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Biological clock vs Social clock conflict in Adolescents

March 2021
Journal of Applied and Natural Science 13(1):327-342

March 2021
13(1):327-342

DOI:10.31018/jans.v13i1.2571

License
CC BY-NC 4.0

Authors:

Pragya Verma

University of Lucknow

Arjita Yadav

University of Lucknow

Shalie Malik

University of Lucknow

Alteration of day and night is one of the essential circadian rhythms that build the phenomenon of sleep/wake in humans and other animals. Daily rhythms impact different individuals differently. Light exposure and an individual's circadian response are two aspects that create diversity in phenotype. These diverse phenotypes are called chronotypes. Chronotype varies over the life history stages. Chronotype is seen as morning type in children, evening type in adolescents, and again reverts back to the morning type in adults and old-aged individuals. It is observed that adolescents being evening types have bedtime later in com-parison to children and adults. Adolescent physiology/ body clock does not allow them to sleep early and school routine/social clock does not let them sleep till late. Thus, their night phase is shrunk and sleep hours are reduced, which hinders their day-time functioning, including mental tasks such as cognition, learning and memory-based exercises, and physical tasks such as physical presence during field and athletic events. These days sleep debt is a critical health concern in the adolescent popula-tion. The current review focuses on the adolescent sleep-needs and various factors affecting their healthy sleep. This also en-compasses the understanding of biological clocks, their misalignment, disrupters, causes and impact. The present study would be helpful in finding out the difference between the biological clock and social clock of the adolescent population, elaborates the need for sleep education and suggests a solution to this alarming problem of sleep debt in teens.

Impacts of severe sleep disruption on cognitive and emotional responses (redrawn from Wulff et al., 2010).

…

Effects of sleep disruption on physiological responses (redrawn from Foster and Wulff, 2005).

…

A conceptual map showing circadian misalignment leading to the alcohol abuse and substance use in adolescents (based on Hasler and Clark, 2013; Hasler et al., 2015).

…

Figures - uploaded by Pragya Verma

Content may be subject to copyright.

Content uploaded by Pragya Verma

Content may be subject to copyright.

Biological clock vs Social clock conflict in Adolescents

Pragya Verma

Department of Zoology, University of Lucknow, Lucknow-226007 (Uttar Pradesh), India

Arjita Yadav

Department of Zoology, University of Lucknow, Lucknow-226007 (Uttar Pradesh), India

Sangeeta Rani

Department of Zoology, University of Lucknow, Lucknow-226007 (Uttar Pradesh), India

Shalie Malik*

Department of Zoology, University of Lucknow, Lucknow-226007 (Uttar Pradesh), India

*Corresponding author. Email: shellymlk@yahoo.com

Article Info

https://doi.org/10.31018/

jans.v13i1.2571

Received: February 5, 2021

Revised: March 8, 2021

Accepted: March 12, 2021

This work is licensed under Attribution-Non Commerc ial 4.0 International (CC BY-NC 4.0). © : Author (s). Publishing rights @ ANSF.

Published online: March 14, 2021

ISSN : 0974-9411 (Print), 2231-5209 (Online)

journals.ansfoundation.org

Review Article

CLOCKS IN HUMAN: AN INTRODUCTION

All living systems have endogenous, self-sustained

biological clocks. Thus biological clocks are ubiqui-

tous. These are inherent timing mechanisms that time

the periodicity of various underlying physiological,

behavioural and biochemical processes. These en-

dogenous clocks synchronize themselves with exter-

nal cues such as light, food, society, etc (Van Drunen

and Eckel-Mahan, 2021). The ebb and flow of daily

life impact individuals differently. This shows that light

exposure and an individual's circadian response are

two aspects that create diversity in phenotype. These

different phenotypes are called chronotypes

(Roenneberg, 2015; Kalmbach et al., 2017). This tem-

poral difference of day and night between the two

chronotypes could be as large as ten hours

(Roenneberg et al., 2007). Studies indicate that chro-

notype changes significantly throughout the life span

(Randler et al., 2017). Various cross-sectional studies

demonstrate that pre-adolescents are morning type,

but when they reach their adolescence, they show

maximum shifts towards evening types and exhibit

the same till 20 years of age; thereafter, they re-shift

towards early-type (Roenneberg et al., 2004; Tonetti

et al., 2008; Randler et al., 2016). Besides age, there

are reports indicating gender-based differences in

chronotype (Duffy et al., 2011; Tonetti et al., 2008).

Chronotypes are linked to individual's sleep-wake

variability, cognition, learning behaviour, and other

endogenous clock properties, thereby creating indi-

vidual temporal niches (Kerkhof, 1985; Karan et al.,

2021). As we live in a 24X7 world, keeping aside the

body's physiological demands, lead to increased risk

Abstract

Alteration of day and night is one of the essential circadian rhythms that build the phenomenon of sleep/wake in humans and

other animals. Daily rhythms impact different individuals differently. Light exposure and an individual's circadian response are

two aspects that create diversity in phenotype. These diverse phenotypes are called chronotypes. Chronotype varies over the

life history stages. Chronotype is seen as morning type in children, evening type in adolescents, and again reverts back to the

morning type in adults and old-aged individuals. It is observed that adolescents being evening types have bedtime later in com-

parison to children and adults. Adolescent physiology/ body clock does not allow them to sleep early and school routine/social

clock does not let them sleep till late. Thus, their night phase is shrunk and sleep hours are reduced, which hinders their day-

time functioning, including mental tasks such as cognition, learning and memory-based exercises, and physical tasks such as

physical presence during field and athletic events. These days sleep debt is a critical health concern in the adolescent popula-

tion. The current review focuses on the adolescent sleep-needs and various factors affecting their healthy sleep. This also en-

compasses the understanding of biological clocks, their misalignment, disrupters, causes and impact. The present study would

be helpful in finding out the difference between the biological clock and social clock of the adolescent population, elaborates the

need for sleep education and suggests a solution to this alarming problem of sleep debt in teens.

Keywords: Adolescent physiology, Biological clock, Circadian rhythms, Clock disruption, Sleep-wake cycle, Social clock

How to Cite

Verma, P. et al. (2021). Biological clock vs Social clock conflict in Adolescents. Journal of Applied and Natural Science, 13(1):

327 - 342. https://doi.org/10.31018/jans.v13i1.2571

328

Verma, P. et al. / J. Appl. & Nat. Sci. 13(1): 327 - 342 (2021)

for health and safety. Maximum work profiles in our

social and professional world, irrespective of an indi-

vidual's chronotype, prefer morning schedules over

any other time of the day. In this course, young adults,

especially adolescents, are the most vulnerable age

group, as most dramatic changes in human life take

place in this phase (Susman et al., 2003).

The focus of this review is to bring out the cause and

consequence of sleep disturbance in adolescent stu-

dents. Previous studies have shown that sleep behav-

iour changes during the adolescent years because of

the physiological demand of the body. Teenagers pre-

fer being awake late at night but out of the compulsion

of school regime they have to get up early as most of

the schools in our country have an early start time

(Knutson and Lauderdale, 2009). This latency in going

to bed and rising early creates chronic sleep debt in

adolescents' life (Hansen et al., 2005). For adoles-

cents, the school timings not only hold the key posi-

tion in the plan of the daily schedule but are also re-

sponsible for their overall health and well-being. By

addressing the problem of "early school start time,"

we can deal with most adolescent health problems.

Other societal factors like late-night- screen time, mo-

bile use, internet addiction, workouts, study sched-

ules, exam stress, use of caffeinated drinks at night

and many such individual issues also contribute to

this problem (McKay et al., 2021). As we are aware,

the penalty of the sleep debt is severe; and the pay-

off is the students' physical and mental health, which

compromises their potential for day-time functioning.

We have tried to explain the importance of the biologi-

cal clock and its synchronization with the social clock.

We witness a periodic recurrence in the forms of

rhythms in almost every phenomenon formulated by

nature. We witness these rhythms in every natural

phenomenon. Whether it is the alteration of day and

night or seasons and tides, everything runs in harmo-

ny in nature. Every individual on this planet, from al-

gae to human-being have their internal rhythm. These

internal rhythms of an individual are synchronized with

the cyclic movements of the environment. Circadian

(Circa = about; Diem = a day) rhythms in living beings

are regulated by a biological timepiece positioned in

the Suprachiasmatic Nuclei (SCN) which lies in the

hypothalamus. This clock tunes them with the outer

world by accepting various environmental cues

(Lockley and Foster, 2012). The body clock sets up

the chronotype of a person according to the time pre-

ferred by the body's internal demands, which leads to

determining major behavioural patterns like- sleep-

wake cyclicity, emotional balance, introvert-extrovert-

ness, mental-physical performance. The body clock

also maintains other crucial biological processes like

metabolic activity and physiological demands that in-

clude, meal time preference, regulation of blood glu-

cose, the release of the required hormone and many

such responses (Kozlowska et al., 2020). Suprachias-

matic nucleus is a tiny region of the brain in the hypo-

thalamus responsible for running the circadian body

clock and other rhythms associated with the body's

peripheral organs (Hilton et al., 2001; Hastings et al.,

2003). Circadian rhythmicity is associated with the

changes with day-light and day-length. When chang-

es in the light wavelength and light intensity are con-

spicuous; they are critical for the entrainment of the

endogenous circadian timekeeping system in nature.

Such non-parametric entrainment underlies a phase-

dependent (discrete or phasic) sensitivity of the circa-

dian rhythms to daily light-dark cycles. The dark

phase is equally important for existence as the light

phase of the 24-hour cycle of the day. Dark hours are

generally associated with the rest of the sleep.

Sleep, which seems to be very simple, is a very com-

plicated process. It involves several regions of the

brain. In addition to it, neurotransmitters and hormo-

nal pathways also play a crucial role. None of these

factors can build sleep alone on their own. This com-

plex interplay of different factors makes the process

of sleep unique and valuable; therefore, sleep cannot

be taken for granted.

In the case of adolescents, it is observed that they are

going to bed later in comparison to children and

adults. Thus, their night/rest phase is shrunk in com-

parison to other age groups. Studies have suggested

that the duration of sleep keeps on reducing till the

age of adolescence but the required duration does not

change during teenage years (Crowley et al., 2018).

When we step ahead to understand the adolescent

circadian clock and sleep behaviour, in light of their

physiological demand and the consequences of daily

sleep deprivation for attending school in early hours,

gives a new angle to address adolescent behaviour

(Jain and Khare, 2020). Alongside, Sleep disruption is

also one of the root cause of up- and down-regulation

of various cognitive and emotional behaviours in indi-

viduals (Fig.1). A questionnaire-based study was

done on approx.1,50,000 adolescents in which the

subjects have shown a diversion towards being even-

ing-type. This change occurred earlier in girls, which

matches with the early onset of puberty in them

(Tonetti et al., 2008; Randler, 2011). This change

again reverts when an individual enters adulthood,

which leads to a shift in their chronotype again to-

wards being early-type (Roenneberg et al., 2004).

Many studies have shown that the sleep hours during

the free days or in the summer break are more in

comparison to the work or the school days (Hansen et

al., 2005; Jenni et al., 2005). Other studies have also

shown that their biological rhythm is not lethargy,

which makes them bound to the bed in the morning

hours and keeps them wake-up till late in the night.

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Verma, P. et al. / J. Appl. & Nat. Sci. 13(1): 327 - 342 (2021)

One more study based on actigraphic data of sleep

showed a trend of development where reduced sleep

and delayed onset from child to adolescent are seen

(Galland et al., 2018). Another study was conducted

to find out sleep debt between biological time and

educational time, which has shown the severity of

sleep deficit in varied age groups (Foster et al.,

2013). Also, survey-based studies from China and

Canada indicates that adolescents are prone to

chronic sleep debt (Chen et al., 2014; Patte et al.,

2017). In today's era, sleep deprivation has reached

dangerous levels. This situation is alarming, but fortu-

nately, it is still a controllable affair, which can be

solved by keeping the school timings according to the

biological clock of adolescents.

Alterations on a chronic basis in sleep pattern during

the adolescent period may lead to severe sleep-

related disorders in their later ages, which may harm

their health. It is recommended that approx. 9 hours

of sleep is required for healthy functioning of the body

(Short et al., 2018; Fuligni et al., 2019). Less than 8

hours of sleep on daily basis creates constant sleep

debt which has a direct impact on cognitive power,

emotional balance and physical health of an individual

(Lockley et al., 2004). Studies have also shown that

weak immune system, low metabolism, high blood

sugar levels, cardiovascular disorders, hypertension,

anxiety, stress, obesity and cancerous growth in ado-

lescent are related to the restricted sleep schedule

(Foster et al., 2013; De Souza and Hidalgo, 2014;

Luyster et al., 2012; Kling and Landgraf, 2021). A

study was done to find out the harmful effects of the

short duration (5.7 hours per night for one week) of

sleep on a healthy body in comparison to those peo-

ple who were kept under control condition (8.5 hours

per night for one week); this also revealed that the

activity of total 711 different types of genes

(responsible for circadian expression) are either up-

regulated or down-regulated, because of insufficient

sleep (Möller-Levet et al., 2013). Based on self-

reports of sleep duration made in questionnaire

across 40 countries of the world, a systematic review

reported that the short duration of sleep adversely

affects the mental and physical health of individuals

(Chaput et al., 2016). Those adolescents who re-

ceived recommended amount of sleep were at their

best mental health status (Fuligni et al., 2019) where-

as, those who slept less than the recommended sleep

duration have shown psychological complaints

(NorellClarke and Hagquist, 2018). Disturbances in

sleep lead to the formation of diseases in the body.

Several findings suggest a relation between sleep

debt and obesity (Cappuccio et al., 2008; Chen et al.,

2008; Miller et al., 2018), also the evidence-based

research from experiments and epidemiology from

the past 30 years has connected sleep debt with obe-

sity (Sluggett et al., 2019). Both chronic sleep debt

and obesity are issues concerning public health and

in light of the researches mentioned earlier, it be-

comes more noteworthy (Agha and Agha, 2017).

Therefore, sleep correction becomes significant in the

treatment of obesity (Chaput and Dutil, 2016).

Clock disruption and its effect on adolescents

Borbély was the first to propose the two-process

model of sleep (Borbély, 1982), which explains the

role of the circadian system (Process C) and homeo-

static system (Process S) in maintaining sleep-wake

behaviour. The circadian system is responsible for

sleep timings irrespective of previous sleep/wake cy-

cles, whereas the homeostatic system is responsible

for increasing sleep drive for the amount of wakeful

Fig. 1. Impacts of severe sleep disruption on cognitive and emotional responses (redrawn from Wulff et al., 2010).

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Verma, P. et al. / J. Appl. & Nat. Sci. 13(1): 327 - 342 (2021)

period of that individual. If the circadian system or

central clock of a living organism is disrupted, it will

lead to the misalignment of the entire network of pe-

ripheral clocks (Jain and Khare, 2020), which are

working in synchrony with each other (Foster et al.,

2013). Adolescence is especially an age where delay-

ing in the sleep-wake cycle is notable, and that can

be easily understood with the help of the above-

mentioned two-process model of sleep. Here, with the

progress in pubertal age (Carskadon et al., 2004),

circadian system shifts to later timings of the day that

results in phase-delay in circadian timekeeping sys-

tem (Hagenauer et al., 2009; Hummer and Lee,

2016). This shift can be seen in their chronotypes

(about their sleep-wake times; Roenneberg et al.,

2004). Changes in bio-regulation of sleep-wake cy-

clicity are responsible for sleep burden in adolescents

but these alterations in adolescent physiology are not

taking place in seclusion (Kozlowska et al., 2020). It

is a well-known fact that our body functions efficiently

when both biological and social clocks are simulated

with each other. In ancient period, both the social and

biological time-scales were almost in synchrony be-

cause of the less intervention of artificial light at night,

technology-based 24x7 lifestyle and unruly academic

burden on young people. (Foster and Keitzman,

2014) Difference between social and biological clock

creates a misalignment of various rhythms governing

smooth body functioning. This desynchrony becomes

a potential threat especially to adolescents as they

are already undergoing a physiologically turbulent

phase (Fig. 2). Therefore, changes in adolescents are

an outcome of the mixed effect of the environment in

which they live, their daily routine/lifestyle and many

other psycho-social factors. There are many factors

such as school and exam stress, internet and social

media addiction, use of substance and high caffeine

drinks which create clock disruption in adolescents.

Clock disrupters

a) School regime

Keeping track of time is the basic block on which the

theory of the school system, as well as the biological

processes, are laid upon, but still, both these sectors

have their understanding of time (Peterson, 1996).

The meaning of development in the perspective of the

school system is evaluated in terms of the number of

academic years crossed (based on annual curriculum

and daily time-table (Ward, 2021). This trend is more

or less the same on the global platform. On the other

hand, the biological evaluation of time measurement

is done by calculating the development levels. Devel-

opments can also be evaluated on a short term basis

by considering the response of our body clock in the

Fig. 2. Importance of time in school and biological perspective and how their misalignment creates a desynchrony which

leads to health risks.

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circadian frame. School curriculum and cut-throat

competitive exams have compelled students to give

extra time to studies from their bed hours(Shochat et

al., 2014) and there is no way to compensate night-

time sleep-loss during morning hours as early school

start time does not allows them to sleep till late

(Chaput et al., 2016). Amid all this school going ado-

lescent's physiological demands are compromised. In

addition to it, the majority of schools have morning

schedules that force evening type adolescents to

wake-up early irrespective of their internal clock. This

schedule, on a chronic basis, leads to the circadian

misalignment and reduced Sleep (Liu et al., 2021). On

a chronic scale, this condition serves as the major

cause of "Social jet lag" in adolescents (Wittmann et

al., 2006).

School hours

The school schedule is the main cue around which

the routine of adolescents is weaved. There is a need

for simulation of the educational system according to

adolescent biology. Sleep deprivation among students

is not the sole cause behind rescheduling school

hours; it is also interlinked with other factors. A few of

them are memory-based learning and sleep; circadian

variation, chronotype and individual differences sleep

hygiene. Good Sleep plays a very important role in

building long-term memories (Diekelmann and Born,

2010) and disturbances in it can damage the founda-

tion of the same (Stickgold et al., 2000). Sleep con-

solidates memory, which is important for mental

health and overall well being (Wilhelm et al., 2011).

During the adolescent years, it is the student's natural

tendency to attain alertness in the later period of the

day and remain awake until late at night, making them

more likely an evening type individual. Evening type is

associated with better attention (Bai et al., 2021). The

performance of the adolescents also improves later in

the day (Hansen et al., 2005; Hahn et al., 2007; West

et al., 2011). A study conducted by Matchock and

Mordkoff (2009), showed that at 0800 hours the atten-

tion level of individuals belonging to all the chrono-

types is significantly low and at 1200, 1600 and 2000

hours their scores almost double up. Another study

conducted on the school going students of age group

13-14 years by giving them word-pair test at 1000 &

1400 hours and then evaluating their performance. It

was found that they performed better in the later test

(Kelley and Lockley, 2013). There are other related

studies also, which provide evidence for similar time-

in-day effects (Schmidt et al., 2009; Haraszti et al.,

2014). According to a study done on students of

Spain (12-16 years), late-type students performed

significantly poor (Escribano et al., 2012).

Exam stress

Examination time is considered to be one of the major

stress giving times in an individual's life span. An ado-

lescent who is already undergoing so many ups and

downs physiologically and socially feel under im-

mense tension when the pressure of achieving good

academic grades exceeds. This leads the student to

the condition of stress and altered psycho-physical

behaviour (Rani, 2017). Exam stress is not just a sin-

gle term but is associated with sleeplessness, anxie-

ty, time pressure, appetite loss (Putwain, 2008). Ex-

am time stress leads to physical problems

(Zunhammer et al., 2013) as well as sleep-related

problems. Curtailing on the sleep adversely affects

the cognition strength of students and results in poor

performance in academics (Curcio et al., 2006;

Carskadon, 2011). Certain reports also suggested a

difference in examination pressure found in the stu-

dents studying through science stream and humani-

ties stream. This difference is may be due to Practical

classes during school and coaching classes after

school (Rani, 2017). Boys are less stressed than girls

in their routine (Dewald-Kaufmann et al.2014; Steven,

2016). A study conducted on college-going students

shown that the examination stress also results in the

suppression of their cardio-respiratory rest function

while sleeping at night (Sakakibara et al., 2008). Ex-

am stress is found to be the highest in the examina-

tion week, lower than that is seen in the week just

before the examination and at least two weeks before

the examination started. This kind of pattern is indica-

tive of the role of psychological intervention in the

perception of stress (Dewald-Kaufmann et al., 2014).

b) Screen time

Today our society has turned global, and thus as con-

sequences, there are 24-hour work profiles (Coveney,

2014). In the past ten years, electronic devices have

found their space in almost every home on a global

level or it can be said that almost every adolescent

has access to the technological screen in one form or

the other. They have been brought into play in such a

way that they entered our bedrooms from the living

room. Reports suggest that more than 90% of adoles-

cent remain with some of the other multimedia devic-

es in their bedrooms when they go to sleep, which

hinders the normal sleep timings by delaying it (NSF,

2006). Exposure to light in the evenings will interrupt

circadian rhythms by suppressing the release of mela-

tonin. The rhythm of the melatonin hormone is closely

linked to sleep and sleep timing (Arendt, 2019). In the

evening, exposure to artificial light will alter patterns

of sleep and thus changes the sleep duration (Touitou

and Point, 2020). Besides, electronic devices emit

light with a short wavelength (i.e. blue light). In this

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range, the circadian system is alarmingly sensitive to

light (Cajochen et al., 2011; Bertani et al., 2021). Ex-

cessive use of these gadgets at bedtime has signifi-

cant detrimental effects on sleep duration and quality

(Hysing et al., 2015). 24/7 access to the technology,

especially mobile and laptop screens (which emits

blue wavelength) have played a significant role in in-

creasing alertness and delayed sleep onset (Rüger et

al., 2012). The weekday-weekend gap in getting-up

time is larger in adolescents but in adult evening

types, which shows circadian misalignment (Adan,

1994; Broms et al., 2011).

A widely acclaimed review of 36 studies published in

2010 showed that excessive media use in children

and adolescents is associated with delayed bedtime

and shorter sleep periods (Cain and Gradiser, 2010;

Kokka et al., 2021). A broad US-based survey exam-

ined whether the sleep pattern persisted between

2009 and 2015 and the factors that could contribute

to its decrease. By 2015, more than 40% of teenagers

regularly slept less than 7 hours a night, 16-17%

more often than in 2009. During the analysis period,

time for usage of digital media screens increased

(including mobile devices, social media and reading

of online news) and also the chances for a shorter

period of sleep increased. Notably, during these

years, there has been no rise in other behaviours

which could be suggested to interfere with sleep (TV,

pay job, homework; Twenge et al., 2017).

The cross-sectional data from the Millennium Cohort

Study in the UK were used in another large-scale re-

search (Scott et al., 2019). The authors analyzed so-

cial media usage by 11,872 adolescents aged be-

tween 13 to 15 years and sleep results associations

using 2014 data. The use of social media was meas-

ured using one item: the time spent on social media

on a typical weekday. Larger use of social media has

been related to weaker sleep after covariate control.

Specifically, highly addictive social media users who

used social networks more than 5 hours a day

(20.8%) were more likely to record a late sleep onset

during the school week, compared to users who used

social media 1 to 3 hours a day (31.6%). Handys

(mobiles) are omnipresent and a part of daily life. In

fact, they are seen as an important tool for social in-

teraction by young people. A longitudinal study evalu-

ated the impact of mobile phone use in Western Aus-

tralia for over four years from 2010 to 2013. Individu-

als were asked what time text messages or telephone

calls were typically sent or received and whether they

continued after the lights are off. Over these years,

the use of cell phones at night has increased, equally

leading to corresponding increases in bad sleep prac-

tices (Vernon et al., 2018).

Studies have mostly used the survey-based data and

correlation statistics, although a recent experimental

study requested teenagers to avoid using their mo-

biles one hour before their normal bedtime and also

to complete a sleep diary along with. Results revealed

that during the intervention week, teenagers avoided

using their mobile 80 minutes before, put their lights

off 17 minutes before, and sleep lasted 21 minutes

longer than school-night (Bartel et al., 2019). Along

with circadian misalignment, such individuals also

tend towards psychological dysregulation, addiction to

alcohol abuse and involvement in substance use

(Gau et al., 2007, Pieters et al., 2010; Saxvig et al.,

2012, Stolarski et al., 2021). Survey also shows that

the students have given data for a relation between

sleep-related issues and alcohol consumption along

with substance use (Lund et al., 2010; Pieters et al.,

2010).

c) Caffeine

Caffeine is the commonest consumed psychoactive

substance. It blocks adenosine receptors (Roehrs and

Roth, 2008). Caffeine is seen as a problem for sleep

because adenosine is a neurochemical substance

whose level increases wakefulness in the brain

(FavrodCoune and Broers, 2021); adenosine is sug-

gested to stimulate sleep and play a role in homeo-

stasis in sleep (Basheer et al., 2004). Afternoon or

evening caffeine consumption can be an issue of con-

cern as the half-life of single-dose takes between 3-7

hours and may hinder the process of falling asleep

(Roehrs and Roth, 2008). In recent years, energy

drinks have received publicity; in particular, the youth

consumption trend has increased. Caffeine is a major

component of energy drinks It gives 113-200 mg en-

ergy shot with 70-200 mg presence in a 16-ounce

drink (NCCIH, 2018). More than two-thirds of the ado-

lescents were registered to use energy beverages in

the UK (DHSC, 2018), and one-third in the USA

(NCCIH, 2018). Energy drinks have been noted to

gain popularity among adolescents in recent years, as

it increases the alertness and helps battle the sleepi-

ness (Bryant and Wolfson, 2010, Yasuma et al.,

2021).

Factors other than the above-listed causes are also

responsible for creating motivation for the later sleep

timings in adolescents.

Impacts of clock disrupters

a) Metabolic Imbalances

Many past studies revealed how human physiology

and a few disorders are directly linked with circadian

rhythms (Schernhammer et al., 2003, Gale et al.,

2011, Martino et al., 2008, Wulff et al., 2012 ). Meta-

bolic homeostasis, specifically in adipose tissue is an

important element that is responsible for energy me-

tabolism. Adipose tissue is the reservoir that fulfils the

major energy demands of the body whereas, brown

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Verma, P. et al. / J. Appl. & Nat. Sci. 13(1): 327 - 342 (2021)

adipose tissue accumulates lipids for adaptive ther-

mogenesis caused by cold weather. Adipose tissues

secrete multiple hormones, cytokines and metabolites

that control the signal for appetite in CNS and metab-

olism in peripheral tissues (Choe et al., 2016), e.g.

leptin has unique hypothalamic receptors and is re-

leased from the principal adipocytes. Leptin increases

thyroid hormone levels and stimulates the sympathet-

ic central nervous system, which leads to increased

formation of the uncoupling protein which leads to

greater use of energy (Con et al., 2017). Leptin hor-

mone release follows circadian rhythmicity, where the

night is the time when a maximum of serum leptin

level is recorded (Tsujino and Sakurai, 2012). Now,

Fig. 3. Effects of sleep disruption on physiological responses (redrawn from Foster and Wulff, 2005).

Fig. 4. A conceptual map showing circadian misalignment leading to the alcohol abuse and substance use in adoles-

cents (based on Hasler and Clark, 2013; Hasler et al., 2015).

334

Verma, P. et al. / J. Appl. & Nat. Sci. 13(1): 327 - 342 (2021)

disturbance in the night time sleep may lead to circa-

dian misalignment that can indirectly affect the whole

chain of the secretion of leptin, process of thermogen-

esis and homeostasis of energy. On the opposite,

certain hypothalamic hormones display more night

activity, e.g., growth hormone peaks between 2:00 to

4:00 a.m in the night. Imagine if the adolescent has a

disturbance in nighttime sleep, then it will adversely

impact the growth of that individual. Therefore, partic-

ular attention must be given to children's sleep pat-

terns also (Sato and Ida, 2017).

Chrono-disruption is the misalignment of peripheral

clocks with the central clock (Garaulet et al., 2010),

which leads to some serious diseases (Ahmad, 2020).

Majority of diseases are lifestyle disorders such as

cardiovascular diseases, depression, obesity and me-

tabolism (Garaulet et al., 2014) (Fig. 3). The circadian

clock plays a significant role in the homeostasis of

energy and metabolism. Circadian therapies thus,

focused on rhythm, diet and exercise that have been

introduced in recent times to maintain metabolism,

which is referred to as 'chrono-pharmacology,' 'chrono

-nutrition' and 'chrono-exercise,' respectively (Azmi et

al., 2020). Factors such as shift work, disturbed sleep,

insomnia, that are capable of triggering circadian

rhythm disruption need assessment particularly in

people with metabolic disorders, such as obesity

(Garcez et al., 2021). Plans to schedule workout and

meals according to their normal biological rhythms

can boost treatment efficiency in these patients.

b) Psychological disorders

There is ample literature available that demonstrates

the between mood, light, and circadian rhythms

(Bedrosian and Nelson, 2017; Arns et al., 2021). Light

at night can be considered as one of the most promi-

nent biological and behavioural clock disrupters that

leads to psychological imbalances. Many mood disor-

ders are either characterized by sleep and circadian

rhythm disturbance or by an abnormal light-dark cy-

cle. Seasonal affective disorder (SAD) is a recurring

depressive disorder in which a patient's mood swings

between dysthymia (in winters) and euthymia (in sum-

mers). Other disorders such as Shift Work Disorder,

Severe Depression, Bipolar Disorder, PTS, Common

Anxiety are directly linked with irregular sleep pattern

(APA, 2013). However, the essence of the relation-

ship between circadian rhythm dysfunction and psy-

chopathology is poorly known (Jones and Benca,

2015). However, rodent studies have shown that even

experimentally induced circadian rhythm disorders

can induce changes in healthy animals. If resynchro-

nization of circadian rhythm in patients is targeted,

then symptoms of mood disorders can be improved.

Although circadian disturbances may not be the only

cause of mood diseases, they may cause or intensify

symptoms in people with a tendency of mood-related

disorders.

c) Alcohol, substance abuse and reward

dysfunction

According to the reports, approximately 31% of col-

lege-going students live their life in circumstances

favourable for an individual to get into alcohol abuse,

which is likely to be increased by 6% (Chawla et al.,

2007). The tendency for consuming alcohol and nico-

tine is more in evening-type individuals when com-

pared with morning types.

Eveningness shows its relation with the reward-

related brain dysfunction, which comprises depres-

sion, reduction in reward response and increased

need for sensation seeking (Hasler et al., 2010;

Tonetti et al., 2010) (Fig. 4). Brain areas involved in

the reward processing also show a changed activity,

especially in evening types (Hasler et al., 2012). Ado-

lescents who are comparatively insensitive towards

the reward may develop a tendency to seek reward

through alcohol abuse (Spear, 2000). Two studies

conducted on adolescents report that the larger the

difference between the sleep of weekdays and week-

end, which points towards circadian misalignment,

leads to the increase in risk-taking behaviour (O'Brien

and Mindell, 2005; Pasch et al., 2010). Circadian mis-

alignment generally goes hand in hand with sleep loss

and sleep disturbance, which greatly impacts the in-

creased homeostatic drive which in turn is responsi-

ble for the involvement in reward dysfunction, risk-

taking, alcohol abuse and substance use (Tamura et

al., 2021).

d) Road accidents

Road accidents nowadays have increased in multiple

folds in comparison to the later in a decade. A notice-

able fact is that adolescent drivers have also in-

creased in number. It is seen that the adolescent driv-

ers are more prone to the morning accident in com-

parison to the older ones (Danner and Phillips, 2008;

Czeisler, 2009; Vorona et al., 2011). It is a fact that

sleepiness and tiredness due to incomplete sleep

have a direct link with motor accidents (Garbarino,

2001; Connor et al., 2001, Connor, 2002; Philip et al.,

2002). These accidents are the clear case of function-

al inactivity due to the wake-up schedule which is out

of the circadian phase. Pack et al. (1995) is accredit-

ed for making this on the record and universally ac-

cepted that individuals with sleepiness but without

any known sleep-related disorder could be the reason

for road accidents. Pack's team analyzed the reports

of the crashes in North Carolina in the year 1990 and

1992. The reports revealed the review of those crash-

es in which the driver was thought to have slept while

driving the vehicle. Out of these 55% of crashes

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Verma, P. et al. / J. Appl. & Nat. Sci. 13(1): 327 - 342 (2021)

happed with individuals who were at the age of 25 or

below (Lowden et al., 2009; Akerstedt and Kecklund,

2001). Among teenagers the problem of being drowsy

while driving is a major issue of concern (Pizza et al.,

2010; Taylor and Bramoweth, 2010). According to

some studies done on high school grade students

(having a driving license), where 11% of the total

went into crash while driving automobiles due to

sleepiness as its main cause. Also, 40 % have regis-

tered that they feel sleepy while driving, while two-third

of them were the sufferer of day-time sleepiness and

one-fifth had poor sleep quality (Sagaspe et al., 2007).

These studies are suggestive of the need for the

counter strategy to deal with the problem of road acci-

dents due to sleep deficit in adolescents (Oyegbile,

2020). Setting up school timings according to the bio-

logical clock of adolescents will address the majority

of this problem and rest can be solved by advising the

youth not to drive when drowsy and saying a 'No' to

drink and drive. Planned napping could be another

alternative solution for the same (Smith-Coggins et

al., 2006).

Sleep education is a must

Sleep education is an instrument to deal with the psy-

chosocial and lifestyle factors that can improve the

lives of individuals. Adolescents may take part in be-

haviour that does not encourage them to sleep, alt-

hough the use of good practices in 'sleep hygiene,'

such as regular sleep and a sleep-friendly routine,

may help (Sari and Annisa, 2021). Schools should

provide an atmosphere where teens can get infor-

mation about sleep, just like other valuable infor-

mation about health and hygiene in their classroom.

Sleep education programme focuses on increasing

teenagers' consciousness about the significance of

sleep and enhancing sleep health. Reviews of these

programs' effectiveness indicate that awareness of

sleep hygiene has significantly improved while sleep

behaviour improvement is still limited (Froy, 2012;

Tahara and Shibata, 2013; Oike, 2017).

A suggestive solution

Studies in the field of circadian biology and sleep

medicine influence the education system directly

(Azmi, 2020). There is a need for proper sleep hy-

giene (Sari and Annisa, 2021). The USA addressed

this problem by shifting the schools toward later tim-

ings, where middle and high schools were recom-

mended to begin not before 8.30 a.m. (Brown et al.,

2002). This delaying aimed to minimize insufficient

sleep and social jetlag, thus reducing the mismatch in

adolescents' social and biological clocks. Authorities

and policymakers must be aware of the risks of sleep

debt and they should consider the late school hours

over the early hours to make adolescents, healthy

learners (Kelley and Lee, 2014; Sari and Annisa,

2021). Along with the general approach towards de-

laying school hours, there should be an understand-

ing of the effect of chronotype on an individual's be-

haviour (Karan et al., 2021). This not only will save

the health of students but also will benefit the young

teachers.

Our government is making efforts to create a healthy

environment for school going students (Stolarski et

al., 2021). Later start of school may solve the purpose

to a great extent (Jacob and Rockoff, 2012; Kirby et

al., 2011). Our knowledge of the need for sleep is

enhancing on a daily basis. Still, there is a need for

spreading awareness regarding the importance of

sleep among common people (Chauvette et al., 2012;

Grosmark et al., 2012). In other countries, change

has already started to appear; even the awareness

regarding this is being spread by some agencies like

the National Sleep Foundation and Start School Later

campaign. Shifting school timings to later hours is a

practical approach because misalignment of the sleep

schedule with the school timing, if carried over for a

prolonged period, will result in regularly persistent and

irrefutable sleep-debt. Adolescents already undergo

tremendous developmental changes on the level of

their brain and body, and in addition to it, if they will

not get proper sleep to rejuvenate, then this chronic

sleep debt may hamper their emotional, mental, phys-

iological and metabolic well-being on a serious note

(Hansen et al., 2005; Giedd, 2009; Giedd et al., 2012;

Sawyer et al., 2012; Sørensen et al., 2012; Foster et

al., 2013; Ahmad, 2020). Alignment of the biological

and school clock will help adolescents in improving

their health, along with the better academic perfor-

mance that too in a relatively less stressed atmos-

phere (Ward, 2021). Also, this initiative will not re-

quire any new methodology for teaching-learning or

any kind of expenditure. This will reduce health risk

without using any medication or treatment (Liu et al.,

2021). There is considerable data in support of ado-

lescent population being under the disadvantages of

unsuitable school hours. Keeping the timing of the

schools in sync with the adolescent biological clock is

the call of the hour, which is both practical and essen-

tial. It also reflects that a better environment can be

created for the adolescents, in the light of good trans-

disciplinary research data available on sleep science,

neurobiology and educational research (Gabrieli,

2009; Meltzoff et al., 2009).

Conclusion

Today's teens face obstacles such as completion of

home-work in late-night study schedules, social media

activity, and their own physiology itself pose a limit to

their daily amount of sleep. The impact of social influ-

336

Verma, P. et al. / J. Appl. & Nat. Sci. 13(1): 327 - 342 (2021)

ences is doubtless profound, with an important role in

the proliferation and habitual use of electronic media.

Further study is required to determine the mechanistic

course of effect of the electronic media on sleep.

Chronic sleep debt is a critical health concern be-

cause of the important role of sleep in different as-

pects of our lives. However, it must be remembered

that other sleep and circadian variables are often ex-

plored as potentially influential factors such as sleep

quality, sleep duration, regularity and sleep onset.

Encouragingly, movements to recognize and incorpo-

rate strategies for improvement of sleep for adoles-

cents' well-being have gained traction. The

knowledge about sleep education needs to be spread

to educate the adolescent and youths and empower

them to change jeopardizing behaviour related to

sleep needs.

ACKNOWLEDGEMENTS

This work was supported by the ICMR fellowship

programme under grant (SRF/9/2019/SBHSR;

Fellowship ID 2019-5190). Also, Mr. Ramji Dubey and

Ms. Anupama Yadav are highly acknowledged for their

valuable suggestions.

Conflict of interest

The authors declare that they have no conflict of

interest.

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Circadian Rhythms of the Hypothalamus: From Function to Physiology

Article

Full-text available

Feb 2021

The nearly ubiquitous expression of endogenous 24 h oscillations known as circadian rhythms regulate the timing of physiological functions in the body. These intrinsic rhythms are sensitive to external cues, known as zeitgebers, which entrain the internal biological processes to the daily environmental changes in light, temperature, and food availability. Light directly entrains the master clock, the suprachiasmatic nucleus (SCN) which lies in the hypothalamus of the brain and is responsible for synchronizing internal rhythms. However, recent evidence underscores the importance of other hypothalamic nuclei in regulating several essential rhythmic biological functions. These extra-SCN hypothalamic nuclei also express circadian rhythms, suggesting distinct regions that oscillate either semi-autonomously or independent of SCN innervation. Concurrently, the extra-SCN hypothalamic nuclei are also sensitized to fluctuations in nutrient and hormonal signals. Thus, food intake acts as another powerful entrainer for the hypothalamic oscillators’ mediation of energy homeostasis. Ablation studies and genetic mouse models with perturbed extra-SCN hypothalamic nuclei function reveal their critical downstream involvement in an array of functions including metabolism, thermogenesis, food consumption, thirst, mood and sleep. Large epidemiological studies of individuals whose internal circadian cycle is chronically disrupted reveal that disruption of our internal clock is associated with an increased risk of obesity and several neurological diseases and disorders. In this review, we discuss the profound role of the extra-SCN hypothalamic nuclei in rhythmically regulating and coordinating body wide functions.

Sleep–Wake Timings in Adolescence: Chronotype Development and Associations with Adjustment

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Apr 2021
J YOUTH ADOLESCENCE

Adolescent sleep research has focused heavily on duration and quality with less work examining chronotype, defined as individual differences in sleep–wake timings driven by the circadian rhythm. This study filled a gap in the literature by utilizing actigraphy-based sleep estimates in an accelerated longitudinal design in order to better understand the developmental trajectory and individual stability of chronotype during adolescence, as well as the associations between chronotype with risky behaviors, substance use, and depressive symptoms. A total of 329 adolescents (57% female; 21% Asian American, 31% European American, 41% Latino, 7% other ethnicity) provided actigraphy-based estimates of sleep and completed questionnaires at up to three time points, two years apart, beginning at 14–17 years of age. Multilevel modeling revealed a non-linear developmental trend in chronotype whereby eveningness increased from 14 to 19 years of age followed by a trend toward morningness. Individual differences in chronotype exhibited modest stability during adolescent development. Furthermore, greater evening chronotype was associated with more risky behaviors and substance use among males, and more substance use among older adolescents, whereas depressive symptoms were not associated with chronotype. The findings from this study may have practical implications for adolescent behavioral health interventions targeted at reducing risky behaviors and substance use among youth.

The longitudinal relationship between sleep problems and school burnout in adolescents: A cross-lagged panel analysis

Article

Full-text available

Apr 2021

Introduction Despite the growing body of cross-sectional research linking sleep problems and school burnout, hardly any research has investigated the longitudinal relationship between these two constructs. The aim of this study was to examine the bidirectional association between sleep problems and school burnout in middle school students. Methods A prospective design was used incorporating four time points (approximately 6-month interval). The participants were 1226 (50.3% girls) middle school students from 4 public schools who were in 7th grade at baseline. On average, participants were approximately 12.5 years old at the beginning of the study (Mage = 12.73, SD = 0.68). All participants completed self-report measures in classrooms during regular school hours. The data were analyzed using a cross-lagged structural equation model. We also examined the stability of sleep problems and school burnout in time, and investigated the moderating role of gender. Results The results indicated there is a moderate stability for both sleep problems and school burnout, and those students with sleep problems were more likely to develop school burnout, and vice versa. Gender did not moderate the bidirectional relationship. Conclusions These results suggest that future studies should investigate whether implementing intervention for sleep problems can decrease the occurrence of school burnout and whether interventions targeting school burnout can improve sleep problems.

“Shedding Light on Light”: A Review on the Effects on Mental Health of Exposure to Optical Radiation

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Feb 2021
Int J Environ Res Publ Health

In relation to human health and functioning, light, or more specifically optical radiation, plays many roles, beyond allowing vision. These may be summarized as: regulation of circadian rhythms; consequences of direct exposure to the skin; and more indirect effects on well-being and functioning, also related to lifestyle and contact with natural and urban environments. Impact on mental health is relevant for any of these specifications and supports a clinical use of this knowledge for the treatment of psychiatric conditions, such as depression or anxiety, somatic symptom disorder, and others, with reference to light therapy in particular. The scope of this narrative review is to provide a summary of recent findings and evidence on the regulating functions of light on human beings’ biology, with a specific focus on mental health, its prevention and care.

The Relationship of Sleep Hygiene With Quality of Sleep in Adolescents

Conference Paper

Full-text available

Jan 2021

Review: Identification and Management of Circadian Rhythm Sleep Disorders as a Transdiagnostic Feature in Child and Adolescent Psychiatry

Article

Full-text available

Feb 2021
J AM ACAD CHILD PSY

Objective Sleep disturbances are highly frequent features in a range of child and adolescent psychiatric conditions. However, it is commonly not clear if such sleep problems represent symptomatic features, co-morbidities or risk factors for these conditions. It is believed that underlying dysfunction in the daily biological (circadian) clock may play important roles in the etiology of many sleep disorders, and circadian rhythm changes are also reported in a number of neuropsychiatric conditions. Here we explore the key identifying features of circadian rhythm disorders in child and adolescent psychiatry, and address how such disorders may be managed in the clinic. Method A narrative review of the extant literature of circadian rhythm disorders in children and adolescents with psychiatric conditions. Results We identify key biological and social factors that contribute to circadian rhythm disorders in children and adolescents, as well as outlining the cognitive and neurobehavioral consequences resulting from insufficient sleep. We outline the roles of melatonin and other chronotherapeutic and behavioral interventions for the management of circadian rhythm disorders. Further, we highlight the importance of careful investigation of circadian rhythm abnormalities in shaping the most effective treatment plan according to chronobiological principles. Conclusion Circadian rhythm disorders are common in children and adolescents with psychiatric conditions, and arise out of complex interactions between biological and social factors. Careful clinical attention to, and management of, circadian rhythm disorders in child and adolescent psychiatry has the potential for significant benefit not only in the domain of sleep but also in a range of cognitive, affective and behavioral outcomes.

Exploring the Effects of Problematic Internet Use on Adolescent Sleep: A Systematic Review

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Full-text available

Jan 2021
Int J Environ Res Publ Health

Adolescent suse internet via several devices to gather information or communicate. Sleep, as a key factor of adolescents’ development, contributes to their physical and mental health. Over the past decades insufficient sleep among adolescents has been wide spread, and one of its attributing factors is the increased availability of technology. This review aims to investigate the body of evidence regarding the impact of problematic internet use on adolescent sleep. Extensive search of databases was performed according to PRISMA guidelines for studies published within the last decade, regarding subjects aged 10–19. The final step of the search yielded 12 original studies. The quality of extracted data was evaluated with the AXIS tool, in order to estimate the risk of bias. All studies showed a negative correlation between adolescent sleep and problematic internet use. It was found to affect sleep quality and quantity and provoke insomnia symptoms. Interestingly, adolescent’s sex, parental educational level, type of family and use for leisure or academic reasons appeared as affecting factors of the problematic internet use-sleep relationship. Problematic internet use has several effects on adolescents’ sleep. Results of relevant studies should be embedded in educational interventions addressed to adolescents as well as parents, to eliminate the negative outcomes of problematic internet use on sleep and adolescence’s health in general.

Sleep: A Very Short Introduction

Book

Mar 2012

Sleep: A Very Short Introduction addresses the biological and psychological aspects of sleep. What is sleep? Why do we need it? How much is enough? What is the impact of modern society on sleep? We spend about a third of our lives asleep. References to sleep abound in literature and art, sleep has been recognized as fundamental to the human condition. Over the past century, our knowledge of sleep has developed hugely. The impact of poor sleep on our quality of life is gaining recognition and the prevalence of sleep disorders in the population is increasing as we live ever stressful lives.

Easing stress: Contract grading’s impact on adolescents’ perceptions of workload demands, time constraints, and challenge appraisal in high school English

Article

Apr 2021

Emily Ward

Mastery-based contract grading is a holistic assessment approach for learning and grading in which students choose their desired effort and outcome by contracting for either an A or B to meet high academic standards. This mixed-methods study examined the impact of mastery-based contract grading on secondary students’ (grades 9–12) perceptions of stress and threat appraisal. Participants were 439 adolescents, including 284 returning students and 155 first-year students, completing a high-stakes writing assessment in their required English course. Using an explanatory sequential design, interviews with 40 adolescents from all grade levels and course types explained the findings of matched-pairs quantitative data generated from four psychometrically sound scales. The findings revealed that the contract significantly reduced evaluative threat by clarifying expectations and bolstering confidence. Consequently, compared to their prior experience with or expectations for the task, adolescents perceived workload demands as significantly less stressful and threatening under the contract. The findings of this study make a significant contribution to the field of writing assessment, leading to a call to action for teachers to implement mastery-based contract grading in high school classrooms to create psycho-emotionally healthy learning environments that reduce perceptions of stress and increase challenge appraisal.

The Frustration Social Stressor for Adolescents (FSS‐A):A Newly Adapted Psychosocial Stressor

Article

Jan 2021

The role of stress on adolescents and its impact on development and mental health is of significant psychological concern. Previous research has investigated physiological changes, stressor characteristics, and individual differences in stress responding. Experimental procedures that closely simulate naturally occurring psychosocial stressors have primarily been achievement‐related (e.g., test taking, competitive tasks, psychomotor performance) and anxiety‐provoking tasks (e.g., public speaking, improvisation, invasive medical‐procedures) but few seek to elicit frustration. To address this gap, a new experimental procedure was developed and validated against the Trier Social Stress Test for Teenagers, with a Low Stress Condition as a control. Conflict‐related stressors, such as parent‐ and peer‐related debates, have been found to be effective in provoking frustration in adolescents. The Frustration Social Stressor for Adolescents (FSS‐A), a moderate frustration‐provoking stressor involves a peer debate on a “hot” topic, followed by a serial subtraction task with still‐faced judges. The FSS‐A procedure effectively elicited reliable and valid physiological (cortisol, heart rate) stress responses and was an effective stressor for both sexes. This new, stress protocol mirrors frustrating‐ and anxiety‐provoking stressful situations that adolescents commonly encounter and affords a more detailed study of differential stress response patterns, increased understanding of adolescent stress, and potential for psychoeducational programming, such as directions for education and therapeutic intervention. This article is protected by copyright. All rights reserved.

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