researcher at Brown University and chair of the NSF poll taskforce. "So many 'essential' activities get jammed into every day."

Coping with Sleep Deprivation

ACCORDING TO THE POLL: Only 20% of adolescents report that they get an optimal nine hours of sleep on school nights and nearly half say they actually sleep less than eight hours on school nights.

The NSF poll found that many teens try to "cut corners" when it comes to staying alert during the day, trying to fend off sleepiness rather than getting the sleep they need. These coping behaviors are increasingly apparent with each year of adolescence; older teens (12th graders) report getting just 6.9 hours of sleep on average.

Results of NSF’s 2006 Sleep in America poll show that many teens have adopted unhealthy behaviors including:

* Napping: 38% of surveyed high school students took at least two naps per week in the two weeks preceding their poll interview.

* Sleeping late on weekends: Most adolescents are sleeping between 1.2 and 1.9 hours longer on non-school nights.

* Frequently consuming caffeinated beverages and foods: 31% of those surveyed drink two or more caffeinated beverages a day.

* Giving up on exercise: More than a quarter (28%) of adolescents say they felt too tired or sleepy to exercise.

* Driving drowsy: More than half (51%) who drive say they’ve driven while drowsy during the past year.

While teens and many adults often rely on these strategies as coping mechanisms to make it through the day, these habits are often signs of sleep deprivation and may intensify difficulty sleeping, decrease performance in school, work and activities, and can even pose danger to themselves and others.

Effects of Sleep Deprivation on Mood

ACCORDING TO THE POLL: More than half (55%) of adolescents with the best mood score can say "I had a good night’s sleep" every night or almost every night vs. only 20% of those with the worst mood score.

In the NSF poll, every adolescent was asked five questions derived from a recognized mental health questionnaire to gauge the outlook and mood of each respondent. The results of the poll indicated that the effects of sleep deprivation can also impact adolescents' mood, behavior and attitude. While some parents might think "all teens are moody," or it is natural for teens to act irritable and irrational, in fact, lack of sleep can cause teens to act out and succumb to feelings of anxiety, depression and hopelessness. "Insufficient sleep not only results in difficulty with focus, attention and concentration making it difficult to excel in school but also leads to irritability and mood disorder," says Helene Emsellem, medical director at the Center for Sleep and Wake Disorders in Chevy Chase, MD.

The NSF poll showed that among those adolescents with the best and worst mood scores there was little difference for factors like body mass index, time spent exercising each week, employment, use of caffeine or grades, but those with the worst mood scores were more than twice as likely to have trouble falling asleep than those with the best scores (51% vs. 18%) and were about three times as likely to say they "felt too tired during the day" (59% vs. 19%). An upshot of these findings from the NSF poll: with further research, such sleep-related factors may be used to more quickly identify and help children with mood disorders. Improving their sleep may be the first step in stemming greater mental health problems.

School

ACCORDING TO THE POLL: More than a quarter (28%) of high school students report that they fell asleep in school at least once a week in the past two weeks; 14% say they arrived late or missed school because they overslept.

The place where sleep problems are most likely to present themselves is also the place where parents may not know that sleep problems occur and where everyone is concerned about performance – school. Many teachers and parents who witness an adolescent falling asleep in class, arriving late to school or underperforming each semester may blame it on the adolescent's "laziness", boredom or apathy towards school. Yet results of NSF’s 2006 Sleep in America poll indicate that lack of sleep or poor sleep quality may be a reason for such problems.

The poll found that adolescents' average school day begins around 6:30 a.m. In fact, 52% of American high school students start school before 8 a.m. and on average they leave the house by 7:10 a.m. To top off early start times, busy school days and afternoon and early evening activities, 55% of high school students don’t go to bed until after 11 p.m. on school nights, likely resulting from their natural sleep phase delay as well as their busy routine.

The NSF poll also found that students who get sufficient sleep perform better in school, with 34% reporting better grades than those who didn’t get the minimum recommended sleep. "Many parents (and teens) think that teens have to stay up late to study and be successful," says Judith Owens, director of the pediatric sleep disorders clinic at Hasbro Children’s Hospital in Providence, RI. "The poll results support other studies which show the opposite is true; A and B students report going to bed earlier and getting more sleep than students with poorer grades."

Sleep Environment

ACCORDING TO THE POLL: 57% of 9th-12th graders have cell phones in their bedroom, while only 21% of 6th graders do.

While sleep professionals recommend that all individuals should enjoy relaxing activities before bed, the best thing to do in the bedroom is sleep. High-tech "sleep stealers" such as televisions, computers, cell phones and MP3 players not only cut into sleep time, but they often make their user feel active and alert when they’re used near bedtime and/or in the bedroom. For many adolescents, technology is encroaching on a good night’s sleep. More things are competing for their time, and in a high-tech, 24/7 world, sending instant messages to friends, talking on the phone, or surfing the Internet can be inviting outlets for teens when the day has been hectic and filled with stressors.

The poll confirms that whether or not adolescents are choosing gadgets over sleep, they certainly have the opportunity to do so: 90% of adolescents have MP3 players or radios in their bedrooms and 57% have TVs in their rooms. Plus, how "wired" an adolescent's bedroom is may be linked with age – the poll indicates that the number of "sleep stealers" increases as adolescents grow older.

Some other common "sleep stealers" among adolescents include Internet access in the bedroom (21% of adolescents) and video games or cell phones in the bedroom (43% and 42% respectively).

The poll shows that the hour before bedtime is also filled with numerous alerting activities – four in ten adolescents went on the Internet or talked on the phone within an hour before going to bed. Activities such as playing video games, watching television and exercising in the hour before bedtime are more common for males than females, but the poll shows that the majority of all adolescents seem to have a stimulating activity of choice before bedtime, rather than an activity conducive to sleep. Dr. Owens recommends that parents should "sometimes set limits on things like the amount of TV teens watch, the number of caffeinated beverages they drink, the hours during which they are allowed to call their friends, the number of extracurricular activities that they participate in, and the hours that they work at after-school jobs" in order to help their children make choices when an endless amount of day and nighttime activities present themselves.

The Role of Parents

ACCORDING TO THE POLL: Only 7% of caregivers think their adolescent may have a sleep problem, but 16% of adolescents report thinking they have or may have one. Yet, 31% of those adolescents who think they may have a sleep problem have not told anyone about it.

What is causing such a drastic disparity between caregivers' perceptions and their children’s actions?

One explanation might be that, as a society, Americans often put sleep on the backburner. The 2005 Sleep in America poll showed that on average, American adults are only getting 6.9 hours of sleep a night, less than sleep professionals’ recommended 7-9 hours. Sleep-deprived adults may be so accustomed to their own tired state that they may not recognize sleep problems in their children. With an increasing dependency on caffeinated beverages to get through the day, both adolescents and adults may be "masking" their sleep debt.

The "two-sided" behavior of teens may also fool parents into believing that their children are well-rested. Because the circadian rhythms of adolescents compel them to go to bed later and arise later, parents are likely to mistakenly label their teens’ obstinacy about bedtime as "typical teenage behavior" rather than a facet of their biology. "This is the 'trick of nature' that Dr. Mindell is referring to," says NSF CEO Richard Gelula. "The adolescent doesn’t necessarily feel or appear sleepy at night when other family members do and remains active later, but the scheduled wake-up time occurs too early, resulting in sleep deprivation and daytime sleepiness as well as impaired cognitive abilities, mood and physical performance."

Parents may also not realize that signs of sleep deprivation commonly appear in the morning, rather than at night. They may expect that it is "normal" to be sleepy for the first hour after waking up, or that their teen is "bored" or apathetic about school which causes them to fall asleep in class. In fact, these signs, along with others such as irritability and dependency on caffeine, indicate that teens may be suffering from sleep deprivation and aren’t the happy-go-lucky people they appear to be when they get a burst of energy in the evening.

Results & Making Changes

NSF’s 2006 Sleep in America poll shows that America’s adolescents are caught up in a complex juggling act. As they mature, teenagers are increasingly challenged to take responsibility for difficult choices about their schedules and daily habits. Yet as set bedtimes fade away, sleep is often put at the bottom of the to-do list.

Helping teens navigate the choices of the 24/7 world seems more of a priority now than ever. Teens at the very least need exposure to a health education that includes a focus on sleep, how to get it and how to recognize and respond constructively to sleep problems. They also need to be able to communicate about sleep with their parents or guardians and with their primary care doctor. At the community level, everyone is responsible for seeing that schedules affecting teens’ lives are developed in a realistic way that is informed by sleep biology and a balanced perspective on teen needs.

"If parents and teens know what good sleep entails and the benefits of making and sticking to a plan that supports good sleep, then they might need to do a better job making choices about what truly are the ‘essential’ activities," says Dr. Carskadon. "The earlier parents can start helping their children with good sleep habits, the easier it will be to sustain them through the teen years."

TIPS FOR PARENTS: HOW TO AVOID THE TRICK OF NATURE

* Instead of waiting to see if your teen "crashes" at night, look for signs of sleepiness during the day, especially in the morning

* Ask your teen "how often would you say you get a good night’s sleep?"

* Pay attention to your teen’s caffeine consumption, napping and mood

* Help your teen to establish consistent sleep and wake schedules

* Set a good example – get enough sleep and talk to your teen about the importance of sleep

* Keep "sleep stealers" out of the bedroom – put the TV and computer in a common room instead of your teen’s bedroom