Saturday, 29 January 2011

Sleep and teenagers

Sleep (or lack of…) is an interesting topic. Quality of sleep has been shown to negatively affect human performance for various reasons. Furthermore, there have been numerous reports suggesting a link between lack of sleep and depression.

The relationship between short sleep duration and depression has been suggested to be bidirectional,1 with chronic partial sleep deprivation being a potential risk factor for depression. Cross-sectional studies have found relationships between inadequate sleep and depression in adolescents,2,3 and a longitudinal study has shown that getting less sleep over time increased the symptoms of depression among middle school students.4 Short sleep duration has also been shown to be associated with suicidal ideation5 and suicidal behavior6 in adolescents and adults7 in cross-sectional studies.

A recent quasi-experimental study conducted by Gangwish et al. (2010) has looked at the relationships between parental set bedtimes, sleep duration, and depression in adolescents to explore the potentially bidirectional relationship between short sleep duration and depression.

For this scope they analysed 15,659 US adolescents in grades 7 to 12. The results showed that adolescents with parental set bedtimes of midnight or later were 24% more likely to suffer from depression (OR = 1.24, 95% CI 1.04-1.49) and 20% more likely to have suicidal ideation (1.20, 1.01-1.41) than adolescents with parental set bedtimes of 10:00 PM or earlier, after controlling for covariates. Consistent with sleep duration and perception of getting enough sleep acting as mediators, the inclusion of these variables in the multivariate models appreciably attenuated the associations for depression (1.07, 0.88-1.30) and suicidal ideation (1.09, 0.92-1.29).

From Table 3
Odds ratios (95% CI) for depression
Model 1a Model 2b Model 3c Model 4d
Parental set bedtime on weekday nights
10:00 PM or earlier 1.00 1.00 1.00 1.00
By 11:00 PM 1.15 (0.94-1.40) 1.13 (0.90-1.42) 1.10 (0.87-1.39) 0.97 (0.76-1.24)
By or after midnight 1.42 (1.21-1.67) 1.28 (1.07-1.52) 1.24 (1.04-1.49) 1.07 (0.88-1.30)
Self-perception of how much parents care
1 – Not at all 6.82 (3.11-14.98) 5.88 (2.79-12.40)
2 – Very little 8.32 (4.58-15.12) 6.73 (3.49-12.98)
3 – Somewhat 5.50 (3.72-8.13) 4.93 (3.32-7.30)
4 – Quite a bit 2.43 (1.89-3.13) 2.16 (1.69-2.76)
5 – Very much 1.00 1.00
Adolescent-reported sleep duration
≤ 5 h 1.71 (1.22-2.39)
6 h 1.29 (0.97-1.70)
7 h 1.19 (0.96-1.48)
8 h 1.00
9 h 1.17 (0.88-1.56)
≥ 10 h 1.34 (0.95-1.89)
Enough Sleep 0.35 (0.28-0.43)
aModel 1 – Unadjusted.
bModel 2 – Adjusted for age, sex, race/ethnicity, parent's marital status, and family receipt of public assistance.
cModel 3 – Adjusted for variables in Model 2 plus self perception of how much parents care.
dModel 4 – Adjusted for variables in Model 3 plus adolescent reported sleep duration and perception of getting enough sleep.

The results from this study provide new evidence to support the notion that short sleep duration could play a role in the etiology of depression. Earlier bedtimes could therefore be protective against adolescent depression and suicidal ideation by lengthening sleep duration.

Young athletes have to cope nowadays with various stresses, not only performance related. Studying, maintaining social contacts, training, family and peer pressure are all parts of young athlete’s  lives. Sleep is a simple thing that can make sure they recover properly and can cope with everything they have to deal with.

So, are we making sure they get good quality and good amounts of sleep?

Do we advice them on appropriate bed time?

Do we make sure they don’t spend the night playing videogames or chatting on social networks?

Do we create the right sleeping environment and routines?

Do we know if they are sleeping well?

How about a checklist?

Read Atul Gawande’s book about checklists, The Checklist Manifesto. Not only is the book loaded with fascinating stories, but it honestly changed the way I think about the world. The book’s main point is simple: no matter how expert you may be, well-designed check lists can improve outcomes. So, let’s make sure our young athletes tick all the boxes when it comes to sleep.

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