Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health

Abstract

Sleep changes significantly throughout the human lifespan. Physiological modifications in sleep regulation, in common with many mammals (especially in the circadian rhythms), predispose adolescents to sleep loss until early adulthood. Adolescents are one-sixth of all human beings and are at high risk for mental diseases (particularly mood disorders) and self-injury. This has been attributed to the incredible number of changes occurring in a limited time window that encompasses rapid biological and psychosocial modifications, which predispose teens to at-risk behaviors. Adolescents' sleep patterns have been investigated as a biunivocal cause for potential damaging conditions, in which insufficient sleep may be both a cause and a consequence of mental health problems. The recent COVID-19 pandemic in particular has made a detrimental contribution to many adolescents' mental health and sleep quality. In this review, we aim to summarize the knowledge in the field and to explore implications for adolescents' (and future adults') mental and physical health, as well as to outline potential strategies of prevention.

Keywords: COVID-19; adolescence; circadian rhythms; insomnia; mental health; mood disorders; psychiatric disorders; sleep.

Figure 1

Neurobiological modifications in adolescents, circadian rhythm changes and mechanisms of development of psychiatric disorders. Legend. The adolescent brain faces many changes during a short period related to neurobiological modifications combined with psychosocial and environmental factors. Deep brain areas such as the limbic and reward system areas (ventral striatum and amygdala) increase their neural activity (top on the left). This temporary hyperfunction of dopaminergic circuits can lead to emotional dysregulation (center on the left), augmenting the risk of developing psychological malaise and psychiatric disorders (bottom on the right) [12]. Moreover, circadian rhythm modifications with delayed melatonin secretion (top center) occur during adolescence. These changes, together with environmental and psychosocial factors (increased social interaction and use of technology at nighttime) (top on the right), may result in sleep disturbances (sleep deprivation, circadian rhythm disorders, insomnia) (middle on the right) [13,14]. Of note, sleep loss may decrease functional connectivity between the top-down control regions of the prefrontal cortex and the amygdala [1]. Sleep disorders can drive/worsen emotional dysregulation, which in turn may contribute to the onset and/or maintenance of sleep disturbances. Moreover, sleep disorders may increase the risk of psychological problems and psychiatric disorders, which in turn may induce and/or maintain sleep disturbances [15,16,17].