Teen sleep

Introduction

  • Teenage Sleep and Suicidality

    • Presented by Shawna M. Sisler, Jennifer Hamilton, Amee Moreno

    • Supported by NAPNAP Partners for Vulnerable Youth

Speaker Disclosure

  • No conflicts of interest declared

  • No financial support received related to this work

Importance of Self-Care

  • Highlights importance of self-care among practitioners

Learning Objectives

  • Discuss mechanisms of action and neuro pathways linked to sleep disturbances and suicide

  • Recognize sleep disturbance risk factors that contribute to suicidal behavior

  • Explore behavioral interventions for sleep to reduce emotional reactivity and dysregulation

  • Identify family strategies to enhance sleep health in adolescents and address proximal suicide risk factors

Defining Common Sleep Disturbances in Teens

  • Causes of sleep disturbances are broad

  • Statistics:

    • ~75% of teens report insufficient sleep on school nights (Wheaton et al., 2018)

    • 34% experience chronic sleep deprivation (Cai et al., 2024)

    • Insomnia prevalence ranges from 7% to 40% (Baldini et al., 2024)

  • Sleep deprivation defined as less than 8-10 hours of sleep per night (Paruthi et al., 2016; Kansagra, 2020)

  • Circadian disruption relates to irregular sleep-wake patterns from late-night screen use and irregular schedules

Impact of Sleep Deprivation on Teens

  • Ways sleep deprivation affects teens:

    • Emotion, Behavior, Social, Physiologic, Psychiatric, Economic

Impact on Brain Function and Mental Health

  • Impaired cognitive function affecting:

    • Attention, Memory, Decision-making (Van Dongen et al., 2003)

  • Higher sleep disturbances correlate with increased anxiety and depression (Palagini et al., 2024)

  • Disrupted sleep leads to emotional dysregulation; irritability and mood swings (Chen et al., 2012)

  • Chronic sleep issues linked to lower academic performance (Fredrickson et al., 2004) and social difficulties

Review: Borbély's Two-Process Model (1982)

  • Interaction between Process S and Process C regulates sleep timing:

    • Process S builds during the day, countered by circadian alerting signal of Process C

    • Sleep onset occurs when Process C's wake-promoting effect diminishes in the evening

Connecting Suicidality and Sleep

  • Teens with sleep disturbances are 2.28x more likely to experience suicidal ideation (Baldini et al., 2024)

  • Poor sleep quality increases depressive symptoms, a significant suicidality risk factor (Lofthouse et al., 2009)

  • Each hour of lost sleep increases adolescent suicidal ideation risk by 14%

  • Sleep disorders linked to impulsivity and emotional dysregulation

Recent Studies

  • Gowin et al. (2024): Cohort study with 8807 participants shows:

    • Severe sleep disturbances significantly associated with suicidal thoughts or attempts by age 12

    • Parental reports of preadolescent sleep disturbances suggest long-term suicide risk

  • Importance of sleep identified as a risk factor and intervention for youth suicide prevention

Other Associations

  • Strong correlations to suicide risk:

    • Nightmares, daytime sleepiness, difficulty sleeping (Gowin et al., 2024; Lopez-Castroman & Laussent, 2020)

    • Early childhood sleep problems increase suicidal thoughts probability post-8 years (Hoyniak et al, 2023)

    • Late-night phone use and cyberbullying impact sleep and suicide risk

    • Parental monitoring reduces suicidal thoughts and behaviors (Dittus et al., 2023)

Relationship = Complex Neurobiological Mechanisms and Pathways

  • Dysfunction in:

    • Serotonergic System

    • HPA Axis

    • Neuroinflammation and Kynurenine Pathway

  • Impaired Prefrontal Cortex Function affecting Mood Regulation

  • Mesolimbic Dopamine System alterations

  • Hypersomnia exacerbates depressive symptoms (Castiglione-Fontenellaz & Tarokh, 2024)

Clinical Implications

  • Consider both sleep and mental health in evaluations

  • Treatment must address both aspects simultaneously to enhance outcomes

  • Further research needed to clarify causation and improve guidelines

Behavioral Interventions for Sleep Hygiene

  • Evaluate sleep habits among adolescents

  • Utilize sleep diaries or questionnaires for habit assessments

  • Apply CBT techniques to modify negative beliefs and behaviors about sleep

    • Include cognitive restructuring and behavioral strategies

  • Educational strategies on creating conducive sleep environments and establishing sleep schedules

  • Ongoing monitoring of progress and adjustments in interventions

What is CBT-i?

  • Sleep Restriction Therapy: Limits time in bed to boost sleep efficiency

  • Stimulus Control Techniques: Encourages leaving bed if unable to sleep

  • Cognitive Strategies: Address unhelpful sleep-related thoughts

  • Relaxation Training Strategies: Reduce pre-sleep arousal

  • Integrative model over 6-8 sessions focusing on thoughts, feelings, and behaviors that contribute to sleep problems

Digital Tools and Resources

  • Self-guided platforms providing:

    • Interactive educational content

    • Sleep tracking diaries

    • Personalized feedback and cognitive restructuring tools

    • Relaxation exercises

    • Sleep schedule reminders

Supporting Families in Crisis

  • Promote discussions on sleep and mental health

  • Education on healthy sleep practices including sleep schedules and bedtime rituals

  • Use of CBT for negative thoughts and sleep promotion

  • Provide community resources and safety plans with emergency contacts

Resources

  • Crisis Resources: 988 National Helpline

  • Support Organizations: NAMI, DBSA, and Child Mind Institute

  • Professional Support: American Academy of Sleep Medicine, American Foundation for Suicide Prevention

Contact Information

  • Dr. Shawna M. Sisler: shawna.sisler@nurs.utah.edu

  • Dr. Jennifer Hamilton: Jennifer.Hamilton@nurs.utah.edu

  • Dr. Amee Moreno: Amee.Moreno@baylor.edu

References

  • A comprehensive list of studies and articles relating to sleep disturbances and suicidality, highlighting various findings and recommendations.

Lecture Voice Recording Notes

Teen sleep in person lecture notes

Teenage Sleep Deprivation

  • Adolescents often suffer from insufficient sleep, impacting cognitive functioning, mental health, and overall well-being.

  • Around 70% of teens report insufficient sleep on school nights, with over 30% experiencing chronic sleep deprivation.

Factors Affecting Sleep

  • Several factors contribute to sleep issues in adolescents:

    • Academic pressures

    • Social activities

    • Use of electronic devices before bedtime

    • Changes in circadian rhythms affecting sleep patterns

Consequences of Sleep Deprivation

  • Emotional and cognitive dysregulation includes:

    • Heightened irritability and mood swings

    • Poor school performance, leading to bad grades and a lack of focus

    • Changes in appetite

    • Increased reliance on caffeine

    • Poor problem-solving abilities

Circadian Rhythms

  • Adolescents experience biological changes that alter their circadian rhythms.

  • Process S: Sleep-wake process based on wakefulness, creating sleep pressure through the daytime.

  • Process C: Circadian pacemaker, signaling alertness primarily during daylight.

  • These processes interact, affecting sleep structure and duration.

Impact on Mental Health

  • Sleep deprivation negatively influences:

    • The emotional state (overstimulated amygdala leading to poor decision-making)

    • Cognitive functions (rational thought decline and risk-taking behaviors)

    • Increased prevalence of mental health disorders like depression and anxiety

    • Potential increases in suicidality, especially noted in children with high levels of sleep disturbance.

Studies on Sleep and Suicidality

  • A significant study found links between sleep disturbances and increased suicidal thoughts.

  • High sleep disturbance rates correlate with worse psychological well-being and strained relationships.

  • Optimal Sleep Duration: Adolescents require 8-10 hours of sleep, ideally 9 hours, with the risks of oversleeping affecting mental health negatively.

Identifying Sleep Issues

  • Look for:

    • Prolonged sleep latency (greater than one hour to fall asleep)

    • Frequent nightmares

    • Daytime sleepiness affecting learning and mood

  • Validate concerns about sleep issues during consultations with parents and understand social determinants affecting sleep.

  • Consider discussing health practices that limit devices in bedrooms and promote consistent sleep routines.

Recommended Interventions

Cognitive Behavioral Therapy for Insomnia (CBT-I)

  • CBT-I is an effective treatment focusing on:

    • Family dynamics and establishing consistent sleep patterns.

    • Cognitive strategies to manage sleep-related concerns.

    • Monitor and adjust habits across the family unit.

Parental Involvement and Education

  • Parents should model good sleep habits and engage in discussing sleep routines and patterns with their teens.

  • Encourage family-centric approaches to manage and improve sleep issues.

Safety Planning

  • Develop safety plans addressing sleep issues within crisis intervention strategies for adolescents experiencing suicidal thoughts.

  • Include sleep discussions in well-child checkups to identify risk factors early on.

Future Directions and Policies

  • Advocate for policy changes regarding school start times to better align with teen sleep needs.

  • Encourage sleep education within school curricula to promote awareness of sleep health among students.

  • Continuous research on the connection between sleep disorders and mental health must be prioritized, along