Feasibility and behavioral effects of an at-home multi-night sleep restriction protocol for adolescents

Background: Sleep deprivation is common among adolescents and has been associated with adverse behavioral and educational outcomes. However, it is difficult to draw strong causal conclusions because of a dearth of experimental sleep research. In part, this appears related to methodological challenges when working with this population. This study tested the feasibility and behavioral effects of a multi-night, at-home experimental sleep restriction protocol in a sample of adolescents. Methods:Twenty healthy adolescents aged 13.9-16.9 years were enrolled in a three-week sleep manipulation protocol using a counterbalanced cross-over experimental design. The protocol included a baseline week, followed in random order by a short sleep week (Monday-Friday nights limited to 6.5 hours time in bed) and an extended sleep week (10 hours lights-out time in bed Monday-Friday nights). Sleep was monitored via self-report and objective actigraphy. These were reviewed with participants and parents on the Saturdays at the end of each week, when parents and participants also completed behavior rating questionnaires. Results: One participant dropped out of the study, but each of the remaining 19 displayed markedly less sleep in the short sleep condition than the extended sleep condition (average nightly gap similar to 2.5 hours). Data also reflected indirect effects of sleep deprivation that are consistent with an increase in homeostatic sleep drive. Compared to the extended sleep week, parents during the short sleep week reported that the participants displayed significantly greater problems with sleepiness, attention, oppositionality/irritability, behavior regulation, and metacognition. Participant self-report results were similar, though less robust. Conclusions: A multi-night, at-home sleep manipulation protocol for use with adolescents is indeed feasible. This study also provided the first experimental evidence that chronic sleep restriction during adolescence is causally related to a wide range of behavioral deficits.