|Dr. Wendy Sue Swanson (L), Dr. Maida Lynn Chen (C), and Dr. Catherine Darley (R) discuss disruptions to teen sleep and the valid reasoning behind later school start times for Seattle public schools at this event hosted at Town Hall. (March 2015)|
Three advocates for later school start times for Seattle’s teens recently presented their cases before the city’s Town Hall audience.
Dr. Maida Lynn Chen, Dr. Catherine Darley and Dr. Wendy Sue Swanson each tackled the troubling problem of raising teens to succeed in a culture which undervalues the very resource that teens require if they are to become successful and healthy students and human beings: sleep.
Dr. Swanson, known by twitter followers as @seattlemamadoc for her blog of the same title, is a practicing pediatrician and serves on both the medical staff at Seattle Children’s Hospital and as a clinical instructor in the Department of Pediatrics at the University of Washington. Her presentation, “When School Gets in the Way: Later School Start Times,” highlighted some disconcerting recent attention to adolescent sleep deficits coming out of current pediatrics research, including a spotlight on an alarming trend in sleep deprivation among teens which has been coined “The Great Sleep Recession.”
“Our community has the grave task at hand in valuing sleep,” Dr. Swanson said, warning that “this is a biology thing, not a laziness thing.”
(It was noted during Q&A that Europe still culturally practices the idea of “siesta” and that in Asia, afternoon napping is enforced, pointing to the strange misnotion in the US that somehow people who succeed never sleep or that sleep is for the lazy.)
At the top on Dr. Swanson’s list of impediments to quality sleep for teens was the ubiquity of electronic handheld devices, which remain in use into the darkest hours of the night. For years, the detrimental effects of television viewing on sleep health have been touted, but a recent study in Pediatrics has shown that TV is not nearly as problematic in the bedroom as are the small screens–smartphones, backlit pads, handheld game consoles, laptops or other devices–which Dr. Swanson asserted “are more disruptive than TV.”
She also pointed out that even when school districts delay start times to match the physiological needs of high schoolers, who naturally experience delayed sleep phase as part of their own adolescent development, our public school culture still finds ways to place demands on students through early morning sports practices and so-called “zero periods,” which are offered before school as perhaps the only option for kids who want to take more than one band class or other academically related activity.
(Curator’s note: I call this Activity Creep… my own kids have gone through this same environment where the district said, Yes, we will support more sleep for our kids! while, in the meantime, coaches made a land grab for practice space and activity programmers, classrooms, thereby ignoring the wisdom of the school district and encroaching on our teens’ sleeping time nonetheless. For those kids who rely on these activities to help land them scholarships for college, the choice to not participate can be devastating.)
Dr. Swanson wisely pointed to the value of parents as models, stating that “parenthood is guided by love but instructed by modeling.” If parents expect their teens to sleep 8-9 hours a night, then parents should probably mirror this practice by valuing their sleep as well and put in their own 8-9 hours. Unfortunately this isn’t the rule, but the exception, for many adults, often easier said than done. In 2015, economic pressure is forcing many adults (parents or not) to defer crucial sleep in order to just get to work on time or to pay the bills or to transfer from one job to the next over the course of the day. The New York Times captures this reality quite eloquently, even coining a new term for back-to-back shiftwork (“clopening”) in its recent article, “In Service Sector, No Rest for the Working.”
Dr. Chen, director of the Pediatric Sleep Center and attending physician at Seattle Children’s Hospital and assistant professor in the Department of Pediatrics at the University of Washington School of Medicine, further elucidated the disconnect between an adolescent’s physiological sleep needs and the expectations set by public schools and/or parents in her presentation, “The Science Behind Adolescent Sleep.”
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She posited that, while parents and schools believe and expect their kids to be in bed, asleep, by 10pm on a school night, the physiological reality of sleep phase shifting to later bedtimes–a normal development for teenagers–puts kids in bed, asleep, at around 1am. Were they to sleep until 9am, it would be a perfect world. But teens aren’t naturally suited to this schedule: The National Sleep Foundation asserts that it is nearly impossible for teens to fall asleep before 11pm. Instead, they are required to rise closer to 6am, shaving off two or more good hours of sleep a night that truly aren’t optional.
It’s recommended by the American Academy of Pediatrics that teens sleep between 8.5 and 9.5 hours a night. If kids are falling asleep around 1am, which is closer to the norm (even without Facebook to keep them up), and they are expected to rise at 6am, they are getting only 5 hours of sleep, well below the recommended amount. The National Sleep Foundation also estimates that only 15 percent of all teens get adequate sleep (that’s 7 or more hours a night).
It’s not that these kids don’t sleep once they are asleep, Dr. Chen pointed out. “Delayed Sleep Phase Disorder is more a timing problem than a sleep disorder,” she says. The result? Kids are wrenched out of critical REM sleep periods before they should be; they arrive at school self-medicated with caffeinated beverages, only to fall asleep in class in mid-afternoon as their sleep pressure builds following a night of deprivation.
|This graphic from The Insomnia Blog shows the vicious|
cycle of sleep deprivation tormenting today’s teens.
And “binge sleeping doesn’t help,” she explained when asked about the familiar practice of teens sleeping in late on weekends. Changing the sleep schedule over the weekend may give the adolescent a few more hours of sleep, but as was noted in the previous article on the “sleep recession” above, the ongoing sleep debt accumulation of these teens over time will not be even remotely paid off by sleeping in to catch up. Quite the opposite: teens will give their circadian clocks a negative reset, thereby making that first Monday morning the next weekly launch of cycles of brand-new sleep deprivation.
These cycles are cruel and very difficult to change. If you try various therapies for shifting their sleep phases, you are asking for parents to supervise their teens 100 percent of the time, you are asking for exhausted teens to forego naps and caffeine, said Dr. Chen. These kinds of therapies require a huge family-wide commitment, she explained. The risk of relapse is very high because the reality is that most parents are not going to be able to supervise their teens 100 percent of the time, and that means that, about day 3 into intense shift phasing therapy, these teens will likely sneak in a nap when their parents aren’t looking and completely upset any reprogramming that has taken place.
So what else can we do to help out teens out? Dr. Chen argued, as did both of her companions, for a change in the system. By recognizing the unique physiological needs of teens, who continuously lose sleep to the demands of schools, activities, jobs, homework and social activities (including Facebooking) from the age of 12 through age 18, the best solution is to shift the school start time to better match with their circadian rhythms.
|Dr. Catherine Darley|
dispels the myths and
later school start times.
Dr. Darley, founder of the new field of naturopathic sleep medicine and the Institute of Naturopathic Sleep Medicine in Seattle, is also co-chair of Start School Later/Seattle. (You may recall that Dr. Darley was featured in this Q&A with SHC last November on the topic of restless legs syndrome.) Her background in pediatric sleep health includes work with one of sleep medicine’s most prominent practitioners, Mary Carskadon.
She has been advocating for later school start times in the Seattle area for years now and demonstrated in her presentation, “Myths & Misconceptions,” that all of the arguments against later school start times are specious.
One key argument of opponents of later school start times is that they believe it is too expensive to facilitate. Darley cites evidence to the contrary from the famous Edwards 2012 study published in the Economics of Education Review, “Early to rise? The effect of daily start times on academic performance,” which, among other things, posits that increased test scores (a two percentile point increase) for students in a reduced class size would cost seven times as much to implement as it would to simply start school one hour later.
How interesting that the darling of education economics–the smaller class size–would be infinitely more expensive than a simple shift in the schedule.
Other arguments–that we would be coddling kids, that kids will just sleep more, that kids need to adhere to society’s expectations, or that extracurricular activities would suffer–were shown by Darley to be easily refuted.
(Curator’s note: In my own experience, I can share this observation. One of my children was in club water polo, and it required that they hold practice until as late as 10pm, then turn around and return to practice at 530am the next day. After strenuous exercise, the human body needs a couple of hours to burn off all the adrenaline that results. Give those kids two hours to relax, and that puts them to bed at midnight. Still, they have to be at practice in less than 6 hours, even while it is recommended that they get the bare minimum of 7.
Even the kids knew their performance was suffering because of lack of sleep; however, coaches and community centers providing the space for these activities are mostly trying to work in more practices around the school schedule and do not think about the specific physiological needs that teens have when it comes to sleep. When teens complain about not wanting to go to morning practice, it really isn’t because they are lazy–we are talking about kids who tread water for up to 2 hours at a time!–but because they are sleep deprived.)
Dr. Darley pointed out additionally that other positives come from later school start times besides better-rested kids. Teens who are sleep-deprived are likely to engage in dangerous, high-risk behaviors, for instance, such as those which lead to teen pregnancy, most cases occurring during the mid-afternoon, after school lets out but before parents have returned home from work.
Drowsy driving is also an especially dangerous side effect of sleep deprivation among teens. The greatest odds for a person to have a car accident generally occur during the first six months after receiving a driver’s license; add sleep deprivation to the mix and it’s not surprising that teen car accidents in the morning are on the rise.
Darley acknowledges that there are many different factors that go into facilitating a district-wide change in school start times: busing, childcare issues, after-school jobs and extracurricular activities. However, for those school districts which are thinking about implementing later school start times, she points to the recommendations from the Brookings Institute’s Hamilton Project, which states that “for schools with scheduling flexibility, starting class later can be an inexpensive way to boost achievement; even for schools where changes will be costly, we argue that investing the resources to alter busing schedules and accommodate later after-school activities can be a worthwhile investment.”
Interestingly, when asked if there were any compelling arguments against giving teens an extra hour or two of sleep, Dr. Darley’s answer was an unequivocal “No.”
If you live in a school district, in Seattle or otherwise, which has not yet shifted school times later to help adolescents get their sleep, and you wish to support this effort, you may participate in the following petitions and organizations.
- American Academy of Pediatrics Position Statement: Let Them Sleep: AAP Recommends Delaying Start Times of Middle and High Schools to Combat Teen Sleep Deprivation
- MoveOn: Promote legislation to prevent public schools from starting before 8 a.m.
- Start School Later Campaign for Seattle
- Start School Later National Campaign