By: Amrita Rehal
In recent years, sleep disruptions
and insufficient sleep have been implicated in the development of a multitude
of metabolic disorders.1 It is becoming clear that enough sleep, and
well-timed sleep for that matter, are extremely important in maintaining
optimal energy removal and usage from food throughout the 24-hour circadian
day. As more attention is turned to disparities in sleep health amongst a variety
of populations, the difficulties faced by vulnerable and marginalized
populations are being illuminated. One of the most overlooked of these populations
is adolescents.
The adolescent transition marks a time
of great change for young people, as they undergo puberty and transition into
high school, encountering numerous biological and psychological changes. One of
these major changes occurs in their sleep habits.2 There is a well-established
two-process model of sleep regulation that involves a homeostatic Process S which
depends on sleep/wake patterns and a circadian Process C that depends on the 24-hour
internal clock. Both processes undergo developmental changes during adolescence,
as teens experience a circadian phase delay. This means that they exhibit an
evening preference that causes them to desire significantly later bed and rise
times. A slowing of Process S also occurs in adolescence, causing sleep
pressure to build up much slower. Sleep pressure increases as one remains awake
and dissipates as one sleeps. Developmental delays to the homeostatic sleep and
wake cycle results in a much later sleep onset and the newfound ability to stay
awake longer in adolescence. This is because sleep pressure is not as powerful
at night for adolescents.3 This biological shift, for which the reasons
are not yet well understood, contributes to circadian misalignment in teens. It
is defined as a mismatch between one’s sleep/wake schedule and their internal
body clock timing.
Adolescents in the United States
regularly experience circadian misalignment due to the extremely early high
school start times being a huge constraint to their sleep. Recent media articles have come to focus upon these issues more as research in this area is
becoming more recognized.4 Teens in the U.S. are often waking up between
5:30am and 6:30am to get to school. Although developmental delays to bed and
wake times cause adolescents to prefer later sleep and wake times, they are
forced have an earlier wake time than their Processes C and S would
biologically initiate.2 The circadian misalignment that these teens
experience has been implicated in mental health problems, emotional
dysregulation, poor school attendance and performance, and even physical problems
such as metabolic disorders.
The early school start times of
adolescents in the U.S. are contributing to circadian misalignment, leading to the
metabolic disorder known as insulin resistance. Insulin resistance occurs when
cells stop responding to insulin, which causes less blood glucose to be taken
up into cells. This results in tonic high levels of blood glucose and excess
insulin production. Type 2 diabetes eventually results when the body can no
longer keep up with the insulin demands, causing obesity amongst other
long-term issues, such as sleep apnea, heart disease, stroke, or heart attack.
It has been established that less sleep occurring during a person’s biological
night results in correlates of insulin resistance.5 Adolescents
sleep very little during their biological night and are often awake and sitting
in classrooms during it.
It remains of dire importance to
examine potential treatments or interventions to improve sleep quality in
adolescents. These could include policy changes to delay school start times and
educational programs to improve sleep hygiene.4 Many great research
labs are focusing on the widespread effects of ill-timed and poor sleep habits.1,6
Hopefully, soon, policy makers and researchers can work hand-in-hand to
establish better guidelines for vulnerable populations in the U.S., helping
improve sleep timing for our youth so they aren’t vulnerable to metabolic
disorders such as insulin resistance.
Works Cited:
(1) Fishbein, A. B., Knutson, K. L., & Zee, P. C.
(2021). Circadian disruption and human health. The Journal of clinical
investigation, 131(19).
(2) Crowley, S. J., Acebo, C., & Carskadon, M. A.
(2007). Sleep, circadian rhythms, and delayed phase in adolescence. Sleep
medicine, 8(6), 602-612.
(3) Crowley, S. J., Wolfson, A. R., Tarokh, L., &
Carskadon, M. A. (2018). An update on adolescent sleep: New evidence informing
the perfect storm model. Journal of adolescence, 67,
55-65.
(4) Kinney, M., & Hopkins, K. (2023, February 28). Adjusting
to later school start times is good for overall Adolescent Health. Courier
Journal. Retrieved March 3, 2023, from https://www.courier-journal.com/story/opinion/2023/02/28/why-adjusting-to-later-school-start-times-is-better-adolescent-health/69950023007/
(5) Simon, S. L., Behn, C. D., Cree-Green, M., Kaar, J. L.,
Pyle, L., Hawkins, S. M., ... & Nadeau, K. J. (2019). Too late and not
enough: school year sleep duration, timing, and circadian misalignment are
associated with reduced insulin sensitivity in adolescents with
overweight/obesity. The Journal of pediatrics, 205,
257-264.
(6) Poe, A. R., Zhu, L., McClanahan, P. D., Szuperak, M.,
Anafi, R. C., Thum, A. S., ... & Kayser, M. S. (2022). Developmental
emergence of sleep rhythms enables long-term memory capabilities in
Drosophila. bioRxiv, 2022-02.