Study: Drinking problems later for teens who skip sleep now

A study shows that teens who skip sleep now have more drinking problems later in life.

Sleep-deprived teenagers find it difficult to focus in class, and they're more likely get sick. They are also more likely to develop problems with alcohol later on, according to a study published Friday in the journal Alcoholism: Clinical & Experimental Research.

The study included teens who suffered from conditions like insomnia as well as those who simply weren't getting enough sleep. Teenagers ages 14 through 16 who had trouble falling or staying asleep were 47 percent more likely to binge drink than their well-rested peers.

Sleep problems were linked to even more issues with alcohol later on.

Teens who had trouble sleeping when the researchers first checked in with them were 14 percent more likely to drive drunk and 11 percent more likely to have interpersonal issues related to alcohol a year later. And five years after that — when everyone was college-aged or older — those who had sleep issues in high school were 10 percent more likely to drive drunk.

About 45 percent of adolescents don't get the recommended eight to 10 hours a night, polls show.

The findings are based on data collected from 6,500 adolescents who were part of the larger National Longitudinal Study of Adolescent Health, which began tracking a group of adolescents in the mid-90s.

Researchers have known for a while that lack of sleep and alcohol use are related, says Maria Wong, a psychologist at Idaho State University who led the study. "This study shows that sleep issues can actually precede and even predict alcohol use later on."

And the influence of sleep on drinking behaviors can be dramatic, Wong tells Shots. In the study, each extra hour of sleep the teens got corresponded with a 10 percent decrease in binge drinking.

"We're not saying that sleep is the only risk factor for alcohol use," Wong says. In fact, another study published in the same journal issue found that a combination of genetics and peer influence affect teens' decisions to drink.

But a child's genetic makeup isn't something anyone can change, Wong says, "and beyond a certain extent, we cannot control whom kids spend time with outside the home."

Sleep, however, may be something that teenagers and their parents can control. "If we can make sure they have enough sleep, we can help them make good choices," Wong says.

Of course, that's much easier said than done. Teens don't usually take well to having bedtimes imposed on them. And even if they did, forcing kids to get in bed early won't necessarily help, says Dr. Maida Chen, the director of the Pediatric Sleep Disorders Center at Seattle Children's Hospital. "Because of their biology, simply saying to teens, 'Go to sleep earlier' is not a plausible solution," says Chen, who wasn't involved in the recent research.

The body's natural circadian rhythms tend to shift during adolescence, Chen explains, so teens may find it difficult fall asleep until 11 p.m. or midnight.

That's why many parents and pediatricians have been pushing to delay school start times for middle and high school students. "Teens have to get up at 5 or 6 in the morning in order to get to school by 7 or 8," Chen says, which means that most of them aren't getting nearly enough rest.

Last year the American Academy of Pediatrics issued a policy statement calling on middle and high school to start at 8:30 a.m. or later.

"This new research shows what we have long suspected — there seems to be a link between lack of sleep and risky behaviors in teenagers," Chen says.

The people involved in the recent study were teenagers in the 1990s, Chen points out. "I wouldn't be surprised if the situation was in some ways worse these days," she says, "because nowadays, everyone has some electronic distraction that they carry into bed with them."

Many of the patients Chen sees at Seattle's Children come in because their grades have started to fall or because they're having behavior issues at school, she says.

"This is not just about teens not sleeping enough and then feeling a bit grumpy the next day," Chen says. "Sleep really affects their ability to function and make good decisions."

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Twin study shows there is a genetic component to insomnia

According to a study on twins, there is a genetic component to insomnia.

A new study of twins suggests that insomnia in childhood and adolescence is partially explained by genetic factors.

Results show that clinically significant insomnia was moderately heritable at all stages of the longitudinal study. Genetic factors contributed to 33 to 38 percent of the insomnia ratings at the first two stages of the study, when participants had an average age of 8 to 10 years. The heritability of insomnia was 14 to 24 percent at the third and fourth follow-up points, when the average age of participants was 14 to 15 years. The remaining source of variance in the insomnia ratings was the non-shared environment, with no influence of shared, family-wide factors. Further analysis found that genetic influences around age 8 contributed to insomnia at all subsequent stages of development, and that new genetic influences came into play around the age of 10 years.

"Insomnia in youth is moderately related to genetic factors, but the specific genetic factors may change with age," said study author Philip Gehrman, PhD, assistant professor in the Department of Psychology at the University of Pennsylvania in Philadelphia. "We were most surprised by the fact that the genetic factors were not stable over time, so the influence of genes depends on the developmental stage of the child."

Study results are published in the January issue of the journal Sleep.

Insomnia involves difficulty initiating or maintaining sleep, or waking up earlier than desired, according to the American Academy of Sleep Medicine. Children with insomnia may resist going to bed on an appropriate schedule or have difficulty sleeping without intervention by a parent or caregiver. An insomnia disorder results in daytime symptoms such as fatigue, irritability or behavioral problems.

According to the authors, the results suggest that genes controlling the sleep-wake system play a role in childhood insomnia. Therefore, molecular genetic studies are needed to identify this genetic mechanism, which could facilitate the development of targeted treatments.

"These results are important because the causes of insomnia may be different in teens and children, so they may need different treatment approaches," said Gehrman.

The study group comprised 1,412 twin pairs who were between the ages of 8 and 18 years: 739 monozygotic pairs, 672 dizygotic pairs and one pair with unknown zygosity. Participants were followed up at three additional time points. Average ages at each of the four waves of the study were 8, 10, 14 and 15 years. Results were interpreted in terms of the progression across time, rather than differences between discrete age groups. Clinical ratings of insomnia symptoms were assessed by trained clinicians using the Child and Adolescent Psychiatric Assessment and rated according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition.

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Teens who sleep less gain more weight in 20s

A study shows that less sleep during the teen years means a person gains more weight by age 21.

Lack of sleep not only puts teens at risk for poor grades, it also puts them at increased risk for obesity, researchers warn.

The study authors analyzed data collected from more than 10,000 Americans when they were aged 16 and 21. Nearly one-fifth of them got less than six hours of sleep a night when they were age 16, and this group was 20 percent more likely to be obese at age 21 than those who got more than eight hours of sleep per night at age 16, the investigators found.

Although lack of exercise and too much time spent watching television were also risk factors for obesity, these behaviors did not account for the link between lack of sleep and obesity, according to the study published online recently in the Journal of Pediatrics.

"Lack of sleep in your teenage years can stack the deck against you for obesity later in life. Once you're an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer," study author Shakira Suglia, an assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, said in a university news release.

"The message for parents is to make sure their teenagers get more than eight hours a night. A good night's sleep does more than help them stay alert in school. It helps them grow into healthy adults," Suglia added.

Teens should get nine to 10 hours of sleep a night, according to the U.S. Centers for Disease Control and Prevention.

It's known that daytime sleepiness and fatigue affect what and how people eat by triggering cravings and altering appetite. For example, sleep-deprived people find it easier to buy calorie-laden fast food rather than preparing a healthy meal.

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Teenagers need more sleep

This article explains that teenagers need more sleep, and not getting enough sleep can lead to health consequences.

Health experts say if you don't snooze, you lose. They say teenagers actually do need their beauty sleep.

'Let them sleep!' said the nations largest pediatrician group, the American Academy of Pediatrics. Studies have shown that only one in five teens get nine hours of sleep on school nights, the recommended amount.

The AAP is urging schools to start high school and middle school classes at 8:30 a.m. or later. Lack of sleep in adolescents is shown to increase risk for obesity, stroke and Type 2 diabetes. There is even an increase in anxiety and depression, which can lead to risk-taking behaviors.

The AAP said naps and caffeine only temporarily counteract the lack of sleep, but it's not enough.

"Kids who, for example, take a biology class at 7:20 in the morning, if you compare that group of kids to kids that take that class at 10, 11 or 1 and then you give them all the same standardized tests, as a group the kids that take that class later in the day perform better," said Chief of Division of Pediatric Sleep Medicine Heidi Connolly.

With much controversy surrounding later start times at schools, there may be a long road ahead for teen sleep.

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Pediatricians urge later school start time

This article explains why pediatricians are urging for later school start times for older kids in middle and high schools.

U.S. high schools and middle schools should start classes later in the morning to allow kids some much-needed sleep, a leading group of pediatricians is urging.

Ideally, the American Academy of Pediatrics says, the first bell should ring at 8:30 a.m. or later -- which is the case at only 15 percent of U.S. high schools right now.

At the very least, classes should start no earlier than 8 a.m., said Dr. Judith Owens, the lead author of a new academy policy statement on school start times.

The recommendations, published in the academy's journal Pediatrics, are based on research showing that U.S. kids are sleep-deprived, which has consequences for their health, school performance and safety.

"This is an important issue," said Dr. Marcel Deray, a Florida sleep specialist who wasn't involved in the recommendations.

"I see a lot of teenagers who are tired and have problems in school because they have to get up so early," said Deray, who directs the Sleep Disorders Center at Miami Children's Hospital. "Some kids are getting up at 5 a.m., 6 a.m."

Many people think the answer is for kids to just get to bed earlier, Owens noted. But it's not that easy, she said, because biology has other plans.

Around puberty, the body's natural sleep-wake cycle shifts, and it's actually hard for teenagers to fall asleep earlier than 11 p.m.

"Teenagers' bodies release melatonin later than (adults') do," Deray explained, referring to a hormone the brain secretes in the evening to induce drowsiness.

"The other issue," Owens said, "is that teenagers' sleep needs are greater than many people think. They need nine to nine-and-a-half hours."

Yet, 43 percent of U.S. public high schools start classes before 8 a.m., according to the U.S. Department of Education. Middle schools, meanwhile, typically start classes at 8 a.m. -- with about 20 percent starting earlier than that.

"And that's the first bell," Owens said. "That's not even counting the commute time."

So in areas where kids take the school bus, the actual school day could begin before sunrise.

According to Owens, U.S. high schools started bumping up start times back in the 1950s and '60s, mainly to space out bus runs. Many school districts start high schools and middle schools first, then circle buses back to pick up elementary school kids.

One option would be to flip elementary and high school start times, but parents often oppose that -- since young children could be standing at bus stops in the early-morning dark, or have no one at home after school. Another option -- running more buses -- would be expensive.

Transportation is not the only obstacle, according to the National Sleep Foundation, which supports pushing back school start times. Some other arguments are that sports and extracurricular activities would end too late; teenagers would have no time for after-school jobs; and a later start could conflict with working parents' schedules.

Owens acknowledged the logistical challenges, and said parents and school staff sometimes oppose later start times. As an example, she said the Fairfax County, Va., school district has been debating the issue for years. Four options, including one with a 9:15 a.m. high school start, will be put to a vote this fall.

Some districts have found "creative solutions" to certain obstacles -- like having high school students switch from school buses to public ones, according to the academy.

Deray thinks tackling the practical challenges is worthwhile. He said studies have linked kids' sleep deprivation not only to poorer school performance, but also to higher rates of car accidents, obesity and depression.

In a recent study of eight U.S. high schools that delayed their start times, researchers found improvements in kids' grades, attendance and car crash rates.

Later school starts are just one way to help sleepy kids, however. Deray offered parents some tips.

"All electronic devices should be turned off an hour or two before bed," he said. "The blue light from them suppresses melatonin production."

He also advised avoiding physical and mental stimulation close to bedtime -- which means exercise and homework should be done earlier in the evening. And while teenagers love to sleep till noon on weekends, that will only further disturb their sleep/wake cycle. Deray said kids should get up by 9 a.m. on weekends and get plenty of morning sunlight.

He acknowledged, though, that all of that is easier said than done.

Owens agreed. "One of the issues is that kids are overscheduled," she said. "Don't give them so many things to do that they can't get to bed before midnight."

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Young males' brains and risky behaviors

A study gains insight into brain mechanisms that explain why young males engage in more risky behaviors.

It's common knowledge that teenage boys seem predisposed to risky behaviors. Now, a series of new studies is shedding light on specific brain mechanisms that help to explain what might be going on inside juvenile male brains.

Florida State University College of Medicine Neuroscientist Pradeep Bhide brought together some of the world's foremost researchers in a quest to explain why teenagers -- boys, in particular -- often behave erratically.

The result is a series of 19 studies that approached the question from multiple scientific domains, including psychology, neurochemistry, brain imaging, clinical neuroscience and neurobiology. The studies are published in a special volume of Developmental Neuroscience, "Teenage Brains: Think Different?"

"Psychologists, psychiatrists, educators, neuroscientists, criminal justice professionals and parents are engaged in a daily struggle to understand and solve the enigma of teenage risky behaviors," Bhide said. "Such behaviors impact not only the teenagers who obviously put themselves at serious and lasting risk but also families and societies in general.

"The emotional and economic burdens of such behaviors are quite huge. The research described in this book offers clues to what may cause such maladaptive behaviors and how one may be able to devise methods of countering, avoiding or modifying these behaviors."

An example of findings published in the book that provide new insights about the inner workings of a teenage boy's brain:

• Unlike children or adults, teenage boys show enhanced activity in the part of the brain that controls emotions when confronted with a threat. Magnetic resonance scanner readings in one study revealed that the level of activity in the limbic brain of adolescent males reacting to threat, even when they've been told not to respond to it, was strikingly different from that in adult men.

• Using brain activity measurements, another team of researchers found that teenage boys were mostly immune to the threat of punishment but hypersensitive to the possibility of large gains from gambling. The results question the effectiveness of punishment as a deterrent for risky or deviant behavior in adolescent boys.

• Another study demonstrated that a molecule known to be vital in developing fear of dangerous situations is less active in adolescent male brains. These findings point towards neurochemical differences between teenage and adult brains, which may underlie the complex behaviors exhibited by teenagers.

"The new studies illustrate the neurobiological basis of some of the more unusual but well-known behaviors exhibited by our teenagers," Bhide said. "Stress, hormonal changes, complexities of psycho-social environment and peer-pressure all contribute to the challenges of assimilation faced by teenagers.

"These studies attempt to isolate, examine and understand some of these potential causes of a teenager's complex conundrum. The research sheds light on how we may be able to better interact with teenagers at home or outside the home, how to design educational strategies and how best to treat or modify a teenager's maladaptive behavior."

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Teenagers with emotional problems after concussion

This article discusses which symptoms after a concussion, such as sensitivity to light or noise, that may indicate a teen is more likely to have emotional problems.

After a concussion, teens who are sensitive to light or noise may be more likely to also have emotional symptoms such as anxiety, according to a study released today that will be presented at The Sports Concussion Conference in Chicago, July 11 to 13, 2014, hosted by the American Academy of Neurology.

The symptoms after a concussion can vary widely from person to person. Symptoms can include physical, emotional and cognitive difficulties.

"While most people recover from a concussion within a week, a number of factors affect people's recovery, and studies have shown that teenage athletes may take up to seven to 10 days longer to recover than older athletes," said study author Lisa M. Koehl, MS, and Dong (Dan) Y. Han, PsyD, of the University of Kentucky in Lexington.

The study involved 37 athletes age 12 to 17 who had persisting symptoms for an average of 37 days following a concussion. Participants were excluded if they had a previous history of psychological issues. One group of 22 teens had emotional symptoms such as irritability, aggression, anxiety, depression, apathy, frequent mood changes or excessive emotional reactions after the concussion. The second group of 15 teens did not have emotional symptoms. There were no differences between the two groups in factors such as what percentage experienced loss of consciousness or amnesia, indicating that the groups were likely comparable in the level of severity of concussion.

The study found that of the 22 teens who had emotional symptoms, five teens (23 percent) were sensitive to light while three teens (14 percent) were sensitive to noise. In comparison, of the 15 teens without emotional symptoms only two teens (13 percent) were sensitive to light and no teens were sensitive to noise.

The number of concussions experienced and whether teens also had headaches or nausea were not related to whether they also had emotional symptoms. Researchers also found that having a family history of psychiatric problems did not make teens any more or less likely to have emotional symptoms after a concussion.

Teens who had anxiety were 55 percent more likely to self-report attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability. The authors noted that the findings are preliminary with small samples and stressed the importance of replicating this study with a larger sample size.

"Identifying factors such as these that may exacerbate issues teens experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school for these athletes," Koehl and Han said.

The study was supported by the American College of Sports Medicine Research Foundation.

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Study: Teenagers who go to sleep late have lower grades

A study shows that teenagers with late bedtimes have lower grades than those who go to sleep earlier.

Teens with late bedtimes during the school year and schooldays that start early have lower academic performance and are at risk for later emotional distress. A new study in the Journal of Adolescent Health provides further evidence for a growing body of research that supports a movement to delay school start times for adolescents.

"Going to bed after 11:30 pm, particularly in younger adolescents, predicted worse cumulative grade point average (GPA) at high school graduation and more emotional distress in the college years and beyond," said the study's lead author Lauren D. Asarnow, MA, a doctoral student in the department of psychology at the University of California, Berkeley.

The study gathered data on sleep and the number of hours slept from 2,700 teens age 13 to 18 participating in the National Longitudinal Study of Adolescent Health in two cohorts, one in 1995, the second in 1996. In 2001-2002, as respondents aged, data on academic performance and self-reported emotional health were collected for longitudinal comparison. The overall goal of the study was to examine the relationship between the sleep/circadian patterns of high school adolescents in a nationally representative sample, their overall academic performance in high school and rates of emotional distress reported post graduation.

For both high school cohorts, 23 percent of participants reported going to bed at 11:15 pm or later. By the time these teens reached graduation and college age, late school year bedtimes in high school predicted both lower cumulative GPA at graduation and more emotional distress between age 18 and 26. The researchers noted previous research found that adolescents who prefer late activities and bedtimes (a pattern of behavior often referred to as an evening circadian preference) were tested in the morning; they performed worse on cognitive tasks.

Asarnow urged parents to help youngsters get to bed earlier and added that a teen's sleep behavior is highly modifiable with proper support. However, shifting a teen's bedtime from a late to an earlier hour can be hard, she added, in part because for 30 percent to 40 percent of teens, delayed bedtimes have a biological basis tied to the onset and progress of puberty. Furthermore, academic pressure, habits around technology use and the bedtimes of friends also influence a teen's choice to turn in or stay up late.

Timothy Monk, Ph.D., director of the Human Chronobiology Research Program at the University of Pittsburgh agreed that the need to rise very early for school can put students at risk for underperformance academically and for other problems tied to a lack of sleep. "An early school start time both limits the sleeping time of the student and asks him or her to learn at what is close to the nadir of their circadian cycle."

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Less concussions occur at higher altitudes in high school sports

An interesting study claims that the likelihood of a concussion in high school sports is lower at higher altitudes.

According to a recent study done by doctors at Cincinnati Children's Hospital Medical Center, high school athletes who play collision sports at higher altitudes are less likely to suffer from concussions than those who play at lower altitudes.

The doctors who were involved in the study recognized that prior research indicated that the volume and/or pressure of intracranial fluid, which acts as a cushion to protect the brain inside of the skull, is affected by one's altitude and that it may be associated with the likelihood and/or severity of a concussion. They hypothesized that when adjusting to higher altitudes, physiological responses increase intracranial fluid volume and these responses would provide a "tightened fit" which should help protect the brain from concussions like bubble wrap.

Data on concussions and more than 20 million athlete exposures were gathered between 2005 -2012 from nearly 500 high schools across the US. The data focused on concussion occurrence in a variety of sports including but not limited to boys' and girls' soccer, volleyball, basketball, cheerleading and boys' football and ice hockey. The altitude of the participating schools ranged from 7 to 6903 ft.

When concussion rates were examined relative to altitude, sequential elevations in altitude above sea level were associated with a reduction in concussion rates overall. Specifically, high school sports played at higher altitudes demonstrated a 31 percent reduction in the incidence of total reported concussions. Further analysis showed that concussion rates at increased altitude for football players were reduced by 30 percent for overall exposures, 27 percent for competition exposures and 28 percent for practice exposures.

Dr. Greg Myer, Director of Research, Sports Medicine, Cincinnati Children's Hospital Medical Center, says that "this research shows us that the physiological responses to altitude may be associated with a reduction in sports-related concussion rates, especially in collision sports."

He goes on to say that future research that focuses on other techniques that can optimize intracranial fluid volume (via jugular compression) will play an important role in the determination of the most effective approaches to prevent sport related concussion in athletes.

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Sleep deprivation epidemic in teenagers, study claims

A study claims that there is currently an epidemic of sleep deprivation among teenagers and discusses how this is harmful to their health.

Caffeine, late nights and lack of sleep are just a few ways to describe the life of a typical teenager. Fortunately, a recent teen sleep study conducted at the Golden Bear Sleep and Mood Research Clinic at UC Berkeley aims to help address this problem. Allison Harvey, a psychology professor and the main investigator of the study recognizes the growth in the number of sleep-deprived adolescents and the need to do something about it.

This study has been going on for four years. Participants in the study must be between the ages of 10 and 18 and experience at least one problem relating to emotional health, social aptitude, behavioral irregularity or academic achievement. They also must report having problems sleeping at night. If all criteria are met, they are then invited to a sleepover at the UC Berkeley sleep lab for observation.

Researchers of the study used many methods for improving sleep among the teenage participants. For instance, common methods included motivation interventions and chronothereapy — a type of therapy that involves controlling sleep cycle times as well as the amount of light present — in order to adjust the participants’ circadian rhythm, the internal clock that regulates our biological functions every 24 hours.

The aim of the study was to try to shift the bedtimes of the teenagers. To do so, researchers manipulated melatonin — a hormone which aids in sleep and wake cycles. Once the participants arrived at the campus for the sleepover, they were expected to complete a six-week intervention. The intervention included sessions with a sleeping coach, interviews, saliva samples as well as monitoring activity levels through a special watch known as the Actiwatch.

The study wouldn’t have been possible without the undergraduate student research assistants, whose help includes everything from helping with recording, monitoring Actiwatch, being a morning or night buddy for the participants and having an active role in the biomeasures and outreach group.

Grace Wang, an undergraduate student majoring in psychology, molecular biology and nutritional science, has been an active member of the research assistant team for the study.

“More and more people realize how important sleep is and how important it is to set a regular sleep cycle. Perhaps it would be harder for the teenaged generation to understand, acknowledge and actually implement this into their schedules as they have a lot of things on their plates: clubs, activities, homework, etc.,” Wang said, who is no stranger to unhealthy sleeping cycles herself, in an email interview.

However, sleep-deprived teenagers are not only exclusive to the UC Berkeley campus. Ariel Sim, a third-year UC Davis statistics major and economics minor, has the tendency to calculate the number of hours of sleep she will be getting, though sadly it’s not nearly enough. Just like many students found over all sorts of campuses, Ariel is involved in not only her academics, but other activities as well.

“I am a student leader at a Christian fellowship on campus. I also have to work as much as I can without sacrificing schoolwork to cover rent, tuition, bills, insurance, groceries and any other living expenses. While I have a lot of responsibilities that take up my time, I also suffer from mild insomnia. Perhaps, that’s why I don’t get an ‘ideal’ amount of sleep or ever feel fully rested,” Sim said in an email interview.

Dr. Irwin Feinberg and Dr. Ian Campbell, both from the UC Davis Sleep Research Lab and the Department of Psychiatry and Behavior Sciences are also interested in studying sleep deprivation among teenagers. Both are involved in a sleep need study in adolescents and how the need changes from the ages of 10 to 18 years old.

“There is a decreased need of sleep across adolescence from 12 to 16.5 years, and right now the recommended hours of sleep for teenagers is nine to 10 hours a night,” Dr. Campbell said.

Feinberg and Campbell’s findings lead the researchers to believe that adolescents need less recuperation during the night if they achieve it through naps during the day. Because these findings are not yet conclusive, they are working on teasing out the details.

So if you have brothers or siblings at that age or care for kids yourself, and if they are falling asleep during the day, then most likely they are sleep-deprived. According to both Dr. Feinberg and Dr. Campbell, it is equally important that teenagers develop a regular sleeping schedule regardless of the weekday or weekend.

As a rule of thumb, it is important to try to ensure that teenagers are well-rested in order to have a healthy lifestyle, but in the process of ensuring their sleep, don’t forget to catch some shut eye yourself.

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Sleepy teenagers are at greater risk of pedestrian accident

Pedestrian teenagers who are sleepy due to sleep deprivation are more likely to be hit by a car.

Sleep-deprived teens are at increased risk of getting hit by a vehicle while crossing the street, researchers warn.

The new study included 55 teens, aged 14 and 15, whose ability to cross a street safely was tested in a virtual-reality setting in the Youth Safety Lab at the University of Alabama at Birmingham.

Teens whose sleep was restricted to four hours the night before the test took more time to begin crossing a street, crossed with less time before contact with vehicles and had more close calls than those who slept for eight and a half hours. Four hours of sleep is half the amount considered adequate for 14- and 15-year-olds.

The sleep-deprived teens averaged 2.2 close calls or hits by vehicles on 25 of the simulated street crossings, compared with 1.42 close calls or hits for those who had an adequate amount of sleep, according to the study, which was published Sept. 3 in the Journal of Adolescent Health.

The findings suggest that teens' ability to cross the street safely can be compromised after only one night of too little sleep, said study author Aaron Davis, a psychology post-doctoral fellow in the Leadership Education in Adolescent Health program at the university.

"It is easy to discount the idea that this loss of sleep could have a significant impact if it occurs rarely, but this study demonstrates that adolescents' safety could be put at risk after just one night of inadequate sleep," Davis said in a university news release.

An estimated 8,000 teens aged 14 and 15 require medical attention for pedestrian-related injuries each year in the United States, according to background information in the news release.

Study co-author David Schwebel, director of the Youth Safety Lab, said the study "demonstrates the importance of sleep for human functioning. Our results show clearly that insufficient sleep influences adolescent safety; without sufficient sleep, they are inattentive, distractible and poor decision-makers."

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Management of epilepsy in women of child bearing age - World Health Organization

Question -  In women with epilepsy, should antiepileptic therapy be prescribed as monotherapy or polytherapy to decrease the risk of fetal malformations?

11. Does the use of folic acid preconceptually decrease the risk of foetal malformations in women with epilepsy?

11. Do phenytoin, phenobarbital, valproic acid or carbamazepine enter breast milk in quantities which are clinically significant to the baby?

Management of epilepsy in women of child bearing age

Management of epilepsyPopulation:

• women with epilepsy who may become pregnant
• women with epilepsy on antiepileptic drug treatment wishing to breast feed
• Interventions:
• use of antiepileptic drugs as monotherapy or polytherapy during pregnancy
• use of phenobarbital, phenytoin, valproate or carbamazepine during pregnancy
• use of folic acid preconceptually and during early pregnancy
• breast feeding while taking phenobarbital, phenytoin, valproate or carbamazepine
• Comparison:
• pregnant women with epilepsy taking no antiepileptic drugs
• pregnant women without epilepsy
• Outcomes:
• congenital malformations in the infant
• clinically important amounts of antiepileptic drugs secreted in breast milk.

Recommendation(s)

Women with epilepsy should have seizures controlled as well as possible with the minimum dose of antiepileptic drug taken in monotherapy, wherever possible. Antiepileptic drug polytherapy should be avoided. Valproic acid should be avoided if possible.
Strength of recommendation: STRONG

Folic acid should routinely be taken by women with epilepsy of child bearing age who are on antiepileptic drugs.
Strength of recommendation: STRONG

Standard breast feeding recommendations remain appropriate for women with epilepsy on the antiepileptic drugs included in this review (phenobarbital, phenytoin, carbamazepine and valproic acid).
Strength of recommendation: STRONG