Adolescent Sleep and Mental Health

Primarily focusing on optimising sleep and mental health in young people, Dr Cele Richardson has dedicated her efforts to developing ground-breaking therapies for sleep disorders, notably Delayed Sleep-Wake Phase Disorder and pediatric insomnia. 

A clinical psychologist and lecturer in the School of Psychological Science at the University of Western Australia, she has extended her expertise to implement these therapies among diverse populations, including adolescents grappling with depression.

To find out more about how a better night's sleep can assist your overall health and wellbeing visit www.sleep.hif.com.au

Transcript

00:00
HIF acknowledges the traditional owners and custodians of the land on which this podcast is produced. We pay our respects to Elders, past, present and emerging, and to all Aboriginal and Torres Strait Islander peoples. The following episode contains general information and discussion about sleep treatments and advice and is intended for informational purposes.

00:24
More often actually it's the case that sleep problems precede the onset of things like depression in adolescents. So sleep is a really important risk factor for mental health problems in this developmental stage. And importantly, sleep is seen as one of the only kind of factors, risk factors for mental health problems that young people can actually modify themselves. Welcome to Sleep Easy with HAF. I'm your host, Guy Rawlinson.

00:54
And in this episode, we speak with Dr. Cele Richardson, a clinical psychologist and lecturer in the School of Psychological Science at the University of Western Australia. Dr. Richardson's research primarily focuses on optimizing sleep and mental health in young people, and she's dedicated her efforts to developing groundbreaking therapies for sleep disorders, notably delayed sleep-wake phase disorder and pediatric insomnia.

01:21
More recently, she's extended her expertise to implement these therapies among diverse populations, including adolescents grappling with depression. Dr. Celia Richardson, welcome, and thanks for joining us on Sleep Easy with HIV. Thanks so much for having me. I'm so happy to be here. Before we dive into our conversation, I have to ask, did you get a good night's sleep last night?

01:49
Now I typically do, I'm a wonderful sleeper usually, but I have to admit that our eight-year-old Greyhound Brady did wake me up at about 2.30 this morning to let him back in from outside. So yeah, it took me a couple of hours to get back to sleep last night. So I'm running on a little bit less sleep today than I'm used to. Because while it's important that we as adults do try to get some good shut eye, it's even more important for adolescents and young adults,

02:18
that they might be facing, right? Yeah, definitely. I guess our teenage years are a time where we're grappling with lots of different changes, new found autonomy. And at the same time, I guess teenagers are going through a lot of physiological kind of changes as well that mean that they need good quality sleep, but often a lot of teenagers aren't kind of getting the amount of sleep that they need. Now, firstly, I mentioned in the introduction that one of the important components of the work that you're doing

02:47
is in the field of delayed sleep-wake phase disorder. What is that? Yeah, it's a pretty long, complicated name for a sleep disorder, isn't it? My PhD actually focused on the sleep disorder, and I think even at the end of my PhD, my parents still couldn't remember the name of the disorder. So yeah, it's kind of a great pleasure to, I guess, try and increase understanding about what this disorder is amongst the wider population. It's a circadian rhythm sleep disorder that is quite common in

03:16
adolescents. Basically what it's characterized is by a delay in our underlying circadian rhythm or our body clock, which means that there's this misalignment between when young people or when people in general want to be able to sleep and when their body is kind of telling them that they need to sleep. Typically how this looks is a lot of people with DSPD will report difficulty falling asleep or the inability to fall asleep until quite a late clock time. And then because they're

03:43
body clock is delayed, they want to sleep in and have incredible difficulty getting up in the morning at a time that they need to to be able to go to school and work, for example. So usually there's a delay of about two hours or more of their body clock compared to when they ideally need to be sleeping. Now, correct me if I'm wrong, but I read quite recently that adolescents are the most chronically sleep-restricted subpopulation in both Western and Eastern societies.

04:11
And as a group, collectively at least, sleeping too late and too little. Is that, is that true? Yes, that is true. So I think, I mean, across the lifespan, particularly even in adulthood, I guess there are a lot of adults who are not getting the sleep that they need. Um, but in, in particular, adolescence, a particular, at particular risk of, of poor sleep, and this is because there is this normative trend for body clock timing or circadian rhythms to delay from the onset of puberty into sort of early adulthood.

04:40
But of course, daytime commitments don't change when we're teenagers. We still need to get up and get to school at quite an early time. And so particularly during the school week or the work week, there is this kind of trend where teenagers are going to bed late, they want to sleep in, but they're not able to because they have school. And so they're kind of falling asleep late and not getting enough sleep. So what are the stats or more likely the general consensus around

05:06
how many hours the average teenager, if there is such a thing as an average teenager, should get in terms of sleep per night. Now, how does this compare with say, a typical adult? So the National Sleep Foundation does have some guidelines for the amount of sleep we should be sort of aiming for and they have norms right across the lifespan.

05:26
For teenagers, they do recommend that teenagers get between 8 to 10 hours of sleep. But there is some recommendation that a little bit less than that might be okay for some teenagers. They might feel good and function well on a little bit less sleep. And of course, there are some teenagers who have a slightly longer sleep need, say needing up to about 11 hours of sleep to feel good and function well during the day. In terms of how much sleep teenagers are actually getting, there was a meta-analysis done, which basically...

05:53
pulls together data from all of the studies that have been done in this area to look at how much sleep adolescents are actually getting. And this meta-analysis showed that particularly on school nights, the vast majority of those studies found that teenagers were getting less than that recommended eight hours of sleep. And there were also some really interesting patterns in terms of how much sleep adolescents were getting in different regions of the world as well. So the teenagers who tended to get the least sleep were actually in the United States, they got about.

06:22
7.46 hours of sleep on school nights. Then we had our kind of Asian teenagers who were getting about 7.64 hours of sleep. And teenagers over in Europe are actually getting the most at about 8.44 hours of sleep on average. And so we think, particularly in the US, the earlier school start times that they have were contributing to

06:43
I guess them having the least sleep around the globe. And there's some interesting kind of cultural aspects, I guess in Asian countries where there's quite a high pressure to perform well academically. And so we think that teenagers in that region of the world are sort of sacrificing sleep so that they can perform well at school. Does this also correlate with say, developing brain needs and how does that compare when you reach adulthood?

07:07
So I guess adolescents are still developing quite a lot in terms of, I guess, developing their brain and going through a lot of kind of physical development. So high quality sleep is really important at that stage of the lifespan. There have been some studies to actually, I guess, statistically model how much sleep adolescents do need, of course, from those guidelines, we know somewhere between sort of eight to 10 hours, but there have been some studies that have been done looking at how much sleep you need to optimize your mood and to optimize your cognitive performance in adolescence.

07:37
And both of those two separate studies came up with a similar sort of number at about 9 and a quarter hours of sleep. So they found that that amount of sleep was the optimal amount of sleep on average for teenagers to kind of perform the best cognitively and to feel best during the day as well. Importantly, and particularly from, I guess, your point of view, are there any physical and mental health implications?

08:04
which can arise in adolescents due to irregular sleep patterns or simply a lack of sleep. Yeah, so sleep, I guess, affects every aspect of our functioning. So as you can imagine, the impacts of not getting enough sleep are really pervasive kind of across the board. We know in teenagers, if they're not getting optimal sleep, then they're at an increased risk of experiencing mental health problems and having difficulty socializing.

08:28
The effects also extend to our physical health. So if you're not sleeping well, you have an increased risk of experiencing things like obesity and cardiovascular disease. Importantly for teenagers, there is a link between worse sleep and worse academic outcomes. So we think that this is possibly through the effect that sleep has on cognitive functioning, but it might also be the case that if teenagers aren't sleeping well, they're getting to school late, maybe missing out on content or not getting to school at all.

08:55
And finally, I guess the teenage years are where we're kind of trying to push the boundaries and see where the limits are and things like that. And worse sleep in adolescence is also linked to increased risk-taking behaviour like drug and alcohol use and risky driving as well. So if I could turn for a moment to that relationship between sleep issues and adolescent depression, risk-taking. It's an area you obviously have a passion for.

09:23
specifically, is it common for sleep problems to proceed the onset of adolescent anxiety or depression? And if so, what are the factors that contribute to that relationship? Yes, definitely. So I guess we've come from this kind of point of view where sleep problems were seen as a symptom of other mental health problems. So they sort of seen as secondary to depression and anxiety. But we're now learning that I guess they are two separate problems and often it's the case.

09:50
More often, actually, it's the case that sleep problems precede the onset of things like depression in, in adolescents. So sleep is, is a really important risk factor for mental health problems in this developmental stage. And importantly, sleep is seen as one of the only kind of factors, risk factors for mental health problems that young people can actually modify themselves. So there's a variety of different mechanisms that might explain why sleep problems mean that you're more likely to experience.

10:18
mental health problems. So like I said earlier, there's a link with, you know, difficulty socializing, difficulties with, you know, cognitive functioning and executive functioning. One area that I'm particularly interested in is the role of repetitive negative thinking. So there's this idea that

10:35
As teenagers, you know, their body clocks drift later, maybe they start having difficulties falling asleep. And what we think happens is that they're kind of lying awake for, you know, sometimes hours on end, they're in a dark environment, it's quiet and they can't help but have repetitive negative thoughts kind of come to their mind. You know, thinking about what didn't go so well that day, worrying about things that you've got to do the next day. And repetitive negative thinking is quite a robust risk factor for mental health problems like depression and anxiety.

11:04
So I've actually conducted a study in this area recently as part of the raw project, the risk to adolescent wellbeing project. In this project, we had about 500 young people that we followed up every year and we've followed them up for about seven years now. But for this particular study, I looked at the first six years of that data. And what we found was that sleep problems in the teenage years predict increases in repetitive negative thinking a year later.

11:30
And that repetitive negative thinking predicts increases in symptoms of depression, generalized anxiety, social anxiety, but also eating disorder pathology as well. So that explains some of the relationship there, but there was still a direct relationship between sleep problems and mental health problems. So part of my work will be to try and work out what other mechanisms might be going on there as well. This episode of Sleep Easy with HIV is brought to you by the Health Insurance Fund of Australia.

11:59
What if your health insurer gave you the freedom to choose? I'm certain that many parents can relate to the experiences with their teenagers' sleep routines. So what are some of the signs then of teenage sleep problems that parents should probably be looking out for? So generally what we're interested in looking at, whether people perceive a difficulty falling asleep or returning to sleep during the night.

12:25
There are some kind of quantitative cutoffs we can use as a bit of a rule of thumb there. So for example, if you're taking regularly more than half an hour to fall asleep at the start of the night, or you're regularly spending more than 30 minutes awake across the night, that might be a bit of an indication that there is a sleep problem there. For a sleep problem to be diagnosed, we...

12:45
I guess we need to kind of see these sleep problems being around at least three days a week and it needs to be kind of chronic enough. So for example, that sleep problem needs to have been around for about three months. I guess the other thing related to delayed sleep wake phase disorder is that it might be a bit more of a, the problem is the timing of sleep. So it might be the case that the young person is falling asleep really late and they want to kind of sleep in and that's the primary problem.

13:12
Beyond, I guess, just looking at what sleep looks like at the night time, though, another important thing to consider is how you're functioning during the day. So if your young person is reporting a lot of daytime sleepiness and a lot of fatigue, for example, that might be another cue that they're experiencing a sleep problem. So how do the needs of adolescents in terms of sleep differ from, say, younger children or even older adults? And

13:40
What are the factors that contributed to these differences? I mean, as our brains and emotional maturity develop, do we see a change in our sleep patterns? So I guess based on those sleep guidelines that I mentioned earlier, there is this general trend where teenagers are expected to need less sleep than younger children. And then as we go into our adult years, we can expect to get kind of less sleep as we go on.

14:05
I guess that study that I mentioned earlier though, that suggested that teenagers need about 9.25 hours of sleep to function optimally, maybe suggests that actually maybe teenagers don't need that much less sleep than their younger counterparts. But I do recognize, like you said, that there's a huge individual difference there as well. So, so yeah, different people differ in the amount of sleep that they need. One thing I guess we've spoken about is that age is one of these factors that that affect how much sleep that we need.

14:34
And this is because as we go through development, we kind of get better at dealing with extended wakefulness. Obviously infants are not very good at handling extended wakefulness. So that's why they sleep a lot during the day. And as we kind of develop, we get better at dealing with being awake for longer periods of time. So age is a factor that contributes to how much sleep we need. There's likely a

14:55
kind of genetic component to that as well. And there are sort of behavioral factors as well. So I guess depending how active you are during the day. Yeah, for example, if you're really active like an athlete, perhaps you need a bit more sleep than somebody who is a little bit less active or more sedentary during the day as well. And a big question of course is technology. And when it comes to technology usage, such as smartphones and computers, what approaches

15:21
from where you stand can be adopted to lessen these impacts because more often it's about the content as much as the device itself, right? Or is it a combination of both? Yeah, so there was a sort of theory of factors that were thought to link technology use with worse sleep, particularly in young people. There's this thought that it might be the lights that's coming from the devices that might be harmful. It might be the case that I guess the content that we're engaging in is just so interesting that we inadvertently...

15:49
go to bed later and so we're kind of displacing our sleep. And there's also this idea that in terms of the content, it might be, you know, really exciting and just prevent the normal de-arousal processes that happen in our body, uh, with the literature where it is at the moment, I guess we're moving away from light being the kind of primary thing that's harmful about devices and it seems like it, it perhaps is more about the content that we're engaging with that.

16:16
Yeah, it might mean that we go to bed later and inadvertently then cut our sleep opportunity short, or it might be that the content is, you know, making us feel really anxious and things like that. And then that has a detrimental impact upon sleep. With some of my research though, I guess it's kind of challenged this uni-directional relationship that that's often kind of spoken about, that it's technology that affects sleep.

16:40
And again, in the raw project that I was working on, I set out to look at the bi-directional relationship because there's, I guess, increasing appreciation now that perhaps young people might be using technology as a bit of a sleep aid or a way to kind of cope with sleep loss.

16:57
particularly as body clock is kind of drifting later. And if your bedtime kind of doesn't change, then you might be going to bed much earlier, then you feel physiologically ready for sleep. And so teenagers might be kind of filling in that time by using technology, or it might be a way for them to kind of regulate their emotions. And so what that study showed was that yes, there was a relationship there with if teenagers got less sleep, then they tended to, or if they use more technology, sorry, they tended to get less sleep over time.

17:26
But I also showed that teenagers who had more of that evening preference and those that were sleepy tended to then increase their technology use over time. So that did provide some of the first evidence that there is this kind of, I guess, symbiotic, bi-directional relationship between technology use and sleep. So I guess for parents, I would recommend not just having a blanket kind of rule around technology use and maybe having an open kind of conversation with your young person about what it is that

17:54
what function that technology use is playing, is that technology use, you know, aiming to kind of, for them to regulate their emotions and to kind of fill in in time, and then kind of set some kind of limits around that. It might be setting some limits around the kind of content that they're engaging with, but it might also be kind of switching out one form of technology for another. So for example, there doesn't seem to be a relationship at all between TV use and worse outcomes in terms of sleep.

18:24
So maybe it might be, you know, the closer that you get towards sleep, you might kind of pop the phone down, have a stop time for your mobile phone, pop it on the charger and not look at it again. And then you can switch to watching TV or something that's a little bit more of a kind of passive activity. Does that include things like gaming as well, which is obviously very, very big at the moment.

18:44
So the relationship between gaming and sleep again is quite a complicated one. And this isn't an area that I have particular expertise in, but it does depend a little bit upon, you know, whether you're a habitual gamer or whether it's something that's kind of new to you, I guess, for how long you're playing at the types of games and the kind of content that you're engaging with as well. So I would recommend again, that parents just have

19:08
quite a non-judgmental kind of open conversation about whether that's an activity that's really kind of winding their teenager up and preventing sleep, or whether it is something that helps them to kind of de-arouse and regulate their emotions and things like that. So overall, as a takeout for parents and teenagers that are listening, what are some of the top tips you would offer? Yeah.

19:30
So the first thing that I would recommend would be to have a really regular sleep schedule. So that means having really regular bedtimes and wake up times. And unfortunately for teenagers, this means having a regular wake up time even on weekends. I guess there's this desire to kind of catch up on sleep and sleep in on weekends. But if we sleep in on weekends, this means that our eyes are closed for longer and are not exposed to light.

19:54
And this means that we're not resetting our body clock. And so even over, you know, a weekend of sleep ins, this can mean that our body clock kind of drifts later again. And therefore, particularly on Sunday night, when you need to get ready to go to school, it can be incredibly difficult to fall asleep on that, that, that night. So my first tip would be just to have really regular sleep timing on weekdays and weekends.

20:17
Because the body needs time to, I guess, physiologically de-errows and for your mind to kind of quieten and de-errows as well, I would recommend having some wind down time before bed, ideally having a bit of a bedtime routine and doing activities that are gradually getting you into that state that's ready for sleep. I guess if you are having difficulty falling asleep or returning to sleep during the night, rather than lying there awake for long periods of time, which I've described can lead to

20:44
repetitive negative thinking and can lead to people feeling a lot more wound up and really anxious about their sleep. I would recommend that maybe they get out of bed for a short period of time, grab a blanket, sit in a chair, do a little bit of reading until you feel ready to try and sleep again and then get back into bed at that point. And I guess these kind of things can be described as sort of healthy sleep practices. The more that you engage in these kind of activities, the better it is for your sleep.

21:11
But if you do have a kind of diagnosable sleep problem, these healthy sleep practices can only go so far. And so what I would recommend to families is that if they've tried these things and you're still experiencing a sleep problem to actually seek out professional help, so I am a kind of sleep psychologist. We have really effective sleep treatments that work in just a couple of weeks. And so I would recommend that you kind of take that step, maybe discuss the kind of sleep symptoms with a GP and then get a referral.

21:40
to a sleep psychologist such as myself. There is help out there and we do have really effective treatments. Dr. Celie Richardson, thank you for your expertise and personal insights, but also to your four legged alarm clock Brady for taking the time from your busy schedules to join us on Sleep Easy with HIV. Thanks so much. It's been a pleasure.

22:02
The content provided on this podcast is not intended as a substitute for professional medical advice, diagnosis or treatment. If you have any sleep related concerns or questions, we encourage you to seek advice from a licensed healthcare professional or sleep specialist based on your specific circumstances.