Research Shows Many Teens, Younger Kids Have Sleep Problems

A new research study in the Feb. 15 Journal of Clinical Sleep Medicine found that 60 percent of middle- and high-school students have difficulty falling asleep, and 22 percent say they never get enough sleep.

The study, which was led by FP James Pagel Jr., M.D., explores relationships among rates of sleep disturbances in students in grades six through 11; the youngsters' grade point averages, or GPAs; and factors such as household income. According to the abstract for "Adolescent Sleep Disturbance and School Performance: The Confounding Variable of Socioeconomics," Pagel and the other authors obtained responses to sleep questionnaires in 2005 from 238 students at a middle school and high school in Pueblo, Colo. The article focuses on the 165 students who reported their GPAs on a four-point scale, where 1 is a D and 4 is an A.

"The first 'take-home' for family physicians from this study is the extreme frequency of sleep disturbance in this age group," said Pagel, director of Rocky Mt. Sleep in Pueblo, which sponsored the study; associate clinical professor in the Southern Colorado Family Medicine Residency, Pueblo; and chair of the education committee of the American Academy of Sleep Medicine in an interview.

Sixty percent of the 165 students said they had difficulty falling asleep at least once a week, a figure that includes the 21 percent who reported difficulty falling asleep every night. When asked whether they felt they got enough sleep, 9 percent of the 165 students said they rarely got enough sleep and 22 percent said they never got enough sleep.

By comparison, said Pagel, earlier research indicates that about 30 percent of adults have sleep disturbances irregularly and about 14 percent of adults have sleep disturbances on a chronic basis.

"The second key point (from the study) for family physicians is how sleep disturbance affects school performance," said Pagel. "And finally, there's the huge impact of low family income on sleep disturbance in relation to school performance." In the study, the authors classified a family income of less than $50,000 as low income and an income of at least $75,000 as high income for this population; Pagel calls the research a middle-class population study.

"Half of the kids coming from low-income families did have high GPAs," said Pagel. "But all of the kids that had low GPAs (defined as equal to or lower than 2) were from low-income families."

In the study, the authors note, "In general, students with lower GPAs were older and reported lower household incomes than students with higher GPAs, although the relationship between income and GPA is complex and not linear." Among students who reported difficulties at least once a week, "those with the highest GPAs were less likely to have restless/aching legs when trying to fall asleep, difficulty concentrating during the day, and were less likely to fall asleep in class," according to the authors.

About 26 percent of the 165 students said that, at least once a week, they had restless/aching legs when they were trying to fall asleep. However, none of those with a GPA of at least 3.5 reported having restless/aching legs every night when they tried to go to sleep. The authors stress the strong correlation between restless/aching legs at sleep onset and poorer school performance and add, "This sleep complaint has not generally been addressed in previous studies."

Socioeconomic factors other than income -- factors such as ethnicity, parents' marital status, number of children in the household and number of individuals in the household -- did not significantly affect sleep patterns and GPAs, said Pagel. The effect of lower income "is a political hot potato" when considered in the context of the Bush administration's No Child Left Behind policy, Pagel noted. "This study, which addresses school performance in a middle-class population, suggests that it will be very difficult for schools with lower-income families to perform up to the levels of schools in higher-income areas."

Concerning treatment, Pagel said he recommends behavioral manipulations such as light therapy during early morning hours and advises some youngsters to use certain over-the-counter drugs. The medications often taken by adults with sleep problems have not been tested in children, said Pagel, and he warned against recommending "bad actors" such as benzodiazepines and antihistamines because they may intensify students' sleepiness and affect older students' driving proficiency.

The disturbance in circadian sleep rhythms called delayed sleep-phase syndrome is common in adolescents, said Pagel, who noted that if adolescents had the option, they would normally go to sleep later than adults and wake up later. Minnesota, he added, reports positive results from postponing the starting time for the high school day so those with delayed sleep patterns can sleep longer in the morning.