My daughter has been a high school junior for eight days and already, as I prepare for bed myself near midnight, I'm seeing the familiar sight of light, still glowing underneath her bedroom door. She should be asleep, but she is trying to complete her assignments for the next day.
This is nothing new in my own home or in homes across the county. As schools open their doors to vacation-rested students, the real issues surrounding kids and their inadequate sleep are being obscured by an overemphasis on school start times, as can clearly be seen in reports similar to the NBC Nightly News story that originally aired on August 25, 2014 [1].
At the center of the news story is a new policy statement issued by the American Academy of Pediatrics (AAP) concerning school start times [2]. The policy makes several recommendations, the most concrete of which is that all middle and high schools start classes at 8:30 a.m. or later to better "align with teens' changing sleep rhythms."
Unfortunately, the message put forth by the policy's own lead author, Dr. Judith Owens, during the broadcast was not about the multiple benefits the committee found from looking at school start time research. Instead she made the following statement, "They [sic students] are biologically programmed to fall asleep at 11:00 p.m. and wake at around 8:00 a.m., and that's the time that they are already in first period class."
Hopefully, this statement was taken out of context, because the idea that all children are engineered to slump over at the 11:00 p.m. conclusion of America's Got Talent and spring back to life around 8:00 a.m. is absurd and completely ignores both the concept of chronotype. Is the child a morning lark or a night owl? It also ignores a child's unique sleep duration need -- 8.5 hours of sleep may be great for many, but it is not right for all. Japanese studies have suggested that for adolescents, sleep times between seven to eight hours are best for optimal health [3]. Even in her own position paper, Dr. Owens uses the term "average teenager" when discussing these times. The simple fact is that when it comes to individual students and the best timing and duration of sleep, the sleep community is still not sure.
Using concrete times like 11:00 p.m. and 8:00 a.m. creates confusion and goes against the AAP's goal of educating the community properly about sleep science. The National Hot Dog and Sausage Council calculated that the average American consumes 70 hot dogs every year. This statement may describe the eating habits of some Americans, but it is not a fact describing all Americans. I personally have not eaten any hot dogs this year. Does this mean I have four months to consume 70? We need to stop using sleep averages in this country as sleep standards. They are not the same thing.
Sadly, these kinds of comments can create sleep problems. Consider a young 16-year-old boarding school patient I just saw in my clinic, struggling with an inability to fall asleep at night. At her school, in an effort to ensure their children are getting adequate sleep, lights are strictly out at 11:00 p.m. and on again at 8:00 a.m. While the motivation for this policy may be admirable, what if a student simply is not sleepy at that time? What if they are biologically programmed differently? This frequently happens. My patient feels most sleepy around midnight and often awakens on her own at 7:30 a.m., feeling great during the day without a hint of excessive sleepiness. Trying to shove all adolescents into the same 11 p.m. - 8 a.m. box leaves some kids feeling like they have something wrong with their sleep. This is the first step on the path of creating a 36-year-old patient who comes in saying she "has been a bad sleeper all of my life." She's not a bad sleeper, just a different sleeper.
This brings me back to my own teenager's sleep. Her school starts promptly at 8:55 a.m. every day, later than the 8:30 a.m. start time recommended by the AAP. Problem solved, right? Not quite, because an interesting thing happens when a school start time is delayed. The school release time is delayed as well. This means everything from sports practice to club meetings to dinner time and homework is pushed later into the evening. So my daughter is eating dinner at 8:00 p.m. and doing homework until midnight or beyond.
The AAP writes, "It should also be emphasized that delaying school start times alone is less likely to have a significant effect without concomitant attention to other contributing and potentially remediable factors, such as excessive demands on students' time because of homework, extracurricular activities, after-school employment, social networking, and electronic media use." This is the crux of the issue. Until we figure out how to more efficiently schedule the time of our teenagers, the real problems surrounding teens and their sleep will remain. Preliminary data looking at homeschooled children indicates that students can thrive in a less structured and more efficient academic environment. We ate lunch during class in medical school. Perhaps after school sports and music lessons could excuse students from certain classes and allow them additional study halls. There are small fixes out there, but in the meantime, as parents we can be proactive in ensuring healthy sleep for our kids.
Here are my five recommendations for parents of teenage sleepers:
1. Monitor your teen for signs of excessive sleepiness, and when present, take steps to address it. A later school start time does not shield your teen from excessive sleepiness.
2. Be an advocate for your child. Discuss a plan with your child's teachers early in the school year for what to do when they are "in the weeds" with multiple assignments due on days when their extracurricular activities or other obligations (such as a job) make assignment completion at a reasonable time impossible. Teachers are usually more than happy to accommodate students who genuinely cannot get the work done in the time they have to complete it.
3. Every person (and this includes teens) is unique and has his or her own sleep needs, both in terms of duration and timing. Be aware of averages and norms, but understand your child may be different.
4. Set a standard for your teen's sleep environment. Eliminate electronics, laptops, televisions and computers from their bedroom. These devices promote poor sleep on multiple levels.
5. Once you have ensured that their sleep schedule and sleep environment is pristine, if sleepiness persists, insist on your child seeing a sleep specialist. Your teen's sleepiness may be related to a sleep disorder and have nothing to do with the timing of their sleep or their sleep environment.
As sleep specialists, we must use our voice and media exposure to better educate the population about teen sleep and steer clear of "one size fits all" recommendations. We also cannot afford to congratulate ourselves too much as schools start delaying their start times. Far more meaningful and innovative changes need to be made if teens like my daughter are going to make it to bed at a reasonable time tonight.
References:
1. NBC Nightly News: Let Them Sleep In: Docs Want Later School Times for Teens
http://www.nbcnews.com/health/kids-health/let-them-sleep-docs-want-later-school-times-teens-n186976
2. Policy Statement: School Start Times for Adolescents
http://pediatrics.aappublications.org/content/early/2014/08/19/peds.2014-1697.full.pdf+html
3. Kaneita Y1, Ohida T, Osaki Y, Tanihata T, Minowa M, Suzuki K, Wada K, Kanda H, Hayashi K. Association between mental health status and sleep status among adolescents in Japan: a nationwide cross-sectional survey. J Clin Psychiatry. 2007 Sep;68(9):1426-35.