Dr. Ronald Green joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about teens and sleep.
Read the transcript of Dr. Green's talk with Health Matters radio or listen here
Health Matters: Before we get started my question was about Daylight Saving Time I always seem to be a little messed up. What messes your sleep up more, the fall back or spring forward?
Dr. Green: Oh, that's a great question, and I think really the spring forward is what's gonna mess your sleep up more. We are able to stay up later easier than we are to go to bed earlier because of our biological clocks, the way it works. By staying up, by the change in the light and the change in the time, it makes it a bit harder for us to fall asleep. We have kind of a double whammy here in the Northwest, because I really enjoy this time of year, because it's lighter later and later and later...
Dr. Green: As that's happening, then all of a sudden the clock shifts as well, and so it ends up being light even later. The biggest alerting factor in our lives is daylight. It makes it more challenging for us to fall sleep if it's light out, and so it's getting lighter later and that's what makes it more difficult. Then, on the other end of things, as well, with the longer days here in the Northwest as we get more towards summer, we're talking daylight, what, 4:30-5:00 in the morning, and if you don't have blackout curtains, that's gonna wake you up early as well.
Health Matters: It always kind of throws your biorhythms off. Talk about biorhythms. How do they affect our ability to gain that sleep or that need?
Dr. Green: We have an internal clock, our circadian rhythm. Circadian, circa, approximately, dian means day, and so we all have an internal clock. Actually, every organism on the planet from one cell to us has an internal clock, and that clock helps regulate different processes in our body, and the biggest contributor to that regulation is the sun. So the clock that we have in our brains is this little bitty part of the brain called the hypothalamus. It's this little bitty nucleus called the suprachiasmatic nucleus.
Dr. Green: But, the take home message is that there is an internal clock that we have and that clock tells us when we should wake up in the morning and it tells us when we should go to bed at night, and it helps keep us awake during the day and helps regulate our processes. There's a very prevalent theory that has been accepted in the sleep community. It's called the dual process theory of sleep. There are two processes going on. Number one: This sounds pretty obvious, but I will say it anyway. The longer you're awake, the sleepier you get.
Dr. Green: If, the longer you're awake the sleepier you get, then how can you stay awake when you're up for 12-14 hours by 8 or 9 o'clock at night? The reason you can stay awake is because that little internal clock volume starts getting turned up around 5:00 or 6:00 in the evening, and so that dip in alertness that we all have normally during the day at about 4 o'clock is because we've been awake so long that we're getting sleepy, but the volume of that wakefulness from our clock is still turned down, and then it starts getting turned up louder and louder and louder, and that's what helps us stay awake in the late evening. And then, when that volume drops off at our bedtime, we fall asleep quickly. Now, that is what leads to a lot of sleep disorder problems, especially insomnia in adolescents, in teenagers. When teenagers go through puberty, when they mature, that clock goes from wanting to go to sleep about 9 pm to wanting to go to sleep at about 11 pm. That clock is delayed. And, what's happening exactly as that's occurring? They are going into high school, they're having more after school activities, they're having more homework, they're having more socialization, and, they have to get up early for school.
Health Matters: And, they're always tired.
Dr. Green: Exactly.
Health Matters: Whenever I ask my children, my teenage children, what's going on, it’s “I'm tired, dad.” Are they, is that just natural?
Dr. Green: No, it's not, and that is because of the biological clock problem...which leads to chronic sleep deprivation, chronic insufficient sleep. Teenagers from about the age of 13 to 20 need nine hours of sleep a night. And, the average teenager in this country is getting about seven or 7½ hours. Now, it's very easy to slam the teenagers, "Oh, you're socializing, you're on the Internet all the time, you're playing video games," but there's a lot in our society that is pushing against that including the early school start times and the brain shifting to wanting to stay up later. So, mom and dad are trying to get you to bed at 9 o'clock and your brain is not ready to sleep until 11:00, so you lay in bed awake for this time and then you get yelled at for that. And then, mom and dad try to drive you out of bed at 5:00, 5:30, 6:00 in the morning for school when your brain is saying, "I don't want to wake up until 8:00 or 9:00." Now, the important thing about this is that the wake time is what sets the internal clock.
Dr. Green: I'll say that again. The wake time is what sets the internal clock. So, if your internal clock wants to get up late and you do that one night a week, one morning a week, let's say Sunday morning, right? You want to sleep in, you're a teenager, you sleep in until 11:00 or noon, that's your wake time. That's the time in your brain it is set for waking up. So, let's take noon and let's subtract 9 hours from that, right? That's the time that you want to go to sleep. So, a teenager that's doing that is going to want to get to sleep at 1:00 in the morning and their parents are trying to get them to sleep at 9:00. It does not work.
Health Matters: So, what you're saying, that one day, that Sunday where they sleep until noon, cause they do...basically throws their biorhythms off or that rhythm, that sleep rhythm of alertness and sleepiness, for the next period.
Dr. Green: So, think about rewarding the clock. If you reward the clock where the clock wants to be, the clock is stuck at that place. And, your brain doesn't know if it's Saturday night or if it's Tuesday night. That's what you're dealing with. Now, the thing I was just talking about with our internal clock and our sleepiness that happens during the day that builds up slowly at about 4:00 in the afternoon is our maximum sleepiness. However, when that clock turns on and starts getting loud, our maximum awakeness during the day is around 7:00 or 8:00 at night.
Dr. Green: We call that the wake promoting zone. If you have a normal rhythm, get to bed about 10:00 - 10:30 at night, try taking a nap at 8:00 in the evening or 7:30. You can't do it. So, take that and apply it to a teenager's brain. Let's say the teenager's normal biological sleep time is midnight?
Dr. Green: If you're telling them to go to bed at 9 pm, 9:30 pm, that is in the middle of their most alert time of day.
Health Matters: Peak alertness.
Dr. Green: They're not gonna sleep.
Health Matters: When you deal with adolescents, when do these kids wake up? If they're going to school in that zero period, first period, and they have calculus or physics, some of these, you know, high intense classes, can you tell by their grades or how they're doing in early morning classes?
Dr. Green: There are studies that show that kids that are chronically sleep deprived do not do as well in school. There is more truancy, they have lower grades, and there are more behavior problems. They actually went into the Minneapolis, St. Paul School District and did a delayed school start time study. They started school about 9:00 in the morning. The kids did better, they were absent less in the morning classes, and the behavior problems at school dropped off.
Health Matters: Then, why doesn't school start at 9:00 all over?
Dr. Green: Very good question.
Dr. Green: The optimum thing would be for younger kids who want to go to bed early and get up early to start school early, and the older kids who want to stay up late and get up late start school late.
Health Matters: It's the other way around, isn't it?
Dr. Green: It is exactly the other way around. And, it has to do with bussing and after school activities.
Health Matters: Right.
Dr. Green: And parents push back. So, we are in a societal situation where we are setting our teenagers up for failure because there's evidence that if you have chronic sleep deprivation you basically metabolically look like a diabetic. You have trouble processing sugar, your blood pressure is higher, and your brain doesn't work as well. You have increased risk of depression.
Health Matters: And, what about the, you know the kids these days with their energy drinks…It's a vicious cycle. What does caffeine thrown into this do?
Dr. Green: Caffeine makes it worse.
Dr. Green: If you use caffeine strategically it can actually help you, as in, what we call a counter measure. But, the problem is that it lasts about 4-6 hours. So, if you're trying to crash in the evening and you drink some caffeine, you're gonna stay awake longer and you're not gonna be able to fall asleep, so it works, actually, against you. Really, one of the best countermeasures for sleepiness in a teenager who is chronically sleep deprived is taking a 30-45 minute nap after school, actually. That's a really good way to wake yourself up. If you get a little bit of sleep, you can still sleep at night. Because, the thing about sleep is that the longer you're awake, like I said, the sleepier you get. That builds up as a straight line during the day. When you sleep, that sleepiness that's built up as a straight line slowly falls off exponentially, very, very rapidly. So, if you take a very long nap, that sleepiness that's built up all day is gonna go away and you're not gonna be able to sleep.
Health Matters: We're talking with Dr. Ronald Green from The Everett Clinic. Let me ask you a question. I always hear, you know, "I couldn't go to sleep." This is my life. I'll wake up like at 2 o'clock in the morning and just be wide awake, thinking of stuff, and get horrible sleep, and normally, back in the day, I could react quicker. Nowadays, at 56 years old, it kind of kills me for two days. Why is that?
Dr. Green: Your brain just is not as resilient as it used to be.
Health Matters: Can you ever catch up your sleep?
Dr. Green: You can catch up your sleep.
Dr. Green: There's a concept called sleep debt. There's a concept called sleep debt. Basically, it's like thinking about a checking account. The more money you put into the checking account the more money you can take out. However, if you take out too much money you're at a negative. But, if you put back a little bit, but not enough, you're still negative. What happens in sleep debt is that, let's say you biologically need 7½ hours of sleep a night, you're getting 6½ night after night after night, so, for 5 days of the work week you're down one hour a day, so you're down five hours of sleep. The weekend, you sleep eight hours two nights. "Woo hoo, I'm sleeping eight hours. This is great. Why am I still so sleepy?" You're still down by three hours, and that builds up over time.
Dr. Green: You build up a sleep debt.
Health Matters: As a country, I think Americans have the largest sleep debt of any other nation.
Dr. Green: We do. It's very, very difficult to get enough sleep. I treat all kinds of different sleep disorders, and my patients, my coworkers, my family, my friends, we are all saying the same things in this country. We have too much on our plates, there is too much asked of us, and what gives is your sleep. Now, I will say this about sleep, and this is a nice little thing to think about. You can go longer without eating or drinking than you can without sleeping.
Health Matters: You bring up a good point. What’s the purpose of sleep for the body. Why do you need sleep?
Dr. Green: That is such an incredible question that humanity has been asking for thousands of years. The answer is: we're not quite sure. If you were to have asked me that question 15 years ago, I would have said, "I have no idea. Nobody knows." However, we have some very interesting brain science that's been going on in the past 10 years to really come to light as to what's going on with this, and there have been some very interesting experiments about learning, and memory, and sleep. Sleep serves a lot of purposes. It's way beyond just shutting down and resting, because the brain is quite active during sleep.
Dr. Green: There's some very good evidence now that when we sleep our memories and our brains are shifting from more short-term memory to intermediate and longer-term memory. If you think of it in computer senses, the RAM is moving out and it's moving into different parts, and there have been some fascinating experiments, especially in Harvard, where they've done an experiment where they teach somebody something and then eight hours later they test them on that. Eight hours of wake. They teach somebody something and then eight hours later they retest, after a night of sleep. And, the people that have slept on it have better recall of what they've learned than the people who don't, wake versus sleep, and there have been all kinds of experiments that way. It's getting to the point now where the really brilliant neuroscientists are being able to tease out dreaming sleep and non-dreaming sleep and the memory that's laid down in both of them, and really kind of teasing that out. So, that's one big process that's going on. The other process is basically our metabolic, endocrinology, our glands are working well, repairing out bodies during sleep. What’s an organism like a human, like us, do when we're sick? We sleep.
Health Matters: Sleep.
Dr. Green: Sleep causes repair of the body. You take people who are chronically sleep deprived and have, let's say, obstructive sleep apnea or insomnia for whatever reason, and you look at their inflammation in their body by drawing their blood and looking at different markers, they are sky high.
Health Matters: More susceptible to those chronic illnesses.
Dr. Green: More susceptible to chronic illnesses, exactly. Our cancer surveillance doesn't work right if we're sleep deprived. There was a huge study, the Nurse's Health Study that looked at nurses working night shift versus nurses working day shift. Higher incidence of breast cancer in nurses working night shift than nurses working day shift.
Health Matters: Wow, interesting. What can a parent do with an adolescent that has sleep problems?
Dr. Green: They can talk to their pediatrician about it to begin with, if there's a lot of problem, and, if not, you can go to the National Sleep Foundation website, and read about healthy sleep in teens.
Health Matters: Good. Healthy sleep in teens. I'm going to go there.
Health Matters: Dr. Ron Green, thanks so much. You have to come back on with us. It's just fascinating stuff. From The Everett Clinic, everettclinic.com is where you'll get more information. There's all kinds of information out there to help you sleep.