Stacy Simera MSSA LISWS SAP ssimeraaolcom The Crux of the Issue Various health groups have recommended later middle and high school start times Why the focus on those age groups Adolescent melatonin secretion stops 0900 ID: 648580
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Slide1
School Start Times:
Implications and Solutions
Stacy
Simera
, MSSA, LISW-S, SAP
ssimera@aol.comSlide2
The Crux of the Issue
Various health groups have recommended later middle and high school start times.
Why the focus on those age groups?Slide3
Adolescent melatonin secretion stops 09:00
22:30 Adolescent melatonin
secretion starts
Research reveals that puberty creates a temporary change in circadian rhythm: Slide4
In addition to later secretion of melatonin, adolescents also experience an extended sleep drive.
These pubertal changes occur in adolescents around the world and are physiological, not social or habitual.
Teens obtain their healthiest sleep from approximately 11 p.m. to approximately 8 or 9 a.m.
Early wake times directly disrupt and reduce teen sleep.Slide5
Impacts of chronic sleep loss:
A brief literature review…Slide6
Sleep and Mental Health
Johnson,
Chilcoat
, and Breslau, 2000:
Increased risk of future depression and anxiety among children with deficient sleep Slide7
Over 60 studies have found correlations between chronic insufficient sleep and suicide.
“Unlike other suicide risk factors, sleep complaints
may be particularly amenable to treatment.” (pg 1)
Bernert
and Joiner, Sleep disturbances and suicide risk:
A review of the literature. 2007.
Sleep and
SuicideSlide8
Sleep and Multiple Sclerosis
Hedström
et al, 2011:1343 incident cases of MS vs. 2900 controls 5129 prevalent cases of MS vs. 4509 controls
Working night shift before age 20 doubled the risk of multiple sclerosisSlide9
Sleep and Sports Injuries
Dr. Matthew
Milewski
, 2012, AAP Annual Conference
Published 2014
68% fewer sports injuries among teens
with more than 8 hrs of sleep
compared to their peers with lessSlide10
Auto Accidents: Minnesota
In 2005 the Mahtomedi School District moved start times from 7:30 am to 8:00 am.
During that school year, auto accidents among 16-18year olds in the district decreased by 65%
(
Wahlstrom
et al, 2014 – UMN CAREI Studies
)Slide11
Auto Accidents: Wyoming
In 2012 the Jackson Hole School District moved start times from 7:35 am to 8:55 am.
During that school year, auto accidents among 16-18year olds in the district decreased by 70%
(
Wahlstrom
et al, 2014 – UMN CAREI Studies
)Slide12
Sleep and Illnesses
(N=56 teens)
Two main findings:
Acute illnesses were more frequent in otherwise healthy adolescents with shorter sleep
Illness events were associated with less sleep during the previous week than comparable matched periods without illness
(
Orzech
et al, 2013)Slide13
Sleep and Dietary Choices
13,284 teens surveyed. Teens who slept less than 7 hours per night (compared to teens who slept more) were:
More likely to consume fast food two or more times per week
Less likely to consume fruits and vegetables
Despite race, gender, SES, physical activity and family structure
“…we need to start thinking about how to
more actively incorporate sleep hygiene education into
obesity prevention and health promotion interventions.” -Lead researcher Dr. Lauren Hale, Stony Brook Medicine Press Release, June 20, 2013Slide14
Sleep and Insulin Resistance
Matthews et al, 2012:
245 healthy white and black adolescents:
Elevated insulin resistance [HOMA-IR] associated with shorter sleep duration
Findings were independent of age, race, gender and adiposity [amount of body fat]
“…interventions designed to extend sleep in short sleepers may be beneficial for metabolic health in adolescence and beyond.”
(pg 1357)Slide15
Sleep and Risk-Taking Behavior
O’Brien and
Mindell
, 2005:
Adolescents with less than 8.5 hrs sleep per night engaged in more
violence
unsafe behaviors
drug use
sexual activitiesKahn et al, 2006 – similar results: “[Our] findings suggest that sleep deprivation significantly weakens the inhibition of aggression… through reduced metabolic activity in prefrontal regions of the brain
….” (pg 214)Slide16
Sleep and Weapons
(Analysis of 2009 YRBS data, N=14,782)
High school boys with less than 8 hrs sleep on school nights were more likely to carry a weapon on school property
(
Hildenbrand
et al, 2013
)
“Our findings suggest that sleep education interventions may serve as a viable avenue for enhancing school violence prevention efforts.”
(pg 413)Slide17
Sleep and School Victimization
(Analysis of 2009 YRBS data, N=14,782)
High school students with less than 8 hours of sleep were more likely to:
Miss school because they felt unsafe at school or on their way to or from school
Have been threatened or injured with a weapon on school property
Be bullied on school property
(
Hildenbrand et al, 2013)Slide18
Sleep and Pedestrian Safety
Study by Davis et al (2013) of 14 and 15 yr olds:
50% increase in ‘hits’ or ‘close calls’ in virtual reality cross-walks when sleep-restricted (4hrs)
Researchers’ Recommendations:
1. Explore policies regarding school start times
2. Better sleep hygiene education
3. Better parent educationSlide19
Sleep and GPA
Increase in GPA in core courses in 5 of 6 high schools studied after changing start times:
School
Start
Time C
hange
Mahtomedi, MN
7:30am → 8:00am
South Washington, MN
7:35am → 8:35am
Boulder, CO 7:30am → 8:00 am (9am on Wed)
Fairview, CO 7:35am → 8:05am
Jackson Hole, WY
7:35am → 8:55am
St. Louis, MN *
(*results not statistically
significant)
7:50am → to 8:20am
(
Wahlstrom
et al, 2014 – UMN CAREI Studies)Slide20
Sleep and Grades
Study of 6,165 US Air Force Academy cadets over 4 years. (
Carrell et al, 2011
)
Cadets with 7:50 am classes courses performed better in all their courses for that day compared to cadets with 7:00 am classes
50 minute later start improved teacher quality by one standard deviation
“…later start times may be a cost-effective way to improve student outcomes for adolescents”
(pg 80) (Lead author Scott
Carrell: UC Davis Department of Economics) Slide21
Sleep and Disparities:
‘Insufficient Sleep and the Socioeconomic Status Achievement Gap’ –
Buckhalt
, 2011:
“Insufficient sleep in children from low SES negatively affects them to greater degree than it does more advantaged children…
…This view is consistent with the idea that when multiple health disparities associated with low SES are present, any single additional stressor has a greater effect.”
(pg 63)Slide22
Sleep and Disparities:
Hamilton Project Report: ‘Organizing Schools to Improve Student Achievement’
– Jacob and
Rockoff
, 2011:
“The earliest school start times are associated with annual reductions in student performance…
equivalent to replacing an
average teacher with a teacher at the sixteenth percentile
in terms of effectiveness.” Slide23
Sleep and Emotional Intelligence(Kilgore et al 2008, study of baseline and post-sleep deprivation testing)
Total sleep deprivation resulted in:
Lower emotional intelligence
Poorer constructive thinking
Poorer stress management
Reduced empathy
More reliance on superstition and ‘magical thinking’Slide24Slide25
Research database available via www.StartSchoolLater.netSlide26
Adolescent Sleep Needs
14 13 12 11 10 9 8 7 6
8.5 – 9.5 hours (more for athletes)
(Source:
2007 – 2013 YRBS
)
The average adolescent sleeps
6.75 hrs on school nights
Less than 10% of high
schoolers
get 9 or more hours of sleep per nightSlide27
Percentage of high school students who obtain
9 or more hours of sleep on school nights:
(Source:
2007 – 2013 YRBS
)Slide28
Students
who obtain more than
8 hours of sleep
on an average school night – by grade.
(Note: adolescents require around 9 hrs of sleep.)
(
Source: 2015 YRBS
)
9th grade
34.4%10th grade
28.4%11th
grade22.9%12th
grade
22.4%Slide29
Adolescents are the most sleep-deprived age group in the United StatesSlide30
Primary Culprits in Teen Sleep Loss
#1: Early Wake Times
#2: Evening Stimulation
#3: Lack of AwarenessSlide31
#1: Early Wake Times
The Problem:
Early wake times are the primary culprit in teen loss due to the later shift in sleep cycle during puberty. Waking at teen at 5am disrupts the sleep cycle and is biochemically similar to waking an adult at 2am.
The Solution:
Follow CDC and other health group recommendations and start middle and high schools after 8:30am.Slide32
The first health group to speak on the issue was the Minnesota Medical Association in 1993, when they passed a resolution to educate the public on:
the biological shift to a later sleep pattern in adolescence
the impact of inadequate sleep on driving safety and school performance
the recommendation for schools to eliminate early starting times for adolescents
(Minnesota Medical Association, mnmed.org)Slide33
In 2000 the National Sleep Foundation released a publication on adolescent sleep that highlighted the benefits of later school start timesSlide34
In 2011 the National Education Association passed a resolution supporting ‘school schedules the follow research-based recommendations regarding the sleep patterns of age groups’Slide35
In September of 2011 the Brookings Institution released a Hamilton Project policy brief, written by economists, recommending later middle and high school start times due to the economic benefitsSlide36
In the spring of 2014 the Education Commission of the States released this policy brief recommending later school start times for adolescents. The ECS is a non-partisan think-tank created by the states.
They conclude:
“Few, if any, educational interventions are so strongly supported by research evidence from so many different disciplines and experts in the field.”
(pg 3) Slide37
In August of 2014 the American Academy of Pediatrics released their landmark position statement calling for middle and high schools after 8:30amSlide38
In March of 2015 the National Association of School Nurses and the Society of Pediatric Nurses released a joint consensus statement supporting the AAP recommendations of school start times after 8:30am for adolescentsSlide39
In June of 2015 the American Thoracic Society released a statement citing health concerns of insufficient sleep and recommending schools align their schedules with adolescent circadian propensity. Slide40
In August of 2015 the Centers for Disease Control released statistics on school start times and recommended middle and high schools start after 8:30amSlide41
In June of 2016 the American Medical Association adopted a position endorsing school start times no earlier than 8:30 a.m. for middle and high schools.Slide42
“Individual teens and families can set healthier bedtimes. But if you want to change hundreds or thousands of lives quickly, consider alleviating the pressure from early school start times.”
- Dr. Dean Beebe
P.hD
., ABPP
Professor of Pediatrics
Cincinnati Children’s Hospital Medical Center
University of Cincinnati College of MedicineSlide43
More position statements can be found at
Start School
Later’s
website:
www.startschoollater.net/position-statementsSlide44
#2: Evening Stimulation
The Problem:
Adolescents are naturally wired to become sleepy around 10 or 11pm. Evening stimulation such as blue light exposure from mobile devices, caffeine within 6 hours of bedtime, nicotine, and late exercise can delay sleep onset even later.
The Solutions:
Educate parents and students on healthy sleep hygiene.
Limit late night sports practices and events. Slide45
#3: Lack of Awareness
The Problem:
Most professionals and the public are not aware of the immediate and long-term implications of sleep loss. Many people are aware teens don’t get enough sleep, but they assume the only impact is temporary fatigue.
The Solution:
Share the research on the impacts of chronic sleep loss on health, mental health, safety, and learningSlide46
“Ignorance is the worst sleep disorder
of them all.”
- Dr. William Dement
Stanford University
The Promise of SleepSlide47
In August of 2013 physicians with the Centers for Disease Control called for better awareness of sleep as a public health issue:
https://www.cdc.gov/pcd/issues/2013/13_0081.htmSlide48
In 1997…
Minneapolis Public School District’s 7 high schools changed from:
7:15 am - 1:45 pm school days
to
8:40 am - 3:20 pm school days
(Affecting 18,000 students)Slide49
In a study 4 years later:
“
Contrary to the fears and expectations that a later start would result in students staying awake an hour later on school nights…
Minneapolis high school students get
five more hours of sleep per week
than their peers
[with early school start times].”
(Wahlstrom, 2003)Slide50
Benefits of Later Start Times
In Minneapolis (statistically measured):
Increased total sleep
Increased attendance
Reduced tardiness
Increased enrollment
Slight improvement in grades (“difficult to measure”)
(Wahlstrom, 2003)Slide51
Benefits of Later Start Times
Anecdotal and Survey Reports from Minneapolis:
According to the faculty and staff:
Less students falling asleep in class
Students more alert during first two periods
Improved student behavior
Quieter hallways
According to the students:
Learning was ‘easier’ (Wahlstrom, 2003)Slide52
Rhode Island Comparison:
Late Starting (8:37 am) benefits compared to Early Starting (7:25 am) Middle Schools:
Increased total sleep times
Less daytime sleepinessImproved grades among females in 7
th
grade
(no statistical difference among males)
Improved grades among both genders in 8th grade (Wolfson et al, 2007)Slide53
Wilton, Connecticut
Changed start times in 2003
A local sleep disorders center survey, one year later, showed that Wilton high-school students were obtaining an hour more sleep per night.
“Six years later, no one is even looking back… Our students are happier, performing at the highest levels academically, and our sports teams continue to be the among the best in the state.”
(CT LWV, 2009 Statement)Slide54
What about sports? Slide55
In Wilton, Connecticut
‘a self-described sports town’:
After changes in school start times in 2003:
Participation in high school athletic programs ‘continued to rise’
Upper elementary extracurricular involvement increased
Other schools in the conference accommodated late arrivals to events – with some of those schools ‘looking at making the change themselves’
(CT LWV, 2009 Statement)Slide56
St. George’s School, RI
“We have found it (switching to 8:30 start) one of the best things our school has ever done. The impact on athletics is minimal. Coaches have given up 5 minutes per day of practice time, willingly…”
John R. Mackay
Director of Athletics
Head Football Coach
(2/8/2011 email)
St George’s School maintains 48 teams in 22 sports.
Students are required to play at least 2 sports per season.Slide57
Fayette County, Kentucky
Note: When this school district changed start times, teen auto accidents decreased 24.3% (Danner& Phillips, 2008)
“The time issue has never been a problem for us. Our schools start time is 8:25 and practice after usually starts around 3:30 or 3:45.”
- Donald Adkins, Athletics Director
Fayette County Schools, Kentucky
1/12/12 emailSlide58
Hudson, OH
“It has actually worked out better than we anticipated.”
~
“We have not really had any problems getting everything done before dark.”
-Ray Ebersole, Athletic DirectorHudson Public High Schools
12/8/2011 and 5/13/2012 emailsSlide59
Short-Term Recommendations
Give standardized testing after 10am, when adolescents are more alert
Decrease nightly homework hours
Give plenty of notice for large assignments
Educate schools, physicians, mental health providers on the impact of sleep deprivation
Educate parents that weekend ‘catch-up’ is normal, however sleeping beyond 2 hours past normal wake time is not recommended
(Hansen, et al 2005;
Wolfson and
Carskadon, 2005)Slide60
Resources for Schools
University of Minnesota: “Implementing Later Start Times:”
https://umconnect.umn.edu/p66919141/
Children’s National Medical Center – Blueprint for Change Team: “School Start Time Change:”
www.tinyurl.com/FCPSBlueprint4Change
Student education - posters and curriculum - extensive list compiled on Ohio Adolescent Health Partnership website:
http://www.ohioadolescenthealth.org/sleep-resources.html
More resources:
www.startschoollater.netSlide61
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