Adolescent Sleep Patterns Biological, Social, and Psychological Influences MARY A. CARSKADON Brown Medical School

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sleepiness-alertness and its nocturnal determinants. In addition, and of great importance to the topic of this book, she directed a longitudinal study of a cohort of children as they went through the great transition of adolescence.

At the beginning of this remarkable decade of research, the gold standard of assessing daytime sleepiness, the multiple sleep latency test (MSLT), was developed and applied. Using this test each summer on the longitudinal cohort, it was established that sleep need does not change or may even increase during the great transition. The MSLT also allowed an assessment of the effect of sleep restriction on daytime alertness; for the first time, it was clear that the impact of lost sleep accumulates from day to day. This accumulation is often referred to as the “sleep debt. Finally, the great disparity between MSLT measures of sleep need in adolescents versus questionnaire data on actual sleep obtained at home during the school year allows us to conclude that many, if not most, adolescents must be severely, chronically sleep deprived. The data basesare very small, but students falling asleep in class are a familiar sight to middle school and, particularly, high school teachers. This situation is further complicated by the biological tendency for phase delay of circadian rhythms and the markedly increased prevalence of students holding extracurricular jobs, usually in the evening, to earn money.

During much of 1990 and 1991, Dr. Carskadon and I served on the National Commission on Sleep Disorders Research, which carried out a congressionally mandated study of the role of sleep deprivation and sleep disorders in American society. One of the areas that we examinedwas whether the facts about sleep that we have known for more than two decades have actually been integrated into the educational system and the health care system. Unfortunately, crucial education about sleep need and biological rhythms and sleep disorders likely to occur in adolescence was completely absent. It is my very strong opinion that all human beings become victims of the lack of awareness about sleep during the great transition and, to some extent, for the rest of their lives. Although data on sleep disorders in latency-age children are limited, the studies conducted by Dr. Carskadon, particularly for children in middle- and upper-class environments, suggest that sleep needs are generally fulfilled at this age with a resulting optimal daytime alertness and performance.

In terms of developing a society in which healthy sleep is a priority, the optimal target may be the developing adolescent. Crucial material about sleep, sleep deprivation, biological rhythms, and sleep disorders

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