According to the Mental Health Foundation, 20% of adolescents may experience a mental health problem in any given year. 50% of mental health problems are established by age 14 and 75% by age 24. 10% of children and young people (aged 5-16 years) have a clinically diagnosable mental health problem, yet 70% of children and adolescents who experience mental health problems have not had appropriate interventions at a sufficiently early age.
Mental health issues in teenagers have been rising in recent years and the impact of the Covid19 pandemic has accelerated this. Now, the incidence of mental health issues is becoming critical and an enormous challenge for public health services. Therefore, supporting mental health is a major priority for health services across the younger generation.
There are multiple triggers and drivers of metal health disorders, which can be very complex. It is also important to say that some mental health conditions are extremely serious, with suicide the leading cause of death in the under 35s. This article is not aiming to provide therapies for mental health disorders, but to highlight factors that can help support cognitive, mental and emotional function.
One big issue for teenagers, which has a significant issue on mental health is sleep. Sleep deprivation in adolescents is common. A US Youth Risk Behaviour Survey found that 72.7% of students reported an average of less than 8 hours of sleep on school nights.1
During adolescence the makeup of sleep changes dramatically. Firstly, there is a switch from a dominance of REM sleep (rapid eye movement sleep, where we tend to dream) during childhood to non-REM sleep. Research suggests that the high amount of REM sleep during childhood encourages neural development and development of many synaptic connections. Non-REM (NREM) sleep, dominating in teenagers, is associated with cleavage and snipping of unwanted connections, aimed at refining cognition, this appears to be essential for brain maturation. Interestingly, the final part of the brain to undergo this maturation process is the frontal lobe, which enables rational thinking and critical decision making.2 This is why rationality may be one of the last things to develop in children and why some teenage behaviours may appear to be irrational, and it is more difficult to encourage them to prioritise sleep.
Additionally, when we move out of childhood and into adolescence our body clock, or circadian rhythm, begins to change. It is thought this may be an evolutionary adaptation, whereby teenagers want to become more independent from their parents but remain within the security of family home. Hence, a teenager’s body clock will shift back a few hours and instead of sleep naturally being initiated at around 7-9pm, as in childhood (approximately), it will move past the natural clock of their parents to around 12-1am. This alone makes it difficult to initiate sleep in the evening.2
This is a double whammy as children still need to attend school, which does not accommodate the shift in the teenage body clock and begins at some time usually between 8 and 9am. This is a bit like an adult starting work at 5 or 6am, not impossible but certainly a challenge on energy levels and normal cognitive function, especially at a time when the brain is developing and strongly in need of NREM sleep to support maturation. This is also at a time where there is a high number of requirements for learning and the strain and pressure of exams, not to mention their emotional and physical development. All in all, this is a time when sleep should be a priority, but often becomes the opposite.
This system can lead to a deficit, even if albeit relatively small, which over the course of time can lead to teenagers becoming chronically sleep deprived. Chronic sleep deprivation can lead to3,4:
- concentration difficulties
- mentally ‘drifting off’ in class
- shortened attention span
- memory impairment
- poor decision making
- lack of enthusiasm
- moodiness and aggression
- risk-taking behaviour
- slower physical reflexes
- clumsiness, which may result in physical injuries
- reduced sporting performance
- reduced academic performance
- increased number of ‘sick days’ from school because of tiredness
All of these can be commonly seen in teenagers but are not always consciously associated with a lack of good sleep.
A prospective study has demonstrated the reciprocal effects for major depression and sleep deprivation among adolescents. Its shows reduced quantity of sleep increases risk for major depression, which in turn increases risk for decreased sleep.5
There is a strong correlation between depression and poor sleep. The same neurotransmitters that are disturbed in mood disorders such as depression, play a role in the sleep wake cycle. During sleep the brain goes through a self-cleaning process, and it is essential for synaptic plasticity and reducing inflammation, as well as many other beneficial processes. So low mood can be a cause and an effect of poor sleep.2,5,6
Serotonin – considered our feel-good neurotransmitter and in some cases of depression is reduced, is a precursor to the sleep neurotransmitter melatonin. Therefore, if serotonin production and/or signalling is disrupted, not only can we see low mood but also poor sleep, which can then exacerbate depression.
Additionally, melatonin itself has benefit to cognitive health as it7:
- Up-regulates antioxidant defence systems
- Helps reverse inflammatory processes
- Aids the breakdown of beta-amyloid plaque and prevents formation
- Protects brain mitochondria from free radicals
- Inhibits tau tangles formation
- Helps promote Brain Derived Neurotrophic Factor (BDNF) for the development of new healthy neurons. BDNF also has an anti-depressant effect
GABA – is our calming neurotransmitter – low levels are associated with anxiety and stress. GABA is associated with slower brain waves, which are consistent with sleep. When GABA levels are insufficient it is associated with night-time waking and a higher level of anxiety.8
Cortisol – our stress hormone, is responsible for our sleep-wake cycle and works in opposition to melatonin, therefore helping us to feel awake. When we are stressed, our cortisol levels increase and hence can stimulate waking, so, even if we feel tired, high cortisol levels can inhibit our ability to fall asleep. Insomnia and sleep deprivation are stressors on the body, so they in turn increase cortisol production. Therefore, prolonged stress can contribute to poor sleep as well as depression and vice versa.9
If sleep can be improved, this can have a positive benefit to both mental health and cognitive function in all individuals but is it especially important in teenagers.
What’s stopping teenagers sleeping?
As mentioned, the change in circadian rhythm will have a significant influence over the ability to fall asleep however there are many other factors that can be an issue, especially during the teenage years.3
Social Media – adolescents who use social media more – both overall and at night – and those who were more emotionally invested in social media experienced poorer sleep quality, lower self-esteem and higher levels of anxiety and depression.10
Blue light exposure – blue light emitted from devices such as phones, tablets, televisions and computer screens inhibit the production of melatonin. Therefore, the use of screens late at night can inhibit sleep.
Vicious circle – insufficient sleep causes a teenager’s brain to become more active. An over-aroused brain is less able to fall asleep.
Hectic after-school schedule – homework, sport, part-time work and social commitments can cut into a teenager’s sleeping time
Social attitudes – in Western culture, keeping active is valued more than sleep
Top tips for a good night’s sleep
- Try relaxation promoting activities such as yoga, yoga nidra, meditation, mindfulness, breathing and massage
- Take a warm/hot Epsom salt (a handful) bath before bed to aid sleep and relaxation. Hot baths bring blood vessels to the surface allowing your core body temperature to cool, which helps the body prepare for sleep, as body temperature begins to drop during night
- Ensure daytime full light exposure as well as activity. Take a run or walk during daylight hours to top up on serotonin and vitamin D. Ensure you don’t exercise too late in the evening as this can delay sleep onset
- Keep noises down (earplugs might help)
- Keep the room cool. Most people sleep best at around 18oC with adequate ventilation
- Make sure the bed is comfortable. Waking often with a sore back or neck suggests the mattress or pillow may need changing
- Create an aesthetic environment that encourages sleep – use serene and restful colours and eliminate clutter and distraction
- Avoid work or watching television in bed
- Consider using a relaxation, meditation or guided imagery app, any of these may help with getting to sleep and will certainly help with relaxation.
- Cut down on caffeine
- Start your bedtime routine a little earlier than usual (for example, 10 minutes). Do this for one week, then add an extra 10 minutes every week until you have reached your desired bedtime
- Get active during the day so you are more physically tired at night
Nutrients that may be useful:
Nutrients which can support sleep are:
Montmorency cherry – a natural source of melatonin, cherry juice or concentrated Montmorency cherry supplements have been shown to improve sleep quality.
Magnesium – aids muscle and nerve relaxation and is a cofactor for the enzyme which produces serotonin (which is then converted to melatonin).
B6 – cofactor for the production of serotonin and GABA.
5HTP – precursor to serotonin, converted in the presence of magnesium and B6. Tryptophan the amino acid precursor to 5HTP is also found in walnuts, almonds, banana, turkey and salmon.
B12 – essential for normal psychological and cognitive function.
Probiotics – a healthy balance of gut flora is associated with sleep, dysbiosis (imbalance of the microflora) is associated with poor sleep.
Glutamine – an amino acid which is the precursor to the neurotransmitter GABA.
L-theanine – another amino acid which supports GABA production and has been shown to have anxiolytic properties.
FOS (fructo-oligosaccharides) – considered a prebiotic (food for live bacteria within the gut). Recent studies have shown that the balance of the microflora influences sleep quality. (90% of serotonin is produced in the gut)
Ashwagandha – an Ayurvedic adaptogenic herb, which is associated with modulating the stress response and aiding sleep. It has also been shown to increase the neurotransmitter GABA. Studies have also suggested that it plays a potential role in the clearance of amyloid beta
- With mental health disorders a growing concern, particularly among adolescents, sleep health is an essential factor that should be considered in these individuals.
- The circadian rhythm of teenagers shifts, meaning that their signals to initiate sleep occur later in the evening, yet they still need to rise to attend school, therefore their sleep window is being shortened.
- Non-REM (NREM) sleep dominates in teenagers and is associated with cleavage and snipping of unwanted connections, aimed at refining cognition, this appears to be essential for brain maturation. Loss of this reduces rational and critical thinking.
- Poor sleep is strongly correlated with low mood, anxiety, and depression. Neurotransmitters involved in mood and calmness, also have an influence on sleep. Additionally, our sleep neurotransmitter melatonin, plays and essential role in support and protecting cognitive health.
- Therefore, prioritising sleep when you are a teenager is essential. Looking at maintaining a healthy bedtime routine and sleep hygiene is a good start.
- Supporting serotonin and/or melatonin production which nutrients such as 5HTP, B6, magnesium and Montmorency cherry can be useful.
- Also, nutrients which are involved in supporting a healthy stress response such B5, ashwagandha and magnesium.
- Gut health is important as 90% of serotonin as well as GABA are produced in the gut, so supporting gut function with probiotics and prebiotics have been demonstrated to be useful.
- Glutamine and l-theanine have also been shown to support GABA production.
If you have questions regarding the topics that have been raised, or any other health matters, please do contact me (Helen) by phone or email at any time.
Amanda Williams and the Cytoplan Editorial Team
- Kansagra, S. (2020) ‘Sleep Disorders in Adolescents’, Pediatrics, May, 145 (Supplement 2) S204-S209;
- Matthew Walker, (2017) Why we sleep. Penguin Books.
- Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 2, Sleep Physiology. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19956/
- Roberts RE, Duong HT. The prospective association between sleep deprivation and depression among adolescents. Sleep. 2014 Feb 1;37(2):239-44.
- Grandner MA, Malhotra A. Connecting insomnia, sleep apnoea and depression. Respirology. 2017;22(7):1249-1250.
- Shukla M, Govitrapong P, Boontem P, Reiter RJ, Satayavivad J. Mechanisms of Melatonin in Alleviating Alzheimer’s Disease. Curr Neuropharmacol. 2017;15(7):1010-1031.
- Hepsomali P, Groeger JA, Nishihira J, Scholey A. Effects of Oral Gamma-Aminobutyric Acid (GABA) Administration on Stress and Sleep in Humans: A Systematic Review. Front Neurosci. 2020;14:923. Published 2020 Sep 17. doi:10.3389/fnins.2020.00923
- Wright KP Jr, Drake AL, Frey DJ, et al. Influence of sleep deprivation and circadian misalignment on cortisol, inflammatory markers, and cytokine balance. Brain Behav Immun. 2015;47:24-34. doi:10.1016/j.bbi.2015.01.004
- Woods HC, Scott H. #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. J Adolesc. 2016 Aug;51:41-9.