The Consequences of Insufficient Sleep for Adolescents: Links Between Sleep and Emotional Regulation.

Any review of adolescent lifestyles in our society will reveal more than a dozen forces converging to push the sleep/arousal balance away from sleep and toward ever-higher arousal. What harm could there be in trying to push back a little toward valuing sleep? The potential benefits, according to Dr. Dahl, seem enormous. ADOLESCENTS often "get by" with relatively little sleep, but it may be far less than they need. The observations of many parents, educators, and clinicians are in close agreement with a wealth of scientific data about the growing frequency of this worrisome pattern of behavior. As discussed in other articles in this special section, there has been recent progress in understanding many of the factors that contribute to adolescent sleep loss, including the role of early school starting times and the role of various biological and social influences on adolescents' self-selected bedtimes. The increasing evidence that teenagers seem to be getting less sleep leads inevitably to the pragmatic question "How much sleep do adolescents really need? " Unfortunately, the medical/scientific answer to this question seems tautological. Sufficient sleep is defined as "the amount necessary to permit optimal daytime functioning. " As impractical as that answer may appear, there are two important reasons for such a definition. First, sleep requirements can be remarkably different across individuals. Second, at a physiological level, sleep and waking states are closely intertwined aspects of a larger system of arousal regulation. (Sleep researchers often use the Chinese symbol of yin/yang to designate the interrelationship of sleep/wake states.) At the center of this discussion is a critical and pragmatic point: any evaluation of the sleep habits of adolescents must include a careful consideration of the waking consequences of sleep loss. The question becomes, in essence, "What are the daytime signs of diminished functioning that indicate insufficient sleep? " While there is a shortage of well-controlled research studies that seek to answer this question, this article focuses on the convergence of evidence suggesting that changes in mood and motivation are among the most important effects of sleep loss. Thus an important place to begin looking for evidence of insufficient sleep among adolescents is in the area of emotional or behavioral difficulties. There is no shortage of epidemiological and clinical studies documenting recent increases in the rates of many psychiatric disorders among adolescents. Certainly many complex factors are likely to have contributed to the emotional and behavioral problems of teenagers, but the possible link to adolescent sleep patterns bears some scrutiny. There is clear evidence that sleep loss can lead to the development or exacerbation of behavioral and emotional problems.1 The key question is "How great is the contribution of sleep deprivation to these problems? " The magnitude of this link remains an open question that can only be answered through careful empirical research. In the meantime, these issues have enormous ramifications for the fields of medicine and education with regard both to the physical and mental health of adolescents and to detriments to effective learning and social development. Many policy decisions will be influenced by our understanding and interpretation of the importance of sleep in these areas. In this article I provide an overview of current scientific and clinical information regarding the consequences of insufficient sleep in adolescents. I pay particular attention to links between sleep and emotional regulation. The following is a brief outline of the main points to be presented: 1. Sleepiness. This is the most direct consequence of adolescent sleep loss, and it manifests itself most significantly in difficulty getting up on time for school and in falling asleep in school. …