Update on AAP Policy Statement – Insufficient Sleep & Recommendations for School Start Times for Adolescents

Insufficient sleep in teens has become a hot topic lately but for good reason- it’s a serious problem that has both medical and psychological implications as well as a potential impact on learning.

Adequate sleep has not received the medical credit it deserves. Many of us don’t view sleep importantly and in our busy worlds it can be marginalized. But the impact of a chronic lack of sleep, especially in teenagers, is becoming more clear and important. Teens need more, not less, sleep as their bodies (and minds) are rapidly changing and growing. We also know that teen’s “sleep cycles” are pushed back – biologically they are “wired to” stay up later although they still need to wake up ( or be woken up) earlier than their “biological clock” expects to wake up resulting in less restful/restorative sleep. Add to this the social and cultural constructs of homework, after school activities and jobs and, of course, omnipresent technology, and we’ve created a viscous cycle that is taking its toll.

The consequences of this are multiple. We now have evidence linking poor/insufficient sleep to a variety of long term medical conditions including obesity, heart and metabolic disorders and actual sleep disorders like obstructive apnea. The psychological issues related to inadequate sleep are equally as concerning. Consider yourself when you’re tired and sleepy. Emotionally we’re irritable and fussy. We tend to lack motivation and will avoid taking on more complicated tasks or will make less thoughtful or impulsive decisions or, even worse, will simply put off doing anything and will opt for “comfort” – eating, watching TV, etc.  This is all true for teens and more! Tiredness alters our decision making process- it makes us more vulnerable to making poor choices and increases risky behaviors. Teens, developmentally, are more susceptible to making risky, less thoughtful choices and tiredness only makes it worse.

Additionally, insufficient sleep directly impacts learning and school performance. Tired kids can’t concentrate, remember or retain information, interact or participate or perform as well on standardized testing.

Kids and teens admit and realize that they aren’t getting enough sleep: 2/3 of middle schoolers and over 3/4 of high schoolers say that they don’t get enough sleep.

This is neither a minor nor insignificant problem and culturally appears to be worsening and needs to be addressed as a medical concern/condition from both an individual and public health perspective in much the same way as we have addressed childhood (and adult) obesity over the last decade.  We understand that individual change is undermined if public health and community support for change are not simultaneously addressed. The issue of delaying start times for school is a perfect example of this.

The AAP supports shifting school start times back and recommends an 8:30 start time. Some communities have made this change with reported success in academic achievement. However, this is easier said than done with notable concerns regarding transportation/costs/after school activities, etc. all needing to be addressed by local communities.

The AAP encourages the medical community to:

1) Educate our families about the importance of sleep and make them aware of both the short and long term medical/psychological implications of insufficient sleep.

2) Encourage parents and families to establish a higher priority about bedtime and enforce technology “curfews”. Remember that going to bed and falling asleep are not the same thing and that limits on TV, video and cell phone usage are a parenting prerogative and guidelines/limits are an important parental responsibility.

3) Health care professionals and families need to advocate in the community for what is in their children’s and patient’s best interest. All the best teachers, technology and updated schools are undermined if our children are tired and not at their best to learn and perform.

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