Image: Shutterstock/Peter Snaterse
|Medically Reviewed by Dr. Gregory Minnis, DPT|
|Dr. Gregory Minnis is a physical therapist with an interest in orthopedic manual therapy. He graduated from the University of St. Augustine in Florida with a Doctor of Physical Therapy degree. His work experience includes orthopedic physical therapy, sports medicine, neurological rehab, advanced assessment and treatment of running injuries, and advanced treatment of the pelvic complex, spine, and extremities. He loves spending time outdoors biking, skiing, and surfing.|
The Teen Insomnia Problem
Nearly everyone has experienced insomnia, or the inability to sleep at some point. Occasionally, transient insomnia lasts for a night or two and may be caused by such factors as stress or changes in sleeping habits. But chronic insomnia can last for months or even years and can have a profound impact on daily life. Did you know that teens are at risk for both transient and chronic insomnia? Here’s what parents need to know.
How Much Sleep Should Teens Get?
You may be surprised to learn how common it is for teens to survive on less sleep than they actually need. While every kid is individual, and some require less sleep than others, researchers have identified some overall trends. Studies in the United States show that:
- Teens need approximately nine hours of sleep each night, on average.
- Among middle school students, defined as those in 6th through 8th grades, about 60% do not get enough sleep on school nights.
- Among high school students in 9th through 12th grades, more than 70% do not get enough sleep on school nights.
- A stunning 2/3 of high school students report seven hours or less of sleep on school nights.
- Close to 17% of teens meet the clinical definition of insomnia, meaning that they are unable to fall or stay asleep at least two nights per week for a month or longer.
What’s Going On?
There are many contributing factors to teen sleep deprivation. It’s important to check with your child’s doctor to rule out medical issues that could be limiting their ability to sleep. Experts have identified some major trends that are common causes for teen sleep deprivation. Below are some possible factors to take into consideration when helping your teen get a more quality sleep.
School schedules are at odds with the natural bodily rhythms of most teenagers. During and after puberty, kids naturally fall asleep later than either younger children or older adults. Sending teens to bed early doesn’t usually turn out as expected, as they will lie awake until midnight or later, despite their best efforts at sleep. Yet school rarely starts later than 8 a.m. in most of the United States.
Approximately 17% of school districts have begun to get the message, moving their start times to 8:30 a.m. or later for middle school and high school students. Experts note that these experiments have been successful, leading to more sleep, fewer car accidents, and even better graduation rates.
Stress is also powerfully linked with insomnia, and most teens are under a lot of pressure. From exams to homework to social activities, the middle and high school years are fraught with tension. Research shows that 27% of teens report high-stress levels. The most commonly reported source of teen stress is school, at 83%, while 69% of teens are stressed out about getting into college or choosing a life path after high school.
Puberty and gender
Puberty throws the mind and body into chaos, and sleep cycles are not immune. In fact, the entire sleep-wake pattern tends to reorganize itself, delaying the natural sleep onset and rising times, and shortening the length of sleep. This leads to sleepiness during the day, as well as irregular sleep patterns in which kids attempt to catch up on sleep over the weekends.
Also, the growth spurts associated with puberty can cause physical discomfort. These “growing pains” tend to worsen around bedtime and may even cause teens to wake up in the middle of the night. Although they are not dangerous, these pains can contribute to poor sleep quality.
It also appears that gender also plays a role in teen sleep deprivation. Girls are more likely than boys to report short sleep duration. This could be due, in part, to sexually differentiated biological and social factors during puberty. For example, girls tend to have higher overall stress levels and greater reactivity to stress.
Other neurodevelopmental disorders
Research shows that teens with neurodevelopmental disorders may be at increased risk for sleep problems. Disorders such as autism, attention deficit hyperactivity disorder (ADHD), Down syndrome, cerebral palsy and even fetal alcohol syndrome can increase anxiety and make it more difficult for kids to settle into sleep. They can also make it more difficult to maintain sleep throughout the night.
A note on COVID
The COVID-19 pandemic has wreaked havoc on the mental health of citizens across the globe, and teens are no exception. According to a June 2020 Harris Poll, approximately 70% of teens report that their mental health has been negatively impacted by the crisis. Stress, anxiety and depression, coupled with a collapse in daily school structure and increased screen time, can exacerbate the typical sleep issues that teenagers face. Parents need to carve out quality non-screen time with kids, as well as to help them build routines.
How does insomnia affect teens?
Although missing an occasional night’s sleep rarely has serious consequences, chronic insomnia can have a major impact on both physical and mental health in teenagers. Physically, researchers have found that poor sleep quality and insufficient sleep increase teens’ risk for diabetes, obesity and even injuries.
Psychologically, even sleep-deprived kids who do not meet any clinical definitions for mental health problems are likely to suffer from behavior problems and reduced performance in school. They are also at risk for anxiety, symptoms of depression and feelings of hopelessness. They are more likely to engage in dangerous behaviors like drinking and driving, not using seatbelts, and risky sexual practices.
Although people of all ages can experience negative cognitive impacts from a chronic lack of sleep, adolescents are at higher risk due to the profound developmental changes that occur during this time. They may have trouble with learning and retaining new information, performing well on tests and assignments, and regulating their emotions throughout the day. They also tend to be less motivated.
Although it is not yet clear if teens react in the same way, younger children who are sleep deprived tend to show a strong performance gap when compared to their peers. Losing just one hour of sleep per night can cause a child to perform in school similarly to a fully rested child two grades below.
Executive function is the ability to process and organize incoming data, focusing the mind and filtering out extraneous thoughts to prioritize tasks and accomplish each in an orderly way. It is an essential skill for success in all aspects of life. Executive functioning begins to develop in early childhood, and it becomes more sophisticated throughout the teen years. Yet, sleep problems can interfere with this developmental process, potentially setting kids up for future difficulties in their future from their careers to their relationships.
Teen insomnia and mental health
The impacts of insomnia on teenagers’ mental health are well worth a closer look. Keep an eye on your teen, especially if you know that they are struggling with sleep problems. If you notice signs of a potential mental health problem, consult a professional who specializes in teenagers as soon as possible.
Negative mental health outcomes associated with poor sleep
Although you might assume that a minor reduction in sleep carries minimal risks, this is not necessarily true. Even a single hour of lost sleep can have a major impact on kids, and as sleep problems worsen, so do the risks. Every hour of lost sleep raises the likelihood of feeling sad or hopeless by 38%. It also increases the risk of substance abuse by 23%, suicidal thoughts by 42% and suicide attempts by 58%.
Even after researchers accounted for demographics, substance abuse, suicidal ideation and symptoms of depression at the beginning, those who suffered from sleep problems for a year were 20% more likely to have thoughts of suicide, as well as more likely to actually make a suicide attempt.
Of course, not everyone who is sleep deprived becomes suicidal. But in tandem with all the changes of puberty and the intense pressures that many teens feel, a lack of sleep could be enough to heavily offset the balance in teenagers.
Insomnia and depression: a special case
Insomnia and depression are often linked in complicated ways. Depression may make it more likely for teens to grapple with insomnia, while those with insomnia are at increased risk for depression. Here is what you need to know about these linked disorders.
Insomnia and depression comorbidity
Comorbidity is a technical term for two or more disorders that occur at the same time. Depression is one of the most common mental health issues among teenagers, and depression and sleep problems often go hand in hand. Studies show that among children and teens diagnosed with depression, more than 70% have insomnia or another sleep disorder, and those kids tend to be more severely depressed than those without sleep difficulties. This indicates that the depression and the insomnia likely influence each other, worsening both problems.
Insomnia and depression risk
In addition, insomnia seems to be a risk factor for developing depression. Kids with chronic trouble sleeping are more likely than their peers who sleep normally to report symptoms of both anxiety and depression. Interestingly, depression does not seem to be a risk factor for insomnia. Kids who report trouble sleeping are more likely to develop depression and even attempt suicide in the future, but those with depression are not more likely to develop future insomnia.
Insomnia interferes with depression treatment
Cognitive behavior therapy, or CBT, is an extremely popular and highly effective treatment for many forms of depression. The idea behind it is that our thoughts create our reality, and distorted thought patterns are responsible for our moods. Cognitive behavior therapy focuses on changing both thoughts and behaviors, replacing them with healthier responses to the stresses of daily life.
Unfortunately, insomnia can make CBT less effective, possibly due to the impact of sleep disorders on logical thinking and executive function. Kids with chronic trouble sleeping are more likely than those who sleep normally to have their depression recur after treatment ends.
If your teenager has been diagnosed with depression, let her therapist know about any symptoms of insomnia. Mental health professionals are used to dealing with comorbid disorders and may be able to tweak the course of treatment to address both the depression and insomnia simultaneously. This can increase the likelihood of a successful outcome.
Even the most logical and thoughtful teenager can fall victim to the effects of sleep loss. Kids who report sleeping seven hours or fewer on school nights are also more likely to report carrying weapons, using marijuana or tobacco, binge drinking, drunk driving, fighting or other potentially dangerous behaviors.
The reverse is also true. In school districts that have shifted to later morning start times, students tend to sleep more. They also have better rates of enrollment and attendance, are less likely to fall asleep in class, show fewer symptoms of depression, and even have fewer car accidents. When wide awake, teens tend to think more clearly and make better, more responsible decisions.
What parents need to know
Now that you know the important links between sleep and both physical and mental health, you may be wondering what you can do to help. Here is what every parent needs to know about promoting high-quality sleep in teenagers.
Parents are the key
Even in adolescence, kids need their parents’ help to wind down for bed. Everyone is different, but the majority of middle school students require at least nine hours of sleep per night, while high school students need at least eight. Setting a bedtime for a high school student may be difficult, but the CDC reports that “adolescents whose parents set bedtimes are more likely to get enough sleep,” suggesting that parents can have an impact on their child’s sleep by lightly enforcing it.
Even if a strict bedtime is not in the cards, you can help your child wind down and get ready for sleep in the evenings. Set a good example by reducing noise and lowering lights as the evening progresses. Try to avoid late-night battles over homework or chores, and instead promote a relaxed environment.
Childhood sleep problems become teen and adult sleep problems
Even if your child is not yet a teenager, it’s never too early to start promoting good sleep habits. Many kids develop chronic sleep problems early in childhood, which may continue throughout life. In fact, early childhood sleep issues may indicate more risk-taking behavior in adolescence, including early use of marijuana, which can in turn lead to insomnia as an adult. Likewise, adolescent sleep issues are linked with a higher risk of depression in adulthood.
There is a bit of a chicken and egg conundrum in the research. Are some people genetically predisposed to sleep problems, depression and substance use? Or does one lead to another? The answers are not yet clear, but the links between these three issues are strong and the message is clear: Parents should intervene early to help children overcome sleep problems.
Teach kids to cope with stress
Stress reactivity is a response pattern in which a person has a low threshold for what is perceived as a threat, and a strong stress reaction to any perceived threat. It makes it harder to think clearly, and switches the brain to self-preservation rather than higher-order emotions such as compassion or empathy. Stress reactivity can develop after traumatic events, but many kids show a natural predisposition to it early on.
Research shows that stress reactivity is highly correlated with insomnia, and some experts suggest having younger kids assessed for it. The theory is that both stress and insomnia become more pervasive in adolescence, so identifying and intervening early with stress reactive kids could head off sleep problems as they grow up.
Even in teens without stress reactivity, worrying right before falling asleep can impact the quality and quantity of sleep. Therefore, it only makes sense to help your kids learn to process stress and worry in healthier ways. Work with them to name their feelings and develop assertive, proactive responses. Encourage them to participate in extracurricular activities. Help them break large tasks into smaller chunks and teach them to reframe negative thoughts. Promote downtime and help them practice for intimidating events such as giving a speech.
Create the right environment for sleep
While some people are blessed with the ability to fall asleep anywhere, anytime, the vast majority do better in an environment designed to promote sleep. You don’t need to invest a pile of money, just work with your teenager to make some intelligent tweaks.
Teach and model “good sleep hygiene”
Good sleep hygiene is a collection of healthy habits that encourage sleep. Kids watch what their parents do, so be sure to model these behaviors rather than just telling your teenager what to do. Examples of good sleep hygiene include, but are not limited to:
- Exercise regularly, but not right before bed.
- Eat a healthy diet, but limit late-night eating to a light snack.
- Lower fluid intake right before bed
- Go to bed and get up at the same time every day, even on weekends and vacations.
- Create a relaxing bedtime routine such as a hot shower or 30 minutes of reading for pleasure.
- If you don’t fall asleep right away, get out of bed after 20 minutes and do a quiet activity until you feel sleepy.
- Keep your bedroom cool and dark.
Make your child’s bedroom a comfortable and stress-free space
Help your child create a comfortable and relaxing bedroom oasis. From soothing paint colors to essential oil diffusers, the internet is filled with easy and inexpensive bedroom ideas — see our 101 Tips for Better Sleep for more ideas. One of the most important investments you can make, though, is a good mattress. Research shows that sleeping on a new, high-quality mattress can reduce nighttime pain, decrease stress and promote better sleep. Mattresses are available in a vast array of types and firmness levels, and comfort is highly subjective, so let your teen choose the mattress that feels right to her.
Get serious about screen time
Screen time is an inevitable part of modern life. An incredible 72% of teens use a cell phone before bed, 64% use an electronic music device, 60% use a laptop and 23% play video games. And 18% report being awakened several nights per week by their cell phone.
It’s vital to set limits, as nighttime screen usage can make it more difficult to sleep for several reasons. Exposure to the blue light emitted by these devices can suppress production of the sleep-promoting hormone melatonin. Phones, game consoles and other interactive devices tend to increase arousal, making it difficult to drift off to sleep. The short sleep-wake cycles caused by incoming calls or messages can lead to chronic sleep deprivation, even in kids who otherwise sleep well.
Model responsible screen-related behavior by turning off your electronic devices before going to bed, and encourage your kids to do the same. Analog activities such as reading a book or drawing are much more conducive to falling asleep.