As an anxiety specialist for children and adolescents, I see all kinds of kids with all kinds of fears. Phobias, social anxiety, panic, separation jitters, selective mutism—the list goes on and on and on. The kids I see are all unique, and the way their problems present vary just as much.
However, one group is different: my teen patients. Regardless of their anxiety disorder, my teens all have one thing in common—they are all under-slept. Every single one of them.
Take Lydia, a 14-year old who came to treatment for what looked like a severe case of social anxiety with some depression layered on top. Her parents reported that she was constantly irritable. She was also pale and tearful and spoke quietly, if she spoke to me at all. The initial treatment plan seemed pretty straightforward: Cognitive Behavioral Therapy (CBT) for the social anxiety with an expectation that a significant reduction in the anxiety would also reduce the irritability and depression.
But before I could relay the plan, I remembered to ask Lydia that most important question…
“What time did you fall asleep last night?”
Her answer caused me to experience anxiety: “12:30 a.m. or maybe 1 a.m.?”
This was bad. Lydia had to wake up at 6:30 a.m. on weekday mornings because her school started at 7:50 a.m. and she had to catch the bus. She was averaging about six hours of sleep a night, except on weekends, when she would sleep until 11 a.m. or noon. This would set her up to have difficulty falling asleep on Sunday evening, and the cycle of late nights would start again.
No wonder Lydia was miserable! This poor girl was in a chronic state of sleep deprivation. No amount of therapy was going to make a dent in her social anxiety or depression until we addressed that.
Almost 90% of High Schoolers are Sleep Deprived
How much sleep does Lydia need? Per recommendations by the National Sleep Foundation, teenagers need between eight to ten hours a night.1 But, the majority of teenagers do not get that amount. In a 2006 poll by the National Sleep Foundation2, the majority of parents thought their teens were getting enough sleep, but 59% of middle schoolers and 87% of high schoolers reported that they were not. In that study, the average amount of sleep reported by high schoolers was less than seven hours per night. In another study, 20% of 11-17 year olds reported getting only six hours per night.3
The situation is so bad that in 2005, the American Academy of Pediatrics (AAP) declared teens’ insufficient sleep to be a major public health problem.4 In 2014, the AAP released a policy statement declaring that no middle or high school should start before 8:30 a.m.5
What is causing this nation-wide epidemic of too little sleep for teens? Most adults would guess “staying up playing video games or texting their friends,” but that’s only a part of the problem. The single biggest contributor is the changes that puberty brings to teens’ bodies, including a shift in melatonin production that makes their brains get sleepy around 11 p.m. and want to wake up at around 8 a.m. If all middle and high schools started after 8:30 a.m., teens’ days would match their brains’ clocks.5 Of course, this isn’t the case: nationally, only 15% of public high schools start at 8:30 a.m. or later, and 43% (almost half!) start earlier than 8 a.m.
In other words, it’s the bad policies of grown-ups, rather than the bad habits of teens, that are leading to this national epidemic (or should I say national disgrace?).
Poor Sleep = Poor Mental Health
Sleep deprivation is a big problem for teens and I will tell you why! Research has linked insufficient sleep in teens to irritability, depression, suicide ideation, compromised school achievement, missed school, poorer health, obesity, and increased risk of car accidents.6 With regard to mental health, teens who are sleep deprived report that they feel more tense and anxious,7 and among samples of youth with anxiety disorders, 42% to 88% reported having experienced sleep problems.8
How to Help Teens Get the Sleep They Need
Still awake? Alarmed even? Parents ask me all the time what they can do to help their teens get enough sleep, and I generally recommend the following:
- Enforce a set bedtime for your teenagers.
- Instill a family rule that all electronic devices are turned off and stowed away from bedrooms at least 30 minutes before bed. Yes, this means parents, too.
- Remove TVs from the bedrooms. Again, parents, too.
- Rely on old-fashioned alarm clocks in bedrooms to effectively ban sleep-robbing electronic devices.
- Avoid caffeinated drinks after noon because caffeine stays in teens’ systems far longer than they think.
- Do not allow teens to drive between 12 a.m. and 6 a.m. or at any other times when they are sleep deprived.
- Start an aggressive campaign in your school district to delay middle and high school start times to 8:30 a.m. or later. Be prepared to fight for your child’s life.9
Whenever I succeed in convincing a teen and her family to adopt the above habits, I am amazed at what a difference it makes in the teen’s life! For example, with some effort and consistency, Lydia’s sleep habits improved dramatically. As a result, I was able to treat her social anxiety and depression allowing her to regain her footing as the happy, healthy young woman she was destined to be.
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1Hirshkowitz, M., Whiton, K., Albert, S., et al. (2015). National Sleep Foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health, 1, 40-43.
2National Sleep Foundation (2006). Summary of Findings: 2006 Sleep In America Poll. Washington, DC: National Sleep Foundation.
3Roberts, R., Roberts, C., & Xing, Y. (2011). Restricted sleep among adolescents: Prevalence, incidence, persistence, and associated factors. Behavioral Sleep Medicine, 9, 18-30.
4Millman, R., Working Group on Sleepiness in Adolescents/Young Adults, AAP Committee on Adolescence. (2005). Excessive sleepiness in adolescents and young adults: Causes, consequences, and treatment strategies. Pediatrics, 115, 1774–1786.
5American Academy of Pediatrics. (2014). School start times for adolescents. Pediatrics, 134.
6Owens, J., Adolescent Sleep Working Group, AAP Committee on Adolescence. (2014). Insufficient sleep in adolescents and young adults: An update on causes and consequences. Pediatrics, 134.
7Baum, K., Desai, A., Field, J., Miller, L., Rausch, J., Beebe, D. (2014). Sleep restriction worsen mood and emotion regulation in adolescents. Journal of Child Psychology and Psychiatry, 55, 180-190.
8Alfano, C., Ginsberg, G., & Kingery, J. (2007). Sleep-related problems among children and adolescent with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 224-232.
9Wahlstrom, K. (2010). School start times and sleepy teens. Archives of Pediatrics and Adolescent Medicine, 164, 676-677.
Katherine K. Dahlsgaard, Ph.D., is a licensed clinical psychologist specializing in Cognitive Behavioral Therapy for children, adolescents, and young adults. She focuses on anxiety disorders, including selective mutism, social anxiety disorder, and OCD, among others. Dr. Dahlsgaard is an accomplished lecturer, published author on child development and mental health, and holds prominent positions at the Anxiety Behaviors Clinic and the Picky Eaters Clinic in The Children’s Hospital of Philadelphia.