The Impact of Technology Use on Sleep Health for Adolescents

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness.

Caitlin White (Host): Remember how early you used to have to wake up to get to grade school on time? Ugh, not fun. Children and teens typically do not get enough healthy sleep because of their overloaded schedules and now the use of electronic devices. For some children and teens, sleep can be a natural challenge despite how early they try to get to bed. Lack of healthy sleep can disrupt the body's overall wellbeing, which is why it's important to educate children, teens and their families about the importance of healthy sleep. Joining me to discuss this is Dr. Gary Feldman, Medical Director at the Stramski Children's Developmental Center. So Dr. Feldman, what sleep challenges are children and teens faced with?

Gary Feldman, MD: So, I think you can break these challenges up into sleep schedules, okay, because children and teenagers are not immune to having bad sleep schedules. You know, being a child and a teenager you may want to think that you can have your own sleep schedule, but it really often it has to be mandated or monitored by a parent. And, you know, in our modern lifestyle, you know, if you have two parents that are working or a single parent that's working, and it's, you know, is at work all day, child's in an after-school program or may have sports or something and they get home and it's rush, rush, rush, and you've got all sorts of things to do, it's sometimes very difficult to maintain a schedule. And kids may be left to their own devices, and that can result in some of them actually going to bed a bit late, or they just develop bad habits where they're, you know, playing Fortnite or doing video games. And, you know, they don't want to stop and the parents are busy answering emails, etcetera, etcetera, and people's lives are just too busy to to monitor and make sure that things are done in a, you know, things are done in a regular way and schedules adhere to. I think it boils down to from a parent's perspective of being diligent and making sure that things are, things are predictable. Predictability is really helpful for both children and for teenagers.

Caitlin White (Host): It sounds like sleep is kind of hard for everyone to attain in a family. What are some good sleep habits that adolescents and their families can build on together?

Gary Feldman, MD: You know, again, having good sleep, what we call sleep hygiene, it just means good habit, so you've got a good schedule, you've got a predictable routine. Predictability is helpful, like, so get ready for bed, so go shower, go, you know, finish your homework, pack your stuff for school, get everything ready, turn off electronic media about an hour before bedtime, all those things, what I would call front loading, so that a lot of things is you can play on the iPad, sure, because I mean nowadays to prevent a child from being on electronic media is, you know, it's worse than being in prison for life. So it's not that you want to take it, you know, you say well you can't do this anymore, but it's you can do it, but this is when you can do it, and this is for how long you can be on electronic media. So it's really just front loading and saying fine, okay so, you know, bedtime is coming up in an hour, you've got 30 minutes to be on your iPad, and then after this time we're done, you need to put it away. So just getting everything nice and tidy in advance goes a long way to helping, you know, good sleep habits. The other thing that also with, you know, being exposed to electronic media is, you know, besides the fact that it's mentally very stimulating, and I don't know, like, if you're watching a thriller movie just before you go to bed, I don't know how easy it is for you to fall asleep, but it's hard for me. So for these kids when they're, you know, playing something that's really exciting and there's some video game and they're online with someone else and they're competing, you know, their mind, they're very, very amped up, and then, you know, to go to bed straight after that, they're just going to have difficulty sleeping. The other thing is that, you know, being exposed to the screen emits different frequencies of light and particularly the blue frequency of light inhibits your brain from producing melatonin, which is a very important sleep hormone. When your melatonin level should be going up that, you know, help regulate your sleep pattern and help with sleep onset, that's being suppressed because you've been exposed to screen time. And then that makes it more difficult for you to go to sleep.

Caitlin White (Host): So what are some signs and symptoms that children and teens may be dealing with a sleep disorder?

Gary Feldman, MD: Well I mean the most obvious would be, hey, they're having difficulty falling asleep. So they'd be complaining I can't sleep. And particularly for teenagers, I mean it's gets pretty complicated because teenagers, the incidence of anxiety is much higher in teenagers generally speaking, and so if they, especially if they're performance, and at school, they're, you know, they're competitive, academically competitive or there's some drive for them to want to get to school and want to be at school early, and particularly for, you know, in high school if you have zero period, you know, I've got to get to sleep, I've got to get to sleep, I've got to be at, you know, got to get up at 5:30 tomorrow morning. If they are anxious about that and they've been on screens and been on social media and have had, you know, had to deal with with cyberbullying or someone said something mean to them on Instagram or Snapchat, you know, then they're dealing with that as they're going to sleep and then they might, they start to get anxious and then the anxiety sort of further prohibits them from being able to fall asleep. In addition to that, for teenagers in particular, their natural physiology is such that whereas say a middle schooler would be tired and really tired by 10 o'clock or 10:30, a teenager may not physiologically be tired until later, because their whole body clock goes through sort of a migration to a sort of a later later stage, and they only naturally they sleep build up, what we call sleep pressure, as we go through our day and as the night approaches we get more and more sleepy until the point where we get, you know, it's very difficult to resist sleep because our sleep pressure is so high. Now the rate of climb of sleep pressure in teenagers is actually slower. So their sleep pressure only peaks at a much later time. So you've got a teenager, or even a parent that says you need to go to bed at 10 o'clock because, you know, you've got a zero period you got to get up at 5:30, you must go to sleep. So the teenager, besides all the stuff that they've been doing to stimulate their mind with social media, etcetera, now they get into bed, so their mind's buzzing like crazy, but then also physiologically, their body's not ready to go to sleep until 11:30, 12 o'clock. So now they can't sleep, I can't sleep, I can't sleep, and now they start to get anxious and then they get into this thing what I call sleep hunting, where you start hunting for sleep. And somebody once said sleep is like a dove. If you gently reach out your hand it will alight, but if you reach out to grab it, it’ll fly away. So the very act of trying to fall asleep makes sleep more difficult to attain because you're activating your mind and trying to hunt for sleep. So hunting for sleep is a fruitless exercise. Sleep has to come to you. And I usually tell my patients that think about sleep as being a character that's very shy, and if you give it attention, it shies away. So if you don't give it attention, it'll come to you when it's ready. So the idea is to take your mind off “I must sleep”. So it's important to, you know, to have a kind of a good sleep schedule, prevent these your teenagers from being exposed to all these things that stimulate them, but also, at least for teenagers, having some allowance to understand allowance for them to actually go to sleep a little later, which is a little counter-intuitive but also is beneficial because if they go to bed too early and their body's not ready to sleep, you can induce a secondary sleep problem which we, you know, could be anxiety or even something which we call psychophysiological insomnia. And then that just perpetuates itself. The challenge though with teenagers, you know, because okay fine so teenagers may be only ready to go to sleep at 11:30, maybe sometimes as late as midnight, okay, but they need about nine hours of sleep. Teenagers actually need a little bit more sleep than a middle schooler. So if you head to midnight, that means school really needs to start at 9 o'clock, right, because if you gotta get up at 5:00 for zero period, you're gonna be chronically sleep-deprived. Right? And the average senior is getting about 6 1/2 hours of sleep. That's why there's such a push, like the state of Minnesota, you know, when they school, high school start times are, I think 9 o'clock or 9:30, and that's how it should be because that fits in perfectly with what the teenagers physiology is, where they, they go to sleep late not because they necessarily being oppositional or willful, but just because that's what their physiology is and they need to sleep in to get their nine hours of sleep.

Caitlin White (Host): Gosh, I remember waking up for school like that and it always seemed impossible.

Gary Feldman, MD: The thing is that it's really very difficult because I mean, our lives are just not, our lives are just not compatible. Our society, the way our society operates is just not compatible for the life of a teenager who goes to school. And it's not to make excuses for them because teenagers of course can be irresponsible, you know, and they can be playing Fortnite until 3:00 or 4:00 AM, that's irresponsible, and that's where parents have to say cut it out.

Caitlin White (Host): Well that leads me into my next question: why is it important for parents to be aware of their child's sleep habits? I guess for, you know, to make sure they're not staying up all night, but maybe to kind of be more understanding also of that wiggle room.

Gary Feldman, MD: Well, parents need to be aware of child sleep habits to make sure that they're not playing hooky so to speak, and they're not shirking their responsibility. I mean I’ve had patients, middle schoolers who come in because they're excessively sleepy and long story short it sounds like they're getting enough hours of sleep and then eventually when you give them a wearable, like a Fitbit or some other kind of monitor to monitor their sleep hours, you discover that these kids are waiting for the parents to fall asleep, turn off their lights, waiting for their parents to fall asleep and then they pull out their electronic media or they read or they’re playing video games until late. So parents really have to be vigilant about kids, and make sure that if a child cannot be responsible, then they have to take drastic steps to make sure that at bedtime it's bedtime, there's no access to any kind of entertainment whatsoever, whether it's television, whether it's tablets, video gaming, whatever the case is. But I think also it's important for parents to understand that for teenagers there is this natural shift for their body to only want to go to sleep later, and so to kind of, within reason, make some kinds of allowances. Now, that’s very difficult, because if school times remain early, what are you supposed to do? But, at the same time, if you make your teenager go to sleep at 9:30 because they have to be up at 5:30, that teenager is unlikely to fall asleep until 11. So then they’re going to be lying awake, and that’s going to cause secondary problems.

Caitlin White (Host): Why is healthy sleep so important for these specific age groups?

Gary Feldman, MD: I think healthy sleep is specifically important for every age group, for all of us. You know, sleep is vital for our functioning in the day, and you know, sleep is important because it helps us package our memories. You know, like when you imagine you're getting on a trip and you're packing a suitcase, there's two ways to pack a suitcase. You can just take your clothes and just throw them in a suitcase and just squish it down, or you can, like, you know, fold the items and put all your shirts on one side and this on that side. When you get to the other side and you're looking for a particular item of clothing in the suitcase that you just threw everything in, you don't have to throw everything out in order to find what you're looking for and then it will take you some time. But if you packed your suitcase nicely, you will know that in the top corner, obviously are all your shirts and the third shirt from the top was the yellow one that you're looking for you'd be able to go to it straight away and then that's the analogy. For sleep, sleep helps package memories to make it easily retrievable. Sleep is also really important for helping you in terms of your executive functioning. You know how you function in the day? How you organize, how do you plan, how do you regulate your emotions. How well do you concentrate? We have to socialize appropriately and all those things can be compromised with lack of sleep.

Caitlin White (Host): I know I've been having some trouble just the last couple days. You know, of course, with daylight savings time. What are some ways that parents can help their children adjust to things like that?

Gary Feldman, MD: Yeah, so like for daylight saving time. You know we lose an hour. So essentially the simplest way to do it is just about a week before is get your child up an hour earlier so that they're slightly sleep deprived. Now yeah, it's easy to say we know they've got school, so maybe we can just reduce it to just a few days before school starts or maybe the Saturday, or maybe the Friday. But essentially, if you can just get them to wake up earlier, they'll be a little bit sleep deprived so that the next night they should go to sleep a little earlier and then that should help them anticipate you know have their bodies kind of adjust. Ideally, we would want a whole week to be able to do this, but it's not always possible. It would be nice, you know when we have daylight saving for us to have a long weekend. It would be great, starting maybe like on a Wednesday would be awesome, that would really help.

Caitlin White (Host): I like the way you think. And where can people go to learn more about sleep health for adolescents at Miller Children's and Women's?

Gary Feldman, MD: Anyone interested in more information for their child, they can go to millerchildrens.org/sleep or they can call 562-728-5245.

Caitlin White (Host): Well, thank you so much, Dr. Feldman. It's always great to talk about some ways we can get some more sleep in. And like Dr. Feldman said, you can find out more information on millerchildrens.org/sleep or call 562-728-5245. I'm Caitlin White, thanks for tuning in.