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Clinical & ResearchFull Access

Studies Highlight Impact of Sleep on Mental Health of Youth

Published Online:https://doi.org/10.1176/appi.pn.2019.9b24

Abstract

Early findings from the Adolescent Brain Cognitive Development study suggest children who have trouble sleeping have more symptoms of depression and more behavior problems than children who sleep well.

Identifying and treating sleep disturbances and encouraging healthy sleep habits among children and adolescents may boost their long-term mental health, according to data from two longitudinal sleep studies presented at the annual meeting of the American Academy of Sleep Medicine and Sleep Research Society.

Photo: School bus
iStock/bmcent1

Early findings from the Adolescent Brain Cognitive Development (ABCD) study suggest children who have trouble sleeping have more symptoms of depression and more behavior problems than children who sleep well. The ABCD study, which is tracking nearly 11,900 9- and 10-year-olds through adolescence and early adulthood, is the largest long-term study of brain development and child health in the United States (Psychiatric News).

As part of the study, the children undergo annual, in-person exams and interviews, where they provide saliva, blood, hair, and other biosamples and answer questions about their sleep on an iPad, explained Aimée Goldstone, Ph.D., a research scientist at the Center for Health Sciences at SRI International in Menlo Park, Calif., and a member of the ABCD sleep study team. Parents also use an iPad to answer questions about their children’s sleep and behavior. Starting in year three of the study, the children will wear a Fitbit for 10 days or longer at least every other year to provide objective measures of their sleep and activity.

Sleep Problems Linked to MH Concerns

The American Academy of Sleep Medicine recommends children aged 6 to 12 years sleep nine to 12 hours. At enrollment in the ABCD study, nearly 90% of the children slept at least eight hours on most nights, with nearly half getting between nine and 11 hours of sleep.

About 11% of the children had trouble falling or staying asleep, 4% were excessively sleepy in the daytime, and 10% had multiple sleep problems, according to parents’ reports. The greater the sleep disturbance, the more likely the children had symptoms of depression, acted out, or displayed physical aggression or other problem behaviors. Sleep disturbance at baseline proved a better predictor of mental health concerns one year later than total sleep time, Goldstone told Psychiatric News.

Students Sleep Longer, Feel More Alert When School Starts Later

After middle and high schools in a Denver suburb delayed their start times by 50 and 70 minutes, respectively, in fall 2017, middle school students (grades 6 to 8) slept 31 minutes longer, and high school students (grades 9 to 11) slept 48 minutes longer on average on school nights.

Lisa Meltzer, Ph.D., an associate professor of pediatrics at National Jewish Health in Denver, and colleagues surveyed students at 11 middle schools and six high schools to determine how delayed start times affected sleep; academic engagement; homework; and participation in afterschool sports, extracurricular activities, and employment. All students in grades 6 to 11 completed online surveys in school before the start-time change in spring 2017 (n=15,700) and after the change in spring 2018 (n=18,607).

Before the change, only 27% of area high school students slept at least eight hours on school nights—a rate consistent with that of high school students nationwide. After the change, the percentage rose dramatically: 61% slept eight hours or longer. Among middle schoolers, only 38% slept at least eight hours on school nights before the change, while 59% did so afterward.

High school students’ reports of feeling worried fell by 8.9%; nervous, 6.1%; and sad, 4.6%. Middle school students’ reports of feeling worried fell by 2.6%; nervous, 1.6%, and sad, 0.4%.

Fewer students in all grades said they felt too sleepy to do homework. More felt prepared for and engaged with first-period class work. The impact on afterschool activities was minimal.

Follow-up data from 4,951 children so far suggests depression symptoms at baseline often persist one year later, Goldstone said. “The power of this study is its longitudinal nature,” she noted. “Being able to identify modifiable problems, such as sleep disturbances, is exciting to us. We may be able to intervene early to limit the progression of depressive symptoms and prevent the onset of a depressive disorder in adolescence.”

Sleep Loss Undermines Mood

A separate study presented at the meeting points to the challenges that can arise when adolescents don’t get enough sleep. Data from the ongoing Fragile Families and Child Well-being Study (FFCWS) suggests that insufficient sleep makes adolescents more sleepy, angrier, and lonelier the next day.

FFCWS is following a cohort of nearly 5,000 children born between 1998 and 2000 in 20 large U.S. cities. To date, researchers have assessed the children at birth and at ages 1, 3, 5, 9, and 15 years. Parents or caregivers also were interviewed at the same times.

Orfeu Buxton, Ph.D., a professor in the Department of Biobehavioral Health at Pennsylvania State University, and colleagues explored daily variations in sleep and mood for one week in a randomly selected sample of 1,000 children aged 15. They also examined data from the group as a whole.

The 15-year-olds wore a device on their wrist around the clock for seven days and nights to capture data on sleep, activity, and light exposure. The teens also described their previous night’s sleep and the current day’s activities, diet, social interactions, and moods in an electronic diary. The study team analyzed datasets comprising three or more days from 557 teenagers.

After nights with less than their usual amount of sleep—an amount that varied from person to person—teenagers rated themselves as angrier and lonelier the next day. Teenagers who slept longer and more soundly than they usually did felt happier the next day. They also felt happier and less angry on weekends, when they typically slept longer than on schooldays.

Being able to examine data from individual teenagers across a week is among this study’s major analytic strengths, Buxton told Psychiatric News.

Most adolescents need 8 to 10 hours of sleep a night to feel well and perform well, said Buxton. Teenagers who sleep less than seven hours on average experience more emotional problems than those who sleep longer. They have increased levels of stress, anger, and anxiety.

Correcting problem sleep in adolescents may improve mood, he said. One way to increase sleep time might be to delay school starts (see box above). In a 2017 study of 413 teens in the FFCWS study, Buxton and colleagues found that the only students who managed to sleep at least eight hours on school nights were those whose classes started at 8:30 a.m. or later.

Doctors might consider contextual factors that limit sleep, like early school start times, Buxton said, in their consideration of patients with mood dysregulation. ■

More information about the ABCD study is posted here. More information about FFCWS is posted here. “High School Start Times After 8:30 AM Are Associated With Later Wake Times and Longer Time in Bed Among Teens in a National Urban Cohort Study” is posted here.