TeenFX.com Interview with Dr. Mary Carskadon

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Dr. Mary Carskadon

What is your title and position/field?

I am the Professor of Psychiatry and Human Behavior at Brown Medical School. I am the Director of Sleep and Chrono-biology research laboratory at EPS Bradley Hospital. I specialize in Sleep Research.

What are some of your major professional accomplishments, for example; positions, publications or awards?

I am the past President of the Sleep Research Society. I served on the National Commission on Sleep Disorders Research. I am an associate editor for the journal of Sleep. I have received a Nathaniel Klietman Award from the American Sleep Disorders Association, and I am the editor-in-chief of the Encyclopedia of Sleep and Dreaming.

What is excessive sleepiness?

Excessive Sleepiness can be explained on a number of levels. The complaint of an individual that they cannot stay awake when they want to be awake; this would be considered the clinical level.

On the experimental or laboratory level sleepiness can be determined by a test called the Multiple Sleep Latency Test. The speed of falling asleep is assessed at standard conditions at intervals across the day. The standard for excessive sleepiness is a range of 6 minutes or less on average to fall asleep. Most patients with disorders of excessive sleepiness are in the range of 2-4 minutes. So basically their head hits the pillow and they fall asleep.

Why is sleepiness of importance to teenagers?

This as well can be explained on a number of levels.

Excessive Sleepiness is associated with changes in personality and mood. So when one is excessively sleepy, he or she is irritable and less happy; sometimes this switches over to a depressed kind of mood.

We think adolescents may be at specific risk for depressed moods that may arise from sleepiness. Then we have the effects that occur on the side of memory and learning. There is now growing evidence that Excessive Sleepiness interferes with memory on a number of levels, even when Excessive Sleepiness is a result of inadequate sleep at night, sort of a life style type of issue. It is also becoming clear that inadequate sleep at night can interfere with certain types of memory consolidations.

The other issue with Excessive Sleepiness is that you are likely to fall asleep when you don’t want to: for example, when sitting in class, while in front on the computer, or worse while driving in a car. The #1 or #2 cause of death amongst teenagers is related to automobile crashes. A North Carolina study of several thousand automobile crashes caused by the driver falling (the police officers were trained to and were able to attribute the cause of the crash to falling asleep and not drugs or alcohol). Found that a bit more than 50% of the crashes had a driver aged 25 or younger. Thus, the people most likely to have fall asleep crashes as a group are these adolescents and young adults.

Can you give a case of a teenager with sleepiness?

One of the most tragic cases involved a car crash of a young man who was a senior in High School.

What makes this case particularly poignant is that he had taken part in a competition for the best driver in the country through his drivers education course and he won the Best Driver in the US.

He drove to visit the college that he would be attending the next year and while driving home from the visit he fell asleep at the wheel and had a head on collision with another car. Both drivers were killed and other driver also happened to be a teen. His good driving did not protect him.

Automobile crashes are the worst outcome side of excessive sleepiness, but you can also see it in the day-to-day things that you are doing. When the computer crashes and they haven’t saved the essay that they have been working on, or when they hit the wrong key on the computer and everything gets erased and they have to start from the beginning and can be up all night.

How much of a problem is sleep deprivation in teens?

The scope of the problem is huge. In all of our studies we are finding that teens are not getting enough sleep.

In the teenage years optimal sleep is 9 1/4 hours a night. We have found only very few teens that were able to get that much. Our last survey of 3000 teens in Rhode Island showed that the average teen on a school night had about 7 1/2 hours of sleep a night.

That’s a nightly sleep deficit of 1 3/4 hours a night. About 25% of that group was sleeping less than 6.5 hours on school nights, and that piles up and the brain remembers and it adds on night after night.

One of the things I find interesting is when we speak to teachers and school administrators and when we actually get back the data from the kids is how many kids cut school or are late for school and the reason they give on our form is that they are too tired to go to school. They make up for the lack of sleep by missing school. Many of these kids are confronted with a very difficult challenge because of the starting times of schools, which are often extremely early in the morning.

Given what we know about the psychosocial dynamics of adolescence, the cultural milleur that these 21st century kids are growing up in, and our understanding of the biology of the sleep system during adolescence, it is unreasonable to expect most kids to be at school at 7AM or 7:30AM and if they have any length of a commute they have to get up at 5:30AM to catch a bus to get to school.

Most kids in our sample where schools are starting at about 8AM they have to get up by 6:30AM. So when you do the math, you see that in order for a teen to get optimal sleep they would have to be going to bed in some cases at 7:30PM. In 21st century United States to expect a teen to be in bed at 7:30PM is just silly. These early school start times put kids in a terrible position.

Can depression cause sleepiness?

It is not clear that depression per se can cause sleepiness.

In some kinds of depression, the changes that occur in the brain do seem to be associated with a need for more sleep. Some depressed adolescents really do seem to need more time to sleep. I think in some cases it is very clear that mood disorders is a result of sleep disorders.

What is Narcolepsy, and how would a teen know if they had Narcolepsy?

Narcolepsy is a major sleep disorder that runs in a small percentage of the population, and it may run in families. It involves excessive sleepiness, so feeling sleepy all the time.

Adult patients with Narcolepsy may fall asleep in 2-3 minutes all day long on the Multiple Sleep Latency Test, regardless of when they go to bed. They also may have a reverse transition into sleep; so where-as normally we fall asleep and go from wakefulness to non- REM sleep to REM sleep, patients with Narcolepsy reverse that and go directly from wakefulness to REM sleep. REM sleep is just a gorgeous kind of sleep, but it is associated with some interesting things that seem to break loose and characterize some symptoms in patients with Narcolepsy.

One of the things that happens normally to all of us every night when we go into REM sleep is that our muscles become paralyzed. Now that is great in REM sleep because our brain is dreaming then, so if the brain is dreaming that we are jumping off a diving board, we can lay in bed and have the dream safely because our muscles are paralyzed. If you take those two parts of REM sleep (muscle paralysis and dreaming) and break the boundaries, you get what we see in patients with Narcolepsy. One of those things is Cataplexy.

Cataplexy is when the motor paralysis or weakness that’s normal in REM sleep happens when the patients are awake. It is also interesting because cataplexy is often associated with very strong emotions. So if the patient was awake and actually jumping off the diving board and got excited about it they could actually experience that paralysis when they were awake it could be quite hazardous. Usually cataplexy is not a total paralysis, it is a weakness in the arms or neck.

Cataplexy is less characteristic of Narcolepsy in teens. Some of the other features are more characteristics of the early on set of Narcolepsy, and one of those is called Hypnagognic Hallucinations and that is when you lay down to fall asleep in your room and you see things that are not there. We think that is the dreaming state of sleeping occurring when you are awake.

For those of us who do not have Narcolepsy that barricade of non-REM sleep at the beginning of sleep protects us from this other world our brain creates when we are in dreaming sleep; but for patients who go right into REM sleep from being awake, they don’t have that protection and so this “weird” REM sleep stuff emerges when they are still conscious. Often times it is very scary: you think you hear someone walking up the stairs of the house and you see the shadows coming towards you. It’s particularly frightening because your muscles are paralyzed at the same. You can’t seem to break yourself out of the hallucination.

Kids who experience funny things like that or when they wake up in the morning and feel like they can’t move that is called sleep paralysis, and if this kind of stuff runs in their family then they should be tested for Narcolepsy. But at the same time kids who are getting too little sleep, may be abusing their sleep systems to the extent that these symptoms might occur even though they don’t have a sleep disorder. The first step is to try to get more sleep.

What tests are available for the diagnosis of sleepiness?

Sure sleep disorder centers do this all the time and one of the most common tests is the Multiple Sleep Latency Test.

This test is great particularly for sleepiness or Narcolepsy or the ruling out of Narcolepsy. You do it four or five times across a day and if the person falls directly into REM sleep then it’s probably Narcolepsy. If the person falls asleep really fast but not directly into REM sleep, then it probably isn’t Narcolepsy but another cause of excessive sleepiness.

There is another test lots of sleep clinics use that is opposite of the Multiple Sleep Latency Test. The Multiple Sleep Latency Test tests how fast someone falls asleep; the other test is called Maintenance of Wakefulness Test. You put someone in a dark room and see how long they can stay awake. People who cannot stay awake for more than 4-5 minutes when they are asked to stay awake may be even more scary, because that means the body really doesn’t have any buffers against falling asleep at all.

What type of treatment is available for sleepiness?

There are lots of treatments; it depends on what the disorder is.

In the teenagers the biggest problems tend to be lifestyles and in that case the best solution tends to be a change in lifestyle and making getting enough sleep a priority. For Narcolepsy the treatment is usually chemicals or drugs. It all depends on the patient.

Post a Comment
	Corinne	03-15-06

I suffer from sleeplessness which seems to relate to my anxiety. When I'm more on the up and up, then I can sleep better. When I'm freakin' out, I can't sleep. I do take medication for it and it seems to , but I still feel I don't get enough sleep thanx to school. I was also shocked to learn that falling asleep at the wheel is more commonly the reason for crashes than drugs or alcohol in teens.


	Brittany	03-18-05

I don't ever sleep, but only becuz of my ADHD medicine.


	~~~Emma*~~*~	02-13-05

I always hear that I need atleast 9 hours of sleep. That's great to know but my question is; how do I get 9 hours of sleep?


	courtney	06-22-04

i really enjoyed this article. man if were supposed to have 9 1/4 hrs of sleep a day i miss like 4 hrs but the thing is im never tired!


	Gracie	06-13-04

I really enjoyed this article. It taught me a lot. Thanks Teenfx!


	Jace	10-17-03

I have just entered the contest too. Sleep is a very fascinating subject and I now have a better understanding of its importnace. Thanx!!


	Tessa	08-04-03

I am here to get the answers to the TeenFX Contest, 'WAKE-UP TEENS in America'. I also hope to win!!!


	Amy	02-20-03

Great interview. Thanks TeenFX.


	tracy	01-30-03

I found it interesting how someone could fall directly into REM sleep. I was surprised that there are so many car crashes yearly due to teenagers falling asleep at the wheel. -ben


	tracy	01-28-03

I know a person that was killed because they fell asleep behind the wheel of a car while driving home. Could this have been related to this? I wonder......


	Andrew	11-09-02

A lot of teens have sleep problems, but I think we all have sleep deprivation in common. I found your information really interesting.


	Nicole	07-24-02

Is there anything a teenager or anyone can do to prevent excessive sleepiness?


	Joey	07-10-02

I have heard of accidents like that, where the driver has fallen asleep at the wheel. It's sad to read stories like that, especially when the person is so young and has their whole life ahead of them.


	Summer	07-03-02

I have heard that about driving. You shouldn't drive such long hours without takin a rest.


	Kelly	06-14-02

Some times i feel like I suffer from excessive sleepiness as I'm sure most people do. But i never thought about it causeing me to get into a car crash. I'll be more carefull from now on and either try not to drive when i'm tired or pay more attention on being aleart!!


	Joey	06-13-02

I've always wanted to know: Why do some people wake at a dime while others can sleep through just about anything.


	James	02-13-02

i have a question...(dont know that it'll be answered, but here goes) i have trouble falling asleep. i'm tired during the day, but it usually takes me a half hour at the least to fall asleep. it's been like this as far back as i can remember thinking about this. do you, by any chance, have any insight into this? oh, and btw, i may sound like a crackpot, but i swear i get little instances of esp - i'll dream something, and then one day i do it and it hits me 'whoa...i dreamt this'. it usually is only a few second that i see myself dreaming about in advance. is this a mind trick or is there any substantiual evidence suggesting that this might be real 'paranormal' activity?


	Cynthia	02-03-02

Wow, that Articles was great I have real problems with sleepiness and it makes pretty good sense to me!


	Misty	02-01-02

This article was very interesting and full or information. I enjoyed it very much and I hope to see more article like this (I know I will)!


	marly	01-29-02

I really appreciated this article. I enjoyed this text


	Markia	12-13-01

This article would help a lot of teens who are unaware of it. It was indeed a very helpful and interesting article.


	kiska	10-14-01

ohh thats awesome just by reading it it made me sleepy. . . at least now i know aBOUT IT


	Markia	09-05-01

thanx, this was very informative. It's nice to read these kinds of interviews. Not that I want TeenFX to stop getting music people, but I like the mix.


	Mariah	08-14-01

Thank-you sooooooo much 4 the info! You r very good at what u do =0)


	TIM	08-02-01

Most teenagers died is cars because they fall asleep!!! what!! How come I have never heard on this before and why do the school drill into out heads about damn drinking when thats not really wear its at. Why don't you write to the schools and tell them to teach us about not falling alseep at the wheel. Then they would lay-off all this drinking stuff.


	Beth	08-01-01

This was very helpful because I do have some sleeping problems and now I know that I can get help!


	jake	07-17-01

I learnt a lot :)


	Erin	07-02-01

Yaaaaaawwwwwwwwww ZzzzzzZzZzzzzzz


	eigenvalues	06-28-01

Dear Dr Carksadon, Do you have any theory's concerning the role of sleep and subconscious thoughtpatterns in relation to situations where people which undergo meditation experience supernatural phenomena.


	Krystal	06-27-01

That is very interesting. I would have thought that the major cause of accidents were drugs or alcohol.


	jake	06-26-01

This has helped answer a lot of questions. thankyou.