Delayed School Start Times for Adolescents and the Emotional, Academic and Physical Benefits

Transcription

1 Delayed School Start Times for Adolescents and the Emotional, Academic and Physical Benefits

2 Daniel J. Buysse, M.D. UPMC Professor of Sleep Medicine Professor of Psychiatry and Clinical and Translational Science University of Pittsburgh School of Medicine 3811 O'Hara St. Pittsburgh, PA Nicole D. Chenet, DDS Diplomate of the American Board of Dental Sleep Medicine 200 Commerce Dr., Moon Township, P AGH Center for Sleep Medicine Fax:

3 Can we sleep our way to better health? Daniel J. Buysse, MD UPMC Professor of Sleep Medicine Professor of Psychiatry and Clinical and Translational Science University of Pittsburgh School of Medicine Moon Area School District Moon Township, PA January 22, 2018

4 Sleep is related to individual health Insufficient Sleep Depression Coronary Heart Disease Obesity Hypertension Early Mortality

5 Sleep is related to adolescent health Bedtime Story: The Troubling Truth About Teens & Sleep WQED, March 17, 2016

6 We live in two worlds

7 24-hour (circadian) rhythms are part of our biology Videnovic, Nat Rev Neurol, :

8 Every cell and organ system has a circadian clock Clock genes regulate their own activity on and are present in every cell and tissue in a 24-hour cycle the body. Takahashi, Nat Rev Genetics, 9(10): , Rosenwasser and Turek, Principles and Practice of Sleep Medicine, 5 th edition, 2011:

9 What controls sleep? The hourglass, the clock, and the alarm How long you ve been awake Time of day Level of arousal Sleep Drive! Sleep Propensity! Arousal Level! Sleep drive Circadian sleep-wake rhythm Moment-to-moment arousal

10 What happens in adolescence? How long you ve been awake Time of day Level of arousal Arousal Level! Sleep drive: Takes longer to build up Circadian sleep-wake rhythm: Later timing Moment-to-moment arousal: Increases

11 Teen sleep: Biology vs. Environment Development, Biology Social Environment Sleep Amount 8 AM 12 MN 8 AM 8 AM 12 MN 8 AM Sleep need unchanged Sleep amount reduced Sleep Timing Timing moves later Social demands push later School start pushes earlier Sleep Consolidation Consolidated sleep is restorative Social, electronics disrupt sleep

12 Teen car crashes: Passengers and time of day 1 30 Highest rate is NOT from Driver deaths per 10 Midnight-2:00 million trips AM, but from 4:00 6:00 AM :00 AM - 10:00 PM 10:00 PM- Midnight Midnight - 6:00 AM No Passenger Passenger 1 Chen, JAMA; 283(12): Rice, Injury Prevention, 2003; 9:

13 Sleep and circadian rhythms in teens Circadian rhythms govern our physical and mental function Sleep comes from the brain, but benefits the entire body Circadian rhythms and sleep change during adolescence Good sleep and circadian health is essential for good health Healthy sleep and circadian behaviors may improve our health, function, and wellbeing Of the many reasons to maintain early school start times, none of them argue that it s better for our teens health.

14 2015

15 A growing list of organizations recommend starting middle/high school at 8:30am or later American Academy of Pediatrics (AAP) American Medical Association (AMA) Centers for Disease Control (CDC) The Sleep Research Society (SRS) The National Association of School Nurses 2017: Society for Behavioral Sleep Medicine (SBSM) The National Education Association (NEA) National Parent Teacher Association (PTS) And several others.

16 Sleep Deprivation Epidemic Currently in the U.S, 1 in 10 teenagers gets the recommended 8-10 hours of sleep recommended by the American Academy of Pediatricians. 8 hours is the minimum amount of sleep recommended by sleep scientists and pediatricians The primary contributing factor of sleep deprivation is school start times. Most high schools start at 7:30 am or earlier when the recommendation is no earlier than 8:30 am.

17 Additional contributing factors Social / Environmental influences Decrease in parental control Use of social media (texts, IMs, etc.) & exposure to light Homework, after school work / activities Sporting events

18 The Circadian Rhythm Shift Requiring our students to wake up at 6 am is the biological equivalent of us, as adults, waking up at 4am. How do you feel when you wake up at 4am? Moody, irritable, can t think straight?

19 How do teenagers compensate? Tired but wired teenage population.

20 Dramatic Brain Development occurs during Adolescence Good Judgement Higher Order Reasoning Problem Solving Time period that reins in Impulsive Behaviors

21 Consequences of Insufficient Sleep: Lower grades & achievement test scores Falling asleep in school More days tardy or absent Mimics ADHD Decrease in impulse control Car crashes Depression Suicide Substance use Violence and risk taking Weight gain / obesity Sports injuries

22 Adolescent Sleep Loss is a Public Health Crisis Adolescent (and adult) sleep deprivation is a widespread, chronic health problem and is associated with negative outcomes. 73%

23 School Start Times in Allegheny County County High School Start Times in Allegheny (Peter Franzen, PhD UPMC Dept of Psychiatry)

24 late-start-high-middle-schools-pittsburgh-north-allegheny- Hampton-Township-Fox-Chapel/stories/ North Allegheny Superintendent Robert Scherrer said in December a reason to consider the late start is to alleviate stress for his district that he characterized as high-performing with high-achieving students, comparing it to schools in California s Silicon Valley. "They started to have some serious crises with some of their students cases of depression, anxiety, suicide clusters," Mr. Scherrer said in December. "And we're kind of ripe for that [in North Allegheny]. We're trying to be a little forward thinking here and sort of own this." N.A. conducted an online survey in November- parents, students and staff on student stress, 50 percent of the staff and 25 percent of parents. Of those who responded to the survey, 80 percent of parents, 63 percent of students and 70 percent of staff said that high school should start later. Of the many public high schools in the area, very few start at 8 a.m. or later. Quaker Valley joins Mt. Lebanon School District, whose high school students begin classes at 8 a.m.

25 Transportation matters: What time do you leave for school? Average: 6:25 AM How do you travel to school? Walk 4% Leave: 6:32 am Car 23% Average Sleep Duration (Hours) Bus 73% 0.25 Bus 6 h 18 min Car 6 h 42 min

26 The case for later school start times: Narrowing the achievement gap A recent review (Wheaton, Chapman, Croft, 2016) of 38 studies found that later start times are associated with: Higher attendance Reduced tardiness Reduced drop-out rates Improvements in standardized test scores Better grades Involvement in extra-curricular activities remains the same or increases Disadvantaged students and highest achieving both benefit. In one study, SAT scores for top 10% of students increased > 200 points with later start times. Early school start times reduce performance among disadvantaged students by an amount equivalent to having a highly ineffective teacher. Jacob & Rockoff, 2011, Brookings Institute Report

27 Schools that have Delayed their Start Time Standardized test scores increased by 2-3% points One study cited a 1 hour increase in start time for middle school increased math and reading test scores by 3 %. Most notably, lower achieving students benefited the most with improvements in scores twice that of their higher achieving peers. 1 Carrell SE, Maghakian T, West JE. A's from Zzzz's? The causal effect of school start time on the academic achievement of adolescents. Am Econ J Economic Policy. 2011;3(3):62 81

28 Three State Study 5 out of 6 high schools noted a significant increase in GPA in core subjects of math, English, science and social studies. These improvements are the equivalent of decreasing class sizes by 1/3 or by replacing a mediocre teacher with an outstanding teacher. Wahlstrom K, Dretzke B, Gordon M, Peterson K, Edwards K, Gdula J. Examining the Impact of Later School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study. Center for Applied Research and Educational Improvement. St Paul, MN: University of Minnesota; 2014

29 Grades Please list your grades on your last report card: English Math Science Social Studies Average GPA was 2.47 GPA <5 <6 <7 <8 >8 HOURS OF SLEEP

30 Sleepiness (local data) I fall asleep in my morning classes: 1 2 x / week: 25% 3+ days / week: 17% I fall asleep in my afternoon classes: 1 2 x / week: 27% 3+ days / week: 7% 42% 34%

31 Absenteeism, Tardiness and Drop Out Rate In one school district that delayed the start time to 8:30 am, there was a 25% decrease in absent and tardy students. (Minneapolis study) The percentage of high school students staying continuously enrolled also increased (drop out rate decreased). Wahlstrom K. Changing times: findings from the first longitudinal study of later high school start times. NASSP Bull. 2002;286(633): Wahlstrom K. Accommodating the sleep patterns of adolescents within current educational structures: an uncharted path. In: Carskadon M, ed. Adolescent Sleep Patterns: Biological, Social, and Psychological Influences. New York, NY, and Cambridge, England: Cambridge University Press; 2002:72 197

32 Consequences of insufficient sleep in adolescents Motor Vehicle Accident Leading cause of death in teenagers (CDC, 2012) In 2010, 22% of drivers ages had been drinking Teen drivers ages are 3x more likely to be in a fatal crash vs. drivers 20+ Teen drivers are at the highest risk of car accidents due to falling asleep, accounting for 50% of all crashes NSF poll (2006): 68% of HS seniors reported driving while drowsy; 15% at least a week

33 Delaying school start times associated with ~25% reductions in teen car accident rates Delaying school start times by 1 hour 7:30 AM to 8:30 AM, in Fayette County, KY (Danner & Phillips, 2008) Teen crash rates dropped 16.5% over prior 2 years In rest of KY, accident rates increased 7.8%, so a comparable decrease by 24.3%. Study of two neighboring districts in Virginia, similar in demographics and per-capita income (Verona, 2010) 25% higher weekday crash rates in the district which started 75 minutes earlier (7:20 AM vs. 8:40 AM)

34 Delayed Start Time and Car Crash Rates Crash rate reduction in year olds of 65% and 70% in 2 of 4 high schools the delayed their start time(jackson Hole, WY) Walhstrom Notably, the high school with the latest start time had the largest decline in car accidents.

35 A Sobering Fact Studies show teenagers driving with 5 hours or less of sleep a night is the equivalent of driving with a blood alcohol content above the legal limit. (Troxell)

36 Depression and Suicidal Ideation In a study of 3,000 students followed for 1 year from Teen Health 2000 (Roberts & Duong, Sleep, 2014) < 6 h sleep on weeknights For each hour of sleep lost A 38% increase in feelings of hopelessness and sad thoughts. A 58% increase in suicide attempts A 55% increased likelihood to use alcohol.

37 Consequences of insufficient sleep in adolescents 2007 Youth Risk Behavior Survey (n=12,154 HS students) 69% <8 hours sleep duration (Mcknight-Eily, et al. 2011, Preventive Medicine) 60 % < 8 h > 8 hr 0 1+ cigarette (daily) Marijuana (past month) Sad / hopeless daily

38 Consequences of short sleep: Physical health Overweight/obesity Link between short sleep and overweight, obesity in middle school, high school High blood pressure and Type 2 diabetes linked to short sleep duration Impairs immune function, and thus, healing and recovery Shochat et al., 2014, Sleep Med Reviews

39 Consequences of insufficient sleep in adolescents Increased sports-related injuries 7 th -12 th graders in California school (Milewski, et al., 2012 abstract) Those who slept 8+ hours were 68% less likely to be injured Risk also increased for higher grade level Independent of gender, amount of sports participation per year, # of sports, strength training

40 If school start time is delayed, won t youth just stay up later? Minnesota: Average bedtimes remained constant 10:40 pm Result was ~1 hour more sleep / night; 5 hours / week Systematic review of 6 research studies (Minges & Redeker, 2016, Sleep Med Rev) School start times delayed from minutes Sleep time increased from minutes on weekdays

41 70% The case for later school start times Wahlstrom (2014): 3-year CDC-funded study n=9,089 students in 8 public high schools in three states, most of which had already shifted school start times later by 30 to 60 minutes. % sleeping > 8 hours on a school night 53% % 18% 0% WHSD 7:00 7:30 7:35 8:00 8:00 8:05 8:20 8:35 8:35 8:35 8:55 Teens who got < 8 h of sleep Higher depression symptoms Fall asleep in class Greater caffeine More substance use Teens with school starts later than 8:30 AM Higher grades in core subject areas Higher state and national achievement tests Higher attendance rates Reduced tardiness

42 content/134/3 School Start Later, Western Pa chapter, Elizabeth Rambeau

43 Thank you! Dr. Daniel Buysse, MD, UPMC Professor of Sleep Medicine Dr.Nicole Chenet,DDS, DABDSM, Sleep Apnea Dental Center, AHN Center for Sleep Medicine