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Protective and Risk Factors for Adolescent Sleep: A Meta-analytic Review

Summary: Teenagers need sufficient sleep to function well on a daily basis, yet there is a lack of consolidated evidence advising which factors protect, or harm, adolescents’ sleep.

A meta-analysis of 41 studies, published between 2003 and February, 2014, calculating mean weighted r values, was conducted to better understand the strength of protective and risk factors for 85,561 adolescents’ (age range = 12–18y) bedtime, sleep onset latency (SOL) and total sleep time (TST).

Results showed good sleep hygiene and physical activity were associated with earlier bedtimes. Video gaming, phone use, computer use, evening light and internet use were related to delayed bedtimes. Good sleep hygiene was negatively correlated with sleep latency. Alternatively, sleep latency lengthened as levels of a negative family environment increased. Tobacco use, computer use, evening light, a negative family environment and caffeine were associated with decreased total sleep time, whereas good sleep hygiene and parent-set bedtimes were related to longer sleep length.

Good sleep hygiene appears to be a protective factor, whereas a negative home environment and evening light appear to be risk factors. Cautious use of technology (other than television), caffeine, tobacco and alcohol should be considered, as these factors, as well as pre-sleep worry, are likely to have some negative impact on sleep. Parent-set bedtimes and physical activity may be beneficial. Future research directions are discussed.

Full-text

Alex’s Notes: In adolescence, sleep deprivation is considered less than nine hours per night, and yet only 22% of adolescents obtain sufficient sleep while 25% don’t even hit six hours per night. This restriction during the weeknights (less than six hours of sleep) is associated with increased interpersonal problems at school, psychological problems, such as lower life satisfaction and lower self-esteem, and higher incidence of drug use. So what is and is not associated with bedtime, sleep onset latency (i.e., the time it takes to fall asleep; SOL), and total sleep time (i.e., night time sleep duration; TST)?

The researchers of the study at hand analyzed 41 studies consisting of 85,561 adolescents in the age range of 10-23y, with reported average ages ranging from 12.2-17.7 years. I have summarized their findings in the table below, and all protective and risk factors associated with sleep variables displayed a small to medium correlation (i.e., +/-.10 to +/-.30).

Variable

Bedtime

SOL

TST

Physical activity

     

Extracurricular activity

     

Sleep Hygiene

     

Pre-sleep worry

     

Parent-set bedtime

     

Negative family environment

     

Time spent with peers

     

Homework

     

Work

     

Television

     

Video gaming

     

Phone use

     

Computer use

     

Internet

     

Evening light

     

Tobacco

     

Alcohol

     

Caffeine

     

Longitude

     

Latitude

     

The green is protective while the red is a risk factor, and before discussing further, it must be emphasized that this meta-analysis is based on correlational studies, meaning that no cause and effect could be determined and future studies are needed to elaborate upon the relationship. Moreover, no adjustments were made for any confounding factors and thus age, gender, culture, and the parent-teen relationship could easily impact the results.

With that said, it is interesting to note that sleep hygiene, which encompasses multiple facets, such as behavioral, physiological and emotional arousal before bed, sleep environment and sleep stability, was beneficial to all sleep parameters. Conversely, a negative family environment was associated with opposite, supporting the notion that a negative or disorganized home environment is detrimental to adolescents’ sleep.

Regarding night light, which everyone loves to blame for circadian disruptions, it does indeed appear to result in later bed times and shorter total sleep times, but not the time it takes to fall asleep. As for technology use, it is amusing to see that it results in later bedtimes only, and that only computer use resulted in less TST. These technologies may engage the user so that they become distracted or apathetic towards the time, thus displacing bedtime. However, given that SOL and TST were for the most part unaffected, it could be that adolescents entertained themselves through the use of technology whilst waiting for sleep. The correlational nature of the meta-analysis demands we consider both sides. The timing and duration of the technology use could also be a factor, as one study in teenagers demonstrated that 50 min of pre-bed video gaming did not impact objective sleep duration or subjective SOL, whereas 150 min decreased sleep duration and increased SOL.

The final variable I want to touch on is caffeine, which was shown to reduce TST, only. This may indicate two things: the use of caffeine makes adolescents more alert and unable to sleep, or adolescents who obtain less sleep are more tired and thus drink caffeinated beverages in an attempt to fight fatigue. Given that the time to fall asleep and bedtime were unaffected, I’m inclined to believe the latter.

So how can we use this information?

Clearly ensuring that your child has a defined bedtime, good sleep hygiene, and engages in regular physical activity will all benefit their sleep (although as they age, giving them a bedtime likely won’t work). Moreover, for reasons beyond sleep, having a positive family environment is critical. Since technology is so omnipresent, putting restrictions on that would likely lead to problems. Instead, we should embrace that the young are night-owls, and much of these issues would be solved by delaying school start times. Let’s be real, school start times are the determining factor of when teenagers wake up, and it has been shown that delaying school start times can improve adolescents’ sleep.

 
 

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