Colman Noctor: Lack of sleep is damaging teenagers' mental health
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I dread discussing the need for sleep with teenagers in therapy. The mention of the word nearly always triggers a glazed-over expression and withdrawal.
Most teenagers have heard it all before and can rattle off the standard advice of ‘no screens or caffeinated drinks late at night’ and ‘get plenty of exercise during the day’. But adhering to the advice is another story.
Knowledge is not an automatic precursor to change. Most of us know what is good for us and what is not, but we don't live our lives conforming to factual information. This is especially true when it comes to sleep.
According to extensive research carried out last year by Planet Youth, 56% of teenagers in the west of Ireland are sleep-deprived. The study also showed a strong correlation between lack of sleep and poorer mental health outcomes. The 44% of teenagers who reported getting sufficient sleep were observed to be doing far better in areas of resilience, self-esteem, and school engagement.
In the Planet Youth survey of 4,500 young people, 83% of teenagers said they kept their phones in their bedrooms at night, which they acknowledged was the most significant barrier to sleep.
Other nationwide studies have also reported on insufficient sleep. In 2022, the Growing Up in Ireland survey found that almost one in 10 teens reported seven or fewer hours of sleep per night, and about a third (30%) acknowledged they have trouble sleeping. Furthermore, the vast majority (82%) of participants reported regularly messaging friends before bed or surfing the internet (83%).
In its 2019 report, the US-based Youth Risk Behaviour Surveillance System (YRBSS) found that 73% of students reported not getting enough sleep on school nights, with most getting far less than the recommended minimum of eight hours.
My son is almost 14 and leaves his phone downstairs at night. Sometimes, when I am up late, I hear it buzzing incessantly. In a time before smartphones, I can remember if the landline rang after 9pm, it was automatically assumed that something serious had happened. However, glancing at my son’s late-night messages would suggest no such drama. The messages are usually banal pictures — a wall with no caption, for example, to keep a Snapchat streak going.
If this is the norm, it is no surprise that teenagers do not get anywhere near the National Sleep Foundation's recommended eight to ten hours of sleep per night. We must find an engaging way to communicate the importance of sleep that instigates meaningful change in their sleep habits.
A generic conversation about the fundamental role sleep plays in their physical and mental health is not enough. The evidence is clear, continued poor sleep will have serious ramifications for our teenagers' physical and mental health, so we must seriously think about how we can change their damaging behaviour.
Parents play an important role in teenagers' sleep patterns, and insisting on no phones in their bedrooms would be an important first step. While there’s no shortage of advice for parents to coach babies or toddlers into a better sleep routine, advice on ways to manage sleep in teenagers is minimal.
Parents often believe they cannot insist on phones being left outside the bedroom at bedtime, especially with older teens, but perhaps this is necessary. For example, if your teenager claims they need their phone for a morning alarm, this is not a viable excuse — a standard alarm clock can be purchased relatively cheaply. While rules and boundaries can work, in my experience, a far more effective longer-term strategy is ‘buy-in’.
Traditionally, teenagers see adults as out-of-touch and perceive us to know nothing about anything, so trying to impart some of our life experience-informed wisdom rarely works. The advice from a parent or an adult automatically lessens its potential impact. The combination of faux confidence and limited competence is part of the adolescent condition. So, to get ‘buy-in’, you have to make it relevant to their lives.
I have explained to ambitious and sporty teenagers that adequate sleep releases growth hormones essential for bone growth and muscle repair, thereby giving them the potential to improve their sporting performance. I have also explained how sleep deprivation can impair their judgment, reaction time, and coordination, thereby increasing their risk of injuries.
In the case of a conscientious teenager eager to perform well in a pending state exam, I explain how sleep is vital for cognitive functions such as memory consolidation, learning, problem-solving, and decision-making, so it is as important an investment as studying. During sleep, the brain processes and consolidates the information it obtains during waking hours, optimising its cognitive performance.
Adequate sleep is also essential for regulating the body's stress response, so I tell young clients that sleep deprivation increases levels of stress hormones, such as cortisol, which can negatively impact mood and increase vulnerability to stress-related symptoms like migraine or tummy aches.
In the case of an anxious teenager who is struggling with panic attacks, I explain that sufficient sleep is essential for emotional regulation, and so getting enough sleep will better equip them to manage stress, regulate their emotions, and lessen the frequency and severity of their panic episodes.
With teenagers invested in their physical appearance, they need to be aware of the role sufficient sleep plays in reducing the risk of obesity by regulating hormones related to appetite and metabolism and how it can significantly improve the quality of their skin, much more so than expensive creams.
While I acknowledge that I am in a unique position as their therapist and parents may be ignored even if they attempt to address the buy-in reasons for sleep, I believe it is worth presenting 'the facts' to them. If teenagers hear similar messages about the importance of sleep from home, school, and sports organisations, there is a greater chance that the information will land and encourage them to respond positively.
Given the continuous rise in adolescent mental health problems and the exorbitant waiting times to access services, it is crucial as a wider society that we address the adolescent sleep issue. With the mounting evidence connecting sleep deprivation to mental health problems, we need to prioritise strategies such as maintaining a consistent sleep schedule, creating a conducive sleep environment, and removing smartphones from bedrooms.
Heather Turgeon and Julie Wright, authors of , state no group has ever slept as little as 21st-century teens. The data suggests that many young teenagers are living in a state of severe and chronic sleep debt, and studies linking sleep loss and poor mental health are widespread. The 2015 YRBS study in the USA found that sleeping five hours a night made them almost twice as likely to consider self-harm.
It’s also crucial to examine how teenagers’ activity schedules, such as homework and evening extracurricular activities like late-night sports training, are counterproductive to conducive sleep environments.
Prioritising adequate and quality sleep is essential for promoting optimal mental health and well-being during adolescence. It is crucial and needs to be taken seriously. I visit many schools and talk to teachers who regularly tell me that pupils are falling asleep in class.
In a world of 24/7 entertainment, most of us are guilty of staying up for an extra hour to watch the next episode of a Netflix series or going to bed with the intention of getting an ‘early night’ only to find ourselves scrolling on social media two hours later. Parents also need to invest in their sleep and role model this to their children.
Instead of telling teenagers they need eight to ten hours’ sleep, we must pitch sleep as a viable and wise lifestyle choice. Many of my reticent clients agree to improve their sleep in the short term. They must first experience the benefits before committing to a regular sleep routine. They need proof before taking on a long-term lifestyle choice.
A good night’s sleep won’t solve their mental health problems, but it will help.
- Dr Colman Noctor is a child psychotherapist