Sleep Deprivation in Teens Increases Injury-Related Risk Taking Behaviors

According to an April 8, 2016 CDC report, insufficient sleep is common among high school students and has been associated with an increased risk for motor vehicle crashes, sports injuries, and occupational injuries. To evaluate the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among U.S. high school students, the CDC analyzed data from 50,370 high school students (grades 9 to 12) who participated in the national Youth Risk Behavior Surveys (YRBSs) in 2007, 2009, 2011, or 2013.


The likelihood of each of the five risk behaviors was significantly higher for students who reported sleeping seven or less hours on an average school night. Although insufficient sleep directly contributes to injury risk, some of the increased risk associated with insufficient sleep might be caused by engaging in injury-related risk behaviors. Intervention efforts aimed at these behaviors might help reduce injuries resulting from sleepiness, as well as provide opportunities for increasing awareness of the importance of sleep.


Unintentional injuries are the leading cause of death for adolescents, with approximately two-thirds of these fatalities related to road traffic crashes. Excessive sleepiness, which is most often a result of not getting adequate sleep, has been shown to increase the risk for motor vehicle crashes and other unintentional injury among adolescents. Although insufficient sleep contributes to injury risk directly by slowing reaction time, impairing ability to pay attention, or causing a driver to fall asleep, this study provides evidence that some of the increased risk associated with insufficient sleep might be caused by engaging in injury-related risk behaviors.


The national YRBS monitors health-risk behaviors among students in public and private high schools and is conducted by the CDC in the spring of odd-numbered years. Each national YRBS uses an independent, three-stage cluster sample design to obtain a nationally representative sample of students in grades 9 to 12. The overall response rates were 68% in 2007, 71% in 2009, 71% in 2011, and 68% in 2013, and sample sizes ranged from 13,583 (2013) to 16,410 (2009).


Reported sleep duration during an average school night was four hours or less for 6.3% of respondents, five hours (10.5%), six hours (21.9%), seven hours (30.1%), eight hours (23.5%), nine hours (5.8%), and ten hours or less (1.8%). Sleep duration varied by sex, grade, and race/ethnicity. Female students reported a higher prevalence of insufficient sleep (seven or less hours) than did male students (71.3% versus 66.4%, p<0.001). The percentage reporting insufficient sleep ranged from 59.7% of students in 9th grade to 76.6% of students in 12th grade (p<0.001 for linear trend).


Overall, 86.1% of students reported infrequent bicycle helmet use and 8.7% reported infrequent seatbelt use. Twenty-six percent of students reported riding with a drinking driver at least one time during the past 30 days; 8.9% of students reported drinking and driving; and 30.3% reported texting while driving during the past 30 days.


In addition to a higher likelihood of engaging in injury-related risk behaviors and disregarding the possibility of negative consequences among students who reported typically sleeping seven or less hours on school nights, infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students sleeping ten hours or more compared with nine hours of sleep. Depression might contribute to both short and long sleep problems and participation in risky behaviors. Sleep problems, including both not sleeping enough and sleeping too much, are common symptoms of depression. One study found that adolescents who reported more depressive symptoms were more likely to engage in several injury-related risk behaviors, including infrequent seatbelt use, infrequent bicycle helmet use, and drinking and driving.


The National Sleep Foundation recommends that adolescents aged 14 to 17 years sleep 8 to 10 hours per night. To help ensure that adolescents get adequate sleep, they can practice good habits that promote good sleep. These habits include going to bed and getting up at the same time each day both during the school week and weekends, minimizing light exposure in the evenings, and keeping computers and other electronic devices, such as computers, video games, and cell phones, out of the bedroom.


Parents can help by setting bedtimes and limiting when (only before a set time or “media curfew”) and where (not in their bedrooms) their teenagers can use electronic devices. Early school start times contribute to insufficient sleep among adolescents. Delaying school start times has been proposed as a means of allowing adolescents to get adequate sleep.


Some students naturally need more sleep than their peers, but waking up and feeling unrested in spite of adequate sleep might be an indication of a problem such as poor sleep quality or an underlying health condition. Poor sleep quality might result from poor sleep hygiene, a bad sleep environment (e.g., too warm, too noisy, or cell phones in the bedroom), or a sleep disorder.


Various resources are available to address injury-related risk behaviors. Public health practitioners can refer to systematic reviews of interventions included in “The Community Guide.”  Some evidence exists that health care providers, in collaboration with health educators, might be able to change adolescent injury-related behavior through screening and brief counseling, followed by a visit by a health educator. High school faculty and administrators, as well as parents of high school students, should be made aware of the increased likelihood for risky behavioral choices among students who do not get enough sleep.


See the CDC Report


See also Medical Law Perspectives, March 2016 Report: Slumbering Concerns: Sleep Disorder Treatment Risks and Liabilities