Teen Sleep Debt

How much sleep do you need? According to the National Institutes of Health in the U.S. there is an essential average amount of sleep people in different stages of life need. For newborns it is about 17 hours a day. Preschool children require about 12 hours and school aged children need at least 10. Adults, as well as the elderly can get by with seven to eight hours of sleep per night and teenagers need between nine and 10 hours every night. That’s right teens need between nine and 10 hours of sleep a night.

What happens if you do not get the recommended amount of sleep? For a very few people not much happens. They are built a bit differently so their sleep patterns are shorter. But that is true for only a limited group. For the rest of us who constitute the vast majority less sleep can add to something sleep researchers call sleep debt. That debt accrues with time so if you are getting only six hours of sleep every night but need 10 you are short four hours every night. After a week of that type of sleep loss you have accumulated a sleep debt of 28 hours! This debt, however, is not one that can be paid off by sleeping extra hours on weekends. The debt adds up to something known as sleep deprivation.

Sleep deprivation is diagnosed clinically by a number of symptoms. These include tiredness, irritability, an inability to tolerate stress, difficulty concentrating and remembering, behavioral problems, learning difficulties, social skills problems, discomfort and pain, infections, blurry vision, appetite changes and difficulty maintaining normal activities. All of these symptoms are found in a variety of other serious medical conditions. These conditions include a host of problems often reported in teenagers most commonly Attention Deficit Hyperactivity disorders and Oppositional Defiant disorders. Tiredness, difficulty concentrating and retaining information and intolerance of activities as well as agitation can often be the primary presenting symptoms of ADHD. Impatience, irritability and difficulty tolerating activity are some of the signs of Oppositionalism.

Over the last month I have been asked to evaluate four 14 year old boys from the same school. All were referred independently one by a parent, two by their pediatricians and one by the school psychologist. They are all ninth graders and their symptoms were very similar to those I described above. Not quick to diagnose I took my time getting to know each of them, their histories, their families and their social lives. I asked about their eating habits, their hobbies and how they get along with their parents and siblings. I used a rating scale and an assessment tool to help me come to my findings.

What I found out about these four boys is that they are all sleep deprived. Initially I thought that the cause for the symptoms may be that they stayed up late to play on their computers or text with their cell phones or perhaps sneak a book under their bed covers and read until all hours. None of these reasons were the cause of their very similar symptoms. There was no viral infection that caused the symptoms nor were they physically or sexually abused, though one parent was concerned of the possibility. What I did find was that they were in fact sleep deprived not of their own doing or by abuse but by their school schedule. Each of them was picked up by a school bus at around seven in the morning. During the day at school they had a half hour break for breakfast and lunch and a total of 45 additional minutes off for various other breaks and recess. On Sunday they are in school until three and Friday until one. They are all dismissed from school Monday through Thursday after eight in the evening. Some of the boys do not arrive home until nine. They all eat a quick dinner and start homework. Homework often takes an hour. At that point they need some time to unwind so they find activities to help them relax. Unfortunately, for teen boys these are often sports related and provide a surge of adrenalin that does not allow them to relax rapidly. They start to get ready for sleep usually after eleven and all four boys said that they almost never fall asleep before one am. They are sleeping two to three hours less most nights than their bodies and brains need. These sleep schedules do not differ much on the weekend for these boys.

Studies of bone density indicate that many yeshiva boys have reduced calcium bone mineral density which is likely due to a lack of exercise among this group. Those studies coupled with this limited finding of sleep suggests that we are gearing our young men up for significant health problems as they get older. A better plan would be to allow them more time for exercise and sleep while still spending time learning.