self-careCENTER FORRESEARCH ONGIRLS

A SERIES OF RESEARCH AND INFORMATIONAL PUBLICATIONS BY CRG“Putting the world’s best research to work for girls.”

by Tori S. Cordiano, Ph.D.

Sleep deprivation is a rising concern for children and adolescents. While it

is recommended that adolescents sleep 9-10 hours per night, only 20%

reach that optimal amount and nearly half average less than 8 hours on

weeknights.1 Teenagers’ sleep generally decreases over the course of

adolescence.2 While improving children’s sleep has been a recent

focus of media attention, overall adolescent sleep has decreased

significantly over the past 20 years.3

Research has long established connections between

sleep deprivation in adolescence and negative

consequences related to mood, anxiety, behavior,

self-esteem, interpersonal relationships, substance

use and academic functioning.4,5,6 Newer research

identifies factors that interfere with optimal adolescent

sleep and illuminates why some teenagers sleep more

than others.

GIRLS, SLEEP AND MINDFULNESS

GIRLS AND SLEEPGenerally, no significant differences have been found between girls’ andboys’ sleep throughout childhood.7 Sleep differences begin to emergeduring adolescence, and while the research is mixed, there is evidencethat teenage girls experience higher rates of insomnia8 and less overallsleep.9, 10 Sex differences in sleep problems appear to remain stable intoyoung adulthood11 and over the course of adult development.12 Aspeople get older, decreased sleep may play a stronger role in physicalhealth problems, including heart disease, for women than for men.13

The exact reasons for sleep differences between teenage girls and boys areunknown, but several factors likely contribute. There may be hormonalreasons why teenage girls sleep less; the onset of puberty, and specificallythe start of menses, appears to play a role in girls’ increased insomnia.14

Research also is attempting to untangle the relationship between sleepand depression, which is more common in girls than in boys.15 Depressionand poor sleep are closely related; some evidence indicates that even girlswe know to be at heightened risk of depression experience more sleepdisruption than those with a lower risk of depression.16

STRESS AND SLEEPMore than a third of teenagers report that stress interferes with theirability to fall asleep, and teenagers who sleep less than eight hours perweeknight report higher levels of stress than those who sleep at leasteight hours.17 The negative consequences of stress and insufficient sleepare cyclical; compared to teens reporting lower stress levels, more ofthose reporting higher stress levels say that not getting enough sleepcauses them to feel even more stressed.18

Stress may be another factor that contributes to differences in girls’ andboys’ sleep during adolescence. Teenage girls report higher levels ofstress in close friendships and a stronger response when multiplestressful events occur in their social relationships. Compared to boys,girls also report more upset feelings when their friends are stressed.19

One study found that the emotion-focused style of coping favored bygirls relates to decreased sleep time during periods of stress.20

Learning to manage stress may be an important component ofimproving adolescent sleep. Many stress-management techniques haveshown promise in boosting adolescents’ well-being, includingmindfulness,21 yoga,22 guided relaxation,23 physical activity,24 andmeditation.25 Recently, researchers have started to explore the potentialbenefits of mindfulness practices on improving sleep. While this hasbeen studied more extensively in adults, there is evidence that teachingmindfulness to children may benefit their sleep and their overall well-being.26 One sleep intervention program that included a mindfulnesscomponent showed improvements in the time it took teenage girls tofall asleep and in their perceived sleep quality.27 When mindfulness-

based stress reduction (MBSR, a commonly-used mindfulness trainingprogram) was used to treat adolescents receiving outpatient psychiatriccare, the participants reported improved sleep along with decreasedmood and anxiety symptoms.28

CRG RESEARCH ON SLEEP A large-scale research study conducted at Laurel School in collaborationwith researchers from Boston College and Boston University exploredthe factors that contribute to and alleviate stress in high-achievinggirls.29 Part of this study specifically examined the relationship betweengirls’ perceived stress and their sleep over time.30 Several importantfindings emerged from this study:

• Girls in this study averaged two hours less than the recommended nine hours of sleep per night, and their sleep decreased over the course of the academic year. • Higher levels of stress preceded fewer hours of sleep for girls in both the fall and the spring. • By contrast, sleep was a negative predictor of stress—greater time spent sleeping preceded lower levels of stress. • Stress appears to have long-term implications for sleep: higher levels of stress in the fall predicted decreased levels of sleep in the spring.

While most teenagers get less sleep than they need, the problem may be more pronounced for adolescent girls.

What is mindfulness?Mindfulness has garnered significant attention in recent yearsfor its benefits in enhancing psychological health and well-being. Mindfulness is a specific way of paying attention to one’ssurroundings that is honed through meditation and acceptancepractices.31 Jon Kabat-Zinn, Ph.D., the Founding ExecutiveDirector of the Center for Mindfulness at the University ofMassachusetts Medical School is largely credited with bringingmindfulness techniques to mainstream culture, with thedevelopment of his mindfulness-based stress reduction (MSBR)technique.32 He describes mindfulness as “the awareness thatemerges through paying attention on purpose, in the presentmoment, and non-judgmentally to the unfolding ofexperience”.33 Mindfulness practices have been adopted bytherapists34 and educators35 and have shown success in treatinganxiety,36 depression,37 sleep disturbances,38 and anger.39

Mindfulness exercises can be tailored to adults and children of all ages. Basic mindfulness activities can incorporate eachof the senses, such as listening to the sounds around you as you take a walk outside, paying close attention to the textureand taste of a piece of food while eating, and noticing thesensation of breath coming into and out of the body.

self-care:GIRLS, SLEEP AND MINDFULNESS

GIRLS, SLEEP AND MINDFULNESS [endnotes]

1 National Sleep Foundation. 2006 Sleep in America Poll: Summary and findings.Available at: http://sleepfoundation.org/sites/default/files/2006_summary_of_findings.pdf.Accessed August 16, 2015.

2 Owens, J. (2014). Insufficient sleep in adolescents and young adults: An update oncauses and consequences. Pediatrics, 134, e921-e932.

3 Keyes, K., Maslowsky, J., Hamilton, A., & Schulenbery, J. (2015). The great sleep recession:Changes in sleep duration among US adolescents, 1991-2012. Pediatrics, 135, 460-468.

4 Roberts, R.E., Roberts, C.R., Duong, H.T. (2009). Sleepless in America: Prospective dataon sleep deprivation, health and functioning. Journal of Adolescence, 32, 1045-1057.

5 Fredriksen, K., Rhodes, J., Reddy, R., & Way, N. (2004). Sleepless in Chicago: Tracking theeffects of adolescent sleep loss during the middle school years. Child Development, 75,84-95.

6 Sarchiapone, M. et al. (2014). Hours of sleep in adolescents and its association withanxiety, emotional concerns, and suicidal ideation. Sleep Medicine, 15, 248-254.

7 Laberge, L. (2001). Development of sleep patterns in early adolescence. Journal of SleepResearch, 10, 59-67.

8 Johnson, E.O., Roth, T., Schultz, L., & Breslau, N. (2006). Epidemiology of DSM-IVinsomnia in adolescence: Lifetime prevalence, chronicity, and an emergent genderdifference. Pediatrics, 117, e247-e256.

9 Keyes, Maslowsky, Hamilton, & Schulenbery (2015).

10 Sarchiapone et al. (2014).

11 Tsai, L.L., & Li, S.P. (2004). Sleep patterns in college students: Gender and gradedifferences. Journal of Psychosomatic Research, 56, 231-237.

12 Zhang, B., & Wing, Y-K. (2006). Sex differences in insomnia: A meta-analysis. Sleep, 29,85-93.

13 Prather, A.A., Epel, E.S., Cohen, B.E., Neylan, T.C., & Whooley, M.A. (2013). Genderdifferences in the prospective associations of self-reported sleep quality withbiomarkers of systemic inflammation and coagulation: Findings from the heart andsoul study. Journal of Psychiatric Research, 47, 1228-1235.

14 Johnson, Roth, Schultz, & Breslau (2006).

15 Chen, M.C., Burley, H.W., & Gotlib, I.H. (2012). Reduced sleep quality in healthy girls atrisk for depression. Journal of Sleep Research, 21, 68-72.

16 Chen, Burley, & Gotlib (2012).

17 American Psychological Association. (2014). Stress in America: Are teens adoptingadults’ stress habits? Available at:https://www.apa.org/news/press/releases/stress/2013/stress-report.pdf. AccessedAugust 18, 2015.

18 American Psychological Association (2014).

19 Rose, A.J., & Rudolph, K.D. (2006). A review of sex differences in peer relationshipprocesses: Potential trade-offs for the emotional and behavioral development of girlsand boys. Psychological Bulletin, 132, 98-131.

20 Sadeh, A., Keinan, G., & Doan, K. (2004). Effects of stress on sleep: The moderating roleof coping style. Health Psychology, 23, 542-545.

21 Burke, C.A. (2009). Mindfulness-based approaches with children and adolescents: Apreliminary review of current research in an emerging field. Journal of Child andFamily Studies, 19, 133-144.

22 Khalsa, S.B.R., Hickey-Schultz, L., Cohen, D., Steiner, N., & Cope, S. (2012). Evaluation ofthe mental health benefits of yoga in a secondary school: A preliminary randomizedcontrolled trial. Journal of Behavioral and Health Services Research, 39, 80-90.

23 Foret, M.M., et al. (2012). Integrating a relaxation response-based curriculum into apublic high school in Massachusetts. Journal of Adolescence, 35, 325-332.

24 Gerber, M., et al. (2012). Adolescents’ exercise and physical activity are associated withmental toughness. Mental Health and Physical Activity, 5, 35-42.

25 Wisner, B.L., Jones, B., & Gwin, D. (2010). School-based meditation practices foradolescents: A resource for strengthening self-regulation, emotional coping, and self-esteem. Children and Schools, 32, 150-159.

26 Rempel, K.D. (2012). Mindfulness for children and youth: A review of the literaturewith an argument for school-based implementation. Canadian Journal of Counsellingand Psychotherapy, 46, 201-220.

27 Bei, B. et al. (2013). Pilot study of a mindfulness-based, multi-component, in-schoolgroup sleep intervention in adolescent girls. Early Intervention in Psychiatry, 7, 213-220.

28 Biegel, G.M., Brown, K.W., Shapiro, S.L., & Schubert, C.M. (2009). Mindfulness-basedstress reduction for the treatment of adolescent psychiatric outpatients: Arandomized clinical trial. Journal of Consulting and Clinical Psychology, 77, 855-866.

29 http://www.laurelschool.org/uploaded/programs/crg/crg_downloads/CRG_STRESS_WELL_BEING.pdf

30 Desilva Mousseau, A.M., Lund, T.J., Liang, B., Spencer, R.,& Walsh, J. (2015). Stressed andlosing sleep: The sleep-stress cycle for affluent adolescent females. Manuscript inpreparation.

31 Burke (2009).

32 Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, andfuture. Clinical Psychology: Science and Practice, 10, 144–156.

33 Kabat-Zinn (2003), 145.

34 Segal, Z.V., Williams, J.M.G., & Teasdale, J.T. (2012). Mindfulness-based cognitive therapyfor depression, 2nd edition. New York: The Guilford Press.

35 Rempel (2012).

36 Semple, R.J., & Lee, J. (2011). Mindfulness-based cognitive therapy for anxious children:A manual for treating childhood anxiety. Oakland, CA: New Harbinger Publications.

37 Segal & Lee (2012).

38 Black, D.S., O’Reilly, G.A., Olmstead, R., Breen, E.C., & Irwin, M.R. (2015). Mindfulnessmeditation and improvement in sleep quality and daytime impairment among olderadults with sleep disturbances: A randomized clinical trial. JAMA Internal Medicine,175, 494-501.

39 Singh, N., & Sabaawi, M. (2007). Adolescents with conduct disorder can be mindful oftheir aggressive behavior. Journal of Emotional and Behavioral Disorders, 15, 56-63.

40 Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mindto face stress, pain, and illness (revised updated edition). Westminster, MD: Bantam.

41 Owens, J. (2014).

42 Snel, E. (2013). Sitting still like a frog: Mindfulness exercises for kids (and their parents).Boston: Shambhala Publications.

CENTER FOR RESEARCH ONGIRLSPutting the world’s best research to work for girls.

LaurelSchool.org/CRG

/CRGLaurelSchool @CRGLaurelSchool

CENTER FOR RESEARCH ONGIRLSPutting the world’s best research to work for girls.

RESOURCES FOR TEACHERSOnline ResourcesHEALTHY SLEEP HABITSTeach students about healthy sleep habits with this engaging PowerPoint® presentation developed by Laurel’sCenter for Research on Girls (CRG). A handout to accompany this PowerPoint presentation is also available.http://www.LaurelSchool.org/CRGcurricula

WHY SLEEP?This handout, developed by CRG, summarizes the role of sleep in promoting mental, emotional, and physical healthand can be used alone or as a supplement to the Healthy Sleep Habits PowerPoint presentation.http://www.LaurelSchool.org/CRGcurricula

MINDFUL SCHOOLSProvides online resources and in-person trainings for adults to learn mindfulness and use it with children. www.mindfulschools.org

RESOURCES FOR PARENTS

BookFULL CATASTROPHE LIVING40

First published in 1990 and now presented in an updated and revised edition, Jon Kabat-Zinn’s introduction to mindfulness-based stressreduction provides information on and techniques for using mindfulness to reduce stress and cultivate well-being.

Online ResourceINSUFFICIENT SLEEP IN ADOLESCENTS AND YOUNG ADULTS: AN UPDATE ON CAUSES AND CONSEQUENCES41

This technical report, produced by the American Academy of Pediatrics in 2014, provides recent information on the causes and effects ofreduced sleep in adolescence.

RESOURCES FOR CHILDREN

BookSITTING STILL LIKE A FROG: MINDFULNESS EXERCISES FOR KIDS42

Provides an introduction to mindfulness and guided practice through mindfulness exercises using an accompanying CD for children ages 5-12.

Online ResourceTEENS AND SLEEPThis guide, produced by the National Sleep Foundation and designed for teenagers, provides information about the consequences of too little sleep and recommendations for establishing good sleep habits. http://sleepfoundation.org/sleep-topics/teens-and-sleep

self-care: GIRLS, SLEEP AND MINDFULNESS

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Copyright © 2015 Laurel’s Center for Research on Girls