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Burning More Than the Midnight Oil:
Sleep Deprivation in Teens
Burning More Than the Midnight Oil:
Sleep Deprivation in Teens
Produced by the Alabama Department of Public HealthVideo Communications and Distance Learning DivisionProduced by the Alabama Department of Public HealthVideo Communications and Distance Learning Division
Satellite Conference and Live WebcastTuesday, May 5, 2015
1:00 – 2:30 pm Central Time
Satellite Conference and Live WebcastTuesday, May 5, 2015
1:00 – 2:30 pm Central Time
FacultyFaculty
Mary Halsey Maddox, MDAssistant Professor
Division of Pulmonaryand Sleep Medicine
Mary Halsey Maddox, MDAssistant Professor
Division of Pulmonaryand Sleep Medicineand Sleep Medicine
Department of PediatricsUniversity of Alabama at Birmingham
and Sleep MedicineDepartment of Pediatrics
University of Alabama at Birmingham
Outline - Sleep Deprivation in Teens
Outline - Sleep Deprivation in Teens
• Is it a problem?
• What’s the physiology?
• What can we do?
• Is it a problem?
• What’s the physiology?
• What can we do?• What can we do?• What can we do?
Sleep in Teens TodaySleep in Teens Today
Coffee won’t help. I’m just not a
morning person.
Amount of Sleep the Child Needs As Estimated by the Parent
Amount of Sleep the Child Needs As Estimated by the Parent
2014 Sleep in America Poll2014 Sleep in America Poll
Sleep Duration on School Nights by Age Group
Sleep Duration on School Nights by Age Group
2014 Sleep in America Poll2014 Sleep in America Poll
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Sleep in Teens TodayIdeal Sleep Time
Sleep in Teens TodayIdeal Sleep Time
Consequences of Sleep Deprivation
Does it really matter?
Consequences of Sleep Deprivation
Does it really matter?
Sleep DeprivationAdults
Sleep DeprivationAdults
Sleep Deprivation Sleep Deprivation
leep
ines
sle
epin
ess
Cumulative sleep lossCumulative sleep loss
While neurobehavioral deficitWhile neurobehavioral deficit increases, increases, subjective sleepiness may plateausubjective sleepiness may plateau
Su
bje
ctiv
e S
Su
bje
ctiv
e S
OMG…Maybe Resident Work Hours Are Good?OMG…Maybe Resident Work Hours Are Good?
NYT 2008NYT 2008
Sleep Deprivation Sleep Deprivation
leep
ines
sle
epin
ess
Cumulative sleep lossCumulative sleep loss
While neurobehavioral deficit increases, While neurobehavioral deficit increases, subjective sleepiness may plateausubjective sleepiness may plateau
Su
bje
ctiv
e S
Su
bje
ctiv
e S
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Sleep DeprivationSleep Deprivation
• This is your brain• This is your brain • This is your brain
without sleep
• This is your brain
without sleep
Sleep DeprivationSleep Deprivation
• Brain with sleep• Brain with sleep • Brain without sleep• Brain without sleep
Sleep DeprivationSleep Deprivation
• This is your brain• This is your brain • This is your brain
without sleep
• This is your brain
without sleep
Sleep DeprivationSleep Deprivation
• Brain with sleep• Brain with sleep • Brain without sleep• Brain without sleep
Sleep DeprivationTeens
Sleep DeprivationTeens
HealthHealthHealthHealth
BehaviorBehaviorBehaviorBehaviorSportsSportsSportsSports BehaviorBehaviorBehaviorBehavior
SafetySafetySafetySafetyAcademicsAcademicsAcademicsAcademics
SportsSportsSportsSports
Sleep DeprivationPhysical Health
Sleep DeprivationPhysical Health
• Increased cardiometabolic risk
• Increased obesity
• Increased purging, fasting and diet pills
• Increased cardiometabolic risk
• Increased obesity
• Increased purging, fasting and diet pillsIncreased purging, fasting and diet pills
• Increased IBS
Increased purging, fasting and diet pills
• Increased IBS
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Sleep DeprivationPhysical Health
Sleep DeprivationPhysical Health
• Decreased growth
• Increased neurologic problems
(seizure, headache)
• Decreased growth
• Increased neurologic problems
(seizure, headache)
Sleep DeprivationMental Health
Sleep DeprivationMental Health
• Increased depression
• Increased anxiety
• Increased suicidality
• Increased depression
• Increased anxiety
• Increased suicidality• Increased suicidality
• Increased suicide attempts
• Decreased impulse control
• Increased suicidality
• Increased suicide attempts
• Decreased impulse control
Sleep DeprivationMental Health
Sleep DeprivationMental Health
• Higher Kessler Psychological
Distress score
• Lower self esteem
• Higher Kessler Psychological
Distress score
• Lower self esteem
Sleep Deprivation - SafetyRisk Taking Behavior
Sleep Deprivation - SafetyRisk Taking Behavior
• Delinquency
– Property (stealing)
– Violence (fighting)
• Delinquency
– Property (stealing)
– Violence (fighting)– Violence (fighting)
• Impulse control
• Sensation seeking (Thrill seeking)
– Violence (fighting)
• Impulse control
• Sensation seeking (Thrill seeking)
Sleep Deprivation - SafetyRisk Taking Behavior
Sleep Deprivation - SafetyRisk Taking Behavior
• Increased drunk driving
• Increased substance abuse
– Alcohol binge drinking
• Increased drunk driving
• Increased substance abuse
– Alcohol binge drinkingAlcohol, binge drinking,
cigarettes, marijuana
– Caffeine – Early, heavy use may
lead to other drugs
Alcohol, binge drinking,
cigarettes, marijuana
– Caffeine – Early, heavy use may
lead to other drugs
Sleep DeprivationSafety
Sleep DeprivationSafety
• Injury
– Double the unintentional injury risk
– Nearly double the pedestrian injury
• Injury
– Double the unintentional injury risk
– Nearly double the pedestrian injury– Nearly double the pedestrian injury
risk (virtual)
– Nearly double the pedestrian injury
risk (virtual)
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Sleep DeprivationSafety
Sleep DeprivationSafety
• Motor Vehicle Crashes
– Increased number of crashes
– Increased chance of numerous
• Motor Vehicle Crashes
– Increased number of crashes
– Increased chance of numerous– Increased chance of numerous
crashes
– Increased “run off the road”
crashes
– Increased chance of numerous
crashes
– Increased “run off the road”
crashes
Sleep Deprivation - SafetyDrowsy Driving
Sleep Deprivation - SafetyDrowsy Driving
• 1% of all motor vehicle crashes;
4% of crashes involving fatality
• Drivers under 25 years involved in
• 1% of all motor vehicle crashes;
4% of crashes involving fatality
• Drivers under 25 years involved in y
>50% of police - report fatigue -
related traffic crashes each year
y
>50% of police - report fatigue -
related traffic crashes each year
Sleep Deprivation - SafetyDrowsy Driving
Sleep Deprivation - SafetyDrowsy Driving
• NSF poll:
– 68% of HS seniors have driven
while drowsy;
• NSF poll:
– 68% of HS seniors have driven
while drowsy;y
– 15% at least 1 time per week
• Impairments related to sleep loss
equal or greater than those due to
alcohol intoxication
y
– 15% at least 1 time per week
• Impairments related to sleep loss
equal or greater than those due to
alcohol intoxication
Sleep Deprivation
SafetyDrowsy
Sleep Deprivation
SafetyDrowsyDrowsyDrivingDrowsyDriving
Drowsy Driving What About Alabama?
Drowsy Driving What About Alabama?
• 3.4% of people in Alabama report
falling asleep driving during the
preceding 30 days (CDC 2010)
• 3.4% of people in Alabama report
falling asleep driving during the
preceding 30 days (CDC 2010)
Drowsy Driving What About Alabama?
Drowsy Driving What About Alabama?
• No laws or license restrictions
regarding drowsy driving
• No requirement for doctors to report
• No laws or license restrictions
regarding drowsy driving
• No requirement for doctors to report q p
sleep disorders
• No drowsy driving info part of
driver’s education
q p
sleep disorders
• No drowsy driving info part of
driver’s education
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Sleep DeprivationAcademics
Sleep DeprivationAcademics
• Multiple studies show that decreased
sleep duration is associated with
lower academic achievement
• Multiple studies show that decreased
sleep duration is associated with
lower academic achievement
Sleep DeprivationAcademics
Sleep DeprivationAcademics
• National Science Foundation Poll
– 28% fall asleep in school at least 1x/week
– 22% fall asleep doing homework
• National Science Foundation Poll
– 28% fall asleep in school at least 1x/week
– 22% fall asleep doing homework
– “A” students
• Sleep 15 minutes more than B students
• Sleep 26 minutes more than C students
• Sleep 36 minutes more than D student
– “A” students
• Sleep 15 minutes more than B students
• Sleep 26 minutes more than C students
• Sleep 36 minutes more than D student
Minute Variability vs. GradesMinute Variability vs. Grades
30
40
50
60
Weekday TST
A/B (n=1238)
B/C (n=1371)
C/D (n=390)
D/F (n=61)0
10
20
30Bed Times
P<0.0001
Sleep DeprivationSports
Sleep DeprivationSports
• Slowing of psychomotor vigilance
(athletes)
• Decreased performance
• Slowing of psychomotor vigilance
(athletes)
• Decreased performance
– Accuracy
– Consistency
– Accuracy
– Consistency
Sleep DeprivationSports
Sleep DeprivationSports
• Conversely – Increasing sleep time
increases consistency, accuracy,
and psychomotor vigilance
• Conversely – Increasing sleep time
increases consistency, accuracy,
and psychomotor vigilance
Sleep DeprivationSports Psychomotor Vigilance
Sleep DeprivationSports Psychomotor Vigilance
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Sleep DeprivationSports PerformanceSleep Deprivation
Sports PerformanceTennis players serving accuracy before and after Tennis players serving accuracy before and after
3 days of sleep restriction3 days of sleep restriction
Sleep Extension - SportsSleep Extension - Sports
Sleep in Teens Today –A Reminder
Reported Amounts
Sleep in Teens Today –A Reminder
Reported Amounts
Sleep Deprivation in TeensIs it a Problem?
Sleep Deprivation in TeensIs it a Problem?
Sleep
SleepDebt
SleepDebt
SleepDebt
YES!
SleepDebt
The Science of SleepThe Science of Sleep
The New YorkerThe New Yorker
“I dreamed I got 8 hours of sleep.”
Science of SleepWhy Do We Need Sleep?
Science of SleepWhy Do We Need Sleep?
• To remember
• To react
• To regulate (Heal)
• To remember
• To react
• To regulate (Heal)• To regulate (Heal)• To regulate (Heal)
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Science of SleepTo Remember
Science of SleepTo Remember
Science of SleepTo Remember
Science of SleepTo Remember
Science of SleepTo React (Emotional Control)
Science of SleepTo React (Emotional Control)
• Sleep - deprived volunteers viewed
emotional images
– Increased response of the
• Sleep - deprived volunteers viewed
emotional images
– Increased response of the
Science of SleepTo React (Emotional Control)
Science of SleepTo React (Emotional Control)
p
“emotional brain” (amygdala)
– Weaker connection amygdala –
PFC = less emotional control
p
“emotional brain” (amygdala)
– Weaker connection amygdala –
PFC = less emotional control
Science of SleepTo Regulate
Science of SleepTo Regulate
• Numerous studies demonstrate sleep
is necessary to mediate health
– Ghrelin and Leptin
• Numerous studies demonstrate sleep
is necessary to mediate health
– Ghrelin and Leptin
– Interleukins and Cytokines
– Insulin and Cortisol
– Cardiovascular function
– Cell reproduction (Cancer)
– Interleukins and Cytokines
– Insulin and Cortisol
– Cardiovascular function
– Cell reproduction (Cancer)
Science of SleepScience of Sleep• Process S (Homeostatic Process)
• Process C (Circadian Process)
• Process S (Homeostatic Process)
• Process C (Circadian Process)
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Science of SleepIt Changes
Science of SleepIt Changes
• Sleep need decreases through life
• Newborns Toddlers School
Age Teens Adults
• Sleep need decreases through life
• Newborns Toddlers School
Age Teens Adultsgg
Science of SleepIt Changes
Science of SleepIt Changes
• Our bodies will only stay
awake so long
• Our bodies will only stay
awake so long
Science of Teen SleepScience of Teen Sleep• Process S requires
more hours awake
to cause sleepiness
• Process C
• Process S requires
more hours awake
to cause sleepiness
• Process C
demonstrates a
natural delay in
melatonin release
demonstrates a
natural delay in
melatonin release
Science of Teen SleepDelay in Melatonin
Science of Teen SleepDelay in Melatonin
Physiology of Teen Sleep Delay in Melatonin
Physiology of Teen Sleep Delay in Melatonin
• Species manifesting Juvenile Phase Delay
– Homo sapiens (humans)
– Macca mulatta (Rhesus monkeys)
• Species manifesting Juvenile Phase Delay
– Homo sapiens (humans)
– Macca mulatta (Rhesus monkeys)( y )
– Octodon degus (degu) [some ?]
( y )
– Octodon degus (degu) [some ?]
Physiology of Teen Sleep Delay in Melatonin
Physiology of Teen Sleep Delay in Melatonin
– Rattus norvegicus (laboratory rat)
– Mus musculus (laboratory mouse)
– Psammomys obesus (fat sand rat)
– Rattus norvegicus (laboratory rat)
– Mus musculus (laboratory mouse)
– Psammomys obesus (fat sand rat)y ( )y ( )
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Physiology of Teen SleepDelay in Sleep Phase Observed Worldwide
Physiology of Teen SleepDelay in Sleep Phase Observed Worldwide
• 6 Continents –• 6 Continents –
Developed and
Undeveloped
Countries
Developed and
Undeveloped
Countries
Teen Sleep –The Perfect Storm
Teen Sleep –The Perfect Storm
Physiology +
Environment
Physiology +
Environment
Circadian MisalignmentCircadian Misalignment
• Teens are biologically programmed
to go to sleep after 11:00 pm
• Teens are biologically programmed
to go to sleep after 11:00 pm
Science of Teen SleepPhysiology
Science of Teen SleepPhysiology
• Likewise, teens are biologically
programmed to wake up after 8:00 am
• Likewise, teens are biologically
programmed to wake up after 8:00 am
Science of Teen SleepPhysiology
Science of Teen SleepPhysiology
Science of Teen SleepEnvironment
Science of Teen SleepEnvironment
“Tommy can’t play now, but he might be able to squeeze you in between soccer and his piano lesson.”
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Science of Teen SleepEnvironment
Science of Teen SleepEnvironment
• School start times
• Sports
• Extracurricular activities
• School start times
• Sports
• Extracurricular activities• Extracurricular activities
• Jobs
• Bus schedules
• Social commitments
• Extracurricular activities
• Jobs
• Bus schedules
• Social commitments
Science of Teen SleepEnvironment
Science of Teen SleepEnvironment
• ELECTRONICS and the
24 HOUR SOCIETY
• ELECTRONICS and the
24 HOUR SOCIETY
Proportion of Parents with No Formal Rules for 6
Behaviors by Age Group
Proportion of Parents with No Formal Rules for 6
Behaviors by Age Group
Science of Teen Sleep “Sleep Regulation”
Science of Teen Sleep “Sleep Regulation”
SleepSleep
HomeostaticSleep DriveHomeostaticSleep Drive
S h lS h l
< 7 hours
12p12p 6p6p 12a12a 6 am6 am
SleepSleep
6a6a
CircadianWake DriveCircadian
Wake Drive
AlertnessLevel
AlertnessLevel
SchoolSchool
Science of Teen SleepWeekend Make-up SleepScience of Teen Sleep
Weekend Make-up Sleep• Discrepancy between weekday and
weekend bedtime / wake-up
associated with learning deficits
• Discrepancy between weekday and
weekend bedtime / wake-up
associated with learning deficits
and behavior problems
• Results in greater difficulty sleeping
on Sunday night
and behavior problems
• Results in greater difficulty sleeping
on Sunday night
Science of Teen SleepWeekend Make-up SleepScience of Teen Sleep
Weekend Make-up Sleep• Leads to a permanent “Jet Lag”
– Can last days – 1 day for every
time zone crossed
• Leads to a permanent “Jet Lag”
– Can last days – 1 day for every
time zone crossed
– GI problems, fatigue, somnolence,
depressed mood
– GI problems, fatigue, somnolence,
depressed mood
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Physiology of Teen SleepIdeal Sleep Time
Physiology of Teen SleepIdeal Sleep Time Physiology
+Environment
Physiology +
Environment
Circadian MisalignmentSleep Deprivation
Circadian MisalignmentSleep Deprivation
So What Can We Do?So What Can We Do?• Educate
• Advocate
• Educate
• Advocate
What Can We Do?What Can We Do?• Educate
– Importance of bedtimes
• Kids without parent set bedtimes
sleep 30 minutes LESS a night
• Educate
– Importance of bedtimes
• Kids without parent set bedtimes
sleep 30 minutes LESS a nightsleep 30 minutes LESS a night
than kids with set bedtimes
sleep 30 minutes LESS a night
than kids with set bedtimes
What Can We Do?What Can We Do?• Educate
– Impact of electronic devices
• Kids with electronics in their
bedrooms sleep 30 minutes
• Educate
– Impact of electronic devices
• Kids with electronics in their
bedrooms sleep 30 minutesbedrooms sleep 30 minutes
LESS a night than kids without
electronics
bedrooms sleep 30 minutes
LESS a night than kids without
electronics
What Can We Do?What Can We Do?• Educate
– Importance of schedule
and limit - setting
• Schedules should be maintained
• Educate
– Importance of schedule
and limit - setting
• Schedules should be maintained• Schedules should be maintained
on weekends to avoid weekend
oversleep and social “jet lag”
• Schedules should be maintained
on weekends to avoid weekend
oversleep and social “jet lag”
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What Can We Do?What Can We Do?• Advocate
– Drowsy driving
• http://sleepfoundation.org/
drowsy driving advocacy
• Advocate
– Drowsy driving
• http://sleepfoundation.org/
drowsy driving advocacydrowsy-driving-advocacy
• Drowsy driving education
in drivers education
– Delayed school start times
(AAP Statement)
drowsy-driving-advocacy
• Drowsy driving education
in drivers education
– Delayed school start times
(AAP Statement)
AAP StatementAAP Statement
AAP StatementHighlights
AAP StatementHighlights
• Teens in the United States are
chronically sleep deprived, yet
physiologically they cannot go to
• Teens in the United States are
chronically sleep deprived, yet
physiologically they cannot go to
sleep routinely before 11:00 pm and
cannot wake routinely before 8:00 am
sleep routinely before 11:00 pm and
cannot wake routinely before 8:00 am
AAP StatementHighlights
AAP StatementHighlights
• Sleep deprivation negatively
impacts learning, mood, behavior,
safety and health
• Sleep deprivation negatively
impacts learning, mood, behavior,
safety and health
• Junior High and High Schools
should not start before 8:30 am
• Junior High and High Schools
should not start before 8:30 am
Supporting DataDelayed School Start /
Quantity of Sleep
Supporting DataDelayed School Start /
Quantity of Sleep
Supporting DataSleep Time in Teens
Supporting DataSleep Time in Teens
5050
6060
7070
Percent of teens getting >8 hours sleep Percent of teens getting >8 hours sleep at various school timesat various school times
00
1010
2020
3030
4040
7:307:30 7:357:35 8:008:00 8:008:00 8:058:05 8:208:20 8:358:35 8:358:35 8:358:35 8:558:55
Series1Series1
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Supporting DataTeen Mood Improvements
Supporting DataTeen Mood Improvements
PARENTS overwhelmingly reported their TEENS were
easier to live with
Supporting DataAcademic Improvements
Supporting DataAcademic Improvements
Supporting DataMotor Vehicle Crashes
Supporting DataMotor Vehicle Crashes
• Decreased crash rates
in several districts
– 16% (Kentucky)
• Decreased crash rates
in several districts
– 16% (Kentucky)
– 65% (Minnesota)
– 70% (Wyoming)
– 65% (Minnesota)
– 70% (Wyoming)
In Conclusion…a Word From Ben Stein
In Conclusion…a Word From Ben Stein
“Sleep makes people calmer, more
alert, less fearful – just plain happier,
or so I see around me and in me.
“Sleep makes people calmer, more
alert, less fearful – just plain happier,
or so I see around me and in me.
In Conclusion…a Word From Ben Stein
In Conclusion…a Word From Ben Stein
I am sure that if this great nation
were to concentrate on getting more
sleep, we would be a happier, more
confident people, and that by itself
would be a major achievement.”
I am sure that if this great nation
were to concentrate on getting more
sleep, we would be a happier, more
confident people, and that by itself
would be a major achievement.”
Thank YouThank You
• AAP
• COA/UAB
• Judy Owens
• John Garcia
• AAP
• COA/UAB
• Judy Owens
• John Garcia
My FamilyMy Family
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ReferencesReferences•• CarskadonCarskadon Sleep 1980 (Sleep in Teens TodaySleep 1980 (Sleep in Teens Today--Ideal Sleep Time)Ideal Sleep Time)
• SLEEP 2003; 2:117-126 and SLEEP 2003; 2:117-126 (Sleep
Deprivation)
•• Sleep deprivation brain pictures courtesy of Judy OwensSleep deprivation brain pictures courtesy of Judy Owens
•• Sleep Medicine Reviews 18 (2014) 75e87 (Sleep Deprivation)Sleep Medicine Reviews 18 (2014) 75e87 (Sleep Deprivation)
•• CarskadonCarskadon Sleep 1980 (Sleep in Teens TodaySleep 1980 (Sleep in Teens Today--Ideal Sleep Time)Ideal Sleep Time)
• SLEEP 2003; 2:117-126 and SLEEP 2003; 2:117-126 (Sleep
Deprivation)
•• Sleep deprivation brain pictures courtesy of Judy OwensSleep deprivation brain pictures courtesy of Judy Owens
•• Sleep Medicine Reviews 18 (2014) 75e87 (Sleep Deprivation)Sleep Medicine Reviews 18 (2014) 75e87 (Sleep Deprivation)
•• J J PediatrPediatr. 2014 May ; 164(5): 1085. 2014 May ; 164(5): 1085––1090 International Journal of 1090 International Journal of
Obesity Obesity –– numerous SLEEP, Vol. 36, No. 8, 2013 Sleep Breath. numerous SLEEP, Vol. 36, No. 8, 2013 Sleep Breath.
2012 Dec;16(4):12112012 Dec;16(4):1211--8 (Sleep Deprivation Physical Health)8 (Sleep Deprivation Physical Health)
•• Sleep 2012; 35 (4) 455Sleep 2012; 35 (4) 455--460 / 460 / JAMA Pediatr. 2013;167(7):647-655
(Sleep Deprivation Mental Health)(Sleep Deprivation Mental Health)
•• J Youth J Youth AdolescAdolesc 2010; 33: 6332010; 33: 633--641 / J Youth 641 / J Youth AdolescAdolesc, 2011; 40: , 2011; 40:
916916--930 / JAMA 930 / JAMA PediatrPediatr. 2013;167(7):647. 2013;167(7):647--655 (Sleep Deprivation 655 (Sleep Deprivation
Safety Safety –– Risk Taking Behavior)Risk Taking Behavior)
•• J J PediatrPediatr. 2014 May ; 164(5): 1085. 2014 May ; 164(5): 1085––1090 International Journal of 1090 International Journal of
Obesity Obesity –– numerous SLEEP, Vol. 36, No. 8, 2013 Sleep Breath. numerous SLEEP, Vol. 36, No. 8, 2013 Sleep Breath.
2012 Dec;16(4):12112012 Dec;16(4):1211--8 (Sleep Deprivation Physical Health)8 (Sleep Deprivation Physical Health)
•• Sleep 2012; 35 (4) 455Sleep 2012; 35 (4) 455--460 / 460 / JAMA Pediatr. 2013;167(7):647-655
(Sleep Deprivation Mental Health)(Sleep Deprivation Mental Health)
•• J Youth J Youth AdolescAdolesc 2010; 33: 6332010; 33: 633--641 / J Youth 641 / J Youth AdolescAdolesc, 2011; 40: , 2011; 40:
916916--930 / JAMA 930 / JAMA PediatrPediatr. 2013;167(7):647. 2013;167(7):647--655 (Sleep Deprivation 655 (Sleep Deprivation
Safety Safety –– Risk Taking Behavior)Risk Taking Behavior)
ReferencesReferences•• Am J Epidemiol2007;166:1053Am J Epidemiol2007;166:1053––1058 / J of 1058 / J of AdolAdol Health 53 Health 53
(2013) 785e790 / JAMA (2013) 785e790 / JAMA PediatrPediatr. 2013;167(7):647. 2013;167(7):647--655 (Sleep 655 (Sleep
Deprivation Safety)Deprivation Safety)
•• Drowsydriving.org (Drowsy Driving)Drowsydriving.org (Drowsy Driving)
•• http://sleepfoundation.org/sites/default/files/4http://sleepfoundation.org/sites/default/files/4--
State%20of%20the%20States%20ChartState%20of%20the%20States%20Chart--9.5.20149.5.2014--FINAL.pdf FINAL.pdf
•• Am J Epidemiol2007;166:1053Am J Epidemiol2007;166:1053––1058 / J of 1058 / J of AdolAdol Health 53 Health 53
(2013) 785e790 / JAMA (2013) 785e790 / JAMA PediatrPediatr. 2013;167(7):647. 2013;167(7):647--655 (Sleep 655 (Sleep
Deprivation Safety)Deprivation Safety)
•• Drowsydriving.org (Drowsy Driving)Drowsydriving.org (Drowsy Driving)
•• http://sleepfoundation.org/sites/default/files/4http://sleepfoundation.org/sites/default/files/4--
State%20of%20the%20States%20ChartState%20of%20the%20States%20Chart--9.5.20149.5.2014--FINAL.pdf FINAL.pdf
(Drowsy Driving)(Drowsy Driving)
•• Sleep Deprivation Academics Sleep Deprivation Academics –– Information courtesy of Judy Information courtesy of Judy
Owens and National Sleep FoundationOwens and National Sleep Foundation
•• Child Child DevelDevel., 1998, ., 1998, VolVol 69:4, pg 87569:4, pg 875--887 (Minute variability vs. 887 (Minute variability vs.
grades graph)grades graph)
•• Asian J Sports MedAsian J Sports Med. 2012 Mar;3(1):15. 2012 Mar;3(1):15--20.20. (Sports (Sports
Psychomotor Vigilance Graph)Psychomotor Vigilance Graph)
(Drowsy Driving)(Drowsy Driving)
•• Sleep Deprivation Academics Sleep Deprivation Academics –– Information courtesy of Judy Information courtesy of Judy
Owens and National Sleep FoundationOwens and National Sleep Foundation
•• Child Child DevelDevel., 1998, ., 1998, VolVol 69:4, pg 87569:4, pg 875--887 (Minute variability vs. 887 (Minute variability vs.
grades graph)grades graph)
•• Asian J Sports MedAsian J Sports Med. 2012 Mar;3(1):15. 2012 Mar;3(1):15--20.20. (Sports (Sports
Psychomotor Vigilance Graph)Psychomotor Vigilance Graph)
ReferencesReferences•• PhysiolPhysiol BehavBehav. 2013 Aug 15;120:93. 2013 Aug 15;120:93--6 (Sports Performance 6 (Sports Performance
Graph)Graph)
•• MahMah. Sleep 2011; 34(7);943. Sleep 2011; 34(7);943--950. (Sleep Extension Sports Graph)950. (Sleep Extension Sports Graph)
•• Sleep in America Poll, 2014 (Sleep in Teens Today Sleep in America Poll, 2014 (Sleep in Teens Today –– Reported Reported
Amounts GraphAmounts Graph
•• Walker. NYAS 2005 /Walker. NYAS 2005 / Trends in Neurosciences, Vol.28 No. 8Trends in Neurosciences, Vol.28 No. 8
•• PhysiolPhysiol BehavBehav. 2013 Aug 15;120:93. 2013 Aug 15;120:93--6 (Sports Performance 6 (Sports Performance
Graph)Graph)
•• MahMah. Sleep 2011; 34(7);943. Sleep 2011; 34(7);943--950. (Sleep Extension Sports Graph)950. (Sleep Extension Sports Graph)
•• Sleep in America Poll, 2014 (Sleep in Teens Today Sleep in America Poll, 2014 (Sleep in Teens Today –– Reported Reported
Amounts GraphAmounts Graph
•• Walker. NYAS 2005 /Walker. NYAS 2005 / Trends in Neurosciences, Vol.28 No. 8Trends in Neurosciences, Vol.28 No. 8Walker. NYAS 2005 / Walker. NYAS 2005 / Trends in Neurosciences, Vol.28 No. 8 Trends in Neurosciences, Vol.28 No. 8
August, 2005 August, 2005 (Science of Sleep to Remember Graph)(Science of Sleep to Remember Graph)
•• YoosYoos. Current Biology, 17, 877. Current Biology, 17, 877--878. (Emotional Control)878. (Emotional Control)
•• J Physiol. J Physiol. AnthropolAnthropol. 2012; 31(1):5 (Process S & C. 2012; 31(1):5 (Process S & C
•• CurrCurr. Biol. Dec 29;14(24):R1038. Biol. Dec 29;14(24):R1038--9 / 9 / HagenauerHagenauer et al., et al., DevelDevel
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