Children aren’t getting enough sleep. As a result, some are displaying behavior problems that mimic attention deficit syndrome including an inability to concentrate in the classroom.
And the way teenagers’ biological clocks are programmed, their sleep patterns will improve if schools start their days later in the morning.
This was the message delivered to Hatfield parents recently by Dr. Wendy Chabot, a pediatrician who works at Amherst Pediatrics and Atkinson Family Practice in Amherst and Sleep Medicine Services of Western Massachusetts. She was invited to give a talk on sleep at Smith Academy in Hatfield last month by the Hatfield Special Education Parent Advisory Council.
Calls from health and educational professionals to make school start times later for teenage students are based on biological facts, Chabot told the small group gathered to hear her. As adolescents transition into puberty, they experience what is called a sleep phase delay, which sets their internal sleep cues back two hours. This makes it hard for them to fall asleep before 11 p.m. because they feel naturally alert later in the night and less awake early in the morning, she said.
“It isn’t just media and screen time that’s keeping teens up, it’s a biological shift in their clock. It just makes sense to honor that change in biology,” she said.
To maintain good health, adolescents need 8 to 10 hours of sleep per night, according to the American Academy of Sleep Medicine. Infants need 12 to 16 hours, toddlers, 11 to 14, 3 to 5 year-olds, 10 to 13 and 6 to 12 year-olds require 9 to 12 hours.
For adults, the recommendation is 6 to 8 hours, although individual sleep needs may vary.
Among adolescents, it seems, a good night’s sleep is the exception rather than the rule. In a study published in 2009 by The Journal of Adolescent Health, only 17.2 percent of youths surveyed reported getting the ideal nine hours of sleep on weeknights, only 28.8 percent reported getting eight hours, and nearly half of adolescents — 43 percent slept seven or fewer hours.
In fact, 30 percent of adults are sleep deprived, too.
According to the federal Centers for Disease Control in Atlanta, 50 to 70 million adults have sleep or wakefulness disorder.
This has health consequences, said Chabot. Those who don’t sleep enough are more likely to suffer from chronic diseases such as hypertension, diabetes, depression and obesity, as well as cancer, according to the CDC. A lack of sleep reduces quality of life and productivity, she said. In her view, sleep is the “third leg on the stool of good health,” along with diet and exercise.
“Sleep is not getting the attention it needs,” she told her audience at Smith Academy.
In toddlers and school-age children, the symptoms of insufficient sleep show up in their behavior. Younger children with sleep problems may have a hard time paying attention and may be hyperactive and impulsive, symptoms that could lead to a diagnosis of attention deficit-hyperactivity disorder, a diagnosis many professionals are quick to make, Chabot said. “There’s a lot of pressure to get kids on medications.”
And those stimulants prescribed to control ADHD, make falling asleep and staying asleep more difficult, she said. That, in turn, can make behavior problems worse.
Chabot said that it is important for teachers, physicians and parents who are considering an ADHD diagnosis to fully understand the child’s sleep patterns.
If a child tends to snore, or shows other signs of breathing difficulties when asleep, Chabot suggests an overnight sleep study because the child may have obstructive sleep apnea.
Obstructive sleep apnea, a disorder in which breathing starts and stops during sleep, can be caused by enlarged tonsils and adenoids. It has only recently been regarded as a cause of sleep problems that affects behavior in children, Chabot said.
Obstructive sleep apnea also can cause delayed growth, cardiovascular problems and in rare cases, it can be life threatening, she said.
Chabot, who sees patients from infants to elderly people in her work, says there are three factors that control the ability to sleep: sleep drive, biological clock and emotional/physical states.
Sleep drive refers to the buildup of a substance called adenosine in the brain that triggers the feeling of sleepiness — heavy eyelids, yawning. It builds up gradually throughout the day. Taking a nap interrupts the process and can make it harder to fall asleep at night, Chabot said.
While some children may need naps until the age of 5 or 6, after that naps are not necessary for proper development, Chabot said, and may start to hinder child’s ability to fall asleep at night.
In addition to obstructive sleep apnea, other physical conditions as well as one’s emotional state may interfere with sleep, she said. Asthma, allergies, eczema, chronic pain, stress, anxiety and depression, all can contribute to wakeful nights. And, along with medications that treat ADHD, decongestants and antidepressants also can have an impact on the ability to sleep.
The third factor, circadian rhythm, also plays a significant role. The human body responds to internal cues, influenced by external factors such as light and temperature, that result in changes in blood pressure, body temperature and hormone levels that prepare the body for sleep.
Chabot said that the ideal sleeping environment is cool, dark and quiet.
Body temperatures naturally drop overnight while the body and mind restore themselves. If the bedroom is too hot, a person may have trouble falling and staying asleep.
Darkness aids sleep because melatonin, called the vampire hormone, responds to it by sending signals to the brain to get ready for sleep.
The light from electronic screens directly impedes melatonin production, Chabot said. Kids who play on their phones and computers or watch TV before bed aren’t getting the biological cue that it’s time for sleep, she said.
In addition, Chabot said, she has seen that first-person shooter video games create emotional arousal in some of her young patients, making falling asleep difficult. Social media can have a similar effect.
As a result, Chabot recommends that parents restrict screens before bedtime.
Chabot, along with other doctors who promote the benefits of good sleep, say that one way to help adolescents sleep better is to institute later school start times.
That issue has raised controversy on both a national and local level among school districts, doctors and parents trying to balance promoting healthy sleep schedules with adjusting transportation times, extracurricular activities and childcare needs.
With start times as early as 7:30 a.m., like at Smith Academy, Chabot said, it’s unrealistic to think that teens are getting enough sleep before coming to school every day.
“If students are waking up at 6:30 to get ready for school, and they go to bed at 10:30-11 each night, they’re losing 30 minutes to a full hour of sleep,” she said. This lack of sleep accumulates and contributes to an ever-growing sleep deficit, comparable to starvation or dehydration, she said.
Hatfield School Superintendent John Robert, who attended Chabot’s talk, said the lecture helped him to understand how a later start time would benefit students but he’s unable to make such a change on his own.
“(It) would take a lot of input from the students, parents, and administration of Smith Academy and would ultimately be up to the School Committee,” he said. “We would have to look into all the ramifications of such a change.”
Chabot, who has been a primary care physician for 30 years, says her focus on sleep arose from her interest in finding lifestyle solutions to reduce health risks. Though sleep habits are often hard to fix because they require daily attention and maintenance, she believes making the effort is rewarding and could result in avoiding medicinal alternatives.
“It’s more empowering to find a solution within yourself than to always rely on something outside of you to fix a problem,” she said.