Teen Sleep Is a Public Health Emergency

Four-fifths of teens don't get enough shut-eye. Here's why that matters, and what parents — and schools — should be doing.

This fall, I’m going to have to start putting my 11-year-old on the school bus at 6:50am, and I can’t tell you how much I’m dreading it. It’s been hard enough this year getting him out the door at 8:15, and I know that with every passing year, my son’s biological clock is going to shift to make early rising even harder.

Still, I never thought that deeply about the long-term public health ramifications of early school start times until I read Lisa L. Lewis’s new book — which is OUT TODAY! — called The Sleep-Deprived Teen. Lisa, a fellow parenting journalist, was instrumental in passing the new California law that goes into effect next month stipulating later school start times, and I hope that it is the start of a nationwide trend. Teens who are forced to wake up early don’t learn as much, are more likely to be depressed and suicidal, and engage in more risky behaviors (including substance use) compared with teens who get enough sleep. There are important equity implications, too. Yes, school start time shifts require some logistical changes, but they are absolutely doable, and “but sports!” is not a valid rebuttal.

I’m thrilled to run a Q&A today with Lisa about teen sleep and why we all need to advocate for later school start times, but there’s far more in the book, which I strongly encourage you to read. Teen sleep — or lack thereof — is a hugely important issue that can affect kids for the rest of their lives.

What inspired you to write The Sleep-Deprived Teen?

My involvement with the issue of teen sleep started back in 2015, when my oldest entered high school. At the time, our local high school started at 7:30 in the morning. And yeah, that's too early. I mean, I'm not a morning person. So it definitely felt too early. But it was really obvious it was too early for him as well. I was the one driving him to school every day; we didn't have bus service to the high school at that point. And I could tell he was really barely awake. He was exhausted every afternoon when he came home. And so, of course, as a parent and journalist, I started looking into the issue. And I quickly realized that the whole issue of school start time was much bigger than just our school or our community. There's a huge body of research out there, and it dates back literally decades.

It just so happened that my involvement coincided with when the issue really felt like it was starting to reach a critical mass. A year earlier, in 2014, was when the American Academy of Pediatrics released its official recommendations — a policy statement — that middle and high school should start no earlier than 8:30 in the morning. And that's because of all of the implications when teens are sleep deprived. Also, the same month that he started school, August of 2015, was when the CDC released a report showing what school start times were around the country. And what that showed was that, at that point, only 18 percent of schools were meeting that guideline.

Wow.

Yeah, so that's what got me involved. And then it really just sort of snowballed from there. So I started researching, writing about the topic, and started advocating locally, hoping to make a change in my district. Eventually, in October 2019, a bill was passed for all public, including charter, schools in the state of California. And it stipulates that high school needs to start no earlier than 8:30 in the morning, and middle schools no earlier than 8. It goes into effect on July 1, 2022.

That's amazing. And then at what point did you decide to write a book about this, too?

I was involved in a group called the Solutions Journalism Network. I had a mentor I was working with. He said, “Is there a book about this?” And I said no. He said, “Well, you should write one.” That was the first thing that planted the seed.

Basically, I ended up writing the book that I wish that I had had when my oldest was first starting high school. I wanted to gather all the information and look at all the research — because there's so much out there — but translate it into a readable, accessible format. To talk about, for parents, the science of sleep, and how it changes during the teen years. And why it is so important, because it affects everything. And then to also give parents real practical advice on what they can do to help change school start times, and also what they can do in their own home.

Walk me through what happens to teens who regularly don't get enough sleep. What kinds of risks does sleep deprivation pose?

The very first thing is for parents and teens to be aware of how much sleep teens should be getting. That number is 8 to 10 hours every single night. In the most recent data, this was from the CDC, only 22 percent of high schoolers were getting at least 8 hours. And it does have ramifications. Nobody does anything better because they're sleep deprived.

Let’s start with with learning. If kids’ brains aren't awake, they're really not learning optimally. They're literally sometimes falling asleep at their desks, if you talk to teachers. The pioneering sleep researcher who has been studying this and doing research for decades, her name is Dr. Mary Carskadon. And as she describes it, there are three key ways to think about how sleep deprivation affects learning. It hampers acquiring new information when they’re sitting at their desk learning, or they're trying to study on their own. It lessens the likelihood of retaining the information, because when we sleep is when all of that is synthesized and consolidated and stored. And also, it impairs their ability to retrieve that information when they need it for tests or to build on concepts that they've learned.

And it affects mood. Just coping, just going through life is more difficult. Their emotional resiliency is thinner. It heightens things that they're already predisposed to, like impulsive behavior. When we talk about mood — depression, anxiety, suicidality — there is a dose-response relationship. One study in Fairfax County, Virginia found that every hour of lost sleep was linked to a 42% increase in suicidal thoughts, and a 58% increase in suicide attempts.

Wow, that is that is huge.

I know. Then you factor in the fact that teens’ mental health dramatically worsen worsened because of the pandemic — it's really, really concerning.

You also discuss in your book the impact that sleep deprivation has on substance abuse, sports, risky behavior, and immunity — there are so many ramifications. What do you suggest parents do if they want to advocate for later start times at their child's school? 

If your kid’s school starts too early, absolutely get involved locally. And that may mean finding other like-minded parents and starting a local chapter of Start School Later. [You want to be] finding other like-minded parents, tapping into existing resources, helping educate parents and the communities. Because I think once people understand the implications, it really helps in terms of setting the stage for conversations about why start time should be moved. Having people understand this is a public health issue, that that's where this stems from, goes a long way — because that's establishing why it is that you're having this conversation in the first place. It's for our teens’ health and well-being. And frankly, that's why, in the state of California, it's being done at the state level. Because otherwise, it is often something that can get derailed by, “Oh, well, it's going to be very difficult because we have to change our buses.” But when you talk about other public health issues, like asbestos or lead paint, you readily recognize the public health implications. Sleep absolutely is a public health issue. I mean, this is why medical groups have made this recommendation.

This is also an educational equity issue, right? You talk in your book about the fact that kids of color, as well as kids from lower-income families, are often most affected by sleep deprivation, and benefit most from later school start times?

It absolutely is an equity issue. Teens are not one monolithic group. Biological females have issues with menstruation and period pain, which can affect sleep. If you’re a sexual or gender minority, you tend to sleep worse than your heterosexual counterparts. If you're a teen of color, you sleep worse. And if you’re a teen living in a lower income neighborhood. And you can be a teen who checked off more than one of those boxes. And in terms of socioeconomic status, we talk about the impacts of poverty and neighborhood environment [on sleep]. And these are things like the noise level where you live, or if you live in crowded living conditions, or if you don't feel safe — all of those affect your ability to get a good night's sleep. Or if you're going to bed hungry.

And when you look at issues of race and ethnicity, there's a lot of research out there showing that teens of color do tend to sleep more poorly. If you want statistics, going back to the CDC report, overall, 22 percent of high schoolers were getting eight hours of sleep or more. But 19.5 percent of Black students, were getting at least eight hours, 22 percent of Hispanic students and 23 percent of White students were.

Research has also shown that when school start times are moved later, students of color and lower income students experience most benefits, right?

Yes. There have been studies showing that. So in Seattle, the largest city to date [that has changed school start times], they did a pre- and post-change study. And what they found was — there were there were two schools, and the one where most of the students came from lower income households, attendance went up, and tardies went down. The lead sleep researcher for that basically described it as the school start time change was having a leveling effect.

That's really powerful. But… I know changing a school start time can take a long time. My last question is: What can you do if your teen is not sleeping enough and you can't immediately change the start time of your school? What can you be doing at home to help them get more sleep?

Again, go back to the fact that they need eight to 10 hours. Parents really need to be aware of that, and to communicate that to their teens, and to make sleep a priority overall in the household. So it's not just “you need to go do this.” If you're going to set a tech rule, like no devices an hour before bedtime, which is the official recommendation, make sure they see you doing that too. Or, if it's to charge all the devices in the kitchen, that should be a family rule, not a teen-only rule.

Ideally, you're not on a Kindle [or other device] late at night, because that does emit blue light. Blue light is not the biggest problem, but blue light does matter, because blue light in the evening can delay the release of melatonin, which is what prompts us to feel sleepy. And then there’s the social media engagement piece – that if you're on social media or video games at night, you're engaged with your friends, that can rile up strong emotions. These were very deliberately designed to be immersive. To keep you sucked in.

Also, helping teens develop a wind-down routine is something that is a really terrific bit of advice that I myself have really tried to take to heart, because it's not just for teens. It’s for all of us.

Last week in The New York Times, I wrote about our mysterious coronavirus experience two weeks ago. Why did my husband and son develop symptoms, but never test positive, after my daughter got Covid-19? Researchers had some interesting theories. (The piece was one of the most popular pieces on the site yesterday!)

My paperback comes out in two weeks! Pre-order it here or anywhere else books are sold.