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ILLINOIS SCHOOL BOARD JOURNAL


September/October 2017

Sleep science sets the snooze
By Theresa Kelly Gegen

Theresa Kelly Gegen is editor of The Illinois School Board Journal

In 2014, the American Academy of Pediatrics released a policy statement based on studies of adolescent sleep requirements, which alarmed parents, awakened a discussion in school districts, and created a rousing chorus of “I told-you-so” from current and former teenagers.

Starting with studies that show that the average adolescent is “chronically sleep-deprived,” and that 87 percent of high school students did not get the recommended 8-10 hours of sleep at night, the AAP examined factors that could relieve “pathological sleepiness.”

In its policy, the AAP concluded that “adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores, and an overall better quality of life.”

So, they should just go to bed earlier, right? Wrong.

Sleep science has determined what almost any teen can tell you: Early bedtimes are not practicable in the adolescent and teenage world.

Two factors determine when people are likely to sleep: Sleep-wake balance (how long it has been since you last slept) and your internal body clock, which determines the circadian rhythm that makes an individual feel wakeful or sleepy at the same time each day.

Circadian rhythms are biological processes that naturally occur in a 24-hour cycle. They affect body temperature and daily hormonal changes, but are best known for how they impact an individual’s patterns of sleep and wakefulness. Circadian rhythms underlie human sleep habits, from an infant’s developing sleep patterns to an adult’s jet lag.

 Most teens experience a “sleep phase delay” as they go through puberty. This is a natural shift in circadian rhythms by two hours — it’s not that they won’t fall asleep at 8 or 9 p.m. — they can’t. These natural sleep cycles of teens, combined with homework, extracurricular activities, after-school jobs, modern technology — not to mention their social lives — make early bedtimes an impracticable solution. The AAP also said, “Napping, extending sleep on weekends, and caffeine consumption can temporarily counteract sleepiness, but they do not restore optimal alertness and are not a substitute for regular, sufficient sleep.”

In addition to physical and mental impacts, the list of academic impacts of chronic sleep loss on children and teens includes impairments in executive function, attention, and memory; deficits in abstract thinking and verbal creativity; and ultimately lower academic achievement, poor school attendance, and increased dropout rates.

After examining the impacts, the conversation drifted towards “identifying potentially modifiable factors,” which led to the later school start times. The AAP’s recommendation:

“… A substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep …”

Sleep science and application to school start times are not a recent development, and most studies acknowledge teen and adolescent habits are partially responsible for performance-hindering lack of sleep. A 1998 study, “Sleep Schedules and Daytime Functioning in Adolescents” by Amy R. Wolfson and Mary A. Carskadon, noted that a child’s sleep needs do not change from childhood to adolescence, but the timing of natural sleep rhythms do change. Adding “environmental constraints,” specifically early school start times, the result is that “for most teens waking up to go to school is neither spontaneous nor negotiable.”

In 1999, U.S. Representative Zoe Lofgren (D- Calif.), began an effort that continues today, to encourage school districts to consider sleep needs when determining morning start times. Known as “ ZZZs to As,” the effort encourages school districts to move school start times to no earlier than 8:30 a.m., to improve academic outcomes. Lofgren worked with the National Sleep Foundation, which stated in a 2000 report on adolescent sleep that “Scientists hypothesize that … sleep-related problems are due largely to conflicts between physiologically-driven sleep needs and patterns, and behavioral and psychosocial factors that influence sleep habits.”

A 2002 Maryland-based study recognized the problem of diminished sleep time but declared that because of “significant costs and impact other activities of families and communities,” later school start times were not warranted without further study. A 2004 article entitled “Sleep Wars: Research and Opinion” burrowed into the public policy discussion. More studies followed, covering circadian rhythms, perceptions of healthy sleep, and the causes and consequences of sleepiness in teens. This led to 2014, when the AAP’s report reawakened the discussion and brought sleep and school start times into mainstream discussion.

Since then, school districts across the country have examined school start times in light of sleep science. And sleep science — such as UCLA’s Sleep Disorders Center patient education page — offers advice on creating better sleep for kids, no matter what time the bell rings:

  • Parents should create a calm atmosphere in the home at bedtime.
  • Teens should have a regular, relaxing routine just before bedtime. They often have busy, hectic schedules. They need a chance to unwind at night.
  • To help them relax, teens should avoid activities that will excite their senses late in the evening. They should find another time for computer games, action movies, intense reading, or heavy studying.
  • They should not have anything with caffeine (including soda and chocolate) after 4 p.m.
  • They should also avoid smoking and drinking. Along with hurting their health, nicotine and alcohol will disturb their sleep.
  • A regular exercise routine and a healthy diet will help them sleep better at night.
  • Keep the lights dim in the evening. Open the curtains or blinds to let in bright light in the morning. This helps keep their body clocks set at the right time.
  • If they must take a nap, they should keep it to under an hour.
  • It can be hard for teens to get enough sleep during the week. They may need to wake up later on weekends. But they should not wake up more than two hours later than the time when they normally rise on a weekday. Sleeping in longer than that will severely disrupt a teen’s body clock. This will make it even harder to wake up on time when Monday morning arrives.

Finally, it should be noted that most of the research is assessing start times as early as 7 a.m. (and/or transportation times making for still earlier mornings). The AAP recommends changes for middle school and high school start times to “no earlier than 8:30 a.m.”

Resources:
Policy Statement: School Start Times for Adolescents, Judith A. Owens, MD, MPH, FAAP, et al. The American Association of Pediatrics, Adolescent Sleep Working Group and Committee on Adolescence, and Council on School Health, August 2014.

Schedules and Daytime Functioning in Adolescents, Amy R. Wolfson and Mary A. Carskadon. Child Development, August 1998.

Association of Sleep and Academic Performance, by Arne Eliasson, Anders Eliasson, Joseph King, Ben Gould, and Arn Eliasson, Association of Sleep and Academic Performance, Thieme Medical Publishers, January 2002.

Sleep wars: research and opinion. Susan Riter and Laurel Wills, Pediatric Clinics of North America, 2004.

Adolescent Sleep Needs and Patterns, research report and resources guide, The National Sleep Foundation, Sleep and Teens Task Force, 2000.

Sleep and Teens. UCLA Sleep Disorders Center , Health Patient Education.

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