Physician Advocacy for Teen Health

In December, the Massachusetts Medical Society adopted a resolution to support policies and laws that prohibit the start of school for adolescents before 8:30 a.m. Terence, we are proud to report, was the physician who proposed the resolution. Although Terence became a delegate to our state's medical society over a year ago, it was the first resolution he wrote and built support for. It is a subject we feel passionately about. In fact, while it certainly isn't the only reason, it is one of the reasons we decided to homeschool our son this year for sixth grade. Each morning, when we wake him at 7 a.m., we remind him that if he was enrolled in public school the bus would have picked him up at 6:30.

Chronic sleep loss and associated sleepiness in adolescents are serious threats to the academic success, health, and safety of our youth and an important public health issue. Adolescents require at least 9 hours of sleep per night and yet studies show that by 12th grade up to 75 percent of students are getting less than eight hours per night on a regular basis. Sleep deprived individuals suffer a variety of poor outcomes including weight gain, increased depression, poor school performance, poor athletic performance, higher rates of athletic injuries, higher rates of absenteeism and higher rates of car accidents (driving sleep deprived is similar to driving drunk).

One of the most significant causes of lack of sleep in adolescents is early school start times. Throughout the U.S., middle and high school start times have been getting earlier over the past 10 years to 20 years. There is an abundance of scientific evidence that shows that adolescent biological rhythms make it impossible for teens to "just go to bed earlier." It's like asking them to will acne off their face. For this reason, the American Academy of Pediatrics has recommend that school start times for adolescents in middle school and high school be no earlier than 8:30 a.m.

Of course, as we are campaigning for later school start times, we are keeping in mind that this change will be a logistical and financial challenge for most communities. Still, we believe the stakes are high enough to justify the work involved. It's not tough to argue that there is a connection between the current opioid addiction crisis and sleep deprivation. When teens are sleep deprived they can be either misdiagnosed with attention deficit hyperactivity disorder (ADHD) or, if they have ADHD, their symptoms can worsen. This increase in ADHD diagnoses leads to an increase in inappropriately prescribed stimulants, a known factor in increasing a teen's or young adult's predisposition for a long-term addiction problem. Also, sleep deprivation lowers a teen's ability to use good judgment when faced with peer pressure to try drugs or alcohol. We also know that later start times decrease absenteeism and dropout rates, and conversely adolescents who drop out of high school are at higher risk for developing addiction problems.

As awareness of the epidemic of sleep deprivation in adolescents spreads across the country we hope that many of you will join in process. We believe it is the role of physicians to look beyond the walls of their office and have an influence on the public health of their communities. Ask yourself: If you don't step up, who will? We cannot solve the problem of sleep deprivation patient by patient in our office, but rather, by reaching out to our local school board, local papers, and the state medical society, we are doing our part.