Effects of sleep deprivation on the mental health of adolescents: a systematic review

Abstract

This paper seeks to identify the factors and impact of sleep deprivation in the adolescent population and suggests pertinent preventive measures. We used diagnostic indicators and keywords to examine literature published from 2013 through bibliographic search tools. The risk of mental health problems is increasing, alongside cognitive and social impairments. Risk factors associated with sleep deprivation include circadian rhythm shifts, early school start times, and lifestyle choices. This may be catalyzed by additional factors such as excessive homework and utilization of social media, which contribute to inadequate duration and quality of sleep, leading to decreased academic and social challenges, higher risk-taking behaviors, stress, suicidal ideation, and diminished physical health. Delaying school start times, limiting electronic device usage before bed, promoting physical activity, and implementing sleep hygiene education can help improve sleep quality and overall well-being in adolescents by acting as preventative measures for this population. Parental involvement, through awareness and the implementation of consistent bedtimes, is also crucial for supporting healthy sleep habits. More research is needed to develop effective interventions within education and healthcare that can address the growing sleep and mental health crisis.

Introduction

Sleep is widely considered one of the most important factors responsible for adolescents’ cognitive, physical, and emotional well-being. In adolescents specifically (individuals between the ages of 10 and 17), sleep is extremely fundamental in developing their physical, social, and academic functioning. It is recommended that adolescents sleep for around 8–10 h every day (Chaput and Dutil 2016). However, a large number of teenagers/ adolescents globally are not getting the required amount of sleep, impacting many aspects of their lives. In the United States, a study showed that 34.9% of individuals between the ages of 4 and 17 slept less than recommended for their age, and 31.2% of all adolescents suffered from sleep deprivation (Wheaton and Claussen 2021). Sleep deprivation refers to the inadequate sleep duration or sleep quality that a person gets.

During adolescence, the risk of being sleep-deprived increases around puberty. This is due to the Circadian rhythm, which shifts a couple hours later during the second decade of life (Reddy et al. 2023). It makes it harder for adolescents to sleep at bedtime, leading to more wake-ups during the night and resulting in less sleep overall. This is further compounded by the fact that although teens are sleeping later due to the rhythm shift, the school start times are not accordingly adjusted. Teens are expected to adhere to early school start times, resulting in a change in the circadian rhythm (Jamieson et al. 2020). This has several negative effects on people’s minds, including depression, anxiety, and stress. It can also impair an individual’s social development and family life (Montie et al. 2019). This could affect adolescents’ academic performance (Owens and Weiss 2017). Furthermore, it creates negative consequences for their physical health, such as an increased risk for obesity, hypertension, and heart disease (Chaput and Dutil 2016). There has also been an escalation in self-injury, suicidal behavior, and thoughts among adolescents with a direct correlation to sleep deprivation (Zhang and Yu 2022).

While there have been innumerable studies on this, there has not been much of an improvement in the sleeping habits of adolescents. Without proper public awareness, protocols, and implementation of positive sleep practices, an adolescent’s self-worth, behavior, day-to-day activities, and overall health could greatly affect their self-worth. Some practices, such as later school start times and awareness sessions on mental health and sleep deprivation with teenagers and their parents, would help alleviate the sleep problem.

This paper seeks to outline the impact of sleep deprivation on adolescents’ mental health, while also emphasizing potential preventive strategies and treatments that could help those affected.

Methods

Information sources

The information in this research paper was obtained from many sources. We conducted a search in the PubMed database to search for studies from 2013 to 2023. The search included keywords such as Sleep deprivation, adolescents, mental health, anxiety, depression, teenagers, prevention, and treatment. The population included adolescents facing mental health conditions due to sleep deprivation. Figure 1 outlines the process used for selecting studies in the review.

Fig. 1

PRISMA flow diagram

Study abstraction and evaluation

This systematic review used a method of data extraction based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and followed PRISMA guidance (Fig. 1). A total of 190 Records was identified from online databases through the inclusion criteria of the aforementioned keywords. An initial screening was conducted for the removal of irrelevances (such as records using non-human participants, records written in a non-English language, Records that do not meet Age Criteria, and Records removed for other reasons), which left a remaining 133 records. After this, a full-text screening was utilized to remove further unrelatedness, which left 73 reports that were sought for retrieval. Reports were finally checked for eligibility, wherein 36 articles were excluded. Articles were excluded if they did not meet the following criteria: (1) They did not meet the population requirements in terms of Age and the topic being studied; (2) They were not pertinent to the study of adolescent mental health and sleep patterns; (3) They showcased out-of-date circumstances by reflecting understanding which isn’t pertinent to the study (prior to 2013); (4) It was not written in English. Table 1 shows the features of those studies which were included in the study.

Table 1 Summary of studies utilized for review

Findings

Sleep quality

Sleep deprivation remains a problem among adolescents. 68.4% of high school students in the US sleep 7 h or less on school nights which is less than the recommended 8–10 h for this age group (Watson et al. 2017). Sleep quality is characterized by an individual’s overall satisfaction with various aspects of their sleep experience. It has four main components: (i) Sleep Efficiency, which measures the percent of the amount of total time asleep to the total time in bed (ii) Sleep latency referring to the duration to transition from wakefulness to sleep; (iii) Sleep duration (iv) Wake After Sleep onset– is how much time a person is awake after falling asleep (Nelson et al. 2022). It encompasses issues such as difficulties in initiating sleep, deviations in Rapid Eye Movement (REM) sleep latency, lighter sleep, and elevated REM density. It has been noted that prolonged sleep onset latency and insomnia are common in adolescents (Hysing et al. 2013). As the sleep schedule gets disturbed and unhealthy sleep cycles are developed, the mental well-being of an individual is also affected. Increased anxiety in adolescents is attributed to low sleep quality (Dickinson et al. 2018). Furthermore, the discrepancy in the sleep cycle between weekdays and weekends leads to negative effects on health, mental disorders, and poor scholastic achievement in adolescents. It increases the risk of substance use, obesity, and suicidal thoughts as well (Sun et al. 2019). This can take the form of delayed sleep-wake phase disorder (DSWPD), a disorder where the regular sleep and waking times are delayed causing difficulties in falling asleep. DSWPD results in poor concentration, fatigue, and contributes to absenteeism. Individuals with this disorder may also have neuroticism and anxiety which could further aggravate insomnia (Futenma et al. 2023).Additionally, numerous studies have indicated that a substantial number of adolescents may exhibit heightened emotional responses when fatigued. Consequently, the prevalent sleep deprivation seen during this developmental stage may be linked to increased emotional volatility, such as intense mood swings involving fear, distress, and anger. Quality sleep is crucial, as inadequate sleep can lead to health issues and negative health outcomes.

Sleep duration

In addition to the low sleep quality, there has also been a major decline in the average sleep duration among adolescents. Teenagers require about nine hours of sleep daily but due to the various factors, most of them don’t meet this required amount of sleep. These factors include after school programs, heavy homework loads, caffeine intake, consumption of digital content, and early morning school start (Owens and Weiss 2017; Campbell et al. 2021). This, in turn, results in a delay in sleep onset which combined with early morning school start times leads to sleep loss (Touitou et al. 2016). Additionally, internal biological processes that occur along with puberty such as a delay in the circadian rhythm also result in a lack of adequate sleep hours (Owens and Weiss 2017). This is evident from instances such as only 26.6% of adolescents in that population meeting the recommended amount of sleep (McLay et al. 2023). Additionally, with the sleep duration of adolescents averaging 5.7 h, individuals with shorter sleep duration were more likely to feel stress, hopelessness and have suicidal ideation (Lee 2017). It has been noticed that sleep deprivation is common, especially on weekdays, and is linked to lower academic performance, depressive symptoms, and an increased risk of overweight/obesity (Sun et al. 2019). Since chronic sleep deprivation threatens academic success and health in adolescents, it is critical to take measures that address the lack of sleep. Various suggestions have been made including later school start times that will enable sufficient sleep, and healthy sleep education for students and families so they can address factors under their control.

COVID-19 pandemic

A study conducted in the pandemic showed that revealed a substantial rise in sleep difficulties during the pandemic globally, which approximates to 36 − 50.5%.

Evidence that supports correlational predicates has been found. These include contributory factors such as higher anxiety levels, increased electronic exposure, lower exercise time, and diet quality (Zhai et al. 2021). Due to various factors such as family responsibilities, earlier wake-up times, and illnesses during the pandemic, there was an increase in sleep difficulties which led to higher stress levels, heavier alcohol use, and screen time (Robillard et al. 2021). Another study found that sleep deprivation during the pandemic was significantly associated with post-traumatic stress disorder and depression and was also a good predictor of new onset of these mental health issues (Wang et al. 2022).

An increase in sleep duration, a delayed schedule, and a greater number of adolescents surpassing minimum sleep were observed during the pandemic (Gruber et al. 2021). While school start times were fixed during remote learning, the removal of travel in the morning likely allowed adolescents longer rest and aligned with a postponed circadian phase (Stone et al. 2021). A study in Lithuania assessed the impact on sleep quality and mental health after schools reopened during COVID-19. Two-thirds of students reported having poor sleep while half reported significant anxiety levels. This study further underscores the need to seriously re-look at later school times as a means of improving sleep and mental health (Puteikis et al. 2022).

Outcomes

Sleep deprivation has been seen to adversely impact the mental health of adolescents worldwide. It has been associated with various mental disorders including depression, anxiety, and bipolar disorders (Dickinson et al. 2018; Campbell et al. 2021; Comsa et al. 2022). In adolescents, sleep deprivation also impacts cognitive functioning, social life, family life, and parental well-being, which consequentially affects their mental health as well (Montie et al. 2019). Those adolescents who spend more time working at home on studying and homework, experience a decline in their sleep hours thus increasing their susceptibility to depressive symptoms (Yeo et al. 2020).

Inadequate sleep is associated with a significant increase in the occurrence of depressive symptoms and indulging in risk-taking behaviors like alcohol and substance abuse (McLay et al. 2023). Sleep deprivation leads to decreased attentiveness, increased risk of obesity, cardio-metabolic dysfunction, diminished cognitive control, lower academic performance, higher incidence of car crashes, workplace injuries, and sports-related injuries (Owens and Weiss 2017). Disrupted sleep resulting from social media use is linked to diminished academic performance and school burnout, which is characterized by feelings of exhaustion due to academic demands, a jaded and disengaged outlook towards schoolwork, and a sense of inadequacy as a student (Evers et al. 2020). Weekday bedtime has an impact on academic performance, with adolescents going to bed between 22:00 and 23:00 h having the best academic performance, as indicated by the Grade Point Average (GPA). Specifically, postponed bedtime on weekends was associated with substandard scholastic performance (Hysing et al. 2016).

Due to various factors such as social media usage, screen time, and early school start times, there has been a major decline in sleep quality and duration in adolescents. Moreover, biological factors such as a delay in the circadian rhythm and puberty also contribute to an increase in sleep deprivation among adolescents.

Treatment and prevention methods

Since sleep deprivation has major consequences for mental and physical health, preventive measures and proper treatment plans must be taken to address sleep duration and quality in adolescents. Adolescent sleep duration and quality can be improved and maintained through various interventions at school, home, and on an individual level like delayed school start times, controlling mobile and social media usage, and increasing physical activity. Since internal circadian rhythms in adolescents change, early school start times reduce the sleep duration and quality which could affect the learning of students along with impacting their physical and mental health. To prevent this, delaying school start times could positively impact students and their academic performance (Watson et al. 2017; Chan et al. 2017).

Mobile phone and social media usage at night have been associated with reduced sleep duration during school days (Royant-Parola et al. 2018). Electronic media usage is also associated with increased sleep difficulties which in turn are related to depressive symptoms (Lemola et al. 2015). Parental rules restricting electronic device usage before bedtime and delaying giving smartphones to a mature age are linked to longer sleep duration (Charmaraman et al. 2021). Hence families should establish limits on the usage of smartphones, social media, and electronic devices before bedtime. In addition to this, exercise has been identified as a favorable predictor of sleep duration and quality. Increased physical activity is associated with restoring sleep (Lang et al. 2013).

Sedentary time at school is negatively associated with sleep duration hence measures to reduce sedentary time in schools can help with addressing sleep deprivation (Choi et al. 2020). Adolescents should also be educated on sleep hygiene, which is the set of environmental and behavioral factors that influence healthy sleep patterns (Alanazi et al. 2023) and the risks of using electronic devices at night. This could be done at school or through mental health programs (Gunderson et al. 2023). An outcome analysis of TeenSleep, a teacher-led sleep education program in the UK, shows that while the program helped in enhancing sleep knowledge among the students, improvement in sleep hygiene and quality are limited to poor sleepers (Illingworth et al. 2020). In addition to the aforementioned, to be truly effective, sleep education may need to be accompanied by other measures like changing school times and active parental involvement (Rijn et al. 2020).

Moreover, parents should also be made aware of the risks of lack of sleep and should implement consistent bedtimes to promote healthy cognitive development (Wheaton and Claussen 2021). A decrease in workload outside of class will allow for earlier and longer bedtimes and may also benefit their sleep and mental health (Yeo et al. 2020).

Discussion

To prevent the deterioration of mental health among adolescents, one of the first steps is to build proper sleep cycles and maintain sleep hygiene. It is necessary to ensure that adolescents are aware of the benefits of a good sleep schedule such as improved concentration, better mood, enhanced academic performance, and overall physical and mental well-being. Bringing attention to the drawbacks of sleep deprivation is essential: the increased danger of mental disorders, mood swings, long-term impacts on physical health, and increased trouble in focusing. Building awareness about sleep hygiene and addressing common barriers to achieving good sleep like curbing electronic device usage and caffeine consumption is equally important (Quante et al. 2019). This can be achieved through various methods including interactive awareness sessions at schools. This should also be started earlier in one’s childhood as learning is much more effective at a younger age. Bringing in experts to introduce and explain the aforementioned points could persuade adolescents to pay more attention to their sleep schedule. This can be combined with parental reinforcement and monitoring to further help adolescents get better and longer sleep every day.

There is mounting evidence that delaying school start times can have a positive effect on the sleep duration of teenagers (Watson et al. 2017; Chan et al. 2017). This has been evidenced in the discrepancy in the increase in sleep duration during the COVID-19 pandemic, however, conflicting results may showcase an increased presence of sleep problems as well (Robillard et al. 2021; Gruber et al. 2021). It may be interpreted that the increase in the longevity of sleep is not impactful on the sleep quality during the pandemic, which in turn results in poor sleep. However, adoption of these delayed school start times is still quite limited due to low confidence in the available evidence and lack of clarity regarding the long-term impacts of delayed start times. These concerns can be addressed by solutions like flexible start times where students can choose a daily start between 8:00 to 8:50 AM and missed study time in that period can be compensated for during gap periods or after (Biller et al. 2022). Further research and experimentation in this area can help us find effective solutions. School administrators and policymakers should seriously evaluate options to provide delayed class times to enhance adolescents’ duration of sleep, school performance, as well as overall mental health.

Those adolescents, who are already facing mental disorders because of sleep deprivation, must seek professional help from psychiatrists or therapists. It is essential to identify and resolve any mental health issues in earlier stages to prevent them from getting worse and causing excessive harm to the individual. For example, later identification could lead to higher chances of developing more serious mental disorders. It could also increase suicidal ideation and withdrawal from society. It is important to incorporate sleep as an important factor to address as part of mental health programs (Gunderson et al. 2023). Furthermore, it becomes more difficult to treat the disorder if it is identified late. To provide more favorable conditions to adolescents hesitant to seek help, there should be prevention programs, mental health programs, and easily accessible guides and facilities for all to use. This requires involvement from the government and school systems. Some measures that can be taken include the implementation of policies protecting adolescents regarding these issues, appointing counselors in schools, increasing the funding for mental health services, training for teachers, staff, and other healthcare professionals to identify mental health issues, and by collaborating with mental health organizations. Such services may be unaffordable for several adolescents, particularly when sought through private service providers. Hence, policymakers must institute measures that address the affordability and accessibility of these facilities.

Moreover, it is essential for parents and other adults to also be aware of the consequences of sleep deprivation. By ensuring that parents are conscious of the importance of good sleep quality and adequate sleep duration, they may be able to establish a good sleep schedule for their children. Furthermore, they might be able to enforce limits on screen time that their children are exposed to, especially before their bedtime (Charmaraman et al. 2021). This could increase the possibility of prevention of mental health disorders and ensuring early treatment if required. As another method, using the peer group to bring improvements in one’s sleep and social media usage could be more effective, as an adolescent’s peer group tends to be much more influential than their parents or teachers. Using online means to garner attention and raise awareness of the matter, is also an effective method of preventing sleep deprivation and its associated mental health issues. By creating websites and apps to relay information on sleep deprivation, a more global reach is achievable (Quante et al. 2019). Some apps promote this information and provide methods to prevent and improve these issues. Additionally, websites which focus on promoting mental health awareness and protection of emotional well-being among adolescents and young adults have yielded positive results. Governments and non-profit organizations can take advantage of the reach social media has among adolescents and use interactive and attention-grabbing posts to laud the merits of a good sleep schedule and the harmful effects of sleep deprivation. To prevent the further rise in mental health issues among adolescents, it is crucial to maintain one’s sleep cycle. Failing to do so would have several detrimental effects. It would negatively affect an individual’s cognitive abilities by impairing various cognitive processes such as memory, decision-making, and emotion regulation along with decreasing reaction time. This would lead to an increase in the risk of multiple mental disorders. Consequentially, these mental disorders could cause a decline in academic performance and physical health while increasing suicidal ideation among adolescents as well. Adequate sleep will have a positive impact on mental well-being, physical health, learning outcomes, and social development of adolescents.

Implications and contributions

This research paper investigates the rise in sleep deprivation among adolescents, thereby urging stakeholders to set regulations to address mental well-being. Current research establishes an association between sleep deprivation and mental health, yet specific research regarding interventions for sleeplessness would help identify solutions for education and healthcare sectors.