Chronic stress undermines the compensatory sleep efficiency increase in response to sleep restriction in adolescents

Abstract

SUMMARYTo investigate the effects of real-life stress on the sleep of adolescents, we performed a repeated-measures study on actigraphic sleep estimates and subjective measures during one regular school week, two stressful examination weeks and a week's holiday. Twenty-four adolescents aged 17.63 AE 0.10 years (mean AE standard error of the mean) wore actigraphs and completed diaries on subjective stress, fatigue, sleep quality, number of examinations and consumption of caffeine and alcohol for 4 weeks during their final year of secondary school. The resulting almost 500 assessments were analysed using mixed-effect models to estimate the effects of mere school attendance and additional examination stress on sleep estimates and subjective ratings. Total sleep time decreased from 7:38 h AE 12 min during holidays to 6:40 h AE 12 min during a regular school week. This 13% decrease elicited a partial compensation, as indicated by a 3% increase in sleep efficiency and a 6% decrease in the duration of nocturnal awakenings. During examination weeks total sleep time decreased to 6:23 h AE 8 min, but it was now accompanied by a decrease in sleep efficiency and subjective sleep quality and an increase in wake bout duration. In conclusion, school examination stress affects the sleep of adolescents. The compensatory mechanism of more consolidated sleep, as elicited by the sleep restriction associated with mere school attendance, collapsed during 2 weeks of sustained examination stress.

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“…Less TST as caffeine consumption increased is consistent with other literature in children [9][10][11] ; similarly, no relationship with SOL was found in a sample of adolescents. 34 With regard to broader sleep problems, sleep routine and restless sleep, specifically in relation to caffeine intake, have not been investigated previously in any age group. Li and colleagues 32 found an increase in the number of nocturnal awakenings when children aged 5 to 12 years consumed caffeine after 6:00 pm.…”

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“…Good sleep requires individuals to have a sense of safety, security, and predictable environments. If individuals feel threatened or worried, they may be vigilant and ruminate, leading to short, fragmented sleep (Astill, Verhoeven, Vijzelaar, & Van Someren, 2013; Hall, Dahl, Dew, & Reynolds, 1995). Short, fragmented sleep is likely to be perceived as low quality and result in daytime sleepiness compared to longer, less fragmented sleep.…”