Better Sleep, Best Self

Dr. Jennifer Kanaan from UConn Health’s Sleep Disorders Center joins Carolyn and Chris to talk about the impact of sleep has on how adolescents do in school and in their relationships. She explains the advantages of later school start times and offers some advice on how to build good sleep habits.

(Dr. Jennifer Kanaan, Carolyn Pennington, Chris DeFrancesco, September 2020)


Chris: Did you know, one of the best things we can do to improve school performance takes place outside of the classroom?

This is the “UConn Health Pulse,” a podcast to help you get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful too.

With Carolyn Pennington, I’m Chris DeFrancesco. Now there are many keys to school success, but what we’re talking about here isn’t the school, the teachers, or even the homework.

Carolyn: It’s sleep. We all know that when we don’t get enough of it, it impairs our performance and we get kind of cranky. So this is especially true in children and teenagers. Sleep deprivation can rob them of their potential and make them very hard to live with. Now, explain more about this is Dr. Jennifer Kanaan from UConn Health’s Sleep Disorders Center. Dr. Kanaan, you specialize in child and adolescent sleep health. Tell us how sleep deprivation really impacts children and adolescents, like specifically their academic performance, how they get along with their peers and their teachers at school.

Dr. Kanaan: Sleep is really a cornerstone to good health, both in adults and children. We know from numerous studies that sleep is critical for learning in terms of rote memory. We know that children who don’t get enough sleep have difficulty with procedural tasks and recalling names and numbers. We also know that sleep deprivation can impact emotional control. So children who aren’t getting enough sleep have problems with angry outbursts and impulsivity. So it’s something that’s important for parents and children to focus on.

Chris: Some common problems that we think our children are having as they’re developing and growing and performing in school, we might mistake it for things like ADHD when in reality, if they just had better quality sleep and more consistent, reliable sleep, that might overcome some of the behaviors that we might be mistaking for other things.

Dr. Kanaan: Absolutely. So in adults, when you’re sleep deprived, you tend to be more lethargic, not functioning up to snuff. For children, a lot of times they present with overactivity, impulsivity, and as you mentioned, these symptoms can be mistaken for ADHD. So it’s critical if you notice that your child is hyperactive to go back and look at how much sleep they’re getting, and then also at the quality of sleep that they’re getting as well.

Another important point for children with ADHD is that sleep deprivation will make those symptoms worse. So, when they have the diagnosis of ADHD and they’re started on medications, the medications can impact their sleep. And then also if they’re not getting enough sleep, it’ll be makes him more hyperactive and more impulsive.

So I’m remembering in my head, I had a patient that I had seen who had come to me, who was in early adolescence, and he was on four different psychiatric medications. And it turns out that he had undiagnosed sleep apnea and was not getting enough sleep. And with effective treatment of his sleep apnea and taking a closer look at his sleep hygiene, we were able to actually wean off a number of his medications, and he did remarkably well just by getting a good night’s sleep.

Chris: Letting the body heal itself through the way it was designed.

Dr. Kanaan: Correct.

Carolyn: Very interesting. I seem to remember that over the years that the schools that have decided on later start times, they’ve actually noticed that the kids get along better, that there’s fewer incidents of kids misbehaving. And that is one of the main, as well as I imagine academic performance, but is that true that they actually have fewer scuffles with other kids?

Dr. Kanaan: Absolutely. So that’s been borne out in studies. Children who have sleep deprivation have problems with relationships, both parent-child and then also teacher-student,as well as peer-to-peer. Newtown, here in Connecticut, was able to successfully change their school start time about three years ago, and in talking to the superintendent there, they’ve noticed a dramatic improvement in student well-being and the ability for students to get along with each other.

Carolyn: So why don’t more schools change their start times?

Dr. Kanaan: I have to say it’s a real challenge for school districts, on several fronts. Some people are concerned because not everybody has lighted fields, so it can’t impact sports practices. In addition, financially, sometimes there are some barriers, particularly when it comes to busing schedules — the schools need to switch from, say, a two-tiered bus schedule to a three-tiered bus schedule. Oftentimes there are problems with students who have commitments after school, in terms of jobs or taking care of other siblings. So it is a challenge to make that change in school start time, however, when you talk to the individual districts that have made that jump, it has been an investment that’s definitely been worth while.

Looking at studies of school districts where they have changed school start times, some of the things they’ve noticed is a dramatic improvement in teen-related crashes. There was one study that showed a 67% improvement in teen-related crashes. They also noticed a decrease rate of depression, suicidal ideation, and a decrease in risk-taking behavior.

Chris: I’d like to drill down a little more on the fact that it seems like almost, if you just base it on biology and nothing else, like none of the factors you just described, if you take all those out of the picture, we completely have it backwards, right? As far as the youngest kids go to school the latest, and then as they progress through middle school, into high school, the adolescents — and you could tell us a little bit about the, what is it, the sleep phase shift phenomenon at that point in development? — they’re the ones who need to, to start the latest, because they’re going to bed the latest. Even if they don’t want to go to bed late, biologically they’re fighting something that happens at that stage of life in most cases, right?

Dr. Kanaan: Yes, definitely. So it’s important to review the biology a little bit with regards to adolescents. It’s not necessarily that they’re being defiant and they want to go to bed later and wake up later. Biologically they’re pre-programmed. As you go through the stages of development as a child and you become an adolescent, you have a delayed release in melatonin. They also have a delayed sleep drive, so it takes longer for them to feel sleepy, and a longer internal day. Everybody has an internal clock inside of them, and that adolescent internal clock runs at a slightly different pace, so they have a longer internal day. All of these biologic phenomena actually shift the circadian curve, the circadian rhythm. And so adolescents are preprogrammed to want to go to bed later and wake up later.

Carolyn: So what do you do? How can you get your teen to get into a different sleep schedule so it benefits them over the long run?

Dr. Kanaan: Some sleep specialists have actually likened it to, they live in an entirely different time zone. So it’s a challenge. You really have to pay close attention to sleep hygiene. And what I mean by that is you really want to focus on your child’s sleep patterns. You want to make sure that they’re turning off their devices at least an hour before bedtime, which can be a challenge. Remember those electronic devices release a blue wavelength of light, which actually suppresses melatonin secretion, so that can dramatically impact a child’s ability to fall asleep at an appropriate time. You want to make sure that their bedroom environment is cool and comfortable, really limit those electronic devices and put them outside the bedroom. Take the TV outside of the room. We’re all on kind of these summer schedules now and you want to start to prepare about two weeks before the start of school by adjusting your child’s sleep time gradually over the next several days over that two-week time period. Make sure they’re not going to bed hungry, that’s another important point. And then ensure that they’re getting enough exercise. You don’t want to exercise close to bedtime, but exercise does help to consolidate sleep and make it less fragmented. So it’s very important to look at those steps to really ensure that your child’s getting the right sleep and a good amount of sleep.

Chris: If we’re already in the school year now, and someone’s listening to this, what are the things that they can do to try to readjust, refocus the priorities at home to try to optimize that time at night?

Dr. Kanaan: So you want to make sure that you as the parent are modeling good sleep behavior, right? You want to ensure that your child’s seeing you go to bed at a certain time and wake up at a certain time. You have to be very careful with the weekend schedule. A lot of times children use the weekend as a catch-up time to catch up on lost sleep. And the problem with that is that you, again, readjust your sleep schedule during the weekend. So if the child’s going to bed really late and waking up really late, come Sunday night it’s going to be hard for them to reinitiate sleep. So you never really want to change your sleep schedule more than an hour on the weekends. That’s critical. And then as you mentioned, even if you are in the school year, you gradually want to pull back in terms of when they’re going to sleep, make these adjustments of 15 minutes at a time.

Chris: Pretty much since March, most school kids, haven’t had to physically get up and catch a bus at 7:15 in the morning. They haven’t had to go on a really structured schedule, so it might be advantageous for some who want to sleep in a little bit, because they’ve had the luxury of being able to do that. Now it’s, for those going actually physically back to school, they’ve got to get back onto that, “Alright, the bus is coming at 7, 7:15, whenever it comes, and we’ve got to get back on that clock.” So I would imagine that’d be an additional challenge for this school year.

Dr. Kanaan: Absolutely. I think COVID has thrown a wrench into everything. The start of the school year is traditionally challenging, particularly for teenagers. And now with a COVID in the fact that so many people were online learning, so many children were online learning over the spring, a lot of those habits that they developed before have been thrown to the wayside. So you really have to make a conscious effort to think about this before the start of the school year, and prepare your child so they’re primed for academic success and they’re able to perform both in the classroom and then outside of the classroom.

Carolyn: Just curious, since COVID started, what kind of questions are you getting from parents? Are you seeing more children with sleep problems?

Dr. Kanaan: Absolutely. So I think the lack of structure has really played a big role into this. And then also with the online learning, children are doing online learning in their bedroom. And so it’s hard for them to now shut down their brain, shut down their device and go to sleep. We have a common phrase in sleep medicine that you want to invite and not demand sleep. So you really want to preserve the bedroom for sleeping and not for working on school projects or staying up late on your phone. You want to keep it kind of a sanctuary. And then also you want to develop a bedtime routine that’s relaxing and inviting for sleep.

Carolyn: That’s good advice.

Chris: I would be interested to hear what is actually happening to our bodies when we are getting good quality sleep, and how does that put us in position to be our best selves the next day?

Dr. Kanaan: So as we discussed earlier, sleep is really a cornerstone to good health. And I think. One of the things that we think about in America is that if you’re not getting enough sleep, it’s really a badge of honor. People feel that if they’re depriving themselves of sleep, they’re working really hard. And actually the converse is true. We all have smartphones, and at night, you plug in your smartphone, right, so that your smartphone is able to recharge? The same thing is happening when you sleep. When you sleep, your muscles are recharging. For children growth hormone is actually released when you sleep. And it enables time for the brain to actually download all the information that it’s acquired during the day, to sort of rebuild some of those synapses that were not utilized during the day. So this is a time when, when the body recharges reprocesses and really looks to consolidate some of the things that have happened during the day.

Carolyn: And maybe just a reminder again, about how much sleep we all need. Is it still the eight hours for most people?

Dr. Kanaan: That’s a great question. So with our younger children, they’re going to need more sleep. Our elementary school kids can need anywhere between 10 to 10 and a half hours of sleep. As you transition into adolescence, a great number of adolescents need closer to nine hours of sleep, eight and a half to nine hours of sleep. And remember, your sleep needs can change depending on what’s going on in your life. So if you happen to have a concurrent illness, or you’re under a lot of stress, or you’re feeling depressed, those may be instances when you actually need more sleep than you did prior to that.

In terms of our adults, generally the recommendation is anywhere between seven and a half to eight hours of sleep. There is some genetic variation to that, so some people need a little bit more and some people need a little bit less. On average, however, I’d say more people think that they need less sleep than they actually do.

Carolyn: So many people are into — maybe it’s just my friends — the homeopathic remedies, like, lavender pillows, and scents, is there anything to all of the more homeopathic –melatonin? Is melatonin safe for children and adolescents?

Dr. Kanaan: I think you have to be careful with melatonin. You have to make sure that you are taking the dose that’s recommended by your physician, and it really should be done in concert with your physician, not independent of that. In terms of the homeopathic remedies, if it helps you develop a bedtime routine that’s relaxing and helps to promote sleep, then I think it’s a good thing.

Chris: Jennifer Kanaan, you are a sleep medicine physician at UConn Health. Thank you so much for joining us today.

That’s our time for today. For Dr. Jennifer Kanaan and Carolyn Pennington, I’m Chris DeFrancesco. Thank you for listening to the “UConn Health Pulse.” Be sure to subscribe, so you can catch us next time, and please share with a friend.