Chris: As the summer winds down, let’s talk about a possible cheat code to having a better school year.
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.
With Carolyn Pennington, I’m Chris DeFrancesco. It’s actually not cheating at all. In fact, it’s the opposite of something a lot of us are cheating ourselves out of.
Carolyn: We’re talking about sleep. Those who make a consistent good night’s rest a high priority put themselves in position to operate their best throughout the day, and that can be particularly helpful in the classroom. So we’ve invited Dr. Jennifer Kanaan from UConn Health’s Sleep Disorders Center to come back and help us get ready for the new school year by getting us back on a school-year sleep schedule. Thank you for joining us.
Dr. Kanaan: Thank you for having me.
Carolyn: Well, we wanted to have you in during the summer because getting back on the school schedule is best done before the night before the first day of school. So when you have several days or weeks to play with, when is the best time to start moving up bedtime?
Dr. Kanaan: That’s a great question. So traditionally we like to counsel patients and their parents to start about two weeks prior to school time. This gives them a chance to gradually adjust their sleep schedule so that the transition is much easier for them.
Carolyn: And how does the children’s age have an impact on how the timing works out?
Dr. Kanaan: Teenagers are at a particular disadvantage because biologically they’re programmed to go to bed later and wake up later. So they tend to release melatonin later during the day. They also have a decreased sleep drive. And so that, in addition to societal pressures, make it very challenging for teens to begin to go to bed at the time that they should.
Additionally, the fact that they have early school start times can really be a challenge for this particular age group. Younger children tend to be much more in line with the school start schedule, but focusing on the importance of sleep is something that we can’t stress enough.
Chris: I want to go back to the part where you said the adolescents or the teenagers have a decreased sleep drive. You and I have talked about this a lot over the years. I’ve never heard “sleep drive” before, and I would say, I happen to live with a 15-year-old, and you might be right on the nighttime end of it, but try waking them up in the morning.
Dr. Kanaan: Exactly. So they live in an entirely different time zone. And all of us have an internal clock, as I’m sure you know. And with teenagers, their internal clock is actually longer, so they have a longer day than you and I. And so that contributes to their decreased drive to initiate sleep. Once they’re asleep, they tend to do a really good job staying asleep. And that’s why it’s so frustrating to wake them up in the morning.
Chris: OK, so they’re actually like, our 24-hour clock is more like a 25-, 26-hour clock for teens?
Dr. Kanaan: So I believe it’s about 24.7 for teenagers, so their day is just longer than yours and mine. And they also are much more addicted to their phones, and pressures of society, being young teenagers.
Carolyn: So when parents come in and talk to you about that, what kind of advice do you give them? How do you get the teens off of their phones?
Dr. Kanaan: So a lot of it has to do with education and the importance of sleep, and we talk about the factors that contribute to insufficient sleep. Knowing that insufficient sleep can contribute to academic performance, it can affect your ability to have a good relationship with your peers and your teachers can be very important for teenagers.
There’s also great research that supports an improved athletic performance when you get a good night’s sleep. So they did a great study on basketball players from Stanford, and it showed that they had an improved foul shot accuracy and improved performance on sprints. And since a lot of teenagers are very interested in athletics, that can really help to sway them by focusing on the importance of sleep.
Chris: When you meet with patients about best sleep practices, do you meet with both parents and teens at the same time, or does that ever happen and do you find yourself in the middle of kind of like, there’s obviously something going on in the home that’s working against us here, and now you have to be the bad guy to tell everybody, you know, put your phone away, shut the TV off, and all that stuff? How do you handle that?
Dr. Kanaan: So we try to have a little bit of time independent from the parents where we talk to the teens directly, and then we do some combined education where we talk to both the patient and the parent at the same time. It is a challenge, and teens really have to buy into the whole concept that sleep can help their overall functioning.
Parents can do a great job by modeling good behavior. So even though we think that our teenagers aren’t watching us, they are in fact watching us. So you want to make sure that you’re doing a good job by prioritizing sleep, shutting down your devices at least an hour before bedtime. A lot of the newer phones do have a nighttime mode, which helps to cut down on the amount of blue wavelength of light that you’re actually receiving when you’re on your phone, but it still is no substitute for shutting off the phones an hour before bedtime.
Carolyn: Are there any warning signs that parents can be aware of for their child? If they’re not getting enough sleep, are there certain behaviors, certain ways of acting that could be sleep deprivation?
Dr. Kanaan: Absolutely. So sometimes they actually have symptoms that are very similar to children with ADHD, so decreased concentration, increased irritability, or emotional lability, those would be things to look for change in how they’re performing at school. All those can be signs of insufficient sleep. I should also mention that it’s a good idea to make sure that there’s not something else going on. So is your child snoring? Are they having unexplained awakenings because of nightmares? Is there sleep walking? Do they have discomfort in their legs that they’re reporting?
So those are important things to just keep an eye out for and make sure that you’re not missing.
Chris: How common are those other things you just mentioned in adolescence, the sleepwalking and night terrors and things like that?
Dr. Kanaan: Sleepwalking and night terrors tend to be more common in our younger children. For teenagers, the most common sleep disorder that we see is sleep apnea. You also have an increased risk of narcolepsy in the teenage years, so that’s that uncontrollable need to go to sleep, falling asleep at inappropriate times. Also, patients with narcolepsy tend to have more unusual symptoms where they feel that they’re dreaming, but they’re actually awake at the same time. So sleep apnea and narcolepsy I would say would be the more common conditions that we see in that age group.
Carolyn: Earlier you mentioned the sports research study that was done and how they shot, what, foul shots better? Are there any other studies out there that show like an improvement in grades or, I feel like, behavior? Has there been any research studies published showing the other benefits?
Dr. Kanaan: So when they look closely at students that are performing well in school, they tend to report a longer sleep time than students that are not performing as well. It’s also very interesting when you look at some data closely with the change in school start times, some of those school districts have reported an improvement in standardized test scores, although that was not shown in all of the study. Teachers additionally tend to report that the students are more alert if they’ve had a good night’s sleep, and they report better performance in the classroom as a whole.
Chris: How do you make the case to explain to 15-year-old who doesn’t want to go to bed before midnight and doesn’t want to wake up before 11 the next day? How do you get into that person’s head and make him or her understand there’s really so much benefit to making this a priority? Do you find yourself explaining what physiologically happens to you when you’re asleep as a way to try to talk them into it? Like, don’t do it ’cause mom’s saying, do it because of these reasons. How does that conversation go?
Dr. Kanaan: So I think a lot of it boils down to what’s important for the teenager. So are grades important? Do they find that sports performance is important? Do they really value relationships that they have with their peers? And then once I’ve identified an area that’s of importance to them, I try to tie it back to insufficient sleep to give them a sense of how things could be better if they get a good night’s sleep. I think American society as a whole does everyone a disservice by talking about lack of sleep almost as if it’s a badge of honor. So we really, as a culture have not bought into the fact that sleep is restorative. It’s gonna help you have an improved quality of life. It’s gonna help you with your performance in modern society. I think we’re always go, go, go, go, go, try to get as many things done as possible, and we don’t take a step back and think about how we could improve our overall performance and how we could be improving our overall quality of life. And so that’s something important to consider.
Carolyn: And good sleep habits now, if children can get into the right routine, really will benefit as they get older too, correct? Because there’s so many other health issues that you hear about, whether it’s being overweight, and then that of course leads to a whole range of heart problems or diabetes or whatever. So there is this link, right, with good sleep hygiene and really being well overall?
Dr. Kanaan: Exactly, so insufficient sleep has been tied to a number of different conditions, and the risk for those conditions increases as we get older. So for example, diabetes, there was a great study that looked at the effects of insufficient sleep on children and the result of insulin resistance, thereby leading to diabetes. So you’re gonna have an increased risk of diabetes. We know in older patients, insufficient sleep is linked to an increased risk of heart disease and heart attacks.
Additionally, there’s fascinating research with regards to dementia. So when we sleep at night, the glial lymphatic system actually is affected and the cerebral spinal fluid, which surrounds your brain, goes in while you’re in the deeper stages of sleep and cleans out those amyloid protein deposits. And really the term is “washing the brain,” kind of cleaning the brain of all those protein deposits. And those protein deposits are critical for the development of dementia and Alzheimer’s disease. So there is a good link between having sufficient good quality sleep and the prevention of dementia.
So, as you mentioned, starting these good, healthy sleep habits now as a child and teenager is something that you can carry on through the rest of your adulthood, and so it’s important to focus on it now.
Chris: In the few minutes we have left ,just one exercise, oversimplified: School bus comes at seven for a high school kid. Person needs to get up at six to get ready. What is the appropriate time, ideally, for it to be lights out and at least starting to welcome sleep in a dark bedroom?
Dr. Kanaan: I am gonna answer the question with almost two answers.
So I think it’s always important to talk about the amount of sleep that an average teenager needs. On average, they need between nine to nine and a half hours of sleep. Having said that, when we look to turning back the clock, if they really need to be up at six o’clock, that may be an unrealistic goal. So, really focusing on seeing if you can have the child begin to wind down somewhere around nine o’clock and then perhaps begin sleep initiation close to 10, that’s perhaps a realistic option for most teenagers. Certainly if they can go to bed earlier, that would be outstanding, but at least getting eight hours of sleep is really, really important.
We know when we look at this group of individuals, teenagers, specifically, if they don’t get enough sleep, they’re gonna be involved in increasing risk-taker behaviors. What do I mean by that? I mean smoking cigarettes, using drugs, getting involved in motor vehicle accidents. So students who sleep less than eight hours are a third more likely to get involved in a motor vehicle accident. And as the parent of a teen, that’s a scary statistic.
Chris: That should get the parent’s attention. And parents, by the way, if modeling for your child isn’t a good enough excuse to take a look at your own sleep habits, you’ll benefit too from sleeping better even when you’re older. Right?
Dr. Kanaan: That’s exactly right. I should also point out that there is a definitive link also with mental health and sleep, so we know that there’s a bidirectional effect of sleep. So in other words, if you’re not getting a good night’s sleep, you’re gonna be at increased risk for depression. And then conversely, we know that depressed patients tend to not have a good night’s sleep, but in terms of looking at things that you can correct to keep your mental health well and healthy, sleep is definitely on that list of important things to do.
Chris: Alright, so it’s time for us to say goodbye. So just real quickly, dark bedroom, lights out, what? An hour before? No more blue light, no more screens, laptops, that kind of a thing. Any other takeaways that we should leave with?
Dr. Kanaan: So cool, dark environment like you talked about. Turn off those screens an hour before bedtime. Get outside. Expose yourself to bright light and exercise on a regular basis. Those things will definitely help to consolidate your night of sleep and help with sleep initiation or getting a good night’s sleep limit caffeine after the morning. Stay away from any products that have caffeine after breakfast.
Chris: OK after breakfast.
Carolyn: Oh boy. I fail that.
Dr. Kanaan: That’s if you’re having a difficult time initiating sleep and staying asleep.
Chris: Understood. And you could make up a little bit of lost time on the weekends, but that’s generally not a great idea either, right? You want to try to keep things consistent?
Dr. Kanaan: Exactly.
Carolyn: Great advice. Thank you.
Chris: Dr. Jennifer Kanaan is a pulmonologist and sleep specialist in UConn Health’s Sleep Disorder Center. Thank you so much for being with us.
Dr. Kanaan: Thank you.
Chris: That is 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.