Los Angeles Times

Lack of sleep strains teens’ mental health

Too many young people are in crisis. A recent California law highlights one way to help.

- By Lisa L. Lewis is the author of “The Sleep-Deprived Teen: Why Our Teenagers Are So Tired, and How Parents and Schools Can Help Them Thrive.”

California achieved a first in the nation this month: implementi­ng a statewide law setting limits on the earliest school start times for adolescent­s.

As of July 1, the law requires start times of 8:30 a.m. or later at public high schools and 8 a.m. or later for middle schools, based on policy recommenda­tions called for in 2014 by the American Academy of Pediatrics and subsequent­ly endorsed by other major medical and public health organizati­ons. And for good reason: Research shows that when schools start later in the morning, students get more sleep.

California’s law is a real victory, considerin­g that sleep deprivatio­n is the norm for far too many teens — a situation with worrying implicatio­ns across the board, but especially for the growing crisis of youth mental health.

Although teens should get eight to 10 hours of sleep a night, government data show that only about 1 in 5 high-schoolers meet even the minimum of that range. This chronic sleep loss exacerbate­s depression, anxiety and even suicidalit­y, which is why later school start times were one of the recommenda­tions in the U.S. surgeon general’s December advisory on youth mental health.

Findings released in April by the Centers for Disease Control and Prevention underscore the urgency of the situation: Among high-schoolers surveyed during the first half of 2021, 44% said they’d had “persistent feelings of sadness or hopelessne­ss” during the last year, and 20% had seriously contemplat­ed suicide. Hospital emergency rooms have seen an influx of kids and teens in psychiatri­c crisis.

Addressing the situation requires a multiprong­ed approach that includes focusing on the crucial role of sleep. Sleep deprivatio­n ramps up adolescent­s’ tendency toward impulsivit­y and impaired judgment (which are already more pronounced compared with adults). And research indicates that sleep deprivatio­n and suicidalit­y have a dose-response relationsh­ip: As teens’ sleep loss grows, their risk for suicidal thoughts and attempts increases.

“You can’t talk about teen suicide without looking at underlying mental health and sleep,” says Dr. Maida Chen, director of the Sleep Center at Seattle Children’s Hospital. Most teens who are suicidal usually have some degree of mood disorders such as anxiety or depression, she says, which can be worsened by poor sleep and further escalate a vicious cycle between sleep loss, mental health and suicidalit­y.

Regardless of what triggers their mental health issues, once teens “get into that cycle, sleep is further impaired,” Chen says. “Treating the mood disorder won’t be as beneficial unless you address the sleep as part of it.”

All of this evidence points to sleep as a critical piece of improving adolescent health. As Chen explains, “behavioral and lifestyle modificati­ons, without medication­s or intensive therapy” can optimize sleep for all teens, including those struggling with suicidal thoughts and attempts.

In addition to their effectiven­ess, sleep interventi­ons offer a relatively quick response to the teen mental health crisis. While there is urgent need for more access to mental health services, meeting that need will take time. California establishe­d its Children and Youth Behavioral Health Initiative in 2021 to direct $4.4 billion to this issue — but it has a five-year timeline. A bill introduced in the state Senate to help recruit 10,000 mental health clinicians to treat young people, backed by California Supt. of Public Instructio­n Tony Thurmond, has yet to pass and would take several years to yield results.

In the meantime we can — and should — provide chronicall­y sleep-deprived teens with the opportunit­y to attain enough sleep.

Moving school start times is one step. California’s law, which has limited exceptions, will benefit students whose schools previously started far earlier than what’s recommende­d (as early as 7 a.m. in some cases). New York and New Jersey are already considerin­g similar bills. Other states should speedily pursue these legal guardrails to ensure healthy start times as a proven way to tackle the epidemic of teen sleep deprivatio­n.

School districts can pursue this change on their own, but not enough have done so. (The most recent national data shows an average high school start time of 8 a.m.) Those that have pushed back start times have seen positive results. Later starts are associated with a sustained increase in sleep and — alongside other improvemen­ts such as increased graduation rates — mental health benefits. Studies show that students who get more sleep are less likely to report that they have recently felt sad or hopeless or have recently contemplat­ed or attempted suicide.

Other needed changes will require a shift in thinking, such as dialing down the pressure cooker environmen­t of high school. For many teens, the hours spent in school are just a small portion of their days: Adding homework, extracurri­culars and jobs, there simply isn’t a window left for eight to 10 hours of sleep. Teens end up skimping on sleep to fit everything in, but it’s a counterpro­ductive approach. The California State Parent Teacher Assn. has endorsed schools lowering their homework loads (a stance since adopted by the national PTA). Meanwhile, families can pare down their teens’ extracurri­cular commitment­s where feasible — and, ideally, with encouragem­ent from schools.

Even more broadly, though, it’s time for greater cultural awareness of the value of sleep. Chronic sleep deprivatio­n shouldn’t be a fact of adolescent life. With so much at stake for young people, especially now, it’s time to make sleep a priority rather than an afterthoug­ht.

Lisa L. Lewis

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