I wonder, can we prioritize sleep? I mean this sincerely. Can we really value it? Sleep is one of the essential parts of being human yet unlike some of the other essential things (think food, exercise, oxygen, or shelter) no one seems to give us credit when we sleep. Come about age 11, kids start to be praised for their achievements more than their skills in self-preservation.

Like most busy moms, I speak from an experienced place–I’m up early today after going to bed late last night. With the dog awakening us with vomiting at 2:30am, I clocked in under 6 hours of sleep when the alarm clock broke the silence this morning. Clearly it is our own responsibility to find ways to prioritize sleep. No one will do it for us. So, how we both model sleep and also advise our children as they grow matters. It is well understood that sleep deprivation isn’t good for us. It’s not good for our performance, our driving, our friendships, our mood, or even our waistlines.

In clinic, I ask teenagers what time they go to bed. I ask them if they sleep with their phones, if they wake up to an alarm, and how easy it is to fall asleep. I ask parents and I ask about the little ones, too. But it’s the teens (and parents) I worry about most. Those little 6-month-old-midnight-screamers, they’ll figure it out. The over-subscribed-stressed-out high-(or-low)-achieving teens? They need a little time on this…A study published this month only confirms my concern.

After I ask about bedtime, I ask teens how late they sleep on the weekend. The reason: I want to know about their sleep debt. Sleep debt is the cumulative amount of sleep below what you need. If you needed 8 1/2 hours and you only got 6, you create a 2 1/2 hour sleep debt. It adds up, a lot like any kind of other debt. Fortunately you can pay it back a bit by making up for it with long periods of rest in the future, taking a nap, or long nights of sleep on the weekend. But I wonder how you do all week while tired. The study evaluated this.

Teens’ sleep debt is often high –a 2006 US poll found that nearly 1/4 of all teens fall asleep at school. In one report, only 15% of teens said they got over 8 hours of sleep during the week. If you go to bed around 11pm and school starts at 7am, it’s nearly impossible to get what you need. Teens need about 8 1/2 to 9 1/2 hours a sleep each night. Part of my job as a pediatrician is to help teens understand that their sleep debt is a sign they aren’t getting enough sleep mid-week. And it’s my job to help motivate them to prioritize sleep. That’s the hard part.

Sufficient sleep during adolescence is important for the development of psychosocial functioning, behavioral maturation, and cognition. Dr Kim et al

In my practice sleep debt is nearly universal. Most teens report a fair amount of make-up-catch-up-refill-the-tank sleep on the weekend. Do you? I remember crashing on the weekends in high school, in college, in medical school, and in residency. Since the boys have been around–yes, this period of life is sleep-deprived, too–and it seems there is no time when parenting young children for making up sleep! Sleep deprivation has been a huge part of life for me in completing what I needed to do to succeed professionally. So I’m not a great example. Neither is our American culture in general.

As school starts, I’ll keep talking to teens about prioritizing sleep like they prioritize food, exercise, friendship, sports, or good grades. I don’t know how much good I do, though. Culturally, we seem to have it all a little backwards. We often praise those who perform on 4 hours of sleep. We marvel at surgeons who stay up all night and operate the following day. We commend kids who over-subscribe to activities so that they are left doing homework in the dark. We focus on work ethic. We focus on achievement. We forget to prioritize sleeping and self-care. We don’t praise those kids who sleep 9 hours at night. How do we illuminate the cost of sleep deprivation? Science…

A study in Archives of Pediatrics & Adolescent Medicine found that teens who created a sleep debt throughout the week had a more difficult time performing tests requiring concentration and attention during the week. In a study conducted in Korea, investigators studied over 2600 teens. They found:

  • Teens slept an average of 5 hours 42 minutes a night during the week. Let me just say, that’s a failing grade in the sleep department!
  • Teens slept an average of 8 hours and 24 minutes on the weekend. They had an average of about 2 1/2 hours of “catch-up” sleep to restore their debt.
  • Teens who had increased hours of catch-up sleep on the weekend had more errors on tasks that required their attention.
  • More, they found that increased sleep debt predicted poorer performance on tasks demanding attention more than the number of hours of sleep a child got each night during the week.

So asking kids about sleep debt is a good start. It may be a flare that a child will have a harder time in school during the week than we knew. And that they are at risk for other consequences of sleep deprivation.

The solution? You tell me. How do we make sleep enticing enough for teens (eclipsing phone, friends, homework, TV viewing) so that they prioritize 8-9 hours each night? How do we do this ourselves?