Adolescent Sleep Patterns: Biological, Social, and Psychological Influences

Abstract

Adolescent Sleep Patterns: Biological, Social, and Psychological Influences edited by Mary A. Carskadon, Cambridge University Press, 2002, 297 pp, $60.00 (hardcover). A consequence of the growth of sleep medicine and sleep research is the number of textbooks that attempt to describe the complexity and diversity of sleep, a behavioral state that takes up one third of our lives. Far fewer books, however, have dealt with sleep during development. Adolescent Sleep Patterns edited by Dr. Mary A. Carskadon, Director of the E. P. Bradley Hospital Sleep Research Laboratory in Providence, Rhode Island, and Professor of Psychiatry and Human Behavior at Brown University, provides the first comprehensive overview of the current knowledge about sleep in teenagers. Dr. Carskadon has devoted most of her longstanding career to the study of sleep in children and adolescents and is doubtless the ideal person to edit such a book. For Adolescent Sleep Patterns, she has assembled contributions of the most prominent researchers and clinicians in the field. The book is a well-balanced presentation of reviews on adolescent sleep behavior and of new data on issues such as sleep patterns in Italian or Brazilian adolescents and the risks of drowsy driving. Readers of various backgrounds, including psychologists, clinicians, teachers, educators, school administrators, sociologists, and policy makers are addressed by this book. Dr. Carskadon was among the first to describe that not only psychosocial factors influence the developmental changes of sleep behavior during puberty, but that also intrinsic biological processes play an important role. In the chapter, “Factors Influencing Sleep Patterns,” she summarizes the research over the past three decades and points to an important conclusion: many adolescents do not obtain sufficient sleep because the timing of their sleep phase is delayed. That this holds true not only for adolescents in the United States, but also for teenagers from other cultures, is demonstrated by two contributions from Europe and South America. In view of this research, we should ask whether social institutions such as schools should continue to promote schedules and policies that are in conflict with biological needs during puberty. Evidence is accumulating that insufficient sleep and daytime sleepiness are directly related to school performance, learning behavior, and mood. The chapter, “Accommodating Sleep Patterns of Adolescents Within Current Educational Structures,” illustrates one school system's approach to improving daytime alertness in teenagers by changing school start times. This part of the book also discusses the practical implications and feasibility of school start delay and could be an important resource for educators and policy makers willing to change public school policy. Dr. Carskadon's book contains descriptions of the developmental changes of sleep patterns across puberty, not only in humans, but also in rodents and rhesus monkeys. Indeed, research on animal models has provided increasing evidence that developmental alterations of the circadian oscillator in the brain contribute considerably to the sleep phase delay across puberty. The chapters, “Maturational Changes in Sleep-Wake Timing of a Diurnal Rodent” and “Nutrition and Circadian Activity Offset in Adolescent Rhesus Monkeys,” add important information about the biological mechanisms of behavioral changes during adolescence. The last three chapters provide clinical perspectives on teenage sleep behavior with current knowledge about influence of stress on adolescent sleep, the interaction of depression and sleep problems, and the effect of sleep on cognitive and emotional development. The authors of these chapters demonstrate that sleep issues in teenagers should not be ignored in clinical practice. I particularly loved the well-written chapter, “Toward a Comparative Developmental Ecology of Human Sleep,” by Carol M. Worthman and Melissa K. Melby, although the authors did not focus exclusively on the main topic of the book. They provide an outstanding overview of the wide diversity of sleep habits across cultures. They argue convincingly that comparative studies of different sleep ecologies may have implications for understanding the behavior of children and adolescents. Worthman and Melby provide some new input for the current debate on cosleeping. They note that “parents in western societies put their children to sleep under conditions of minimal sensory load, but expect them to appropriately focus attention during the day in a world with high sensory experiences.” Interests in and concerns about sleep behavior during adolescence have grown markedly over the past decade. Adolescent Sleep Patterns is an important compendium, which should be on the bookshelf of all health care professionals dealing with adolescents.