Dr. David White, M.D.: How Much Sleep Do Students Actually Need?

Dr. David White, M.D.: How Much Sleep Do Students Actually Need?

The challenges of a new school year begin to enter the minds of students and parents around this time of year. Nobody wants to be set up for poor performance before the first bell even rings. However, poor sleep habits of elementary, middle and high school students are making them sluggish during the day, may hinder their success at school and will likely contribute to long-term health problems.

How much sleep do students actually need? There is some variability based on the needs of individual children. The generally established values are as follows:

Age (years)	Total Hours of Sleep	Typical Range
6	10.5	10-11
10	10	9.5-10.5
14	9.5	9-10
18	9	8.5-9.5

The subjective quality of feeling rested when waking up, or general sleep satisfaction, is difficult to quantify but may also impact performance. While most studies include imperfect and subjective metrics (such as subjective reports of sleep quality, variable measures of academic performance ranging from grade point average to teacher comments), the preponderance of data suggests that reduced total sleep time, erratic sleep schedules, poor sleep quality (difficulty falling asleep or waking up at night), and sleepiness during the day are all associated with poorer academic performance.[1],[2]

Most of these effects are small to moderate, with only modest correlation between grades and subjective sleep measures. Many other variables are likely to influence school performance including school size, family socioeconomic status, teacher salaries, school facilities, and student hours of employment, among others.

A large majority of students, especially those in middle school and high school, have a very hard time developing and keeping proper sleep habits. Adolescents and teenagers go to bed too late. Constant use of technology (Internet, television, text messages, etc.) and an "always plugged in" lifestyle contribute to many students' bedtime habits. There is increasing evidence that adolescents, particularly pubertal or post-pubertal teens, may have trouble falling asleep early enough to get adequate rest even if they are willing to try.

The explanation for this relates to a delay in circadian rhythm. The circadian clock in our brain drives many behaviors over the 24-hour daily cycle, one of which is when we sleep and when we are awake. If this clock dictates a late bedtime and late rise time (a so-called "delayed phase"), it is difficult to both fall asleep at night at a reasonable hour and get up in the morning in time for school. Why adolescents tend to have a delayed clock is just beginning to be understood.[3],[4]

Some students may have an actual sleep disorder. The common disorders in children and adolescents are insomnia and an extremely delayed circadian phase (as outlined above). Some students may have sleep apnea as well. These disorders can all affect sleep duration and sleep quality and contribute to poor performance during the day.

So, what can be done?

Promote consistent bedtime and wakeup routines. Children and adolescents should have enough time in bed to get the required sleep based on the numbers provided above. Consistent bedtime and wakeup time also promotes better sleep quality.

Turn off the light. Exposure to bright light in the evening tends to further delay the circadian clock making it more difficult to fall asleep at the desired bedtime. Softer lighting and less time in front of a computer screen is advisable in the evening.

Talk to a specialist. If the child or adolescent has consistent difficulty falling asleep or wakes up during the night with difficulty returning to sleep a physician's advice should be sought. This could be a true delayed sleep phase disorder or another type of insomnia. If there are signs that the student is sleepy during the day, the cause should be explored medically, particularly if the student appears to be getting adequate sleep at night.

As students get back into a school year routine, it is important to make sure everyone gets a passing grade in Sleep 101!

For more by Dr. David White, M.D., click here.

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References:

[1] Wolfson AR and Carskadon MA. Understanding adolescents' sleep patterns and school performance: a critical review. Sleep Med Rev 2003; 7: 491-506.

[2] Dewald JF, Meijer AM, Oort FJ, Kerkhof GA, and Bogels SM. The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Med Rev 2010; 14: 179-189.

[3] Hagenauer MH, Perryman JI, Lee TM, and Carskadon MA. Adolescent changes in the homeostatic and circadian regulation of sleep. Dev Neurosci 2009; 31: 276-284.

[4] Crowley SJ, Acebo C, and Carskadon MA. Sleep, circadian rhythms, and delayed phase in adolescence. Sleep Med 2007; 8: 602-612.

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Dr Raj Persaud: A British Soldier in Afghanistan Has a Baby Without Knowing She Was Pregnant - How Is This Possible?

Dr Raj Persaud: A British Soldier in Afghanistan Has a Baby Without Knowing She Was Pregnant - How Is This Possible?

The story that a British soldier, who did not realise she was pregnant, has recently given birth 'on the front line' in Afghanistan, is a more common enigma than generally realised.

Pregnancy, particularly late pregnancy when a mother is close to giving birth, would seem an utterly obvious condition. Yet obstetricians repeatedly encounter women who even deliver at full term, without being at all aware they were pregnant.

Many of these predicaments end joyously, with a woman who initially complained to doctors of baffling tummy pain, finding themselves astonished, but eventually pleased mothers. Yet doctors know that the story doesn't end there, what happens to that baby afterwards can be of grave medical concern.

There is a possible and controversial association between so called 'denial of pregnancy' and killing of such newborns. Women who deny pregnancy obviously don't get the right antenatal care and this is hazardous. But is there also a strong link in some cases with neonaticide (homicide within the first 24 hours of life)? This serious problem is being actively researched at the moment.

Some women who deny pregnancy might be much more likely than the general population to kill their newborns, sometimes through neglect, and these can be found in the lavatory, garbage disposal, or a hasty grave.

Klaus Beier, Reinhard Wille and Jens Wessel from the University Clinic Charite´, Berlin and Sexual-Medical Department, University Clinic, Kiel, Germany have surveyed research on pregnancy denial, and found that reports of the phenomenon are in fact increasing recently.

German data suggests one case of denied pregnancy occurs in 475 deliveries for women who were not aware of being pregnant, and did not receive a diagnosis of pregnancy during the first 20 weeks of the pregnancy. Women who do not realize they are pregnant until going into actual labour occurs 1 in 2455 deliveries.

Wessel lead a team whose survey of all births in Berlin over one year, published in the academic journal 'Acta Obstetricia et Gynecologica Scandinavica', found such totally unexpected deliveries of a viable fetus, without any previous knowledge at all of being pregnant, occurs roughly 300 times a year in a country the size of Germany. According to their calculations, in the study titled 'Frequency of denial of pregnancy: results and epidemiological significance of a one-year prospective study in Berlin', this means denial of pregnancy occurs three times more often than triplets.

Wessel and colleagues point out that besides denial of pregnancy, there is concealment of pregnancy; the woman actually knows she is pregnant, but hides it from those around her. Possibly fear of disgrace, or worry her partner will leave, may be factors. Very immature younger women who are victims of an unplanned pregnancy may try to 'forget' they are pregnant, perhaps hoping it will go away.

In their study of 'pregnancy deniers' entitled, 'Denial of pregnancy as a reproductive dysfunction: A proposal for international classification systems' Beier, Wille and Wessel found 38% had actually visited the doctor during their pregnancy, but the physician, remarkably, didn't spot the pregnancy. The researchers explain this surprising finding as not in fact that unusual, and explained by a fair degree of obstetrical ignorance being common in non-gynecologists.

An interesting psychological theory they propose is that an unconscious dynamic sometimes develops between a mother in strong denial and her doctor, so they both end up colluding in the denial. This common process is known as 'projective identification' and a sympathetic doctor-patient relationship is vulnerable to the physician embracing the denial projected on to them by the patient.

Another peculiar phenomenon which contributes to pregnancy denial is the continuation of regular menstruation during a pregnancy, which was the case in 46% of Beier, Wille and Wessel's sample of pregnancy deniers. In the study published in the 'Journal of Psychosomatic Research', the authors declare doctors still don't have a medical explanation for this frequently described mystery. Sometimes in older women no periods is confused or rationalised as the start of menopause.

The authors conclude that women who fail to grasp they are pregnant before delivery are commonly suspected of deception or psychosis, yet this and other research finds the overwhelming majority have a normal lQ, little or no obvious psychiatric disorder, and only around 5% appear to suffer psychotic illnesses like schizophrenia.

Beier, Wille and Wessel point out that before we jump to the conclusion these women are stupid or insane, denial of physical illness is very common. Indeed it is almost normal following a life-changing diagnosis such as cancer or severe heart disease. Such denial frequently leads to not following medical advice and this is even a norm in many serious physical illnesses.

There are many different kinds and levels of psychological 'denial'. One form is 'affective denial' and means while intellectually aware of the pregnancy, a woman demonstrates little emotional reaction. For women with severe addictions for example, if unable to give up their dependency, emotional denial defends against guilt from harming their foetus through substance abuse. Psychotic denial of pregnancy might be particularly likely in those with a previous history of psychosis, combined with prior loss of custody of other children, as a result of their severe mental illness.

Natacha Vellut, Jon Cook and Anne Tursz from the Centre de Recherche Médecine, Sciences, Santé, Santé mentale et Société, Paris, have just published a study examining what proportion of neonaticides are made up of women who deny their pregnancy. In three regions of France over a 5-year period there were 32 cases of neonaticide of which possibly three pregnancies were undiscovered until delivery. The authors wonder whether denial of pregnancy has been over-rated by doctors before as an underlying factor in eventual neonaticide.

The study entitled 'Analysis of the relationship between neonaticide and denial of pregnancy using data from judicial files', argues pregnancy deniers may disconnect pregnancy from childbirth. While aware of being pregnant from time to time, none of these mothers seemed to foresee or get ready for delivery.

Just published in the academic journal 'Child Abuse and Neglect', perhaps the most disturbing finding of the study, is that it revealed neonaticide to be at least 5.4 times more frequent in France than officially recorded in mortality statistics.

The authors also point out that as 25% of cases related to discovery of the corpse of a newborn whose family was never identified, this raises the possibility of a much higher unknown number of bodies never discovered.

If so, denial or concealment of pregnancy, might also be much more common that officially realised.

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Rania Batayneh, MPH: 4 Myths That May Be Affecting Your Waistline

Rania Batayneh, MPH: 4 Myths That May Be Affecting Your Waistline

Every day, we are tempted to try another weight loss product or fad diet. In fact, daily, we engage in thoughts that may not be conducive to our weight-loss goals. These thoughts are communicated to us via media and what celebrities do to lose weight, or by manufacturers who want us to continue to buy their products. In my practice, I am debunking myths and setting the record straight. Here, I am sharing with you four diet myths that may be doing more harm than good.

• 1. A Gluten-Free Diet Will Help Me Lose Weight

  Due to the recent onslaught of media stories showcasing celebrities who have lost weight and claim they did so because of a gluten-free diet, many people believe that removing gluten from their diet will automatically lead to weight loss. A gluten-free diet isn't necessarily healthier: If you simply replace processed, gluten-containing foods with processed, gluten-free foods, you're still consuming just as many calories, fat, and sugars in the form of refined carbohydrates. In some cases, you may be consuming more calories: Food manufacturers add in fats and sugars to replace the loss of texture and taste that gluten provides. However, switching to a gluten-free diet when medically necessary can be healthy, if you replace processed carbs with beans, legumes, vegetables, and other whole foods. Otherwise, enjoy your whole-grain sandwich.

• 2. Products That Are Labeled "Reduced-Fat" Or "Fat-Free" Are More Nutritious Than Their Original Counterparts

  Foods that have been modified to become fat-free or reduced-fat might seem more nutritious than their original form. If you take out the fat, you take out some excess calories, and you get virtually the same product, right? Let's compare one brand's regular peanut butter to their reduced-fat version: Per two tablespoons, the regular version has 190 calories, 16 grams of fat, and three grams of sugar. Their reduced-fat version has 190 calories, 12 grams of fat, and four grams of sugar. Essentially, the reduced-fat version has been stripped of one quarter of its healthy monounsaturated fats, and to replace that flavor, the brand has added in fillings, additives, and sugar. And all for the same amount of calories! Picking reduced-fat products may even end up hurting your waistline: In one study, average-weight participants ate 22 percent more calories if the food was labeled "low-fat," and overweight participants ate <a href="http://www.realsimple.com/health/nutrition-diet/weight-loss/busting-10-diet-myths-10000001700385/page10.html" target="_hplink">up to 50 percent more</a>. Stick to the full-fat versions to retain the healthy benefits of peanuts and their monounsaturated fats: increased satiety and a decreased risk of heart disease and diabetes (and avoid those empty fillers!).

• 3. Organic Or Natural Foods Are More Nutritious

  In one study, two groups were asked to rate the nutritional value and sensory attributes of the same cookie; one groups' cookies were labeled as organic, whereas the other groups' cookies had no label. The participants whose cookies were labeled as organic estimated that their cookies contained <a href="http://www.eurekalert.org/pub_releases/2010-04/cfb-cl042810.php" target="_hplink">40 percent fewer calories</a>, had significantly more fiber, and were more appetizing than other brands. Trigger words like "organic," "natural" and "local" promote misconceptions about the true nutritional value of a food, and can give otherwise junk food a "health halo." A cookie is a cookie, even if it's made with organic grains, cage-free eggs, and local honey -- and it still contains calories, fat, and sugars!

• 4. Diet Soda Is Harmless

  The nutritional panel on a diet soda reads all zeros: zero calories, zero sugars, zero fat. These numbers have led many weight-conscious Americans to switch from regular soda to diet soda - it's an easy way to cut out <a href="http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/focus/" target="_hplink">over a dozen teaspoons</a> of excess sugar a day (per drink!). Statistics tell us that diet sodas may not be so friendly to your waistline, however: A University of Texas study found that people who drank three or more diet sodas per week have a <a href="http://eatthis.menshealth.com/slideshow/print-list/186379" target="_hplink">40 percent greater chance</a> of being obese. Experts believe this oddity is due to the fact that artificial sweeteners tend to trigger your appetite -- making you want more and more sugar -- but without actually satisfying a desire for sweets like normal sugar does. Diet-soda-drinkers end up eating tons of sugary and fatty snacks in order to satisfy their cravings. Diet sodas are also often loaded with additives, including caramel coloring. Although it sounds harmless, this caramel coloring is made by reacting sugars with ammonia and sulfites, resulting in <a href="http://articles.latimes.com/2012/mar/05/news/la-heb-cola-cancer-20120305" target="_hplink">2-methylimidazole and 4-methylimidazole</a> -- two compounds that have been found to cause lung, liver, and thyroid cancers in mice. Gradually wean yourself off the diet soda by switching to fruit juice mixed with seltzer, and eventually switch entirely to water flavored with fresh fruit and green tea.

For more by Rania Batayneh, MPH, click here.

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