With packed schedules, school days that kick off at 8 a.m. and the lure of screens, it’s little wonder that many adolescents in the United States don’t get enough sleep.
National estimates suggest about six in 10 middle schoolers get less than the recommended nine to 12 hours of sleep a night, while about seven in 10 high schoolers clock less than the recommended eight to 10 hours. And more than one in five adolescents grapple with insomnia, characterized by problems falling asleep, staying asleep or getting sufficient quality sleep (or some combination thereof).
“There are two basic things that happen” when teens hit puberty, said Dr. Judith Owens, the director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. “The first is that there’s a shift in their natural circadian rhythms, so their natural fall asleep time and wake time shift later — by up to a couple of hours. The second thing that happens is their sleep drive slows.” So not only do adolescents want to stay up later, but their bodies are actually capable of doing so, she explained.
Despite these biological shifts, experts stress that sleep loss is not a normal or natural part of adolescence, and the American Academy of Pediatrics has said that insufficient sleep is one of the most pressing health risks in adolescents, pointing to consequences like impaired mood and attention and diminished impulse control.
The Times spoke to Dr. Owens and other experts in adolescent sleep and mental health about how to help teens who are struggling with sleep.
Change one poor sleep habit.
Though the data on teen sleep deprivation is stark, Dr. Sonal Malhotra, an assistant professor of pulmonary and sleep medicine at Baylor College of Medicine and Texas Children’s Hospital, offered parents some reassurance: Many of the teens she treats do not have what she would consider true chronic insomnia, even if on paper they meet the criteria of struggling three or more nights a week for more than three months. Instead, they are simply plagued by poor sleep hygiene.
Dr. Malhotra shares that not to be dismissive of the challenges many teenagers face around sleep, but to reassure families that small changes can often make a dramatic difference. She urges adolescents to make one adjustment to their sleep routine that they think will be doable and likely beneficial — ensuring their room is dark and comfortable, for instance, or avoiding having a large meal or caffeine relatively close to bedtime.
“Targeting everything at once isn’t ideal,” Dr. Malhotra said, adding that she tells teens if they can change one habit even 50 percent of the week, she considers it a win.
Consider a harm reduction approach to screens.
“We have truckloads of research showing how destructive technology is to sleep,” said Lisa Damour, a clinical psychologist and the author of “The Emotional Lives of Teenagers.” She is adamant that no one — adults included — should have a phone in their bedroom at night. Dr. Damour urged parents to set that rule early on: “At the time that a child is asking for a phone, they will agree to anything,” she chuckled. “Parents should not squander the massive leverage they have.”
But if that’s not feasible, there are ways to lessen the damage of nighttime screen use.
Passive use, like watching a show, is better than active use, like texting or gaming, said Dave Anderson, a clinical psychologist with the Child Mind Institute. What a teen watches and what they watch it on matters, too: For instance, a sitcom is better than a suspenseful show, he said. And it is preferable to watch on a small screen rather than a 60-inch TV, which emits more blue light.
“Exposure to light, particularly blue light, suppresses the release of melatonin,” Dr. Owens said. “And teenagers are even more sensitive to that suppression of melatonin.”
If teens are going to be looking at a computer or another device late into the evening, Dr. Owens recommends giving them a pair of blue-light blocking glasses or having them use an app to curb blue light exposure. “It doesn’t reduce the cognitive stimulation of doing homework at 10:30 at night,” she said. “But it does help somewhat.”
Be mindful of melatonin.
Experts largely discourage the use of melatonin to help teens sleep. The A.A.P. says it should only be given to kids after a discussion with their pediatrician. The group says that further research is needed, particularly into long-term use, as there are questions about how it might affect growth and development, especially during puberty.
“It’s definitely something that you need to talk to a health care provider about to really understand dosing and timing,” Dr. Malhotra said, adding that there is very little regulation of melatonin. “It’s just a lot more complex than I think people realize.”
Encourage “strategic napping,” but be wary of the weekend catch-up.
Teens are notorious for wanting to sleep late on the weekends, but experts warn it can hamper weekday sleep. “Come Sunday night, they haven’t been awake long enough to fall asleep at a reasonable time in order to get up for school on Monday morning, and the whole thing just kind of gets out of control,” Dr. Owens said.
She and Dr. Damour said it’s OK for teens to experiment with sleeping in a little, but families should keep a close eye on whether it’s having a downstream effect on their weekday rest.
While naps cannot entirely make up for a bad night’s sleep (or a bad stretch of sleep), Dr. Owens said she is a “relative fan” of “strategic napping” to help teens recharge. By that, she means a nap of 30 minutes or less, ideally at some point between 3 and 5 p.m., when there is a natural lull in a teen’s circadian rhythm.
Help your teen ruminate less.
Adolescents, like adults, can get caught in a mental loop that fuels sleeplessness: I still have so much work to do … If I don’t get enough sleep, I will fail my test tomorrow … I couldn’t sleep last night, so tonight will be a disaster, too.
To help curb rumination, Dr. Malhotra recommends teens keep a journal where they can jot down what they have already accomplished that day and what the plan is for tomorrow, along with any worries they may have. At night, parents should let their kids know that if they’re lying awake for more than 20 or 30 minutes, they should get out of bed and do something relaxing, like read a book or listen to calming music.
Bigger picture, parents should take a critical look at whether their child’s schedule is simply too packed, Dr. Anderson said.
He and others also noted that parents should reach out to a primary care physician or mental health provider if they are concerned by prolonged sleep issues or feel their child is grappling with unmanageable stress.
Still, Dr. Anderson said that parents can help alleviate some of the pressure on teens by showing them compassion and pushing back against the kind of all-or-nothing thinking that contributes to the stress many of them feel.
If you repeatedly tell a teenager, “‘Honey, I want you to know that no one grade, no activity, no one missed social event is going to make or break your life,’” he said, that can help.