Teen Sleep Problems Lead to Depression & Drug Abuse
Sunday, February 03, 2013
Byron J. Richards, Board Certified Clinical Nutritionist
Sleep problems in children and teens have reached a crisis level in America. New science shows that these issues are setting the table for obesity, depression, drug abuse, and future cardiovascular disease. Specific biological pathways have now been defined that explain how sleep problems21 may lead directly to substance abuse.
I can’t think of a single parent who would like his or her child to be a drug user. Yet, many parents unwittingly help their children along a path to becoming drug users, a problem that is easily preventable with good parenting – if only you know what the real issues actually are.
I’ve been working on the front lines of clinical nutrition for more than 20 years, and I can assure you that the information in this article is both revolutionary and somewhat earth shattering. Let’s begin by understanding the nature and scope of the problem.
The Arousal Thermostat, Sleep, and Pleasure
Just as your house has a thermostat that controls temperature, new science is showing that your brain has a thermostat that controls arousal or awakeness. If this thermostat is set too low your head won’t stay awake during the day (narcolepsy). If it is set at the right level you will be awake during the day, your energy will feel good during the day, and you will go to sleep with little trouble.
Problems with sleep occur when your arousal thermostat gets set too high. This makes you prone to feeling anxious or “wired” during the day, a somewhat abnormal feeling of energy that is often accompanied by fatigued and disrupted cognitive function (difficulty learning). Stress tolerance will be poor, behavior issues likely. In this condition nerves are set like a coiled spring – too wound up.
Science now shows that your arousal thermostat is established by a pair of excitatory neuropeptides produced by neurons located in the lateral hypothalamus, and projecting throughout your brain. They are called hypocretins.
The new science also shows that hypocretins are linked directly to core urges for reward and pleasure (dopamine and endorphins). This means that when the arousal thermostat is set too high there will be powerful subconscious urges to seek pleasure and reward, a “fix” that temporarily calms down the wired feeling and enables sleep. This is the precise pathway by which sleep problems lead to drug abuse. This arousal thermostat is further aggravated by stress and poor eating patterns, locking in the problem.
I don’t think most parents realize just how serious this problem is for the future health of their children. A recent study points out that adults with bad sleep problems have a four times increased risk of dying from any cause and a five times increased risk of dying from cardiovascular disease. A lifetime of poor health can be prevented by improving sleep in children and teens.
Sleep Problems and Mental Health Difficulties
Sleep problems are an independent risk factor for depression. Research shows that teens with sleep problems21 are 2.3 times more likely to become depressed within seven years, with a statistically significant increase in suicidal thinking and suicidal attempts. The same research linked teen insomnia to a statistically significant increased use of alcohol, cannabis, and drugs other than cannabis.
Another study reported this past summer that parents with sleep problems3 are more likely to have children with sleep problems. This study found that these 14-year-old children were stuck taking tranquilizers and sleeping pills while they continued to experience daytime fatigue, depression, anxiety, and suicidal thinking (and had more suicide attempts during the past year).
Only 20 percent of teens get adequate sleep. Sixteen percent of teens say they have noticeable sleep problems, while 28 percent report falling asleep at school. The fact that these sleep problems directly increase the risk for depression and substance abuse is a very large problem facing many teens.
Inflammation, Oxidative Damage, and Poor Cognitive Ability
Researchers at the University of California Los Angeles have shown that even one bad night of sleep turns on the core inflammatory gene signal4 (NF-kappaB) within cells of your body. This is not good. Once the NF-kappaB gene signal turns on and starts overheating (as in a number of bad night’s sleep), then massive numbers of antioxidants will be required to offset the damage.
What if your child doesn’t have enough antioxidants? Answer: brain damage to a greater or lesser degree. Such inflammation and lack of antioxidants underlies depression and poor mood. But even on a lesser scale it reduces intelligence and cognitive potential. How can a child learn well under such circumstances?
This problem is aggravated by a diet of junk food that is also highly inflammatory and uses up antioxidants. Some of the worst free radical generating foods are unsaturated vegetable oils as found in potato chips, corn chips, and French fries. Unfortunately, your child’s brain, which is inherently fatty, will build brain cells out of whatever fats your child eats. Imagine the intelligence generated by “potato chip brain.”
Researchers at Cincinnati Children’s Hospital5 recently used advanced imaging technology to evaluate brain oxygen levels of children who snore and children who have sleep apnea, in an effort to understand why such children have impaired cognitive ability. They found that children who snore get less oxygen to their brains. Somewhat paradoxically they found that children who snore and have sleep apnea have elevated blood pressure, driving too much oxygen to their brains.
Both types of problems cause children to have have impaired cognitive function. Oxygen is of course vital to brain function, however, it is only needed in the right amount and it must be contained by antioxidants so that it does not cause problems. Conditions of low oxygen or high oxygen cause free radical damage, inflammation, and use up antioxidants. The result is lessened cognitive ability directly resulting from impaired quality of sleep.
Cardiovascular Disease Starts Early
Data coming from the Cleveland Children’s Sleep and Health Study6 shows that even in perfectly healthy teens who do not have sleep disordered breathing (snoring/sleep apnea) a lack of sleep is adequate to begin the process of adverse changes in their cardiovascular system.
Teens need nine hours of sleep per night. The study found that children who slept poorly were 4.5 times more likely to show signs of pre-hypertension, meaning that their blood pressure was elevating (on average four points). This placed them in the 90th percentile of such a problem for their age, sex, and height – meaning they are headed on a path to cardiovascular disease.
Children and teens who do have sleep disordered breathing7 have significantly elevated blood pressure, which gets worse in direct measure to the severity of sleep problem. This is the case whether such children are overweight or not.
Yale researchers found that in overweight children8 with the metabolic syndrome, those with the worst sleep problems have elevated levels of adrenaline and leptin in their blood. The elevated adrenaline is evidence that their arousal thermostats are set too high. The elevated leptin means that the children have leptin resistance and that leptin is not getting into their brains properly.
The researchers found that when they treated the breathing problems the leptin levels came down, even though body weight had not changed. These results imply that sleep problems directly disturb leptin, meaning that in some cases sleep problems may be the driving force behind obesity (not just excess food or a lack of exercise). Of course, the more years a child stays in an overweight or obese condition the greater the amount of ongoing cardiovascular damage that will influence his or her future quality of health.
Obesity and a Lack of Sleep
Individuals who are tired from a lack of sleep will typically want to eat extra food the following day to get energy from the food. As time goes along the extra calories are likely to be stored as fat, resulting in weight gain and eventual obesity.
The new science paints a clear picture of changes in brain chemistry that actually start before weight is gained. It is a combination of the arousal thermostat set too high and leptin resistance (high leptin in the blood that is not getting into the brain properly.)
Hypocretin neurons that comprise the arousal thermostat contain leptin receptors, meaning that leptin speaks directly to them to slow them down. When leptin is not entering the brain properly then there is a lack of instruction to not eat. This causes the overstimulated hyporcretin system to desire excess food, a misguided signal left over from the days of the hunter-gather when extra mental vigilance and less sleep was needed during times of famine so as not to miss a hunting opportunity.
There are many teenagers whose arousal thermostat is set too high, who have trouble sleeping, but are not overweight. While their leptin system is being challenged, it has not yet faltered. Their wired metabolism is burning all the calories they can eat and they may even have trouble gaining weight or keeping weight on. Such teens will be at high risk for becoming overweight later in life.
Many teens are not so lucky, and their leptin system has started faltering at an early age, not only causing obesity-related metabolic problems to lock into place but also seriously compromising future health.
Current research clearly shows a lack of sleep in children is an independent risk factor for obesity, as poor sleepers have a 92 percent higher risk of obesity compared to the best sleepers. Researchers have also identified how a lack of sleep produces a stress response (cortisol excess) that also turns down fat burning and helps lock leptin problems into place.
Sleep and Addiction Risk – Where do Problems Start?
The key issue is that the hypocretin-driven arousal thermostat is set too high. This activates cravings for pleasure and reward. Keep in mind this is a normal system that enables awakeness and positive motivation. Thus, we are talking about an out-of-balance overheating of stimulatory nerves that not only interfere with sleep but that also may lead a person into substance abuse.
One way to excessively activate hypocretin is by having a leptin problem. If leptin does not get into your brain properly then hypocretin lacks “parental supervision” and tends to run wild, resulting in an arousal thermostat set too high.
Research also shows that excess hypocretin is driven by stress9, and that stress is adequate to reactivate cravings for drugs like cocaine via a wound up hypocretin system. This means that the other primary way of getting your arousal thermostat set too high is from chronic stress that causes your brain to be hyper vigilant.
An enlightening study showed that if mom was depressed10 before or during her pregnancy, then her child was much more likely to have sleep problems. This brings up the interesting topic of fetal programming. The developing nerves of the fetus are highly influenced by mom’s stress. Too much stress sets the arousal thermostat too high, as the developing nerves learn the lesson that there is a need to be hyper vigilant to deal with issues. Unfortunately, this type of fetal programming is more like hardware than software – setting a child up for sleep problems.
Likewise, a mother’s weight11 and leptin-related food problems going into pregnancy can also fetal-program leptin circuits relating to food acquisition. We know that children born to overweight mothers are at risk for future obesity. Mothers who diet during pregnancy (malnourished) as well as mothers who eat too much (overnourished) create leptin-related fetal programming problems.
Thus, stress problems and food issues while in the womb are the first predictor of a child’s likelihood for setting their arousal thermostat too high. During the first few years of life, once again as the brain is establishing more core circuits, the issues of stress and food will continue to have bearing on this system. How stable is the home environment? How much love is there? How much quality food is available? Is your child learning to eat vegetables and fruit – or is he or she already on a sugar and junk fat trend? Is your child learning good sleep habits?
The failure of parents to provide stability and quality nutrition in the early years of life (including in the womb) is a prime risk factor for a child having sleep problems and increasing the risk that your child could go down a path of substance abuse.
High Fructose Corn Syrup – A Gateway Drug
High Fructose Corn Syrup (HFCS) as found in many beverages consumed by teens is so detrimental to health it should be banned from the food supply. However, a massive lobbying effort by the corn refiners prevented the feeble minded American Medical Association from issuing a warning on the obesity risk associated with HFCS. The corn refiners have now taken the lack of an AMA warning to be a safety endorsement and are running national TV ads proclaiming the safety of HFCS. Where, might I ask, is the FDA when they are actually needed?
An animal study shows that consuming HFCS makes the animal stupid. Maybe that is why the teen dropout rate is so high.
A rather alarming study (at least to me) showed that HFCS, compared to fruit, inappropriately raises triglyceride levels in the blood over a 24-hour period. Elevated triglycerides block leptin from getting into your brain in the proper amount, a problem that starts prior to obesity and primes the future obesity pump. When leptin does not get into your brain correctly then the hypocretin-driven arousal thermostat will start going higher.
Consuming large amounts of HFCS is sure to throw this system off, causing sleep problems and opening the door for drug abuse. Many children and teens get up to 20 percent of their calories from HFCS! Imagine the combined effect of HFCS and typical teen stress on the arousal thermostat. Next step – substance abuse.
Parents have tremendous power to help their children have a healthier future. It starts with prepregnancy planning for mom. Ensuring her body weight, eating habits, and mood are good before getting pregnant. Ensuring life is stable during pregnancy. Ensuring that good sleep, eating, and exercise habits are taught throughout the early years of life – in an environment that is as stable and stress-free as possible.
Many natural options can be employed to help children and teens sleep better. The basics are eating quality food, following the Leptin Diet, developing good problem solving and stress management skills, taking the time to exercise, and staying on a consistent sleep schedule along with getting enough sleep.
Changing a wound up arousal thermostat can take some time, although many improvements will be noticed early on. Your brain has tremendous capacity to adapt and change circuitry (brain plasticity), including making changes in a positive direction. Part of real health is quality sleep not based on the use of knockout drugs that do little more than put a Band-aid on a very important health topic.
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