Teaching Teens and their Parents on the Impact of Good Sleep Hygiene On Heart Health

In the U.S., more than 70% of teenagers do not get enough sleep, according to the CDC. Typically, teenagers need between 8-10 hours of sleep each night, and without it, the rapid physical and psychological changes that occur during adolescence can be severely affected. Physical and cognitive development, emotional, hormonal, and mental health are all at stake. Even scarier, the latest research shows that lack of sleep is also a significant risk factor for cardiovascular disease later in life.

During the teenage years, arteries begin to accumulate plaque (it forms when cholesterol gets stuck there and can limit blood flow), and poor sleep could potentially accelerate this process. Sleep deprivation intertwines with other factors, such as high blood pressure and inflammation, that also increase the risk of developing heart disease. Research from Columbia scientists shows that even relatively mild sleep problems can cause inflammation in the endothelial cells that line the veins, which could significantly contribute to the development of cardiovascular disease.

In addition, poor sleep can affect the heart indirectly by influencing our choices about food and exercise. “Our research shows not sleeping well may lead to increased food cravings and gravitation to less heart-healthy comfort foods high in saturated fat and sugar. And when you don't eat well, you don't sleep well. The relationship works both ways, and the same is true for physical activity,” says Brooke Aggarwal, EdD, a clinical health education specialist, and assistant professor of medical sciences in the Department of Medicine (in Cardiology) at Columbia University Vagelos College of Physicians and Surgeons. 

"Sleep is taking its rightful place as a significant risk factor for cardiovascular disease, so it’s best to intervene early and get to the root cause of sleep problems in children and young adults,” says Aggarwal. And the root causes are numerous. “Look at the everyday factors. Up to three-quarters of kids have a TV in their bedroom, which helps them procrastinate on sleep. Phones in the bedroom are another distraction. And blue light from all these electronic devices may interrupt the production of melatonin, which helps bring on sleep,” Aggarwal adds.

Adolescent sleep disturbance predicts adult sleep disturbance as well. Studies show modifying sleep behavior between the ages of 16 and 18 is beneficial to overall health as teens, and those healthy sleep patterns could carry over into adulthood.  

With this in mind, Dr. Aggarwal and her team have created an educational program called Reinforcing Essentials of Sleep for Teens (REST) program for high school students in Washington Heights. The REST program is raising awareness of the need for sleep to prevent heart disease and showing teenagers and their families how to get the rest they need. 

How did the “REST” program come about?

Our lab has been focused on studying the effects of poor sleep on risk for cardiovascular disease for the past 7 years, and we have much information implicating short sleep duration as a risk factor for cardiometabolic disorders among adults. In June 2022, sleep duration was added as a new metric as part of an ideal heart health checklist, endorsed by the American Heart Association and called, “Life’s Essential Eight". However, prevention of heart disease is key, and it begins with the adoption of a healthy lifestyle in childhood, including optimal sleep duration. Over half of adolescents sleep less than 8 hours on school nights. Racial and ethnic minority teens may be particularly at risk, as they are more likely to experience deficiencies in sleep and sleep disorders. We developed the REST program in response to this need, and it was the recipient of a 2022 Progress at the Heart Award, which provided funding to launch the pilot.

Why do teens in particular need to get enough sleep?

It’s so important to build healthy sleep habits during the teenage years. Sleep problems that occur during the teen years tend to persist over time, and could predispose individuals to increased cardiovascular risk later on. In addition, adolescents who are sleep-deprived may experience difficulty concentrating, depressive symptoms, drifting off in class, decreased energy, and reduced academic and athletic performance. Teens and their parents may not realize that some of the challenges they face in everyday life could stem from poor quality and/or short sleep.

Can you describe what teens and their families learn in the program?

The program consists of 6 educational modules, which are first administered by a health educator during individual sessions with teens, and then later reinforced through short educational videos that we have created (using feedback from the teens themselves), which are delivered through novel video brochure technology via mail. Importantly, sleep may be affected by cultural factors within the home, and we engage with both teens and their parents to identify sleep problems and tailor the education program accordingly. The weekly modules target the primary areas that we have found to be associated with poor sleep among teens, including 1) procrastination of bedtimes, which may be in part due to self-regulation, a modifiable factor, 2) sleep environment, including noise, light, and temperature, and 3) use of electronic media in the bedroom and close to bedtime. Teens and their families also receive information on good sleep hygiene, including creating relaxing bedtime routines, limiting heavy meals and caffeine before bed, and the importance of exposure to bright light in the morning in order to help regulate internal circadian rhythms.

The REST program was rolled out in Washington Heights. What’s been the feedback? Successes?

We’ve actually been able to pilot the program in both Washington Heights and Los Angeles simultaneously, thanks to the help of Gary Charliyan, MS, a recent graduate of the Columbia University Institute of Human Nutrition program. This will allow us to compare the barriers to sleep that teens face, in two different urban sleep enviornments,  which they express in their own words through the program. We’ve received much positive feedback from teens and their parents about behavioral changes they’ve made to improve their sleep. We’ve also found that the teens in our program are deeply interested in learning the “science” of sleep, including what is happening in their bodies during sleep and information about sleep stages and cycles.

What can we do better as a nation in terms of helping our teenagers get more sleep? What recommendations do you have nationwide?

Due to their biology, teenagers naturally fall asleep later and sleep later in the morning during this period of their lives. One of the best things we can do as a nation to help teenagers get more sleep is to support policies for later school start times (no earlier than 8:30am) for middle-school and high-school students, which is recommended by both the American Academy of Sleep Medicine and the American Academy of Pediatrics.

How did you become interested in the connection between sleep and heart health?

Many years ago, our team organized a health fair for over 350 employees of Columbia/New York Presbyterian Hospital and members of the surrounding community and decided to ask questions about sleep. We found that one-third of the health fair participants slept less than 6 hours per night, and those who had short sleep had significantly higher LDL-cholesterol, a well-established risk factor for heart disease, on their screening results. This began the interest in investigating the connection further.

Were you a sleep-deprived teenager?

Yes! I definitely procrastinated on bedtime. I did not have an iphone back then, but found many other distractions.

Above all else, what’s the most important piece of advice you can give parents to help their teens sleep well?

Although it may be trickier to enforce with this age group, it’s helpful for parents to try to set limits on bedtime and social media use before bed for teens. One way to get teens on board with these limits is to to talk to them about the importance of getting enough sleep, which can help them feel better physically and mentally, and improve how they perform in school and sports. Parents can also set a good example by making sleep a priority for themselves.

If you have a question about your heart health, ask your doctor, cardiologist, or contact ColumbiaDoctors Cardiology.