Pediatrician, Sleep Medicine Specialist: How Teens Can Get More Sleep

In the best of times, sleep in teenagers is a thorny subject. Sleep deprivation is common in teenagers. A study by the Centers for Disease Control showed that fewer than 30% of teens got eight hours of sleep per night on school nights. Only about 15% actually get the recommended nine hours of sleep.

Chronic sleep deprivation in teenagers is associated with many problems including issues with grades and attendance in school, worsening mood, behavior and impulse control, and an increased risk of car accidents. Not to mention health issues like obesity and high blood pressure. 

Teens are not getting enough sleep and that is the cause of a lot of issues. (@kiwitanya via Twenty20)

How many hours of sleep do teens need?

The reasons why teens struggle with sleep are many. As children move into adolescence, their natural sleep schedule shifts two to three hours later. In many communities in the US, high schools start earlier than elementary and middle schools. When I started my practice in 2007, the biggest struggle I had with families was getting televisions out of the bedrooms of their children. Something else happened in 2007— the advent of the iPhone. Now, one of the biggest challenges to good sleep (both quantity and duration) is the ubiquitous smartphone. 

Everyone’s heard the most common sleep advice. Here are some steps you can take to improve your teen’s sleep now—some of which you may not have heard before. 

How to help your teens get more sleep

1. Get extra sleep in the morning by avoiding the snooze button

Does your teen like hammering away at that snooze button? Me too. But here’s the thing— it feels great to get those extra ten minutes of sleep, but you are really cheating yourself. If you set your alarm at 6 AM but never get out of bed before 6:45 AM, just set the alarm to 6:45 and get out of bed. Even if you need 45 minutes to wake up at 6AM, that does not mean it will take you that long to get up at 6:45. Why? Because you have had an extra 45 minutes of uninterrupted sleep. I would try to pick the latest wake time that lets your teen get ready for school in time. 

2. Tactical napping (and caffeine if necessary)

The dogma in the sleep hygiene field is that both napping and caffeine should be avoided— for the reason that they can interfere with the ability to fall asleep at night. However, if your teen can’t keep his eyes open, you need to do something, especially if, say, he needs to finish a history paper or drive somewhere. (Driving drowsy is like driving drunk—please don’t let your teen do it).

Instead, I recommend a tactical nap. I define this as a short nap (15-20 minutes) preferably in the afternoon. Here’s the key to tactical napping: don’t do it in a super comfortable couch or bed. Do it head down on a desk or reclining in your car—someplace you are unlikely to fall asleep for prolonged periods.

Sleep experts have actually studied small doses of caffeine—say, a cup of tea or small coffee—prior to a short nap. It turns out that it is a pretty great way to wake up in a short period of time. I would experiment with short tactical naps first as that is often equivalent to having a cup of coffee.

3. Keep an eye on the homework

In college, I only pulled an all-nighter once—to get a lousy B- on my Biochemistry final. I should have known better. Research has actually shown that getting sleep will help you perform better on a test than staying up all night studying. If your teen can’t finish her homework at night, send her to bed. Trust me. It will be there in the morning. If this happens a lot, please talk to your child’s teachers. Believe it or not, there’s not a lot of evidence that homework helps kids learn.

4. Digital liberation

Ok. I don’t win a lot of popularity contests here. But cell phones are totally corrosive to a good nights’ sleep. Why is this? They emit light that keeps you awake at night by suppressing melatonin secretion in your brain, which keeps you from falling asleep.

They are powerfully addictive. You know how you want to scroll down Instagram just a few more photos or read a few more tweets? Guess what? Social media sites and apps have been engineered by people richer and smarter than you or me to keep you checking in, commenting, posting, liking, etc. That is how they get paid.

They fragment sleep by emitting alerts during the night. Just the other night, my wife and I woke up because I received a text message. Here’s the thing—my phone was silenced and in the bathroom, but the light was still sufficient to wake up two sleep deprived adults at 1 AM.

They can generate anxiety and frustration right before bedtime. Anxiety and stress are contagious, and if you are an anxious or stressed teen, your peers probably are too. Trust me, those Instagram posts will be there in the morning.

There’s a couple of things you can do so you can control your phone, instead of it controlling you. Having counseled teens about this issue for years, I encourage you to have a frank conversation with your child about setting good limits on the phone at night. 

  • Keep it out of the bedroom.

This once solves most of the cell phone related issues. Set a time for it to be surrendered and stick to it. I’ve had parents need to lock their kids phones in cars or fire safes, but usually a shared charging area in the kitchen works fine. 

  • Turn on “Do Not Disturb” and “Night Shift” (on Apple Devices).

These options limit interruptions from your apps and lower the color temperature on your phone. These means there is less blue white light, which is the kind of light that suppresses melatonin. (Note that this is not as good as avowing light altogether.) 

  • Use software to limit interaction with the device.

Apple’s Screen Time software is built into iOS devices. You can also use a paid service like Freedom. These will allow access for apps necessary for homework. 

Limit blue-white light exposure. I recommend turning down brightness as low as possible on all devices. I highly recommend the free f.lux software to limit your blue white light exposure from sunset to sunrise.

5. Less light at night, more in the morning

So, light at night is bad for sleep—but in the morning it’s great. There was a recent study showing that teenagers camping out without electronic devices rapidly reset their body clock by going camping:.

Here’s how to implement this:

“End all artificial lights at night for at least a weekend and drench your eyes in natural morning light,” says Kenneth P. Wright, a professor of integrative physiology at the University of Colorado, Boulder and senior author on a study on resetting sleep cycles. “The most straightforward way of doing this is to forbid any electronics on a camping trip.”

Going for a camping trip may be impractical or impossible during the school year. One easy way to get the benefits of morning light is to use an alarm clock that uses light to wake you up. I got one of these, and it is shockingly effective. (It also does not wake up my younger child, who is out of bed like a shot when my alarm goes off).

The clock starts increasing lightly slowly for 30 minutes prior to a more conventional (read noisy) alarm goes off. Since starting with this I am falling asleep more easily at night and getting up more easily in the morning. 

6. On weekends and vacations, stay on the “Plus Two” schedule

Here’s where I differ a little bit from the traditional sleep dogma. In a perfect world, you should sleep on the same schedule every day. However, most teenagers are so sleep deprived that I don’t think that this is fair.

For my patients, I generally advocate for a “plus two” schedule. What this means is letting your child get up two hours later than you get up for school. This lets her catch up a bit on weekends but should not throw her schedule out of whack. I also recommend keeping this schedule on school vacations.

7. Consider melatonin—if your doctor thinks it is a good idea

Melatonin is a frequently misunderstood medication. Oddly, it is a hormone that is available over the counter (in the US, at least). In a nutshell, it has two effects. It can alter sleep schedules, and it can make you sleepy.

Most of my teenage patients actually need help with their schedule.Thus, the most effective way to use it is 0.5 mg at dinner time, as this will help move your sleep schedule a bit earlier. Sometimes I may add a small dose at bedtime (1-3 mg as well).

Note: Melatonin is a medication and I’m not recommending that you take it. I recommend you discuss it with your child’s pediatrician.

8. Have someplace besides your bed to relax

One of the principles of managing insomnia is called stimulus control. This is a fancy way of saying, if you are having problems sleeping, stop doing stuff in your bed besides sleeping. If your teen does his homework, watches TV, eats fried chicken, and plays Xbox in his bed, take him to Ikea and get you a nice chair for him to relax in. My kids love their beanbag chairs. Trust me, this will help.

About Craig Canapari

Dr. Canapari is the directory of the Yale Pediatric Sleep Center and an associate professor at Yale Medical School. He has written about sleep issues in the New York Times, and is the author of It's Never Too Late To Sleep Train: The Low Stress Way to High Quality Sleep for Babies, Kids, and Parents. He blogs about sleep issues at https://drcraigcanapari.com/

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