Dr Oluwatosin Olorunmoteni, a consultant paediatrician at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, in this report with SADE OGUNTOLA speaks on the importance of sleep, particularly to the health of adolescents and why sleep hygiene is vital to Nigerians.
ADOLESCENTS frequently experience a range of sleep problems that can significantly impact their physical and mental health. Why is this so?
The period of adolescence is a time of significant developmental changes. During adolescence, there are changes in body shape, body functions and emotions linked to pubertal development. Research has shown that significant changes in sleep regulation also occur during puberty. Also, sleep problems have been reported to occur in many adolescents worldwide. These sleep problems can result in adverse mental and physical impacts such as mood and anxiety disorders, depression and behavioural disorders.
There are multiple factors responsible for sleep problems in adolescents. One factor is the biological changes in the processes that regulate sleep from the period of pubertal onset. As a result, adolescents tend to feel sleepy later than usual (physiological phase delay) and often need to wake up later than usual. Also, there are social and environmental factors that can contribute to poor sleep in adolescents.
During adolescence, many parents relax their control of their child’s bedtime, such that the adolescents may sleep late without a check. Access to electronic devices such as phones and televisions provides an alternative to sleep, especially at night.
Furthermore, the pressure of schoolwork, after-school lessons and homework contributes to delayed bedtime in adolescents. Unfortunately, an early school start time, such as what is obtainable in Nigeria, results in an early wake time and a resultant short total sleep time (sleep duration). Aside from problems with sleep quantity, adolescents may also have problems with the quality of their sleep, its timing and its regularity. These sleep problems may be associated with poor physical and mental health outcomes.
Sleep health and mental health have been reported to have a bi-directional relationship. Many mental health disturbances have sleep disturbance as a component of their symptoms, and sleep problems could also be an early pointer to the existence of a mental health disorder. Conversely, sleep disturbances can result in mental health problems. Furthermore, poor sleep may be associated with physical impacts such as poor growth and development, high blood pressure and poor hormone functions.
Hence, poor sleep in adolescents can adversely affect their overall wellbeing.
In Nigeria, what is the most common sleep problem, particularly in adolescents?
The most common sleep problem among adolescents is insufficient sleep duration. Studies have shown that many adolescents sleep less than the recommended 8.5 to 9.25 hours due to later bedtimes and early wake-up times for school. Hence, sleep insufficiency is very common among adolescents, especially during weekdays due to school-related demands and technology use. Poor electricity access in rural communities compared to urban communities and rural adolescents having to perform chores or do early farm work may contribute to late bedtimes.
What is the burden of sleep problems in Nigeria, particularly in adolescents?
The burden of sleep problems in Nigeria, especially in ado-lescents, has been reported to be high. Studies indicate that a high proportion of in-school adolescents experience insufficient sleep, with 44.4 per cent having short sleep durations during the weekdays due to school-related demands, poor quality sleep, excessive daytime sleepiness and risk of sleep apnoea, which may be the result of excessive homework, early school start times and nighttime use of electronic devices at bedtime.
The few questionnaire-based studies available showed the prevalence of sleep insufficiency and problems in Nigerian adolescents to be between 16.4 and 60.8 per cent in a study. A recent publication among rural and urban in-school adolescents, which used an objective method of sleep measurement called actigraphy, found a higher burden of short sleep duration and higher daytime sleepiness among urban adolescents, while rural adolescents had poorer quality (efficiency) of their sleep with frequent night awakenings. There is a need for more research using objective sleep measurements like actigraphy and polys-omnography among Nigerian adolescents.
It is said that many adolescents experience a natural shift in their circadian rhythms, resulting in later bedtimes and wake times. Can you explain?
The natural shift in the circadian rhythm of adolescents may be due to factors that are intrinsic or extrinsic to the adolescent. The intrinsic factors include puberty-related changes and delayed melatonin production contributing to a physiologic delay in bed-time. The extrinsic factors are external factors such as social, academic and environmental factors that play a significant role in the individual’s sleep habits. It has also been said that the natural shift adolescents tend to have in their circadian rhythm tends to worsen with an increase in their age, with a resultant worsening of delayed bedtime and shorter sleep duration as they have to wake up early to meet school demands.
What are the contributing factors to sleeping problems in adolescents?
The contributing factors to sleep problems in adolescents include biological factors, which include circadian rhythm shift during puberty; social factors, which can be at the individual, family, environment and school levels; and the individual fac-tors, which include poor sleep hygiene, such as caffeine intake close to bedtime, substance abuse, irregular sleeping patterns, academic pressure, poor mental health, extracurricular activities and part-time jobs.
Other factors include technology use, which includes excessive use of electronic devices before bedtime, a significant individu-al-level factor because of its increasing burden in our environ-ment, and family factors include the lack of parental supervision over bedtime routines, irregular sleeping patterns in the parents, poor adolescent-parent relationships, violence in the family and bed-sharing.
Sleeping problems could also arise from environmental factors which include artificial light exposure, poor electricity in urban communities, environmental noise (especially from the noise of generators), and poor sleeping conditions in rural settings. Thus, there are urban-rural disparities in the environmental factors that can affect the sleep of the adolescents.
School-related factors include a heavy school schedule which includes early school start times and late school end times; especially with prolonged after-school classes, this can also predispose one to sleeping problems.
How can parents, teachers, and school authorities support such adolescents to ensure sleep hygiene?
Parents can ensure healthy sleep hygiene by encouraging a consistent sleep schedule, limiting screen time, especially before bed, discouraging the use of stimulants such as caffeine and substance abuse (discouraging the use of drugs to sleep or keep awake) and creating a good and conducive sleep environment.
Teachers can also ensure sleep hygiene by reducing homework loads and also advocate for later school start times. School authorities can also implement policies to delay school start times and encourage an earlier school closing time, as well as a reduction in after-school lessons till late in the evening, which all contribute to late bedtimes. The school authorities can also educate students and their parents on the importance of sleep.
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What are the common sleep disorders that affect adolescents?
The common disorders in adolescents include insomnia, which is the difficulty falling or staying asleep, resulting from a shift in the circadian rhythm causing late sleep and wake times; sleep apnoea, which is interrupted breathing during sleep; and excessive daytime sleepiness, often resulting from prolonged sleep deprivation, though a few adolescents also have excessive daytime sleepiness from narcolepsy.
It is important to emphasise that untreated sleep disorders can result in lower quality of life and comorbidities such as hypertension and diabetes in the adolescents. Recent research has shown that adolescents with sleep disturbances can develop the risk factors of chronic, non-communicable diseases like hypertension and diabetes early in life. Hence, it is important to prevent sleep problems in adolescents.
What is the recommended amount of sleep for adolescents, and what are the consequences of sleep deprivation?
The recommended amount of sleep for adolescents is 8.5 to 9.25 hours per night. Consequences of sleep deprivation include cognitive impairments, which include reduced attention, poor memory and poor academic performance; mental health issues such as an increased risk of depression, anxiety and mood swings; physical health problems such as a higher risk of obesity, diabetes and cardiovascular issues; and behavioural problems such as vulnerability to illicit drugs, accidents and risky behaviour.
How do biological changes during adolescence influence sleep patterns?
Biological changes during adolescence, such as puberty-re-lated hormonal shifts and a decrease in melatonin release. which causes a phase delay in circadian rhythms. This shift makes adolescents feel more alert in the evening and sleepier in the morning, leading to later bedtimes and wake times.
Why is it important to increase awareness about sleep problems in adolescents?
It is important to increase awareness about sleep problems in adolescents because of the increasing burden globally and especially in Nigeria. Awareness about sleep problems is crucial because poor sleep can have significant negative impacts on their physical health and mental health, academic performance, which also affects cognitive functions, behavioural risk such as substance abuse, and long-term health consequences such as hypertension, diabetes, and metabolic dysfunction. Awareness also educates adolescents about the importance of sleep hy-giene, and the consequences of sleep deprivation can lead to better sleep practices and improved well-being.