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Sleep Health & High Schoolers

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Justin Kennedy

on 23 June 2014

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Transcript of Sleep Health & High Schoolers

Sleep Health & High Schoolers
Risk Factors for Poor Sleep
Is it really that big of a deal?
This generation of teenagers is probably the most sleep-deprived that the world has ever seen, and we don't know what the repercussions will be. More than
of teens said they get fewer than 9 hours of sleep on most school nights, with
getting even less than 6 hours of sleep. More than half of those say it affected their grades, friendships, and mood.
What does it look like?

Low grades


Weight gain

Morning headache

Worse acne

Auto accidents
By: Karen Bonham, Tiffany Bivens, Carissa Davis, Harvey Huebotter, Justin Kennedy & Kaylen Lebens

difficulty in relationships
development of depression
reduced academic & athletic performance
car accidents
Youth with untreated sleep disordered breathing = future:
heart disease
high blood pressure
all cause mortality
Complications of Poor Sleep
So what do we do about it?
Primary prevention: Sleep Hygiene

Set a bed time which allows for 9 hours of sleep
Bedroom should be dark, quiet and, not too hot or too cold.
Remove all electronics from the room
Avoid large meals before bedtime
Consider exercising to help you sleep but not before bed time
Limit caffeine intake

Screening Recommendations
No clinical screening guidelines by USPSTF or CDC

Healthy People 2020 reports
of students grades 9-12 don't get enough sleep

Critical part of the "Social History"

Be open & honest with your provider...help us, help you!

15yo Caucasian male student presents to clinic with Mom for intermittent headaches and increasing irritability x 2 weeks. He is on the basketball team, plays the saxophone in the school band, and says he has always been a "straight A student". Mother says he has been staying up late to study for finals and has been more forgetful than usual over the past week.

Asthma, Seasonal Allergies
Albuterol, Claritin
Non contributory.
No alcohol, tobacco, drug use; eats lunch & dinner daily; Monster Energy Drinks & Dr. Pepper 2x per day.
Alert, well-appearing male appears stated age and in no obvious distress. Dark circles noted under eyes bilaterally. Exam is otherwise unremarkable.
HR 86, BP 130/72, RR 16, Temp: 98.4⁰F
21 (normal)
Case #1: Overcommitted
And if that doesn't work...??
Secondary Prevention
Screening Tools:
Epworth Sleepiness Scale (ESS)
Adolescent Sleep Hygiene Scale
Pittsburgh Sleep Quality Index
Sleep diary
Sleep Study

Risk Factors:

Caffeine intake
Excessive screen time

Eat breakfast daily
Limit caffeine intake after 2pm
Limit electronic use 1hr before bed
Sleep diary

Case #1 (cont'd)
Case #2 (cont'd)
18 y/o obese Pacific Islander female grocery store stocker presents for f/u after 7/7/2014 MVC. Pt fell asleep at the wheel on the way home from her job at 3:14 am, she was not intoxicated or using drugs. Attends community college classes in addition to school schedule. Airbags deployed, no serious burns. Denies LOC, N/V.

Previously treated for ADHD w/methylphenidate, discontinued 6 months ago.
: None contributory.
Generalized tenderness of paraspinous muscles and C-spine, reduced ROM in C-spine secondary to pain and stiffness, denies numbness or tingling; strength 5/5 in all extremities.
X-ray show no fractures
HR 88, BP 138/84, RR 18, SpO2 98%

31.5 (Obese)
Case #3: Asleep at the Wheel
Risk Factors:
obesity, works night shift, packed schedule, untreated ADHD

Case #3 (cont'd)
Baum KT, et al. (2014). Sleep restriction worsens mood and emotion regulation in adolescents. Journal of Child Psychology and Psychiatry, 55(2), 180-90. doi: 10.1111/jcpp.12125
H., Noland, & S. K., Telljohann. Adolescents sleep behaviors and perception of sleep.(2009). Journal of School Health (79),224-30. http://onlinelibrary.wiley.com/doi/10.1111/j.1746-1561.2009.00402.x/pdf
Lovato N, & Gradisar M. (2014). A meta-analysis and model of the relationship between sleep and depression in adolescents: Recommendations for future research and clinical practice. Sleep Medicine Reviews. pii: S1087-0792(14)00039-2. doi: 10.1016/j.smrv.2014.03.006.
Kato M, et al. (2009). Obstructive sleep apnea and cardiovascular disease. Circulation Journal. 73(8):1363-70.
U.S. Department of Helath and Human Services. (2014). http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=38
Van Cauter E, Knutson KL. Sleep and the epidemic of obesity in children and adults. (2008). European Journal of Endocrinology. 159(suppl 1):S59-66.



Irregular schedule
Work Schedule
Extracurricular activities

Health Problems
A 16 y/o African American male presents to clinic c/o difficulty concentrating in class. He reports having trouble falling asleep at night. His mom died 6 months ago and he is helping his dad with taking care of his little brother and sister. After school he works at Target for 4-6 hrs. as a cashier. Grades are slowly declining and admits to being irritable with friends and family. He reports feeling restless and is not involved in any extracurricular activities.

Not remarkable
Ibuprofen, Headaches, PRN
M: Fibromyalgia, 58
F: Arthritis, Diabetes
Denies alcohol, tobacco, & drug use
Alert, well-appearing male in no obvious distress. Lung sounds clear bilaterally; clear heart sounds with regular rate & rhythm.
HR 82, BP 125/85, RR 18, Temp 98.9F
28.8 (Overweight)
Tertiary Prevention:
Sleep diary
"What ever works for your disease, works for your disease!!" -PA Holmes
Risk Factors:
Irregular Schedule

Establish a schedule
Diet and Exercise Regimen
Counseling for Anxiety

Screening Recommendations:
Case#2: Overwhelmed
Primary Prevention:

Get 9 hrs sleep each night
Follow good sleep hygiene
Maintain ideal body weight
Secondary Prevention:
Screening Tools (Epworth Sleepiness Scale, Adolescent Sleep Hygiene Scale, Pittsburgh Sleep Quality Index)
Sleep diary
Sleep study
Tertiary Prevention:

Sleep study, CPAP
Resume ADHD tx
Lose weight
Thanks for your attention, today...
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