Is Excess Internet Use Late at Night Related to Suicide Risk in Teens?

[seriesbox]A Parent’s Guide to Self-Harm and Suicide Risk in Teens
The Association Between Teen Suicidal Ideation and Childhood Depression and Irritability
Bullying and Cyberbullying Associated with Higher Risk of Suicide in Teens
Are Brooding, Impulsive Teens at Higher Risk for Suicidality?
Risk of Escalation from Self-Harm to Suicide Attempts in Adolescents
Teen Suicide Contagion: Is Suicide Contagious?[/seriesbox]Everyone knows the rules about sleep.

Kids need lots of sleep. The experts say they need at least 12 hours a night when they’re young. Gradually, through grade school and middle school, they need less. By high school, experts recommend they get around nine hours. However, most parents understand and accept the seven to seven and a half hours of sleep teens in the U.S. get each night, on average.

As we age – most of us, at least – we sleep less. Ask anyone past their 30s, and they’re likely to tell you they get around six hours of sleep per night. The lucky ones get around eight. But it’s not unusual to hear people say “I wake up at 3am every night and cannot get back to sleep.” Which puts a lot of us around five hours per night – an amount sleep experts say can lead to health complications.

Insomnia and sleep disturbances are separate issues: insomnia is when a person has trouble falling and staying asleep, resulting in many nights of little sleep, some nights of no sleep, with the cumulative effect known as sleep deprivation. Sleep disturbance is similar. It’s slightly less disruptive than insomnia, but over long periods of time, can lead to sleep deprivation, just like insomnia.

What many adults don’t realize is that teenagers get insomnia and have disturbed sleep, too. Some also have habits that lead to sleep deprivation, like staying up late online chatting with friends, surfing the web, scrolling their feeds, and doing what teens do.

The negative health consequences of sleep deprivation are well known. They include:

• Obesity
• Diabetes and impaired glucose tolerance
• Cardiovascular disease
• Hypertension
• Impaired immune function

Most of us understand that. But what some of us might not understand is the connection between sleep deprivation and mental health problems.

Sleep Deprivation and Mental Health

Research shows that – in addition to the physical problems listed above – sleep deprivation during adulthood can lead to:

• Decreased cognitive function
• Attention problems
• Decreased motivation
• Memory problems
• Impaired decision making

Again, most of us – from teenagers through to adults – can relate. We have a bad night. Then the next day we can’t think straight. We feel sluggish. We’re likely to make poor decisions, as compared to the day after a good night of sleep.

The latest studies indicate sleep deprivation and insomnia can lead to more than feeling groggy and making questionable decisions.

In fact, insomnia that begins during childhood or adolescence is associated with several different mental health disorders, including:

• Depressive disorders.
  • Nine out of ten adults and children with a depressive disorder also have some type of sleep problem.
  • People with insomnia are four times more likely to develop depression than people without insomnia.
  • People with both major depressive disorder (MDD) and insomnia show less treatment success and increased incidence of relapse
• Bipolar disorder (BD)
  • During manic phases of BD, 99% of people with BD report insomnia.
• Anxiety
  • Insomnia and sleep disturbance is common across all forms of anxiety
• Attention deficit hyperactivity disorder (ADHD)
  • Half of kids with ADHD report sleep problems

All that information can help us help kids with sleep problems and with mental health problems. But recent research shows that sleep problems during childhood and adolescence can lead to something else: a higher risk of suicide.

Teens and Sleep: The Statistics

The idea that childhood/adolescent insomnia and sleep disturbances can increase suicide risk among teens is alarming. Before we offer the data from the recent research that reveals these connections, let’s have a look at recent research that connects the sleep patterns of teens with various emotional and behavioral issues.

Researchers in a large-scale study in Hong Kong found:

• 23% of high school students stay up late and get up early
• Among those 23% of high school students, 50% had insomnia
• Those with insomnia were three times as likely to develop emotional, behavioral, or other mental health issues

The connection between adolescent sleep loss and adolescent emotional, behavioral, and mental health issues is clear. Now let’s look at the data that connects adolescent sleep loss with an increased risk of suicide.

Teens, Sleep, and Suicide Risk: New Data

Two studies published recently raise an alarm about the relationship between insomnia, sleep disturbance, and increased risk of suicide among teens.

The first, a meta-analysis that included data on close to 50,000 adolescents from 14 studies showed that teens who said they had insomnia or disturbed sleep had significantly increased risk of:

• Engaging in suicidal ideation
• Making suicide plans
• Attempting suicide

However, among those 14 studies, several with smaller sample sizes – the prospective studies – yielded conflicting results. The prospective studies found associations between sleep problems and suicidal ideation, but not between sleep problems and suicide attempts. Therefore, while the evidence connecting sleep disturbances and suicidal ideation is strong, the evidence connecting sleep disturbances and suicide attempts is not as strong.

But it still raises concerns. The study authors offer this possible explanation of the connection between disturbed sleep/insomnia and suicidal ideation, suicide plans, and suicide attempts:

• Sleep disturbance at night can negatively affect:
  • Serotonin activation, which can affect:
    • Cognitive function, which can lead to:
      • Impaired judgment
      • Deficits in impulse control

It’s widely accepted that impaired judgment and impulse control deficits may increase suicide risk.

We’ll let the study authors connect the dots:

“Sleep deprivation in adolescents might plausibly increase youth suicidality through heightened impulsivity related to incomplete frontal lobe and emotional regulation circuitry.”

That makes sense to us. Teens need adequate sleep not only to recharge the typical function of their brains and bodies, but also to compensate for their developing impulse control and rational decision-making skills.

Excess Internet Use, Sleep Disturbance, and Suicide Risk

Now we’ll look at the second study, which examined data on sleep habits, internet use, and sleep disturbances from 631 middle school and high school students.

Here’s what they found:

• 22.9% reported suicidal ideation
• 42% reported sleep disturbances
• 30.2% reported excess internet use at night
• 26.5% reported severe depressive symptoms

The researchers concluded that “…adolescents with suicidal ideation had higher rates of sleep disturbances, [excess] internet use and depressive symptoms,” and recommended that “…a routine assessment of sleep disruption and excessive use of the internet may be a key to suicide prevention.”

Those conclusions also make sense to us – and they should to parents, too.

How This Information Helps Parents

All this data reinforces things most parents know. Teens need regular sleep – 7-9 solid hours – every night. While the connection between sleep deprivation and mental health issues is well-known, and the connection between mental health issues and suicidal ideation and suicide attempts is also well-established, direct connections between sleep deprivation among teens and the increase in rates of suicide among teens over the past twenty years have not been established.

And let’s be clear. This is correlative data that indicates associations between sleep disturbance/insomnia and suicidal behavior. The data connecting excess nighttime internet use and suicidal behavior is also correlative, not causative, which means scientists do not say staying up late online leads to suicide attempts.

That would be irresponsible and inaccurate.

What they do say, however, is that teens with insomnia or poor sleep habits (that may be partially attributed to staying up late online) and concurrent mental health issues are at increased risk of suicidal ideation. What this says to us is that parents, therapists, counselors, teachers, and anyone who works with teens should understand the importance of sleep hygiene and its impact on mental health.

Here are three simple steps parents can take to help improve sleep hygiene and mental health.

Three Tips for Better Sleep for Teens

1. Lifestyle changes:

• Encourage teens to exercise at least an hour a day
• Eliminate sugar and caffeine at night

2. Meditation or other relaxation practices:

• Mindfulness
• Yoga
• Tai chi
• Self-guided relaxation

3. Healthy sleep habits, including:

• Maintaining a regular sleep schedule
• Turning screens off an hour before bedtime, and keeping them out of the bedroom
• Creating a nighttime relaxation routine, which can include yoga, meditation, taking a walk, or other relaxing activities, such as reading, drawing, or journaling

The publication of this new data on the relationship between sleep disturbance and suicide means that these three simple prescriptions may not only lead to improved quality of life, but may also be life-saving: that’s important information for any parent to know.