FEMALE NARRATOR: Funding for this program was provided by the University of Pittsburgh.

[LULLABY] We hope this show puts teenagers to sleep.

No, really... we want them to sleep-- [ALARM CLOCK] --because major medical research shows teens aren't getting enough of the shut-eye that's crucial for healthy development.

JOEY: School starts way too early and homework and extra-curricular activities go way too late.

DR. ELIZABETH MILLER: Sleep touches just about all aspects of adolescent health.

- You can see them dozing off in class, or yawning.

NARRATOR: Chalk it up to early mornings... late nights... and all the activities teens cram in between.

- They've perhaps become accustomed to life as a drowsy teen.

NARRATOR: And drowsy is dangerous.

New science shows lack of sleep has a big impact on the body... the brain... And behavior.

DR. PETER FRANZEN: More likely to get into a fight with people, have arguments, think that somebody's lookin' at you funny.

NARRATOR: Research paints a clear picture of the problem... but there's no easy route to a solution.

- The more that we ignore sleep, we're not going to be able to address all of these other serious adolescent health issues.

Let's just try to get a little more sleep.

NARRATOR: So get to bed... after you hear this tale of the troubling truth about teens and sleep.

[ALARM CLOCK BUZZES] JOHN: I wake up at six.

There are definitely times that the alarm goes off and I feel like I just went to bed, which is a little bit frustrating.

NARRATOR: John Pugh is a sophomore at Quaker VaATey High School.

He takes honors classes... has a role in the school play... works a job on the weekends.

JOHN: I like to have a more busy life because I feel more productive that way.

NARRATOR: Like many teens, John's super-sized schedule means something's gotta give... And sleep is the thing they sacrifice.

JOHN: Homework is difficult to find the time to get it all done.

If it's a lot of work, you gotta stay up, usually I try to put it away and maybe see if I can wake up a little earlier the next day and see if I can get some done then.

I think that pretty much every single one of my friends has that kind of a jam-packed schedule.

DR. MILLER: The optimal amount of sleep that teens need is about 9 - 10 hours.

And if you're not actually thinking about it, saying it's ten o'clock and it's time to go to bed, if you're not intentional about it, it doesn't happen.

NARRATOR: Dr. Elizabeth Miller is the chief of Adolescent And Young Adult Medicine at Children's Hospital of Pittsburgh.

When it comes to sleep deprivation, she says teens' busy schedules are only part of the problem.

The rest has to do with biology.

DR. MILLER: When they're starting to go through puberty and their bodies are doing this incredibly dynamic growth, that is when young people really need sleep and that is what their body is craving.

NARRATOR: Teens don't need more sleep than adults... but they do need it at different times.

The body's natural sleep-wake cycle-- what's called circadian rhythm-- shifts during puberty.

Teens have a biological urge to go to sleep later and to wake up later.

But early school start times mean teens can't sleep in.

This late-to-bed early-to-rise lifestyle leads to something called sleep debt.

DR. MILLER: Young people are not getting the amount of sleep that they need and it continues to build up and build up and build up.

NARRATOR: And there's plenty of evidence to prove young people who accumulate sleep debt also have problems with daily functioning.

DR. MILLER: The research is that every additional 30 minutes that young people sleep, the better their attention, the better their academic achievement, the better their emotional health.

Study after study after study show that even small increments of sleep make a huge difference.

- On a good day, I would say that I get about eight to eight and a half hours of sleep.

On a bad day, I could say that that would probably get down to like six.

Maybe five and a half.

Especially if I've had a long week, I can't think about class.

All the information will kind of be like going in one ear and out the other.

- There are definitely a ton of people that don't get enough sleep and you can see them dozing off in class or yawning.

- I usually wake up really late, get to school really late, so then my mind's all jumbled because I was late and I'm like, ahh!

It's not good.

NARRATOR: Not good at all... but what's the alternative?

To get the recommended ten hours of sleep at night, teens would have to be tucked into bed by 8 or 9 P.M.!

GIRL: I never go to bed at nine, like, I can't get into the bed at that time.

- I generally go to bed around 11:30 or midnight.

- Uh, like 1 A.M., 2 A.M. - I get around 7 hours of sleep in the best-case scenario, I suppose.

- If I get, like, a good four hours of sleep then it's like, I'm tired all the time, but if I get the normal five or six hours, then it's normally not until 6th period that I get really tired.

DR. MILLER: I think that there probably are factors that are contributing to worse sleep for adolescents today compared to 30 years ago.

The story with cell phones and computers is certainly a big piece of this puzzle.

NARRATOR: That's because digital devices are keeping teens up even later as they use them for homework and late-night socializing.

To make matters worse, the artificial light leads to more disruptions in the body's circadian rhythm.

- On some level, as physicians, I think we have an obligation to essentially write a prescription for a young person that says cell phone out of the bedroom, laptop out of the bedroom.

Sleep touches just about all aspects of adolescent health.

Things like obesity, car accidents, academic achievement, depression, increased risk of suicide.

NARRATOR: Research also shows teens with insufficient sleep get less physical exercise.

And, they are more likely to smoke cigarettes, use alcohol and marijuana, have sex, and get into physical fights.

Long-term, poor sleep is associated with an increased risk for heart disease, high blood pressure, stroke, and diabetes.

- These are really serious health issues and the more that we ignore sleep, we're not going to be able to address all of these other serious adolescent health issues.

NARRATOR: But that's no easy feat when even the teens think optimal sleep recommendations aren't realistic.

BOY: 8 to 10 certainly sounds like a large number to me.

I'm not even sure if I have any friends who get that much sleep.

It might be reasonable but it seems impractical to me.

- It seems like there has to be some sort of a compromise somewhere but I think the difficulty is finding where that compromise has to happen.

[♪♪♪] - Okay, Joey, great job, so we're gonna have you get ready to go to sleep, okay.

- Thank you.

Good night!

NARRATOR: Welcome to the sleep lab at the University of Pittsburgh School of Medicine.

This is Joey, a 14-year-old volunteer in one of the program's research studies.

Those sensors and wires won't hurt him.

They just measure Joey's brain activity while he sleeps.

That's Dr. Peter Franzen.

He's in charge of the sleep lab, and he's leading an experiment to see how lack of sleep affects adolescent brains.

DR. FRANZEN: We know that attention goes out the window.

They start having problems paying attention, problems with learning and memory.

But the other thing we're looking at are just what aspects of emotion are affected by sleep loss.

And it might be that the emotional consequences of sleep loss are some of the most profound consequences.

NARRATOR: To study sleep under controlled conditions, teens like Joey sleep at the lab for two separate sessions.

- I'm just going to plug this into the wall.

NARRATOR: For the first session, Joey gets ten hours of sleep at night.

But during the second session, he's only allowed four hours of sleep at night.

It starts with the read-out from those sensors on Joey's head.

DR. FRANZEN: We can see what kind of electrical activity is going on in the brain and lets us know when they're asleep, what kind of sleep that they're having.

NARRATOR: The steeper and more dramatic the lines, the deeper the sleep.

It's called slow-wave sleep.

- So we think of slow-wave sleep as the deep, restorative sleep that really helps us feel rested and recharged the next day.

NARRATOR: This read-out shows the slow-wave eep of a younger child.

Lots of high, steep lines.

But during puberty, teens become lighter sleepers.

Their slow-wave sleep drops by about 16-percent.

DR. FRANZEN: So here's the same slow-wave sleep, that same sort of deep sleep that we were talking about, but this is in an older adolescent.

The waves get less big.

It's still the same kind of sleep, it's just... there's less of it.

NARRATOR: Being a lighter sleeper means a teen already has less of the slow-wave sleep that will rest and recharge the brain.

Skimp even more on sleep, and it hits the brain even harder.

DR. FRANZEN: If we look at brain development across adolescence, the brain's still developing and still growing.

And the last area to develop is what's called the prefrontal cortex.

The prefrontal cortex is involved in things like planning, cognitive control, control over our emotions.

When you get into a sort of emotionally charged moment, the prefrontal cortex gets overwhelmed and is less able to control or regulate behavior.

And we think that's why adolescents maybe sometimes make impulsive and risky decisions.

NARRATOR: So teens already have trouble managing emotions.

To make matters worse, this part of the brain is also the most sensitive to sleep loss.

Brain scans reveal the impact.

- What we can have them do is a task while they're in the scanner.

And the areas that are hot colors here are the areas that were very active during the task the blue areas are the areas that were not very active during the task.

And in this case, this is a task where we ask kids to try to control their emotions.

They were looking at emotional pictures.

The top sets of brain images are the kids when they didn't get a lot of sleep versus the same kids when they did get a lot of sleep.

NARRATOR: Take another look-- and remember, the bright orange color means the brain is very active.

Rested teens, lots of activity.

Sleepy teens, much less activity.

DR. FRANZEN: So that really suggests they're less able to turn on those areas of the brain that are really involved in the control over emotions and behaviors.

[SCREAM AND TIRES SKIDDING] NARRATOR: This experiment measures pupil dilation... and once again, it provides evidence that lack of sleep leads to lack of control over emotions.

- The harder you have to work at something, the more your pupils will get bigger.

But that also happens for emotion.

This is a particular task where we had people listening to sounds, and so positive sounds are people laughing or joking, negative sounds could be a baby crying or people fighting.

[BABY CRYING] [MAN HOLLERS] NARRATOR: If Joey cannot control his reaction to the negative sound, his pupil will get bigger.

He does the task twice-- once when he's well-rested, and again when he's sleep-deprived .

- Where we really saw the big difference here it was specific to the negative.

So it seems like lack of sleep really creates problems with dealing with stressors and challenges that you face every day.

You might be having bigger reactions to that, more likely to get into a fight with people, have arguments, think that somebody's lookin' at you funny.

JOEY: I was a lot more moody.

I felt exhausted, my movements weren't so great.

My mind was not the way it would normally be.

And I think I do need to get more sleep.

DR. FRANZEN: I think with younger kids it's very obvious that the first thing people point to when kids get cranky, is they need a nap.

And then those kids grow up to be a little bit older and they still need their sleep.

[♪♪♪] NARRATOR: Pitt's sleep lab also studies college students because "adolescence" extends into the early 20s.

One of the research studies focused on students at Carlow University.

- So I laughed out loud when they came to us and said you know, let's study your sleep habits.

And I was like, are you sure you want to do that, I'm a sophomore in college.

NARRATOR: Kristy and Victoria are seniors now and both of them participated in the sleep study.

The girls agree that in college, lack of sleep isn't just a necessary evil.

Sometimes it's seen as a badge of honor.

KRISTY: My friends were pulling all-nighters with me, it's being like good job.

I'm sure you got your stuff done!

Congratulations!

Skipping sleep in college is normal.

It was woven in, almost, to the college lifestyle.

VICTORIA: Sleep was always something that was on the back burner for me.

and I found I could function fairly well throughout the day on five hours of sleep, kind of mid-afternoon I would start to get tired maybe have another cup of coffee to boost me through the rest of the day.

NARRATOR: Those are all bad sleep behaviors.

They're also pretty common among college students.

That's why researchers wanted to find out if learning about better sleep health would encourage better sleep habits.

About 100 students participated in the study... and for two weeks, they completed sleep diaries online.

KRISTY: It was a pretty extensive survey.

It was, you know, did you turn off your phone before you went to bed, did you leave it on, did you watch TV, did you go on the Internet.

- And then when we woke up in the morning, how refreshed we felt when we slept, what our attitude or our mood was when we woke up.

NARRATOR: Other questions asked, what time they started school in the morning.

If they took naps during the day... their habits at bedtime... and how long it took them to fall asleep.

- After the surveys started to come out, and it was asking questions about, like, do you fall asleep with the TV on at night, that was one thing that I initially realized I could probably change in my life and see if it affected me at all.

So I started to turn off the TV.

I found that I was getting more sleep.

I found that I was going to asleep faster.

So that survey itself started to set in the gears, and the works for like, how I thought about my sleep patterns, which was really cool.

MARY FRAN REIDELL: I notice that people will say, oh, I'm going to go on a diet, I need to lose weight.

Or, I'd like to quit smoking.

Or, I'm going to get on an exercise routine and all of those things are wonderful and I would say yes, do all of them.

But I rarely ever hear anybody say, I'm going to really pay attention to my sleep habits and my sleep health.

NARRATOR: Mary Fran Reidell is the Director of Health Services at Carlow.

She served as the university's main contact during the sleep study... and she was excited because sleep was already an issue on the school's radar.

MARY FRAN REIDELL: We wanted to find out what is really interfering with people's success academically.

So we did a survey last year.

Stress was number one, and sleep was number two, and three was cold and flu.

NARRATOR: That matches up with national data from an initiative called Healthy Campus 20-20.

The goal is to improve the general health of college students and staff across the country.

Mary Fran is building a Healthy Campus 20-20 strategy for Carlow, and it calls for changes campus-wide.

MARY FRAN REIDELL: The Healthy Campus 20-20 initiative is really exciting because the idea is that health is not just supposed to be coming from the health care professionals.

It's everybody's responsibility.

One of the things we are thinking about asking our faculty to consider is changing the deadlines for papers that are due because oftentimes they are due by midnight.

But if the deadline was at nine perhaps they think about starting it earlier and then they'd get to sleep a little bit sooner that night.

The professors realize that if they change the due date, it's also changing the culture.

It lets the student know, look, your sleep's important.

And that's also what Healthy Campus is all about.

It's about making policy change or environmental change.

They might complain to their friends or say, oh my gosh, I didn't get any sleep last night but to really sit down and have a thoughtful conversation and look at their habits... you can see the light bulb go off a little bit you know, on top of their head and they say, wow, you know, I'm going to try that.

NARRATOR: Inspiring more of those "a-ha" moments was the goal of the sleep study conducted by the researchers from Pitt's sleep lab.

And once results were in, they concluded the program did work.

Data showed improving sleep knowledge did motivate students to make changes that led to better sleep.

89% of participants made at least one positive change... and students who got less than seven hours of sleep-- called short sleepers-- made changes that added at least 30 more minutes of sleep per night.

KRISTY: My friends know that if I don't get 8 to 9 hours of sleep at night, they don't want to talk to me.

I'm very content with having that much sleep.

I don't need that badge of honor, I don't need to stay up late, and I'm okay with that.

NARRATOR: Jessica Levenson is a clinical psychologist at the University of Pittsburgh.

And she's running a research study to come up with realistic recommendations to help teens get better sleep.

DR. LEVENSON: Teenagers do care about sleep.

A lot of them will say, yeah, my sleep is important to me, or, yeah, when I get better sleep, I do see these positive benefits.

The challenge for us is to figure out how to fit sleep in because there's a lot of competing demands, so it's a choice to prioritize sleep.

What we're doing is interviewing adolescents and parents and we want to find out, where does sleep rank as a priority for them?

What are the things that influence their sleep?

What would motivate them to actually want to make changes?

For adolescents maybe that means that if I get enough sleep tonight, I'm actually going to do a little bit better on my test tomorrow.

Or, maybe that means at my basketball game, I'm going to have a little bit more stamina.

We're trying to figure out how to make getting more sleep attractive.

NARRATOR: Choosing to sleep is the first challenge.

Falling asleep is another feat... and it's all about location, location, location.

DR. LEVENSON: When we think about the bedroom, we need to think about the entire sleep environment.

Is your bedroom dark enough, is it cool enough, quiet enough for you?

Do you not have shades on your window and therefore the light is coming in too strong?

What I would also recommend is to try as much as you can to keep the bed for sleep only.

Really keep the other activities, whether it's TV, video games, chatting on the phone, homework, reading a book, keep that outside of the bed for the most part, and we find that the more you can keep your bed for sleep only, the better your sleep will be.

A lot of teenagers sleep with their phone next to them, it's their alarm clock, but we also know those text messages go off in the middle of the night, that can wake them up, they can disturb their sleep.

Watch, is the phone too close to your bed?

Do you want to turn the ringer off in the middle of the night?

What things can you do to stop the disruptions that come from social media during the night?

Try to get a regular amount of sleep and keep a regular schedule across the week.

So not just the five school days but the seven days of the week.

Most teens, when you say that to them, they say I'm not going to get up at six o'clock on a Saturday or a Sunday.

And what we're encouraging teenagers to do is to just limit the amount that they sleep in on the weekends.

Many teenagers sleep in until noon, 2 o'clock in the afternoon on Saturdays and Sundays.

It's hard for them, come Sunday night, Monday morning, to get back on a sleep schedule.

And we call this social jet lag.

It's almost like every Sunday night, they have to travel back two or three time zones in order to get back onto their weekday schedule.

It's important to talk about sleep as a family as a whole.

And if sleep doesn't seem like it's that big of a deal for the parents, maybe it doesn't need to be as big a deal to me.

So that's a discussion to have with your kids.

What do you see me doing?

Do you think I have good sleep habits?

Should I be changing them?

What about you?

Do you have good sleep habits?

How can we help you get better sleep?

If we can really improve sleep, not only will it make us feel better at night, we're warm in our beds, getting a great night's sleep, but tomorrow we'll probably feel better as well.

[♪♪♪] DR. HEIDI ONDEK: As a former high school principal, I often saw kids kind of sluggishly moving through the school, and through their school day.

When asked, how are you today, I'd often hear, tired.

They've perhaps become accustomed to life as a drowsy teen.

When kids would say 'I'm tired,' I didn't have an answer for them, but it caused me to think seriously about start times.

NARRATOR: There it is: School start times... ...the topic that launched a national controver.

In 2014, the American Academy of Pediatrics suggested bumping back the start time for high schools to as late as nine o'clock in the morning.

But making that shift in a school district's schedule is no simple task.

- I think entire community would have to be on board.

NARRATOR: That's because starting the school day lar also means ending the school day later.

- We have students who care for younger siblings.

We have students who have afterschool jobs.

About 90% of our students participate in two or more activities at QVHS.

What happens to those afterschool activities that are very important to their development?

NARRATOR: It's especially difficult for high school sports.

Many teams compete right after school... so what does that mean for the school with a later release time?

Does the team miss all the sports competitions... or do all of the schools in the region have to shift their sports schedules?

- I feel like that would just change everything, because afterschool sports would just start later, you still would get home later, like... and you'd still probably be able to get to sleep.

- Yeah, I feel like, being athletes, I don't think I would like that just because we'd get home even later from our games and stuff.

- I would end up waking up early to do homework but I didn't have time to do the night before.

I might even end up getting less sleep.

NARRATOR: As extreme as shifting school start times may seem, some school districts across the country have already done it.

- What they have seen in school districts across the country where they're starting school at 9 A.M., they're finding they have had significant decreases in car accidents among teenagers.

That alone is a huge finding.

But they're also finding the kids are much more attentive in school, they're doing better in school, and they're happier kids.

What more could we want?

NARRATOR: One national study followed more than 12,000 students who started high school at 8:30 A.M. or later.

The schools had better attendance rates... improved tardiness rates... better academic performance in core subjects... and higher scores on state and national achievement tests.

And, 60 percent of the students reported getting eight or more hours of sleep each night.

DR. MILLER: I'm firmly convinced that if we come together, I think that the consequences would be huge.

When we look at schools districts across the country where they have delayed schools start times, it has been an amazing community and school collaborative effort.

- What if we turned a high school schedule on its head?

What would that look like?

NARRATOR: Superintendent Ondek believes an out-of-the-box solution could be the key to pleasing many people.

DR. HEIDI ONDEK: Might we consider looking at something more like a college schedule?

A blended approach to learning where students could function quite well academically with flexible hours.

We could be smarter about that, using technology, and giving students choices.

For those who like to start early in the morning and say they're fine, so be it, but for others... looking at more of a Tuesday/Thursday, Monday/Wednesday, Saturday class, there are all kinds of possibilities here.

And how could that support sleep health?

And still support their learning and all of their extracurricular and after school activities that are very important to them?

It's something that we just have to sit down and figure out.

DR. MILLER: Adolescent sleep is vital to the health of our young people, and when we think about really supporting the health of our children, teaching them now the importance of sleep is going to carry them through the rest of their lives.

It's not medication, it's not a pill, there's not some fancy treatment here.

It's really, let's work together to help adolescents sleep more.

[♪♪♪]