chomotor vigilance task (PVT), a test that requires continuous attention to detect randomly occurring stimuli and that is impervious to aptitude and learning effects. In one study 48 healthy subjects were randomized to 4, 6, or 8 hours time in bed for 14 days (Van Dongen et al., 2003). Investigators found a dose-dependent effect, which increased over time (Figure 4-1A). Performance deficits in individuals who slept 6 hours or less per night were similar to those observed in individuals after two nights of total sleep deprivation. Most striking was that study subjects remained largely unaware of their performance deficits, as measured by subjective sleepiness ratings. A second study (Belenky et al., 2003) showed a similar dose-dependent, cumulative effect over 7 days of sleep loss in 66 healthy volunteers (Figure 4-1B). Subjects were followed for 3 days after the period of sleep restriction, during which time they recovered, but not enough to return to their baseline levels. Imaging studies have demonstrated a physiological basis for cognitive impairments with sleep loss that has been linked with metabolic declines in the frontal lobe of the brain (Thomas et al., 2000). Although there is not a large body of evidence, associations are also likely between sleep loss and increased risk taking (Roehrs et al., 2004).

Sleep Loss in Adolescents and Academic Performance

Sleep loss in adolescence is common and grows progressively worse over the course of adolescence, according to studies from numerous countries (Wolfson and Carskadon, 2003; Howell et al., 2004). Average sleep duration diminishes by 40 to 50 minutes from ages 13 to 19. Despite the physiological need for about 9 hours of sleep, sleep duration, across this age span, averages around 7 hours and about a quarter of high school and college students are sleep deprived (Wolfson and Carskadon, 1998). Research indicates that patterns of shortened sleep occur in the preadolescent period and may be most marked in African American boys, compared to white children or African American girls (Spilsbury et al., 2004). The decline in adolescent sleep duration is attributed to psychological and social changes, including growing desire for autonomy, increased academic demands, and growing social and recreational opportunities, all of which take place in spite of no change in rise time for school (Figure 4-2) (Wolfson and Carskadon, 1998). Furthermore, the need to earn income adds to the burden. Students who worked 20 or more hours weekly, compared with those who worked less than 20 hours, were found to go to bed later, sleep fewer hours, oversleep, and fall asleep more in class (Millman et al., 2005).

Sleep loss affects alertness, attention, and other cognitive functions in adolescents (Randazzo et al., 1998), but demonstrating a causal relationship between sleep loss and academic performance has been difficult. Most studies attempting to link the two are cross-sectional in design, based on

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