Transcript
Alyssa Paschke: Hi, everyone, and welcome to our March Q&A. Today's topic is one that has generated a lot of discussion between parents, teens, and even school administrators, and today I'm speaking with Dr. Lisa Meltzer, who is a pediatric psychologist and researcher at National Jewish Health. She has participated in research at several, or participated in research that led to changes in school start times for several school districts here in Colorado. Today we're going to look more closely at her research and the importance of sleep for teens. If you have a question as we go along, feel free to type it in the comments section and we'll try to get to as many as possible, so thanks again for speaking with us today. Dr. Meltzer. Can you start by talking a little bit about yourself and your research focus?
Dr. Meltzer: Sure, so I am a pediatric psychologist with a specialty in sleep, so clinically I work with kids from ages six months up through college age, helping with any sort of sleep-related issue that they may have. My research focuses in several main areas. The one most relevant today is looking at the impact of changing school start times on health outcomes, and that would be for any aged child that's in school, looking at how it impacts families and communities, and so that type of thing.
Alyssa Paschke: Gotcha, so why is it so important for teens to get adequate sleep?
Dr. Meltzer: Sleep is a critical health asset. It's not optional. It's not one of these things that you can choose to do when you want. It's as important as, you have to eat, you have to breathe, you have to sleep, so when you don't sleep, we start to see a number of negative outcomes. The first most notable for parents is mood. Grumpy teens. A lot of parents have noticed grumpy kids this week with the daylight saving time change. Waking them up in the morning is no fun typically, but even worse once we spring forward an hour, so mood is definitely a big area. We know that academic outcomes is a big area as well. Students, it's harder for them to pay attention in school, harder for them to process the information. When they're sleepy, it's harder to get their homework done at night, so we definitely see academic problems as well.
Dr. Meltzer: Growth and development. We know that growth hormone is released during sleep, so kids are literally growing during their sleep, and so when they're not getting enough sleep, that can impact growth. We also know that the hormones that regulate hunger, feelings of fullness in the foods that we crave are also regulated during sleep, so we have direct evidence that if you sleep deprive teens, they will consume more calories, and those calories don't come from things like cheese sticks and apples. They come from cookies and chips, and that they will increase caloric intake, and actually gain weight with not getting enough sleep.
Alyssa Paschke: That is very interesting, and so along with that, what is your recommendation on how many hours per night a teen should sleep?
Dr. Meltzer: The consistent recommendation is between eight and 10 hours. There are a number of really cool studies where they look to see how much sleep on average teens need, and it's about nine and a quarter hours. For some, that even, in addition to about a 45 minute nap in the afternoon, so it's quite a bit of sleep. The national average in the United States is just over seven hours of sleep, and it's only about 27, 28% of adolescents in the US are getting at least eight hours of sleep. We have significantly sleep deprived population of teens.
Alyssa Paschke: Definitely, and with the early school start times that some districts have, I'm sure that has a lot of those negative outcomes like you just mentioned. In addition to that, what are some of the sleep difficulties that can occur with teens in terms of them having trouble falling asleep or staying asleep, and how do you treat those issues?
Dr. Meltzer: There's two primary issues. The first would be insomnia, which is defined as difficulties falling asleep, difficulty staying asleep. It can be caused by a number of different factors, stress, anxiety, mood disorders, bad habits all contribute to difficulties with sleep. What happens for a lot of teens, if they spend multiple hours in bed trying to sleep without any success, and then all of a sudden the bed becomes a negative place. It becomes a place that as soon as they get into bed, they think about getting on their phone. They think about on their laptop, they think about stress. Their body doesn't automatically think about sleep, so we strongly recommend using the bed only for sleep, and sleeping only in the bed, so not sleeping on the couch, not sleeping in other places, but having that consistent place for sleeping.
Dr. Meltzer: Technology in the bedroom is a big detractor for sleep. That can also contribute to insomnia, not only because technology is engaging, but it also emits a lot of light, and so light exposure is something that affects also the other primary issue we see in teens, which is circadian rhythm issues. This all stems from melatonin, so melatonin is naturally produced hormone. It doesn't make somebody sleepy per se, but it helps to regulate sleep, and melatonin is regulated by light and dark, so when darkness occurs that signals the brain through the eyes to make melatonin and start preparing the body for sleep. Once the melatonin is released, a few hours later, one falls asleep. The melatonin continues to be released overnight to help them sleep, and in the morning when we open our eyes to sunshine, at least here in Colorado, that tells our brains to wake up and get going.
Dr. Meltzer: That light stops the brain from making melatonin, so technology light at night can also stop the brain from making melatonin. That's another reason that technology in the bedroom is pretty problematic for teens. But what we also know, those same studies that helped us determine that teens need over nine hours of sleep showed us that the timing of melatonin release is delayed in teenagers, by about one to two hours. What that means is that teens can't fall asleep early like they once could. That delay in melatonin release means it's hard to fall asleep at 9:00, sometimes even 10:00, and that's one of the issues with the school start times. It's not that teens or just being obstinate. Sometimes they are, but they often have a lot of homework. They have a lot of activities, but even if they were able to go to sleep at 9:00, physiologically their bodies are not necessarily able to fall asleep, and then you counteract that on the other end with that early school start time, and then the teams are not getting enough sleep.
Alyssa Paschke: Yeah, and like you said, with all the activities and homework, it's definitely a lot, and there's not that many hours left after all of that's over, right? For parents out there, and maybe even educators that might be watching, what are some of the signs? I know you mentioned mood, stress, anxiety. Any other signs that a parent can pick up on that they're teen's getting deficient sleep?
Dr. Meltzer: Yeah, so teens, kids, grownups, you should be able to wake in the morning pretty easily. When your alarm clock goes off within five, 10 minutes, you're able to get out of bed, get going. Even better is if you wake up without an alarm clock. But if you have to really wake somebody up, and I get reports all the time in my clinic of five, six, seven alarms. We get parents throwing water on their kids. If you're dragging your kid out of bed every morning, that's a clear sign they're not getting enough sleep. There's also called something, weekend oversleep, where if you get two or more extra hours of sleep on the weekend, that's your body trying to pay down its sleep debt. That's somebody trying to catch up on all the sleep they've lost during that week, and so if you're getting a lot of that extra sleep on weekends, holidays, spring break's coming up for some people, that's a sign that you're not getting enough sleep during the week.
Dr. Meltzer: The third is falling asleep in inappropriate places, school being one of them. Kids should not be falling asleep in class, no matter how boring it is. If you've had enough sleep, you'll stay awake, so that's really important. Also kids who fall asleep at sporting events, every time they get into the car, fun celebrations. If your kids are really that sleepy, that ...
Speaker 3: Alexandra just asked, "What happens with countries that a lot of light and that are up until late hours?"
Dr. Meltzer: Yeah, so in the summertime, places that have that 24 hours sun cycle are really late nights and very early, they have to use a lot of adaptations, so that means that a lot of blackout screens, dimming the lights, creating that artificial dark environment. Those places that have really long summer days also have really long winter nights, which is very dark, and so the opposite is true, and you often have to introduce artificial light. Even places like Washington state or Maine where they have very short winter days, you often see the use of light boxes or light therapy in the morning to help wake the body up and improve the functioning during the day.
Speaker 3: She actually had a follow up question that said, "Until which age do you recommend them going to sleep around 8:00 PM?"
Dr. Meltzer: We start to see the phase delay, that circadian shift with the melatonin delays, after puberty. That can range in age for kids, but somewhere between about 12 and 14, we start to see that 8:00 PM bedtime gets pushed to nine, sometimes even to 10. But you can really get that sense of how long it takes your child to fall asleep. Again, up to 30 minutes is normal, but most people take about 10 to 20 minutes to fall asleep, would be considered typical.
Speaker 3: Can you really catch up on sleep?
Dr. Meltzer: Only to a certain degree, so we build up what's called a sleep debt, and in United States, our sleep debt is greater than our financial debt, and it's hard to pay it down. On the weekends you can get a couple extra hours of sleep, but it doesn't make up. If you've lost 10 hours of sleep over the week, two extra hours doesn't pay it fully down, and there's some new studies that are coming out showing that even a little bit of catchup sleep may not be enough to fully catch up on all the functioning that's impaired when you're not sleeping enough.
Alyssa Paschke: Great questions. Anything else?
Speaker 3: Another question was, you mentioned that teens can nap in the afternoon. Do you recommend supporting or encouraging their teens to nap?
Dr. Meltzer: Naps can be really beneficial. The trick is naps have to be short. They have to be 45 minutes, and the thing to know about naps is you never feel good when you wake up from one. You get this thing called sleep inertia. It takes a little while to get going, and so that's something that's really important to consider. If you're able to limit that nap to 45 minutes and it's early enough in the afternoon, such as right after school, that's going to be really helpful. If the naps are too late in the afternoon or the evening, that's going to impact someone's ability to fall asleep at bedtime, so the duration of the nap and the timing of the nap are really important. If you have a teen who's having a really hard time falling asleep, you may want to be careful about that late afternoon nap, because that can only further make it difficult for them to fall asleep.
Alyssa Paschke: Absolutely, so I guess along with that, it's kind of difficult to maybe get that in throughout the day when there's different activities in schools. How would we, I guess, work around some of those things or, would you suggest kind of a right after school depending on when they're done with school? I guess, how would that actually play out?
Dr. Meltzer: Yeah, I think if possible for the nap, it should be right after school, and not later than that, but that'll give youth a lot more energy to get their homework done, to participate in their activities, and those types of thing if they really need it. Again, our ideal world is that they'd be sleeping enough overnight ...
Alyssa Paschke:...that they don't have to.
Dr. Meltzer: That they probably wouldn't need that nap necessarily, and so really having consistent sleep schedules, consistent bedtimes, consistent wake times, and that's on the weekends too. One of the things that we find is that teens like to stay up really late on Friday and Saturday night, and they like to sleep in really late on Saturday and Sunday, and in essence what happens is they give themselves something called social jet lag, and what it feels like every Sunday night is what we all just went through this weekend, right? It's like traveling east times zones where it's really hard to fall asleep on Sunday night and it's really hard to wake up on Monday. That starts the week off poorly for the entire family.
Dr. Meltzer: Everybody's cranky Monday morning. Tuesday is pretty terrible. Wednesday's sort of wacky. By Thursday, teens are able to get their schedules back on track, just in time for the weekend to throw it all off again, so we really recommend not delaying bedtimes and wake times by more than an hour if at all possible. If your teen is going to have a late night and a sleep in, sleep in on Saturday, and Sunday morning, parents need to find a reason to wake their kids up. Otherwise, like I said, the whole family pays the price.
Alyssa Paschke: That makes sense, so along with your research, what are the school start times that you propose and why?
Dr. Meltzer: In 2014, the American Academy of Pediatrics put out a position statement based on all of the scientific data recommending that middle and high schools should start no earlier than 8:30 a.m. This position statement has been supported by just about every medical, and psychological, and sleep organization out there. This is really in the best interest of our youth. We really want to give them the best opportunity to be successful in school, to graduate from high school. We know those two things are really connected to later health outcomes, financial outcomes, and so it's really important to give our youth the best possible chance.
Alyssa Paschke:Yeah, so, what are some of the benefits that maybe you've seen with some of the districts that have done later school start times?
Dr. Meltzer: I've been working with one of the districts here in the Denver area that delayed its start time from 7:10 a.m. Yes, the high school started at 7:10 a.m. Now they start at 8:20, and what we see is that we went from that 27% or so of high schoolers getting eight hours of sufficient sleep up to 61% of our teens getting sufficient sleep just in one year by changing the start time. That alone we know, increased sleep duration, is really important, and is one of the primary outcomes. But what we've also seen is improvements in daytime functioning such as mood. Our teens are reporting fewer symptoms of feeling nervous, feeling sad, feeling worried. They're reporting better engagement in school, especially in the first period. They feel prepared, they feel ready to participate. We just see overall that our teens are feeling better about having that later start time.
Alyssa Paschke: That's great, and so along with that, kind of on the flip side, what are some of the habits before teens go to bed that they should avoid? Cause I know you said technology in the bedroom is one, but are there any others that people should avoid?
Dr. Meltzer: Yeah, so instead of thinking about avoiding, thinking about what families should be doing. Having that consistent sleep schedule, parents need to set bedtimes, even for your high school senior. There's really clear evidence showing that parent set bedtimes is related to better outcomes, not only with sleep, but also to mood, and so this is really important for helping our teens function at their best. Having a very consistent bedtime routine. It's very hard to go from 60 to zero. We can shut our technology off with a simple switch, but our brains have dimmer switches. They need a bit of time to wind down, so getting that technology turned off at least 30 minutes before bed, having a very consistent routine, a nice, simple routine would be something like having a snack, brushing teeth, putting on pajamas, maybe reading something that's not on a technology device for a few minutes, and then trying to go to sleep. If you have that same pattern every night, then your body knows what's coming and it makes it easier for it to fall asleep.
Alyssa Paschke: That probably would work for others in the family as well, to all have kind of the same routines, so that a few family members aren't doing the technology late at night and some aren't, to just have the whole family kind of consistent.
Dr. Meltzer: Yeah, we suggest technology-free bedrooms for the entire family. If parents don't do it, kids aren't going to do it, so we recommend having a central charging station, and we tell families to tuck in their technology, so the technology has a bedtime as well. Everybody tuck it in at 9:00, or 10:00, or whatever the set time is, and if that's agreed upon, then the whole family is going to be getting better sleep.
Alyssa Paschke: That's a great idea. Any other questions that have come in from the audience?
Speaker 3: Yes. Ashley is asking, "What's the best method to shift a bedtime earlier if you or your children are currently going to bed too late?"
Dr. Meltzer: Having that really consistent bedtime, start with that, even if it's a late bedtime, and having a very consistent wake time. Because if you wake up and you wake up early, then come bedtime, you're going to be sleepy. If you, say, have a very consistent bedtime of 11:00 p.m. to 8:00 a.m., and you're trying to move that a little bit earlier, then the next night you would move the bedtime to 10:45, but you would also have to move up the wait time to 7:45 and similarly, every few days you can just gradually move the bedtime back by about 15 minutes. But you have to remember to also move back the wake time so that when you wake up in the morning, again, you're building up over the course of the day enough sleep pressure, enough need for sleep, come bedtime.
Alyssa Paschke: Okay. Anything else?
Speaker 3: Mary is asking, "What's a good way that adults can catch up on sleep?"
Dr. Meltzer: That catch up is hard. Again, it's ... The goal should be to increase your sleep duration every night. At this point you cannot pay down that 10, 15 years of sleep debt that you've accumulated, but you can start to develop healthy sleep habits and just pick one place to start, be it a consistent bedtime, or getting rid of the technology at bedtime. Just try it for a week or two and see how you feel, and if you see that your sleep duration is increasing, even by 15, 30 minutes a night, you should start to notice that during the day you're feeling a little bit better as well.
Alyssa Paschke: Along with that, maybe some teens might be a little hesitant to kind of get into those routines, so do you have any tips for motivating them to kind of do those consistent starting wake times, and also getting no technology in the bedroom, those sorts of things, that can maybe cause a little bit of tension?
Dr. Meltzer: I think it's really helping teens to understand the importance of sleep, and helping families understand the importance of sleep, and that when we sacrifice sleep for other things, we're a lot. We're sacrificing our health, our wellbeing, and so helping families to understand that sleep should be a priority for the entire family. In the United States we have this common misconception that sleep is for slackers and it's a terrible belief, and it really is very problematic to think that we can just, sleep is a waste of time. That's wrong. That's really, really wrong, so helping families to understand that, but then I have teens pick one thing out of that whole long list of things that I've recommended.
Dr. Meltzer: Pick one and try it for a week or two. Another one on that list should be caffeine, limiting or cutting out caffeine. Caffeine has a half life of four to six hours, which means if you're consuming caffeine after lunch, if you're consuming it after school, if you're consuming it at dinnertime, or in the evening, that's going to make it hard to fall asleep. Getting rid of that caffeine, so I give teens sort of a choice of each of these behaviors and say, "Pick one, stick with it for a week or two, see how you're feeling. Prove me wrong. Show me that I'm wrong," but for the most part of teen stick with these recommendations, they do find that they're feeling better.
Alyssa Paschke: Great. That's awesome, and, yeah, caffeine is something that I definitely know for myself and probably others, even after lunch, is not a good idea, so any other questions that have come in?
Speaker 3: Does the amount of sleep have to be continuous for it to be ...
Dr. Meltzer: There's some debate about splitting it up, such can you get like five hours at night, and three hours during the day. The science still isn't conclusive on it, but the general sense, the most recent study that came out, really suggests that having that continuous sleep is really important, so really aiming for that should be the goal. The problem sometimes with splitting up a sleep is that that second shorter sleep period doesn't happen. If you think, I'm only going to sleep five hours now, and then I'm going to work for a while and then I'm going to get the rest of my sleep, something comes up, and you don't get the rest of your sleep, and so that's where it ends up being very problematic.
Speaker 3: A follow up with that. How do you get that sleep to be continuous, and if you're trying to sleep but you wake up multiple times, what do you do?
Dr. Meltzer: Again, having that really consistent sleep schedule, I know this is really repetitive, but it's the same way that you know, you're supposed to eat five fruits and vegetables a day, and exercise 30 minutes a day, and brush and floss twice a day. This is the ideal, is to go to bed and wake up at the same time every day. If you find that you're spending 10 hours trying to sleep, and you're only sleeping eight hours every night, then stopped spending 10 hours trying to sleep. Only give yourself eight, or eight and a half, or even nine hours to sleep, so really limiting that time in bed so you're not spending these long periods of time doing other things that can be interfering with sleep.
Alyssa Paschke: That definitely makes sense, so I think we're just about to wrap up on our time here, and I really want to thank everybody out there in the audience who had great questions. I hope this was informative for you, as it was for me and I really appreciate you coming to speak with us this afternoon. For anybody out there who might be interested in learning more about your research, do you have any resources that we could go find online?
Dr. Meltzer: I think, in terms of the school start times, the start school later, there's an organization, has a ton of information on their websites for families and school districts interested in this. I think it's a great place to look. The school district I worked with, the Cherry Creek School District, has information on their website about how we went about making our change, and then some of our preliminary findings are going to be posted soon. Honestly if you Google my name, a lot of my studies will come up, and you're able to find a lot of the information about this, in terms of finding just more information about why sleep is so important.
Alyssa Paschke: Yeah, I'm sure there's some parents out there that are definitely interested in trying to implement this, where they live as well, so thank you again to everybody for joining us. If you would like more news and information from National Jewish Health, you can visit our website at ww.njhealth.org. Thank you.
Dr. Meltzer: Thank you.
