Teens, Stress and Sleep

Cindy Lopez:
Welcome to Voices of Compassion, CHC’s podcast series providing courage, connection and compassion, highlighting topics that matter to our community, our parents, families, educators and other professionals. My name is Cindy Lopez, and today we’re talking teens, stress and sleep. Lack of sleep is a pattern with teens, especially now. We all know that sleep is important to stay healthy, both physically and mentally and teens face many challenges in getting consistent restorative sleep and one of those is stress. So how does stress impact sleep and how can that be addressed with your teen? Is it just developmental or something more? Listen in to this podcast episode today as we talk with two CHC experts, Dr. Joan Baran clinical director at CHC and Deepika Bose, doctoral psychology intern, about teens, stress and sleep and strategies you can use to support your teen on this essential topic. Welcome Joan and Deepika. I’m just wondering before we get started is there anything you might want to share with our listeners?

Deepika Bose, MS:
In preparation for talking about sleep, I’ve really been thinking a lot about how parents talk about sleep since the very beginning of when their kids are born. People talk about how’s your baby sleeping and so even from when your child is a newborn you realize how important sleep is I’ve been thinking a lot about sleep as a graduate student in my training over the last couple of years, just seeing how much of an issue it’s come up with several of my clients of all ages so I’m just really excited to talk about this topic with everyone today.

Joan Baran, PhD:
And hopefully we won’t put anybody to sleep.

Cindy Lopez:
As we get started in our conversation, lack of sleep is a widespread pattern among teens right now among everyone let’s just say, but our focus today is really teens so why is that and what does the data say about that?

Deepika Bose, MS:
Sleep problems in teens and all ages too has been a really long standing issue that really seems to be getting worse in some ways over the last couple of years since the onset of the pandemic. So the American Academy of Sleep Medicine actually recommends that teens between the ages of 13 to 18 years old sleep between 8 to 10 hours a night, but there are reports that up to 70 to 75% of teens actually sleep less than 8 hours per night, and so this is a major issue because we know that sleep has a profound impact on physical, social and emotional wellbeing, as well as on academic performance. And so when we look at the data, it tells us that there really are multiple reasons why sleep problems happen in teens. Some of it has to do with typical developmental and biological changes that teens have. So we know that the onset of puberty triggers a delayed sleep phase, so teens naturally fall asleep and want to wake up at later times.

And we also know that there are a lot of social changes that happen in the teen years. So teens get to go to sleep later as a result of decreased parental monitoring and so with that decreased parental monitoring, they might use that extra time for screen time at night, whether it’s you know watching movies, chatting with friends, being on social media. And also another issue is that they experienced a lot of increased academic demands and extracurricular activities. So several of the clients that I’ve worked with have said that they want to sleep more and that they wish that they had more sleep, but by the time that they come home from extracurricular activities and finish all their homework, it’s already 1 or 2 am. And then of course there’s the issue of stress and anxiety, which I know is one of the primary topics of this podcast. And we know that stress and anxiety is really closely related to, and can cause sometimes, difficulty falling and staying asleep. And so when we take all of these factors into account and add the demands that teens have to wake up early, because of for example early school start times that really causes a lot of sleep problems for them and so teens don’t end up getting enough sleep or they have poor sleep quality.

Joan Baran, PhD:
I think as you’ve been talking Deepika, some of the things I’ve been thinking about or what our kids are saying is that sometimes staying up late is the only time the house is quiet and during the pandemic you know, a lot of kids have said they stay up late, it’s quiet and they actually have privacy. So, I mean, there are other dynamics at play and obviously even before the pandemic started, this was an issue, right. This is where you had school districts saying let’s start school later because we know that developmentally kids tend to stay up later anyway. So, I really like how you said some of this is typical and some of it has been exacerbated by the pandemic.

Deepika Bose, MS:
Yeah absolutely, and with the pandemic, it was a lot of other things that were subtle and not so subtle about how it impacted sleep. You know, teens were getting less exercise, they had less exposure to sun because they were indoors all day long. And we know that sun is important for regulating sleep cycles. There was also increased opportunities for daytime napping. So I had some clients say that they would take naps during their free periods, which I thought was interesting too.

I think the other concern parents are expressing is that they, as well as their teen, knows how important sleep is but at the same time they are knowing that they’re not getting enough and possibly like you said because they’re just not getting as much activity so they’re not physically as tired either.

Cindy Lopez:
So you both see teens and families in your practices, and I’m wondering what you’re hearing from teens themselves? What are they saying right now about their sleep?

Deepika Bose, MS:
So I think the common theme that I hear among the teens that I’ve been working with is simply that they wish that they were getting more sleep. I sense this sort of motivation to sleep more, but kind of almost as Joan was alluding to a little bit earlier this kind of hopelessness in terms of you know that’s the only time that I get privacy and quiet and it’s hard to meet all the demands of being a teenager and school on top of everything, but the good news is, is that there are strategies and once we can talk to them about the strategies that can help encourage and promote healthy sleep we do see a lot of benefits to that.

Cindy Lopez:
Yeah it’s interesting that the teens themselves are saying they’re not getting enough sleep, that they’re aware of that. So it does indicate that it is a problem, right, and I’m wondering also what we’re hearing from parents, what do parents tell you they’re observing in their teens right now regarding sleep?

Joan Baran, PhD:
I would say parents are saying first of all, they’re really not quite sure how much of sleep their kids are getting. So I’ll ask a parent and they’ll say, “to be honest, I really don’t know, because usually I’m going to sleep before my teen.” How they really know is that, they may be getting ready for work and their teen is still asleep and the teen will just appear either withdrawn or sleepy or irritable, and obviously you have siblings who are sometimes complaining as well.

Cindy Lopez:
Just a note before we continue on with today’s episode, we hope you’re following us on social media, so you don’t need to wait a whole week between episodes to get engaging, inspiring and educational content from CHC. Our social handles are linked on our podcast webpage at podcasts.chconline.org.

Going back to that idea of how stress impacts our sleep could you talk a little bit about how stress and sleep are related?

Deepika Bose, MS:
So stress is very closely related to sleep problems in teens because when we experience stress we often experience worry thoughts, right? So things like, what if I failed the test in school or what if other kids make fun of me during my class presentation, will I get sick or my loved ones be okay? Things like that and when we have these types of worries and thoughts that can really activate a stress response in our body that’s on a biological level and then that leads to increased arousal. So things like a faster heartbeat, faster breathing, you know, our body’s going into fight or flight and so of course being in fight or flight is really incompatible for sleep because sleep is a time when we want to relax our bodies and have our body systems calm down.

Joan Baran, PhD:
I actually had some kids who say they’re having a hard time falling asleep, and they’re worried about having a hard time falling asleep that it kind of becomes this cycle for them.

Deepika Bose, MS:
Absolutely.

Cindy Lopez:
I know I do that myself. So, thinking about this issue of stress and sleep among teens, how can we help them with that? How do we address those issues?

Deepika Bose, MS:
Yeah, there are several strategies for addressing what people kind of refer to as sleep hygiene in teenagers and so to address the sleep problems, initially, we would start off by doing a brief assessment of what might be getting in the way of getting a good night’s sleep for that particular teen and then we’d offer certain recommendations that kind fit the bill for that teen specifically. And so I can go through some of these sleep strategies, there are several, and it might seem overwhelming, but you know parents and teens who are listening can maybe pick a few that might be easier to start with or are the most relevant to them that maybe they would think is the most helpful.

The first is kind of nighttime strategies, so things we can do at night and so one is creating a wind down routine. So that could be something like reading a book, taking a warm bath or shower, listening to relaxing music, reading and also considering a media curfew, which is a little bit of a harder buy-in for some of our teens, but we do know that if we turn off screens at a certain time that can help prepare a body for sleep. Another thing is a lights out queue, so kind of selecting a time prior to the targeted bedtime. So it could be 15 minutes, 30 minutes beforehand when you decrease light exposure and that’s because this triggers biological reactions in our body, like the production of a hormone melatonin, which then helps the body prepare for falling asleep.

Another thing is to use the bed primarily for the purposes of sleep so that the bed becomes automatically associated with sleep and not with staying awake. There are also several daytime strategies that we can do and so like I mentioned the lights out cue for bedtime. In the morning time, we can have the lights on cue because we know that exposure to light can help reduce feelings of sleepiness and fatigue throughout the day. It can also be really helpful to have a brisk wake up routine. And this is something that personally I struggle with a little bit, but that involves avoiding hitting the snooze button because the faster we get up, the faster we can get rid of something called sleep inertia and that really refers to that kind of groggy feeling we experience when we first wake up. And so a brisk wake-up routine might involve you know washing our face with cold water or doing something active soon after waking up. We also recommend that teens avoid taking naps as much as possible and if it’s not possible to avoid taking naps, then to make sure that they’re short so 20 minutes or less and early. So trying not to nap anytime after 4:00 pm and then of course to restrict caffeine later on in the afternoon, we briefly mentioned before how, you know, physical activity can be really good for promoting sleep and then also maintaining a consistent sleep schedule. So really keeping a fixed wake-up time every single day and trying not to adjust more than two hours on the weekend because if we sort of catch up on our sleep, like a lot of people say on the weekends and sleep in more than it’s harder to fall back asleep and get back into our routine by the weeknights.

Joan Baran, PhD:
One of the things that you’re talking about is you’re really making yourself more aware about what are different things that you are doing, or certain behaviors that you need to use in order to get ready for sleep, as well as when you wake up. Do you ever encourage kids to keep like a sleep log or to really monitor their sleep? Do you find that to be helpful to make people more aware of maybe either what they’re doing or what they need in order to have a good night’s sleep?

Deepika Bose, MS:
Yes, absolutely. I do highly recommend monitoring and logging and we can call it a sleep diary and they have plenty of templates online that are available for free, which are really great, that I use with a lot of the clients that I work with as an initial step before we can figure out what strategies we’re going to implement, because then we can see where the issue really lies.

Cindy Lopez:
Deepika, I know that you have additional strategies for thinking about what teens can do, what parents can do to support their kids around stress and sleep.

Deepika Bose, MS:
So specifically in the context of stress and sleep, we recommend practicing relaxation strategies as part of the wind down routine. And so some of the relaxation strategies can be things like slow controlled breathing, which could mean counting your inhalations through the nose, kind of holding for a pause and then breathing out through the mouth for a few seconds. It could also be something that we call progressive muscle relaxation, where we take our muscles and squeeze them and then release them and we can do that starting from our feet and move all the way up to our face and then it could be other things like listening to calming music and some people like to listen to guided meditations and so that might be something else that they could try. Another sort of less commonly known strategy that I learned about from one of my supervisors is something called savoring or switching and so savoring is defined as the ability to attend, to appreciate and enhance positive experiences through anticipation, engagement and reminiscing. And what that really means in this context is that to think of pleasant or positive experiences that are either real or made up in replacement of worry thoughts so that the body can feel relaxed instead of feeling aroused at nighttime. And this strategy doesn’t always work right away when kids and teens that I’ve worked with have tried it, but with repeated practice, it can be really helpful in reducing stress and anxiety around bedtime.

Cindy Lopez:
Well, that’s really interesting that savoring and switching thing, and I think I do that sometimes, try and think of pleasant and positive experiences, you know, and to kind of tune out the stress. So, and I know all of these strategies are great, nighttime strategies, daytime strategies, these strategies related to stress. I’m wondering if you have a story or two that you might want to share, like how this really works in real life?

Deepika Bose, MS:
So at the beginning of the pandemic, I saw a lot of teens who were struggling with sleep issues. And one case that comes to mind is a 14 year old girl who had significant issues falling asleep at night and it was mostly because of stress related things, so worries about uncertainty of the future, worries about her health and safety of both herself and loved ones and she would often go to bed at night, really thinking about these issues. So anytime I do a sleep phase intervention, I always start off with having teens complete a sleep diary in order to monitor how much sleep they’re getting, you know, how many times they wake up in the middle of the night and what additional factors including stress might be contributing to their sleep problems. And so based on the sleep diary that she completed, it became clear that the worry thoughts were really what was contributing to her difficulties falling asleep, and she often napped during the day to compensate for her daytime sleepiness and then that also made it hard for her to then fall asleep by bedtime. And so when I worked with her, I presented all of the sleep strategies to her and really emphasized three. So the first was to decrease that daytime napping, and I recommended that she do some physical activity when she felt sleepy after her remote school. The second thing was I worked with her and her mom to develop a personalized, relaxing and calming wind down routine. And the third thing that we really worked on was that savoring switching technique that I was talking about earlier. And so for the savoring activity, I asked her to think about a time she felt really happy, it could be a favorite memory or an accomplishment or an imaginary situation she looks forward to. So she really liked Disney so I suggested, you know, thinking about her next trip to Disney. And she quickly said that her favorite memory was the day that she brought her puppy home. She really loved her dog and so then I had her talk about that and write down the memory in as much detail as possible, really trying to activate all five senses when she was recalling the event. You know so asking her what the scene looked like, what color she remembered, what did it physically feel like to hold her dog or her puppy for the first time? Could you recall any smells, sounds, things like that. And then once you wrote that all down, I asked her to recall that memory at night, right before bedtime, after she did the nighttime relaxation activity. And so she followed all of those recommendations, including resisting the urge to nap after school, which increased her sleepiness at night and then she practiced the wind down routine initially with her mom, then by herself and practiced the savoring activity before sleep. And so within, you know, one or two weeks of consistent daily practice, she did end up noticing major improvements in her sleep over time.

Joan Baran, PhD:
You know, what I love about that story Deepika is it really shows the power of therapy. It shows about how you identify what the issue is. You work directly with the teen and the teen comes up with, you know, what’s my goal and then you try an intervention, get feedback about how the intervention is working and then you tailor it from there. It’s just such a great example of how a teen working with a therapist, because we all know sometimes it’s easier to work with a therapist, right, who can help you come up with different strategies and then work together to come up with such a successful outcome.

Cindy Lopez:
That’s a great example and just thinking about therapy too, we do have lots of teen therapists at CHC and if you’re interested in checking that out, please visit us at chconline.org and there’s a lot of teletherapy going on now, too. So you don’t have to be here in person to do that. So as we wrap up and think about sleep and stress and teens, like what are the big takeaways that you want for our listeners today?

Joan Baran, PhD:
When we started we talked about how even from when your child is a baby, you are talking about sleep and it’s only because it’s so important about how sleep can impact your mood, your motivation and how you perform and that it’s so important, there are definitely strategies that you can use regardless of age, in order to make sleep better.

Deepika Bose, MS:
We know that sleep is important. It’s been problematic before the pandemic, during the pandemic it’s gotten worse, but there are asleep strategies that can be really helpful and with support and with therapy, even teens have improved their sleep a lot and so there’s every hope that by practicing some of these strategies that your teen sleep can improve drastically.

Joan Baran, PhD:
I hear you talking about what a success story you had with therapy and it brings to mind that there are times when I’ve worked with teens where we have tried interventions, and we are not finding the success that we had expected. And so, the teen has returned to their pediatrician and we’ve actually had sleep studies done to find out if there’s a biological piece to the teen’s difficulties with sleep and so that’s always important to kind of keep in the back of our minds as well.

Cindy Lopez:
Thank you so much, Joan and Deepika for joining us today and talking about this really important topic, especially right now, teens and sleep and stress. It’s all part of their lives right now, and I really appreciate your insights and expertise, and I know that our listeners do too. Thank you for joining us and we hope that you will tune in again next week.

Find us online at podcasts.chconline.org. Also, please follow us on our socials. Find us on Facebook at chc.paloalto and Twitter and Instagram at CHC_paloalto. You can also visit our YouTube channel at chconlinepaloalto. And we are on LinkedIn. Subscribe to Voices of Compassion on Apple podcasts, Spotify and other podcast apps, and sign up for a virtual village email list so you never miss an update or an episode. I always love to hear from you so send me an email or a voice memo at podcasts@chconline.org or leave us a rating and review. We look forward to you tuning in each week