It’s Time to Rethink Educational Start Times (REST)

The American Academy of Pediatrics just endorsed new Sleep Guidelines published last week by the American Academy of Sleep Medicine (Attached). Because these guidelines are brand new (April 13, 2017) and supported by two speciality societies, I believe this is the strongest paper to start with about the scope of the problem. Among other things, the guidelines say:

“Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health.”

“Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts.”

The Current Situation

Today’s high school students are asked to perform at more demanding levels than ever before to prove themselves to college admissions boards.

In this race to the top, they are expected to excel in all course work, take college level AP courses, have a full range of extracurricular activities that include clubs, sports, and volunteerism, as well as high test scores.

In an effort to pack it all in, they get up early (often before their parents) and start “A Period” or “Zero Period” classes before the regular school day starts.

Then they stay after school for sports practices and games, participate in drama rehearsals in the evenings, fit clubs in where they can and volunteer on the weekends.

They often can’t start studying until late in the evening and must stay up late (often later than their parents) to get the next day’s assignments done.

On top of all this, teens are blooming socially and making their first forays into the dating world. Learning how to relate to peers and how to have meaningful adult relationships is one of the most important jobs of teenagers, and shouldn’t be neglected or optional.

Long hours, more work than is possible to do, late nights and early mornings are all part of the problem that’s exacerbated by a system that is working against teens’ natural body rhythms.

With puberty, teens’ body clocks are reset. Their hormone levels are changing and those changes literally keep kids up at night. As hard as they try, most kids can’t fall asleep early. We’re making it worse with blue-light waves in artificial light, big and little screens, and a never-ending flow of always-on communication.

This might not be a problem, except the current system forces high achieving kids to wake up far earlier than their bodies are ready.

The result is chronic sleep deprivation that results in a compromised immune system leading to frequent illness, lowered ability to learn, lowered inhabitations, poor decision making sensitivity, emotional labiality, and falling asleep while driving.

It’s no wonder today’s teens are more stressed and depressed than ever before.

What Needs to Change? Educational Start Times!

We must change both the conversation around high school performance and the demands we are making on our teens.

In the trend-setting Silicon Valley there are two attitudes that need to change:

• “Fear of missing out” — FOMO
• “You can sleep when you die”

Our teens are giving in to this misguided mentality. They need permission, and help, to slow down and to sleep more. We need to change the demands we are making on them and give them permission to enjoy their fleeting teen years.

One way to do this is to change school start time to no earlier than 8:30 a.m. for all students. This one small change will have a huge impact on teens’ lives.   

But let’s be fair, high schools aren’t to blame for early start times. Colleges and universities are.

In the race to gain admission to top colleges and universities, high school students take more than the required number of classes by adding an “A Period” course to their load. In and effort to help their students, high schools resort to offering these courses. They can’t add them later in the day because they must also offer after school sports, music, theater, and club activities.

The ironic thing is most college students, with flexible schedules, don’t start class until mid-morning.

Making REST a Reality

We need a top-down recognition of the problem and a commitment to make teens’ physical and emotional health a priority. We need colleges and universities to commit to erase the credits earned by taking any course work before 8:30 a.m.

Just to level the playing field, if a student takes a PE or non-AP course before 8:30 a.m., one of their AP courses should be assumed as the “A Period” course.

If we use this approach, students will no longer be incentivized to give up much needed sleep to get into great schools and high schools will no longer be forced to offer “A Period” courses.  

We, the responsible adults, can give adolescents back their teenage years. We can make them safer and happier. We can give them a better shot at life. And it’s not hard. Simply …

Rethink Educational Start Times. REST for Success.

Do you have connections at a college or university? Tweet @DrGreene for more information about how you can help.

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References and Resources

Owens, J. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics 2014;134(3):e921-e932

Chen MY, Wang EK, Jeng YJ. Adequate sleep among adolescents is positively associated with health status and health-related behaviors. BMC Public Health. 2006;6:59

Eaton DK, McKnight-Eily LR, Lowry R, Perry GS, Presley-Cantrell L, Croft JB. Prevalence of insufficient, borderline, and optimal hours of sleep among high school students —United States, 2007. J Adolesc Health. 2010;46(4):399–401

Frey S, Balu S, Greusing S, Rothen N, Cajochen C. Consequences of the timing of menarche on female adolescent sleep phase preference. PLoS ONE. 2009;4(4): e5217

Carskadon MA, Acebo C, Jenni OG. Regulation of adolescent sleep: implications for behavior. Ann N Y Acad Sci. 2004;1021:276– 291

Carskadon MA. Sleep in adolescents: the perfect storm. Pediatr Clin North Am. 2011; 58(3):637–647

Crowley SJ, Acebo C, Fallone G, Carskadon MA. Estimating dim light melatonin onset (DLMO) phase in adolescents using summer or school-year sleep/wake schedules. Sleep. 2006;29(12):1632–1641

Carskadon MA, Acebo C, Richardson GS, Tate BA, Seifer R. An approach to studying circadian rhythms of adolescent humans. J Biol Rhythms. 1997;12(3):278–289

Jenni OG, Achermann P, Carskadon MA. Homeostatic sleep regulation in adolescents. Sleep. 2005;28(11):1446–1454

Carskadon MA, Acebo C, Seifer R. Extended nights, sleep loss, and recovery sleep in adolescents. Arch Ital Biol. 2001;139(3):301– 312

Fredriksen K, Rhodes J, Reddy R, Way N. Sleepless in Chicago: tracking the effects of adolescent sleep loss during the middle school years. Child Dev. 2004;75(1):84–95

O’Brien EM, Mindell JA. Sleep and risk-taking behavior in adolescents. Behav Sleep Med. 2005;3(3):113–133

Giedd JN. Linking adolescent sleep, brain maturation, and behavior. J Adolesc Health. 2009;45(4):319–320

Holm SM, Forbes EE, Ryan ND, Phillips ML, Tarr JA, Dahl RE. Reward-related brain function and sleep in pre/early pubertal and mid/late pubertal adolescents. J Adolesc Health. 2009;45(4):326–334

Moore M, Kirchner HL, Drotar D, et al. Relationships among sleepiness, sleep time, and psychological functioning in adolescents. J Pediatr Psychol. 2009;34(10):1175– 1183

Pasch KE, Laska MN, Lytle LA, Moe SG. Adolescent sleep, risk behaviors, and depressive symptoms: are they linked? Am J Health Behav. 2010;34(2):237–248

Curcio G, Ferrara M, De Gennaro L. Sleep loss, learning capacity and academic performance. Sleep Med Rev. 2006;10(5):323–337

Alfano CA, Zakem AH, Costa NM, Taylor LK, Weems CF. Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents. Depress Anxiety. 2009;26(6): 503–512

Lofthouse N, Gilchrist R, Splaingard M. Mood-related sleep problems in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18(4):893–916

Regestein Q, Natarajan V, Pavlova M, Kawasaki S, Gleason R, Koff E. Sleep debt and depression in female college students. Psychiatry Res. 2010;176(1):34–39

Gromov I, Gromov D. Sleep and substance use and abuse in adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18(4):929– 946

Hutchens L, Senserrick TM, Jamieson PE, Romer D, Winston FK. Teen driver crash risk and associations with smoking and drowsy driving. Accid Anal Prev. 2008;40(3): 869–876

Verhulst SL, Schrauwen N, Haentjens D, et al. Sleep duration and metabolic dysregulation in overweight children and adolescents. Arch Dis Child. 2008;93(1):89–90

Gangwisch JE, Malaspina D, Babiss LA, et al. Short sleep duration as a risk factor for hypercholesterolemia: analyses of the National Longitudinal Study of Adolescent Health. Sleep. 2010;33(7):956–961

Hasler G, Buysse DJ, Klaghofer R, et al. The association between short sleep duration and obesity in young adults: a 13-year prospective study. Sleep. 2004;27(4):661– 666

Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008; 31(5):619–626

Fitzgerald CT, Messias E, Buysse DJ. Teen sleep and suicidality: results from the youth risk behavior surveys of 2007 and 2009. J Clin Sleep Med. 2011;7(4):351–356