SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS

SUMMARY OF A WORKSHOP

Forum on Adolescence

Mary G. Graham, Editor

Board on Children, Youth, and Families

Commission on Behavioral and Social Sciences and Education

National Research Council

and

Institute of Medicine

NATIONAL ACADEMY PRESS


Washington, D.C.



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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS SUMMARY OF A WORKSHOP Forum on Adolescence Mary G. Graham, Editor Board on Children, Youth, and Families Commission on Behavioral and Social Sciences and Education National Research Council and Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C.

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP NATIONAL ACADEMY PRESS2101 Constitution Avenue, N.W.Washington, D.C.20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The study was supported by Grant No. 2925-003 between the National Academy of Sciences and Carnegie Corporation of New York and Grant No. 5294-158 between the National Academy of Sciences and the National Institute on Child Health and Human Development, U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-07177-1 Additional copies of this report are available from the National Academy Press, 2101 Constitution Avenue, N.W., Lock Box 285, Washington, D.C.20055. Call (800) 624-6242 or (202) 334-3313(in the Washington metropolitan area) This report is also available online at http://www.nap.edu Printed in the United States of America Copyright 2000 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council and Institute of Medicine (2000) Sleep Needs, Patterns, and Difficulties of Adolescents. Forum on Adolescence. Mary G. Graham, ed. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press.

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP FORUM ON ADOLESCENCE 1999-2000 DAVID A. HAMBURG (Chair), Carnegie Corporation of New York (President Emeritus) HUDA AKIL, Mental Health Research Institute, University of Michigan, Ann Arbor CHERYL ALEXANDER, Center for Adolescent Health, Johns Hopkins University CLAIRE BRINDIS, Institute for Health Policy Studies, Division of Adolescent Medicine, University of California, San Francisco GREG DUNCAN, Institute for Policy Research, Northwestern University JACQUELYNNE ECCLES, School of Education, University of Michigan, Ann Arbor ABIGAIL ENGLISH, Center for Adolescent Health & the Law, Chapel Hill, North Carolina EUGENE GARCIA, School of Education, University of California, Berkeley HELENE KAPLAN, Skadden, Arps, Slate, Meagher, and Flom, New York IRIS F. LITT, Division of Adolescent Medicine, Stanford University JOHN MERROW, The Merrow Report, New York ANNE C. PETERSEN, W.K. Kellogg Foundation, Battle Creek, Michigan KAREN PITTMAN, International Youth Foundation, Baltimore ANNE PUSEY, Jane Goodall Institute's Center, University of Minnesota MICHAEL RUTTER, Institute of Psychiatry, University of London STEPHEN A. SMALL, Department of Child and Family Studies, University of Wisconsin, Madison CAMILLE ZUBRINSKY CHARLES, Department of Sociology, University of Pennsylvania BARUCH FISCHHOFF (Liaison, IOM Council), Social and Decision Sciences, Carnegie Mellon University ELEANOR E. MACCOBY (Liaison, Commission on Behavioral and Social Sciences and Education), Department of Psychology (emeritus), Stanford University

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP Michele D. Kipke, Director Mary Graham, Associate Director, Dissemination and Communications Amy Gawad, Senior Project Assistant Elena Nightingale, Scholar-in-Residence

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP BOARD ON CHILDREN, YOUTH, AND FAMILIES 1999-2000 JACK P. SHONKOFF (Chair), Heller Graduate School, Brandeis University EVAN CHARNEY (Vice Chair), Department of Pediatrics, University of Massachusetts JAMES A. BANKS, Center for Multicultural Education, University of Washington SHEILA BURKE, John F. Kennedy School of Government, Harvard University DAVID CARD, Department of Economics, University of California, Berkeley DONALD COHEN, Yale-New Haven Children's Hospital, Yale University MINDY FULLILOVE, Columbia University KEVIN GRUMBACH, Department of Family and Community Medicine, Primary Care Research Center, University of California, San Francisco MAXINE HAYES, Department of Community and Family Health, Washington State Department of Health MARGARET HEAGARTY, Department of Pediatrics, Harlem Hospital Center, Columbia University RENEE JENKINS, Department of Pediatrics and Child Health, Howard University SHEILA KAMERMAN, School of Social Work, Columbia University HARRIET KITZMAN, School of Nursing, University of Rochester SANDERS KORENMAN, School of Public Affairs, Baruch College CINDY LEDERMAN, Circuit Court, Juvenile Justice Center, Dade County, Florida SARA McLANAHAN, Office of Population Research, Princeton University VONNIE McLOYD, Center for Human Growth and Development, University of Michigan PAUL NEWACHECK, Institute of Health Policy Studies and Department of Pediatrics, University of California, San Francisco GARY SANDEFUR, Department of Sociology, University of Wisconsin, Madison

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP RUTH STEIN, Department of Pediatrics, Albert Einstein College of Medicine PAUL WISE, Department of Pediatrics, Boston Medical Center RUTH T. GROSS (Liaison, IOM Board on Health Promotion and Disease Prevention), Professor of Pediatrics (emeritus), Stanford University ELEANOR E. MACCOBY (Liaison, Commission on Behavioral and Social Sciences and Education), Department of Psychology (emeritus), Stanford University WILLIAM ROPER (Liaison, IOM Council), Institute of Medicine, University of North Carolina, Chapel Hill Michele D. Kipke, Director Mary Graham, Associate Director, Dissemination and Communications Mary Strigari, Administrative Associate Elena Nightingale, Scholar-in-Residence

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP Contents     PREFACE   xi     INTRODUCTION   1     ADOLESCENT DEVELOPMENT AND SLEEP   3     ADOLESCENT SLEEP PATTERNS AND DAYTIME SLEEPINESS   4     CONSEQUENCES OF INSUFFICIENT SLEEP   13     IDENTIFYING AND INTERVENING IN CLINICAL SLEEP PROBLEMS   18     CHANGING SCHOOL STARTING TIMES   23     EDUCATING THE PUBLIC ABOUT ADOLESCENT SLEEP NEEDS   25     NEXT STEPS   26     REFERENCES   31     OTHER INFORMATION RESOURCES   34     APPENDIX: WORKSHOP AGENDA AND PARTICIPANTS   35     SELECTED REPORTS OF THE BOARD ON CHILDREN, YOUTH, AND FAMILIES   46

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP Preface This report summarizes the presentations and discussion at a workshop entitled Sleep Needs, Patterns, and Difficulties of Adolescents, held on September 22, 1999. The workshop was organized by the Board on Children, Youth, and Families and the Forum on Adolescence of the National Research Council and Institute of Medicine, with funding from the Carnegie Corporation of New York and the National Institute on Child Health and Human Development, U.S. Department of Health and Human Services. The workshop brought together policy makers, researchers, and practitioners to examine research on adolescence and sleep. Among the questions it addressed were: How much sleep do teenagers need? What are the typical sleep patterns of adolescents? What are the influences on sleep problems and disturbances? What are the consequences of insufficient sleep? Drawing on participants' presentations and discussions, this workshop summary addresses each of these questions. Of necessity, it reflects the particular emphases of the workshop discussions as well as specific statements made by participants during the workshop. It is important to note that this workshop was an effort intended to take stock of the current knowledge base on adolescent sleep and to highlight key findings from research. Given the limitations of both time and scope, the workshop could not address all issues that are important in this area. For example, the workshop did not explore in depth the social and cultural contexts that influence adolescents and their behavior.

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP It is also important to note that this workshop report summarizes material presented and discussed at the workshop. Although it references published materials suggested or provided by participants, it is not intended to provide a comprehensive or thorough review of the field. It is our hope that this report will illuminate important issues related to sleep and the well-being of adolescents that deserve further attention and consideration. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their participation in the review of this report: Missy Fleming, Child and Adolescent Health, American Medical Association, Chicago, IL; Anthony Jackson, Disney Learning Partnership, Walt Disney Corporation, Burbank, CA; Reed Larson, Department of Human and Community Development, University of Illinois, Champaign/Urbana; Richard MacKenzie, Division of Adolescent Medicine, Children's Hospital, Los Angeles, CA; Barbara McNeil, Department of Health Care Policy, Harvard Medical School; and Shepherd Smith, Institute for Youth Development, Sterling, VA. Although the individuals listed above provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with the authoring group and the institution. David Hamburg Chair, Forum on Adolescence

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SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS: SUMMARY OF A WORKSHOP SLEEP NEEDS, PATTERNS, AND DIFFICULTIES OF ADOLESCENTS

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