Introduction: Waking Up to the Need for Sleep

To my patients and the medical community, I’m known as a sleep doctor who specializes in teen sleep issues. But at home I’m Mom, and, probably like you, I often see in my family life the negative effects of the sleep issues I deal with every day in my clinic. Living with those effects—and with the teens who experience them—isn’t easy, and sometimes it’s enough to drive me wild. During the course of raising my three daughters—the youngest, Elyssa, is now in high school— we’ve had “discussions” about appropriate bedtimes and the need for adequate sleep. There have been many frantic mornings trying to get the kids out of bed and out the door and getting my husband and me to work without sending everyone’s blood pressure into the danger zone. (“Elyssa, are you up?” “Elyssa, FIVE MINUTES!” “ELYSSA, I’M GOING TO THE CAR NOW AND IF YOU’RE NOT THERE WHEN I START IT YOU’LL BE FINDING YOUR OWN WAY TO SCHOOL!” are the louder and louder exhortations my husband and I have used to clear the house on many mornings.) We have been worried about the kids’ health and how well they’re learning and frustrated and irritated by living with perpetually sleep-deprived teen zombies.

Does all of this sound familiar? My experiences and my zombies are probably very much like yours—the overwhelming majority of the



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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits Introduction: Waking Up to the Need for Sleep To my patients and the medical community, I’m known as a sleep doctor who specializes in teen sleep issues. But at home I’m Mom, and, probably like you, I often see in my family life the negative effects of the sleep issues I deal with every day in my clinic. Living with those effects—and with the teens who experience them—isn’t easy, and sometimes it’s enough to drive me wild. During the course of raising my three daughters—the youngest, Elyssa, is now in high school— we’ve had “discussions” about appropriate bedtimes and the need for adequate sleep. There have been many frantic mornings trying to get the kids out of bed and out the door and getting my husband and me to work without sending everyone’s blood pressure into the danger zone. (“Elyssa, are you up?” “Elyssa, FIVE MINUTES!” “ELYSSA, I’M GOING TO THE CAR NOW AND IF YOU’RE NOT THERE WHEN I START IT YOU’LL BE FINDING YOUR OWN WAY TO SCHOOL!” are the louder and louder exhortations my husband and I have used to clear the house on many mornings.) We have been worried about the kids’ health and how well they’re learning and frustrated and irritated by living with perpetually sleep-deprived teen zombies. Does all of this sound familiar? My experiences and my zombies are probably very much like yours—the overwhelming majority of the

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits 11- to 22-year-old set (to which, for the purposes of this book, I refer to as teens or adolescents) simply aren’t getting the amount and the quality of sleep they need, and both they and their families are suffering the consequences. But many people think that being sleepy is simply a normal part of being a teen and, despite the epidemic of sleep deprivation, don’t consider it a serious issue. We expect teens to be exhausted. We also expect them to be irritable, contentious, and at least a bit zoned out. Being tired and difficult, after all, is just part of being a teen. That kind of thinking needs to become a thing of the past. The latest research clearly shows that lack of sleep doesn’t result just in bleary-eyed youngsters trying to keep from keeling over at the breakfast table. Inadequate sleep, which is anything less than eight and a half hours a nght, can have negative effects—and may have dangerous effects under eight hours—on just about every aspect of teens’ lives: their stress level, their grades, their health, their sports performance, their growth, their mood, their emotional stability, their memory, their energy level, their ability to think clearly, their risk of injury, their skin condition, their weight, and their use of drugs and alcohol. Studies have shown that: Fifty-five percent of car crashes that result from driver drowsiness are caused by drivers who are 25 or younger. Female high school students who go to sleep two or more hours later on the weekend than on weekdays report feeling more depressed than those who don’t stay up later on the weekends. Students just leaving middle school and beginning high school who sleep less and go to sleep later display more aggressive behavior than those who get more sleep. Sleep deprivation increases the likelihood that teens will use nicotine and alcohol. Sleepy adolescents react more slowly and have trouble making good decisions. Students who receive C’s, D’s, and F’s go to sleep later and have less regular sleep patterns than those who get A’s and B’s.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits Teens who don’t get enough sleep are at higher risk for high blood pressure, diabetes, cancer, heart disease, migraines, and obesity, as well as for suicide and adjustment disorder. Despite all this evidence, however, most people don’t realize that teens—and not just American teens but teens across the globe—are suffering from a huge sleep deficit. When they were babies, they told us, very clearly, when they were exhausted and needed to sleep—they fussed and they wailed and their faces turned red. But now that they’re older, our kids don’t signal their sleep needs so clearly or so noisily— they often show their extreme fatigue in ways we don’t always associate with lack of sleep and do usually attribute to other causes. If they don’t do well on an exam, we think it’s because they didn’t study hard enough. If they’re irritating and unpleasant, we blame it on those raging teenage sex hormones. If they gain weight or their skin breaks out, they’re not eating a well-balanced diet and not getting enough exercise. If they’re unhappy or depressed, well, that’s just teenage angst. Sexual development, cultural forces, diet, and a strong work ethic, as well as a host of other factors, including family problems, physical and psychological conditions, learning issues, heredity, friends, and the environment, do, of course, greatly affect teen behavior, learning, and health. But now the sleep community knows that lack of sleep also underlies, and has an enormous effect on, all parts of teen life and that the right amount and the right kind of sleep are essential for optimum teen well-being. The sleep community also knows that there’s a physiological factor that contributes significantly to teenage sleep deprivation: Teens’ brains are actually wired to keep them out of step with most of the world. The secretion of melatonin, a brain hormone that helps cause drowsiness, begins signaling hours later in adolescents than it does in children or adults, turning teens into night owls and making it extremely difficult for them to be awake enough to learn anything during the first few periods of school or to successfully follow a typical adult schedule. I want to tell you about this critically important finding. And I

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits want you and your family to understand all the ways that lack of sleep is preventing your teenager from doing and being her* best. I also want to help you create an environment that will encourage your teen to get adequate sleep and give you lots of tips and advice on helping your teen take ownership of the sleep issue. In addition, I’m going to tell you how you and your spouse can be good role models when it comes to sleep, a very important part of the program. If you’re at war with your teen over bedtimes and other sleep-related issues, you know that addressing the problems of sleep deprivation can be a challenge—as children of a sleep doc, my kids get more sleep than most, but they need still more and I still have to work hard to convince them that they do. But through my work in my sleep laboratory, my sleep medicine practice, my research studies, and my experiences (good and bad) with my daughters, I’ve learned a great deal about teen sleep and how to help teenagers get the rest they need. I’ve packed this book with the latest and most helpful information as well as 10 surefire ways to improve your teen’s sleep habits. I start off with the nitty-gritty: the big reason teens stay up all night and sleep all day, generally driving their parents to distraction. Then I talk about the link between sleep deprivation and serious threats to health and well-being, including high stress, obesity, emotional problems, and increased risk of injury; I devote a separate chapter to the newly understood facts about the direct and critical link between sleep and learning. Then I offer a short primer on sleep itself—what it is, how it works, and why teens need so much of it—and information about the cultural forces and the electronic forces that keep teens from getting the sleep they require. In the second part of the book you’ll find specific tools to help your teen get more and better sleep. A sleepiness scale and a discussion of symptoms kick off the section so your teen can measure and see for herself where she is on the sleep deprivation slope; a scale for adults also is included so you can learn if you too are running on less than * Although sleep deprivation negatively affects teens of both sexes, for brevity’s sake I refer to teens throughout the book in the feminine.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits adequate sleep and if you need to adopt better sleep habits. Next, my daughter Elyssa and other teenagers provide lots of tips for how to talk with your own teen about the importance of sleep and how you can encourage her—without fighting—to create, follow, and own a realistic sleep program like the one in Chapter 8; that “no-war” program tells you just what teens need to do to feel and be their best. Then, if a bit of additional help is needed, Chapter 9 provides easy-to-follow information on how to reset a stubborn internal sleep-wake clock. In Part III you’ll find information on sleep disorders, including insomnia and sleep apnea, and how to handle the serious problems, including depression, being suicidal, frequent infections, and frequent headaches, that can accompany lack of sleep. I tell you how to recognize the symptoms and where to go for help. Part IV covers a number of ways you and your community can support your teen’s goal of getting more and better sleep. I discuss steps you can take to follow your own healthy sleep program, live a healthy lifestyle, and maintain a supportive home environment. I also talk about what you can do to make your teen’s school and community more aware of the dangerous effects of sleep deprivation and how you can encourage your local middle and high schools to move their start times later—a proven way to increase teen learning that’s picking up momentum across the United States. Last but far from least, Part V talks about how the teen sleep problem affects adolescents everywhere and the different ways that cultures around the globe are confronted with—and dealing with—the issue of teen sleep deprivation. The Resources section lists helpful Web sites for additional sleep-related information and memory games to play as well as contact information for locating light therapy products. Throughout the book you’ll also find success stories and advice that I hope will encourage you as you set out to improve your teen’s sleep habits and help her optimize her health, learning, and living. In addition you’ll find boxes called “A Teen’s Take” that give you Elyssa’s comments and insight—a teen’s point of view—on the subjects being covered; I hope you’ll encourage your own teen to read these comments, as well as the rest of the book, to understand and own her sleep issues and patterns.

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Snooze…Or Lose!: 10 “No-War” Ways to Improve Your Teen’s Sleep Habits In all, the book will give you the tools you need to jumpstart and sustain a successful sleep program. But will all the information gathered here make your family’s school mornings—and the rest of your days and nights—perfect? In a word, the answer is no. While my husband and I no longer have to shout several times to get Elyssa out the door in the mornings, and she gets enough sleep the night before exams and tries not to sleep all weekend so that her weekdays will be less groggy and her health more assured, occasionally she doesn’t get all the sleep she needs. For Elyssa, like most teens, combining all the elements and pressures of her jam-packed day with the perfect night’s sleep is a work in progress. But for the most part the sleep program she follows—the one included here—gives her the energy, the attitude, and the ability to do and be her best. I believe that program, plus the additional information and solutions offered in this book, will help you and your teen wake up to the importance of sleep and help your teen get the healthy, success-producing sleep she needs.