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Sunday, November 6, 2016

Changing of the Clock is a Good Time to Discuss Sleep Health with Your Kids

 Your Child is Not Health if Their Sleep is Not Healthy

Good sleep promotes good health. Sleep represents a third of every person’s life and it has a tremendous impact on how we live, function and perform during the other two-thirds of our lives. It is indeed as vital as the air we breathe and the food we eat, especially for those with chronic diseases or compromised immune systems. While sleep health is always important, it might not be any more important during our development than during our childhood and teen years.

Key among the many changes in brain function that occur during adolescence is a significant shift in sleep patterns. From a biological perspective, at about the time of the onset of puberty, teens begin to experience a sleep-wake phase delay (later sleep onset and wake times), as a result of well- documented changes in circadian rhythms[i]. This is shown as a natural shift in the fall-asleep time to about two-hours later relative to middle childhood. At the same time, teen sleep needs do not decline significantly from pre-teen levels, and optimal sleep amounts remain in the range of 8 to 10 hours per night. On a practical level, this means that the average teen cannot fall asleep before 11 pm and has significant difficulty in waking before 8 am[ii].

Many studies, professional medical association policy statements and federal reports have documented that the average adolescent in the United States is chronically sleep deprived and pathologically sleepy. As a result, many high school students are at risk for adverse consequences of insufficient sleep including impairments in mood, affect regulation, attention, memory, behavior control, executive function, and impulse control. In particular, many studies have shown an association between decreased sleep duration and lower academic achievement at the middle school, high school and college levels, as well as higher rates of absenteeism and tardiness, and decreased motivation to learn[iii] [iv]. Other documented specific health-related effects of sleep loss in adolescents include increased use of stimulants (e.g., caffeine, prescription medications) to counter the effects of chronic sleepiness, which in turn may increase the risk of substance use later in adolescence and emerging adulthood[v]. Adolescents are also at greater risk for fatigue-related crashes, as well as athletic and other injuries, due to insufficient sleep[vi]. Chronic sleep loss increases subsequent risk of both cardiovascular disease and type 2 diabetes[vii]. An association between short sleep duration and obesity in children and adolescents has been demonstrated in numerous studies, underscoring how chronic sleep loss can undermine the health of our nation’s young people[viii]. While a number of factors, including biological changes in sleep, lifestyle choices, athletic, extra-curricular, and academic demands impact sleep in students, the evidence strongly supports early school start times (i.e., before 8:00 am) as a key factor in contributing to sleep loss in middle and high school students[ix] [x] [xi] [xii] [xiii].

Furthermore, a substantial body of research now demonstrates that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits for students in regards to physical and mental health, safety, academic achievement, and athletic performance. Studies comparing high schools with start times as little as 30 minutes earlier to those with later start times demonstrate adverse consequences such as shorter sleep duration, increased sleepiness, difficulty concentrating, behavior problems, depression, and more school absences[xiv] [xv] [xvi]. Additionally, a substantial body of literature has confirmed that delaying high school start times results in increased sleep, decreased tardiness rates and absenteeism, improved performance on standardized tests, reduced self-reported depression, and fewer automobile collisions[xvii] [xviii]. The sleep health of adolescents has been recognized as an important issue by the U.S. Department of Health and Human Services with the inclusion of a specific objective regarding improving the duration of teen sleep in Healthy People 2020; the nation’s health agenda[xix].

Parents, school staff and community leaders should promote sleep health along with exercise and nutrition as the fundamental building blocks of child development and a healthy lifestyle for all young people.

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[ii] Carskadon MA, Harvey K, Duke P, Anders TF, Litt IF, Dement WC. Pubertal changes in daytime sleepiness. Sleep 1980;2:453-60
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[x] Carrell, S.E., Maghakian, T., and West, J.E. "A's from Zzzz's? The Causal Effect of School Start Time on the Academic Achievement of Adolescents." American Economic Journal: Economic Policy. 2011;3:6281.
[xi] Hinrichs, P. When the Bell Tolls: The Effects of School Starting Times on Academic Achievement. Education Finance and Policy.2011;6:122.
[xii] Spaulding, N., Butler, E., Daigle, A., Dandrow, C., &Wolfson, A. R. Sleep habits and daytime sleepiness in students attending early versus late starting elementary schools. Sleep. 2005; Suppl.28:C228, A78.
[xiii] Epstein R, Chillag N, Lavie P. Starting times of school: effects on daytime functioning of fifth-grade children in Israel. Sleep. 1998;21(3):250-6.
[xiv] Wahlstrom, K. Changing Times: Findings from the First Longitudinal Study of Later High School Start Times. NASSP Bulletin. 2002;286:3-21.
[xv] Htwe, ZW, D. Cuzzone, MB O'Malley, and EB O'Malley, Sleep Patterns of High School Students Before and After Delayed School Start Time, Journal of Sleep and Sleep Disorders Research. Abstract Suppl.2008;31: A74-5.
[xvi] Owens JA, Belon K, Moss P. Impact of delaying school start time on adolescent sleep, mood, and behavior. Arch PediatrAdolesc Med. 2010 Jul;164:608-14.
[xvii] Danner F, Phillips B. Adolescent sleep, school start times, and teen motor vehicle crashes. J Clin Sleep Med. 2008;4:533-5.
[xviii] Vorona RD, Szklo-Coxe M, Wu A, Dubik M, Zhao Y, Ware JC. Dissimilar teen crash rates in two neighboring southeastern Virginia cities with different high school start times. J Clin Sleep Med. 2011;7:145-51.

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