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Do you know that feeling you have when you wake up refreshed? You went to sleep at a decent hour, you slept all night without waking, and now you are awake and feel ready to start the day. Did you feel that way when you woke up this morning? No, neither did I. That is the inspiration for this blog topic: The ever-elusive Good Night of Sleep. As adults we know there are a million things getting in the way of our sleep–work stress, family issues, anxiety about responsibilities, health concerns, etc. But, those are adult problems, right? Nothing for teenagers to worry about…right? Unfortunately, many adolescents are sleep-deprived. Problems sleeping is one of the top 3 complaints I hear from my students on a daily basis.

According to the Journal of Clinical Sleep Medicine, the official publication of the American Academy of Sleep Medicine, “teenagers 13-18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health.” Getting enough good quality sleep leads to better health and educational outcomes such as improved attention, behavior, learning, memory retention, emotional regulation, and mental and physical health. Insufficient sleep increases risk of accidental injuries, obesity, diabetes and depression. In teenagers it has also been associated with increased risk of suicidal thoughts and self-harm.

The CDC (Centers for Disease Control) estimates that 70 percent of high school students are not getting the recommended hours of sleep. Studies have estimated that 11 percent of adolescents have a history of insomnia and children with neurodevelopmental diagnoses such as ADHD have a particularly high risk for sleep disturbances (because of the nature of the disorder and the medications used to treat it).

Although sleep disturbances can turn into a chronic problem, many of them are transient in nature and can be the result of a stressful life event. When a transient sleep disturbance occurs, it is important to address it so that it does not become a chronic issue. The majority of sleep disturbances in adolescents are likely to have behavioral origins and can be successfully addressed with good sleep habits. Once these routines are established, they can benefit an adolescent for a lifetime. This is the time in their lives when their brains are maturing during sleep processes. When your teen experiences sleep disturbances it is important to commit to a consistent sleep plan.

Healthy Sleep Habits (as recommended by the National Sleep Foundation) include the following:
• Go to bed at the same time each night and rise at the same time each morning, even on weekends and during school breaks.
• Make sure your bedroom is quiet, dark and relaxing, neither too hot nor too cold.
• Make sure your bed is comfortable and use it only for sleeping, not other activities.
• Avoid large meals a few hours before bedtime.
• Exercise regularly.
• Avoid caffeine after noon.
• Avoid screen time several hours before bedtime.
• Use relaxation tools, such as meditation or progressive muscle relaxation.

At Oak Hill Academy we do several things to encourage a good night’s sleep for our boarding students. “Quiet Time” starts promptly at 8:30 each evening. During this time students are given an opportunity to be in a quiet, relaxed environment. This encourages their bodies to release melatonin, a natural hormone produced by the brain’s pineal gland that promotes the onset and duration of sleep. We also have a regular lights-out time of 10:30 pm, as well as a regular wake-up time. This keeps our students on a consistent schedule and promotes natural sleep/wake cycles. A few years ago we adjusted our start time for the school day to be 45 minutes later. This change was implemented in response to data and recommendations from several sleep researchers, including the American Thoracic Society. Organizations like the American Academy of Pediatrics, the CDC, and the American Medical Association support later school start times. Structuring the school day and associated activities to be compatible with the natural circadian rhythms of an adolescent’s brain helps achieve quality sleep, the benefits of which are far-reaching.

But what if you can’t sleep? It is hard to conquer the world if you don’t feel well-rested, right? Many people use over-the-counter melatonin or antihistamines to help fall asleep. But pharmacologic intervention should be considered only if a healthy sleep routine is committed to and followed consistently without improvement, or if there is another health issue interfering with sleep. One of the dangerous results of taking medication without professional guidance is that it could cause rebound insomnia when the medication is stopped, producing a chronic issue.

A change in behaviors surrounding sleep is often as effective as using over-the-counter medications–especially if the sleep disturbance is transient in nature. It is important to point out that no hypnotics or other medications have been approved for use by the FDA for sleep problems in people under the age of 16 years. If a sleep medication is prescribed at this age, it should be done with careful monitoring and consideration of benefits versus risk.

We are so close to the end of the school year, when students leave us for the summer. While students are at home, they sometimes do not adhere to a normal schedule and this can throw off their natural patterns of sleep and wakefulness. When they return to school in the fall, they might have difficulty being able to sleep for the first few weeks. Encouraging your teen to stick to a normal sleep schedule during school breaks can go a long way to help prevent this from occurring.

When you lie down, you will not be afraid. When you rest, your sleep will be peaceful.
Proverbs 3:24

Now, go forth and conquer the world – but first, sleep!
Betsy Anderson, RN BSN
Oak Hill Academy Nurse