Dr. Marishka Brown: Hello, everyone, and thank you for joining us
for today's Science of Sleep Facebook Q&A.
My name is Dr. Marishka Brown, and I
am the director of the National Center on Sleep Disorders
Research at the National Heart, Lung, and Blood
Institute at the National Institutes of Health.
The Science of Sleep Series is a three-part series
designed to explore NIH research on the impact of sleep
on our health at every age.
It's cohosted by the Eunice Kennedy Shriver National
Institute on Child Health and Development,
the National Heart, Lung, and Blood Institute,
as well as the National Institute on Aging.
Our topic for today is sleep health for children and teens.
It's my great pleasure to be joined by Dr. Lauren
Hale, who's a NICHD grantee.
Dr. Hale is a professor of medicine, population
and preventative medicine at the Renaissance School of Medicine
at Stony Brook University in New York,
and is the founding editor-in-chief
of the Sleep Health Journal.
Dr. Hale is also the chair of the board of directors
at the National Sleep Foundation,
and today she'll be sharing her expertise
on the social matter--
social patterns of sleep and how they contribute
to health disparities.
Dr. Hale, welcome.
Dr. Lauren Hale: Thank you, Dr. Brown.
It's such a pleasure to be here, and an opportunity to share
some insights from my NICHD-funded research
on the science of sleep and child and teen health--
and really, any opportunity that I
can, to reiterate how important sufficient restorative sleep
is for the optimal functioning of the human body.
And that includes performance on daily activities, sports,
academics, learning, psychological well-being,
and of course, physical health.
Dr. Marishka Brown: Thank you for that, Dr. Hale.
So before we get started, I want to let everyone
know that we will be sharing resources and links on Facebook
throughout today's discussion.
I also want to be clear that the information that is shared
today is not medical advice.
We are sharing insights from the latest research
as well as resources on this topic.
If you need medical advice, please
speak to your medical provider.
As this is a quick Q&A, let's get started.
So, sleep deprivation is an epidemic,
including amongst teens.
Can you elaborate on what this means?
Dr. Lauren Hale: Absolutely-- teens are some of the hardest hit age group,
in terms of not getting enough sleep.
Experts have recommended that teens
get between 8 and 10 hours of sleep
per night for optimal functioning,
and right now only about 50% of teens
regularly get that amount of sleep.
There are basically three broad causes of this differential
in sleep deficiency.
The first are what you would expect,
social and behavioral factors.
Some of these include things that I care about
and that I study, like screen time,
scrolling through social media, excess caffeine
consumption in the afternoon, or the pressures
of daily high school, whether it's sports or homework.
But there are bigger factors, and those
are the structural factors which affect schedules,
like school start time, or work, after-school work schedules.
And school start time is really relevant to about 80%
of teenagers in the US, because over 30 years of research
have-- has shown that teenagers do better when school
starts at 8:30 AM or later.
And yet, as I said, only about 20% of high schools
start at that time.
We're moving in the right direction in that.
Legislation in California has recently
been enacted that requires schools
to start at 8:30 AM or later, but we've got a long way to go.
And then the third big cause as to why teens aren't getting
enough sleep is biology.
Physiologically, when teens go through puberty,
they experience a phase delay, and that
means that their bodies naturally stay up later.
It's not possible for them to fall asleep earlier,
unless they're so exhausted.
They stay up later and they want to sleep in later.
So, this earlier school start time that a lot of high schools
have is in direct conflict with their adolescent biology.
Dr. Marishka Brown: Thank you so much for that, Lauren.
That's a lot of interesting information,
I'm sure, for our viewers.
And so we know that not getting enough sleep
can significantly impact health.
Can you tell us what you and other researchers
have found, especially for the teenage population?
Dr. Lauren Hale: Absolutely-- and it's a good point that it applies
to everyone, but I'll mostly focus on teenagers
for today's talk--
or conversation.
So, we know through, again, decades of research that
insufficient or poor-quality sleep is linked to a whole
range of poor health outcomes--
specifically, obesity, impaired immune function, depression,
and overall emotional and psychological well-being.
It's also linked to a range of poor social outcomes,
and for teenagers this can mean increased risk-taking behavior,
like drug and alcohol consumption,
or for new drivers, unsafe driving.
And so we see that, for example, early school start times
is linked to higher vehicular accidents.
And just by delaying school start times,
you get a drop in car accidents.
And so it's a public safety issue as well.
And then the final big outcome that insufficient sleep causes
is performance markers.
Whether it's academic performance, grades,
and performance on tests, or athletic performance,
we see that more sleep leads to better performance.
And one of my fun studies on this
looked at the Twitter feed of NBA basketball players.
And we showed that, for players, if they were up late at night
tweeting the night before a game,
they actually performed worse on the court the next day.
They scored fewer baskets and had lower shooting accuracy.
So whether you're in it for the grades or the baskets,
sleep is going to help your next-day performance.
Dr. Marishka Brown: So knowing these links between sleep, and performance,
and health, and safety, essentially,
your research focuses on how disparities in sleep
ultimately could lead to health disparities.
And so, can you give the audience a sense
of how these are interconnected?
Dr. Lauren Hale: Absolutely-- so this is what got me interested in sleep
to begin with.
I was looking for underlying causes of health disparities
in populations of all ages, and what we found
is that sleep is socially patterned.
And that means there are variations in sleep health
by race/ethnicity, by socioeconomic status,
by education.
And we saw this in adults, and then we
started to look at children's sleep patterns.
And we did this by following a cohort called the Fragile
Families and Child Well-Being Study,
in which they started collecting information on participants
at birth--
they were all born between 1998 and 2000--
and following up with them at ages 1, 3, 5, 9, 15.
Now we're in the field collecting data at age 22.
And we had some sleep data on the earlier waves,
but at age 15, and now age 22, we're
collecting actigraphy-based data.
So we have objective assessments of sleep.
For age 15, we did it for one week,
and were able to assess a range of factors
in how sleep varies, how it's socially patterned,
in that age group.
And to answer your question about racial and ethnic
disparities, we found--
this is kind of amazing--
that black teens sleep about 32 minutes less per week night
and 41 minutes less per weekend night than white teens.
And this accumulates over the week.
When you think back to the negative consequences
of insufficient sleep on health and performance,
obesity, depression-- you can imagine that sleep patterns set
children and teens on trajectories
that could lead to poor health outcomes and health
disparities.
And we also found that neighborhood mattered
as well for disparate sleep patterns,
in that more disadvantaged neighborhoods at age 15
had poorer quality sleep.
And that could be due to either noise, or light, or safety--
feelings of safety in the neighborhood.
So there's a lot to unpack here, but it's
a very important area for policymakers to think about.
Dr. Marishka Brown: Absolutely-- very complex, but also extremely important.
And so since we're discussing children and teens,
I want to pivot a little bit to conversations around screen,
because I know the audience is very interested in this,
because the screen time has essentially
spiked throughout the pandemic.
So, how does screen time affect children and teens,
in terms of sleep?
Dr. Lauren Hale: Right.
So, screen time is great.
I love my screen time so that I take--
this is personal to me.
I know how hard it is to put your screens down.
Or excuse me, screen time is great--
screen time is enticing.
But unfortunately for us screen-- heavy screen users,
dozens and dozens of studies have
shown an association between later sleep onset,
poorer sleep quality, and reduced overall sleep duration
with increased screen use, especially among screen use
right before bed and interactive screen use.
So interactive would be doom-scrolling on social media,
as opposed to watching TV from 10 or 12 feet away.
So, there are a few reasons why this association exists.
And it's important to dig into the mechanisms,
because without understanding the mechanisms,
you don't know how to mitigate the effects of the mechanisms.
The first is this physiological mechanism
of the light emitted from the screen actually suppresses
melatonin.
And melatonin is a sleep-promoting hormone
informing your body that it's time to go to sleep.
So if you have a suppression of melatonin because you’re face-
to-face with a bright screen, that's going to affect sleep
onset--
or when you go to sleep.
The second mechanism is just the time
that using a screen takes up, because when you're watching
a video, you're taking away from time that you could be sleeping
or should be sleeping, and/or time that you could or should
be getting ready for bed in a restful, relaxing way.
And the third big reason is the psychological effect,
that the content--
this is hard to study, of course--
but the content of the screen could
be disruptive to your thoughts before falling asleep.
For example, imagine a 12-year-old girl looking
on social media and seeing that three of her friends went out,
and she wasn't invited.
That could lead to late-night rumination, feelings
of missing out, and really interfere with her ability
to fall asleep in a way that allows her to get enough sleep.
And the last point is one that we just
tapped into through the Common Sense Media data
a couple of years ago.
We asked, how often do you wake up in the middle of the night
to check your phone?
I think it was like 36% of teens report doing that.
Dr. Marishka Brown: Wow.
Dr. Lauren Hale: So waking up in the night to check your phone
is disruptive to your sleep.
Even if you fall back asleep, it's
probably something you shouldn't need to do.
Dr. Marishka Brown: Dr. Hale, that's some great information,
discussing sleep as far as both behavior as well as
the underlying physiology.
And these points are really important.
And so what would you like teens and parents to take away
from this conversation?
Dr. Lauren Hale: Right.
So again, this is a hard one.
It's hard to get buy-in from everyone on this,
but we need to think about the positive benefits
that healthy sleep confers, and talk with your children
and teenagers about why we value sleep
and why we prioritize it, by giving examples
of the benefits of sleep, and then also role modeling
healthy sleep behaviors-- setting
regular, consistent routines with healthy, calming and
relaxing routines, like reading and dim lights.
And then the hardest one of all is saying,
let's take digital media out of the bedroom.
Do you really need your smartphone next to you
in the minutes before you fall asleep?
Do you need to use your smartphone as an alarm clock?
You can buy an alarm clock that functions just fine,
that doesn't have the internet attached to it--
and not only doing that for your children or your teens,
but doing that for the whole family.
And we recommend setting up a central charging place
for smartphones so nobody in the house is disrupted
and checking their phone in the middle of the night--
or apartment.
So those are the main recommendations.
But as I said, it's hard to get buy-in on that,
because we are all so attached to our devices.
And sometimes we just need a break,
and nighttime's the perfect time for that.
Dr. Marishka Brown: Well, behavior change, we know, is extremely difficult,
but being able to put out these recommendations,
I think, is very helpful and could
impact some of our members listening in the audience.
And so we have reached our time, and so that's
our time for today.
Thank you, everyone out there that joined us, and thank
you very much, Dr. Hale, for highlighting
the important aspects of the science
of sleep for children and teens.
And so for more information and resources for the Science
of Sleep series, of visit www.nia.nih.gov/scienceofsleep.
You can also continue this conversation online
using the hashtag #ScienceOfSleep.
Thank you, everyone, and see you next week.