When thinking about the factors that contribute to teenage drinking and drug use, sleep may not make many parents' lists. But it should. New research investigating the relationship between sleep and substance use among adolescents has found that sleep troubles in teens can predict several problems related to drinking and drug use, including binge drinking and driving while under the influence.
Scientists at Idaho State University investigated the relationship between sleep and substance problems among a group of 6,504 teenagers, using both interviews and questionnaires. Researchers collected data in a series of waves over several years. To determine whether sleep problems might predict alcohol and drug problems, researchers analyzed sleep data collected from earlier waves in relation to substance abuse data in later waves. They determined that among teens, sleep issues are a significant predictor of several alcohol-and-drug-related problems, including:
• Alcohol-related interpersonal problems
• Binge drinking
• Getting drunk or high
• Driving under the influence
• Using illicit drugs
• Being involved in sexual situations they later regretted
The problems with sleep that predicted substance issues included difficulty falling asleep and staying asleep, as well as insufficient time spent sleeping.
This isn't the first evidence we've seen that sleep can influence the risk for substance abuse and related behaviors in adolescents. Studies have shown that poor sleep is strongly linked to a number of risky and unhealthful behaviors in teens, many of which are related to drug and alcohol use. Research has shown sleep problems in teens associated with greater likelihood of illicit drug use, cigarette smoking, and alcohol use, as well as binge drinking, driving under the influence, and experiencing blackouts from alcohol consumption.
The relationship between sleep and substance issues in teenagers is complex, and influence can run in both directions. Sleep problems increase the likelihood of substance use and abuse. In turn, use of drugs and alcohol can negatively affect sleep, diminishing sleep quality and quantity, as well as undermining the consistency of a sleep routine. What's more, the influence of sleep over substance use may be set in motion at an early age, before the teenage years even arrive. One study (conducted by some of the same researchers as the current study) found that sleep problems in children ages 3-8 predict alcohol, cigarette, and marijuana use in adolescence.
Sleep problems among teens, unfortunately, are nothing new. But according to new research, sleep among teenagers in the U.S. has grown worse over the past two decades. Researchers at Columbia University examined sleep trends among adolescents from 1991 to 2012. They used data from a nationally representative survey, which included more than 272,000 teenagers. According to their findings, teenagers today are sleeping less than teens in the 1990s, and there's been a consistent decrease in sleep over those roughly 20 years. In 1991, 72 percent of 15-year-olds surveyed regularly slept at least seven or more hours a night. In 2012, only 63 percent of 15-year-olds were sleeping for at least seven hours nightly on a regular basis. Certain demographic groups were more likely to sleep less than seven hours a night: girls, teens of racial or ethnic minorities, and teens from lower socioeconomic households.
The study also found that sleep among teenagers decreases significantly as they age through adolescence. At age 13, well more than half of teens in 2012 were sleeping seven hours a night or more. By age 18, roughly one third of teenagers were sleeping that much.
Sleep problems can set teens up for increased risk of substance use and abuse and the dangerous behaviors associated with alcohol and drugs. Poor and insufficient sleep also makes teens more likely to experience other health problems, including cardiovascular disease, obesity, and diabetes. Inadequate sleep can compromise teens' attention and focus and is linked to lowered academic performance. Teens with sleep problems are more likely to experience depression and anxiety, as well as other mood disorders and emotional or behavioral problems.
Despite their seemingly boundless energy -- and propensity to stay up late at night -- adolescents need more sleep than adults. The National Sleep Foundation recently updated its recommendations for sleep amounts, and advise that teenagers ages 13-17 should sleep between 8-10 hours a night. There's a lot working against teenagers when it comes to getting this much sleep on a regular basis. Teens are biologically predisposed to stay up later at night and sleep later in the morning. This shift in teens' sleep-wake cycle, which is a normal part of development, can make a 9 or 10 p.m. bedtime difficult. Add to this busy schedules, academic pressures, the proliferation of digital technology, and school schedules that start early in the morning, and it's not difficult to see how so many teens are so routinely short on sleep.
What can parents do? Make sleep a priority in the household -- for everyone. The elements that make up a strong and healthy sleep routine for teenagers are the same fundamentals of sleep hygiene that are important at any age, including:
Stick to a sleep schedule. A consistent sleep routine, with regular sleep and wake times, is the cornerstone of a healthy sleep regimen. For teens, this means a regular bedtime during the week -- and not sleeping too late on the weekends. An hour or so of extra sleep-in time on Saturday and Sunday is fine, but no more.
Limit caffeine. Don't let teens overdo with caffeine consumption, and have them avoid caffeine altogether after 2 p.m. Teens are already predisposed to stay up late -- they don't need any additional stimulation interfering with their rest.
Keep electronics out of the bedroom. Digital devices are everywhere, but they have no place in the bedroom. Their light -- and the stimulation they provide -- will interfere with teens' sleep. TV, phones, tablets and computers should all be powered down at night, ideally an hour before bedtime. There's also reason to limit overall exposure to screen time: new research suggests that the more time teens spend engaged with digital media during the day -- not just in the evenings -- the less they will sleep at night.
Encourage daily exercise. Regular physical activity delivers powerful benefits to sleep. Whether it's organized sports or simply being active, make exercise a part of your family's daily routine.
Help teens manage stress. Teens get overwhelmed, just as adults do. Stress about school and activities, social lives, and the future can easily disrupt a normal sleep routine. Take care with teens that their daily routines aren't too hectic or overloaded, and encourage them to talk about the ways they may feel pressured.
When it comes to developing sleep habits in children, it's never too early to start -- and it's never to late to begin. Whatever your child's age, now is the right time to make sleep a daily priority.
Michael J. Breus, PhD
The Sleep Doctor™