Adolescent Sleep Research

Adolescent Sleep Research:
School Start Times
Stacy Simera, MSSA, LISW-S, SAP

In 1998 the 5 public high schools in Fayette County,
KY changed start times from 7:30 am to 8:30 am.
In the two years afterwards:

Auto accidents involving teens
from Fayette Co. decreased 16.5%,

while auto accidents involving
teens in the state increased 7.8%...

while auto accidents involving
teens in the state increased 7.8%...
…a comparable decrease of 24.3%.
(Danner and Phillips, 2008)

This is part of a slide show created by Stacy Simera,
MSSA, LISW-S, SAP to educate professionals and
communities on the research regarding adolescent
sleep deprivation and early school start times.
This can be shared as long as no references or
citations are changed.
You can contact Stacy in NE Ohio via this link:
http://www.startschoollater.net/oh---
northeast.html

The clinical research supporting later school
start times for adolescents is abundant,
however most of the data has been hidden
away in scholarly journals. Even our future
physicians have had little exposure to the
research…

Sleep Education in Medical Schools -
Curriculum Reviews - 1990 (Owens, 2005)
Among medical schools that did
offer sleep education, the
average time spent was 2 hours.

The Minnesota Medical Association was one of the first
groups to publicly address the issue. In 1993 the MMA
issue a public resolution to educate the public on:
• The need for more sleep during adolescence than
during childhood
• 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)

Between the years of 1996 and 2003, grants
were awarded to twenty medical schools for:
– developing ‘model’ educational programs in the
medical school
– promoting ‘interdisciplinary learning
environments’
– improving sleep education and research, including
educating the public
(Owens, 2005)

In 2000, the National Sleep Foundation
published a 26-page report, Adolescent Sleep
Needs and Patterns, that includes a discussion
of the benefits of delaying school start times.
Here is a link to that report:
http://www.sleepfoundation.org/sites/default
/files/sleep_and_teens_report1.pdf

• Gradually other health professionals have
become more aware of the research, in fact
many groups have joined the MMA in forming
policy statements on later school start times:
– The Maryland State Medical Society
– The American Lung Association of New England
– The Connecticut Thoracic Society
– The Virginia, Florida and Maryland chapter of the
American Academy of Pediatrics
– And more:
http://www.startschoollater.net/position-
statements.html

So what is the research saying?

Adolescent Sleep Needs
• Adolescents require an average of 8.5 to 9.25
hours of sleep each night for optimum health

• In a study by O’Brien and Mindell (2005), only
9.2% of adolescents studied received 8 ½ hours
of sleep or more during the week

• In a study by O’Brien and Mindell (2005), only
9.2% of adolescents studied received 8 ½ hours
of sleep or more during the week
• On average, most teens sleep 6.75 hours on
school nights
(Carskadon et al., 1980; National Sleep Foundation, 2009)

Circadian Rhythm
• Our internal mechanism that controls the
sleep/wake cycle (localized to the
suprachiasmatic nucleus).
• The circadian rhythm among humans averages
24.27 hours, but it ‘entrains’ to a 24-hour day
based primarily on light exposure.
(Crowley, Acebo and Carskadon, 2007)

Melatonin
Melatonin is a hormone secreted by the pineal
gland in response to the circadian rhythm:
– Rising in the evening near the person’s usual
bedtime
– Remaining constant through sleep
– Decreasing during the person’s usual wake time
(Wahlstrom, 2003)

Melatonin Shift in Adolescence
• Measuring of melatonin levels in saliva:
- later onset of higher levels of melatonin among
adolescents – as compared to younger children
and older adults
• Observed in other countries around the world:
- a developmental condition of adolescence – not a
cultural or scheduling phenomenon
(Carskadon et al., 1979; National Sleep Foundation, 2009;
Wahlstrom, 2003)

Thus adolescents naturally do not become
sleepy until later in the evening, approximately
11pm, and are not alert until later in the
morning -
- therefore attempts at early bedtimes to
compensate for early school times do not
succeed.

Pubertal Maturation Correlation:
Delay of circadian phase preference correlates
with degree of pubertal maturation in a 1993
study by Carskadon et al:
– Over 400 6th
graders were scored according to their self-
report of pubertal development
– Those same students were then questioned on their
preferences for daytime activity: morning or evening
– Results showed that more mature students showed a
preference for delayed phase compared to less developed
students

Meta-Analysis of Phase Shift by Age
(Crowley, Acebo and Carskadon, 2007)

Is Weekend Catch-Up OK?
• No: Adolescents who sleep more on the
weekend experience a ‘jet-lag’ effect, with
negative effect on school performance. (Bergin and
Bergin, 2009)

Why is sleep so important?
• For our body: During stage 3 sleep we engage
in tissue growth and repair and release of
hormones.
• For our brains: During stage 4 sleep our brain
is active and is it suspected that we engage in
reorganizing similar to ‘de-fragmenting’ in
computers…

Non-REM Stage 1
Falling Asleep
Light Sleep
Non-REM Stage 2
Fully Asleep
Body Temp Drops
Non-REM Stage 3
Deep Sleep
Restorative
Tissue Repair/Growth
Hormone Release
REM
Every 90 min.
Brain is Active, Dreams
Each course gets longer
through the night

Impacts of Chronic Sleep Deprivation
• Academic
• Cognitive
• Mood
• Behavior
• Health
• Obesity
• Safety

Academic Functioning
• Poorer performance in morning
classes
• Poorer academic performance overall
• Absenteeism
• Tardiness
(Bergin and Bergin, 2009; Carskadon et al, 1998; Kahn et al, 1989;
Noland et al, 2009; Wahlstrom, 2003; Wolfson et al, 2007)

Grades related to sleep patterns
(O’Brien and Mindell, 2005)
School Night Total Sleep Time
Grades
Low:
≤ 405 min
(≤6 ¾ hrs)
High:
≥ 495 min
(≥8 ¼ hrs)
As & Bs 52.9% 62.9%
Bs & Cs 32.9% 28.6%
Cs & Ds 12.9% 8.6%
Ds & Fs 1.2% 0%

Grade Failure
Students with more sleep deprivation are
more likely to fail a grade compared to
students with less sleep deprivation -
- even when amount of homework
completion is similar.

Cognitive Functioning
• Decreased Attention
• Deficits in Problem-Solving Abilities
• Decreased Complex Decision Making
(Gibson et al, 2006; Kilgore et al, 2007)

Mood and Behavior
• Increased impulsivity
• Increased irritability
• Lower tolerance for frustration
• Missing social and sports events
(Bates et al, 2002; Gibson et al, 2006)

Mood and Cognitive Functioning: Sufficient vs. Insufficient Sleep
(Gradisar et al, 2008)

Risk-Taking Behavior
Adolescents with insufficient sleep (less 8.5 hours of sleep
on week nights) engaged in more risk-taking behaviors
(violence, unsafe behaviors, drug use, and sexual activities)
than students who reported sufficient sleep. (O’Brien and
Mindell, 2005)
Kahn, et al (2006): “[Our] findings suggest that
sleep deprivation significantly weakens the
inhibition of aggression and willingness to
behave in ways that facilitate effective social
interaction, possibly through reduced metabolic
activity in prefrontal regions of the brain
important for personality, affect, and inhibitory
behavior.”

Health
• Decreased immune functioning
• Decreased insulin secretion and decreased
ability to utilize insulin
• Association between MS and shift work
before age 20 (after 9pm or before 7am)
• More aggressive forms of breast cancer
• Decreased collagen 1 production
• More…
(Buxton, 2012; Hedstrom et al, 2012; Lancer, 2009; National Sleep
Foundation, 2009; Thompson et al, 2012, more…)

Obesity
• Extensive research had been disproving the
assumed link between TV and obesity.
• Instead, researchers are finding a link
between chronic insufficient sleep and
obesity.
• This link occurs along all ages, but the link is
strongest among children.
(Must and Parisi, 2009; Noland et al, 2009; Taheri et al, 2004)

Research by Taheri et al (2004):
(Research on 1,024 people in a 15-yr sleep study)
Findings:
• Association between increased BMI and
inadequate sleep (less than 8 hours per night)
• Hormonal changes:
– decreased leptin levels by 15.5% (a hormone that
suppresses appetite) among people with inadequate
sleep
– increased ghrelin levels (a hormone that stimulates
appetite) by 14.9%

Safety
Driving while drowsy is a ‘major contributor’ to an
estimated 100,000 motor vehicle crashes per year
and results in more than 1,500 deaths nationwide
(National Highway Traffic Safety Administration, 2005)
“Adolescents are more likely than older drivers to be
sleep-deprived because of school schedules, social
activities, and shifting circadian rhythms.”
(Danner and Phillips, 2008)

Sports Injuries
68% reduction in sports injuries among teens who slept at least 8 hours
compared to teens who were chronically sleep deprived
- ‘not acute lack of sleep before the big game’
(Milewski et al, 2012 – presented at AAP Oct 2012 Conference)
Factors associated with injuries: chronic sleep deprivation, higher grade level
Factors NOT associated with sports injuries: gender, weeks of participation in
sports per year, hours of participation per week, number of sports the
teen engaged in, strength training, private coaching, and subjective
assessments of "having fun in sports”
"Our study shows that everyone's mom was right when she said you need
to get a good night's sleep. While this was felt to help you get good grades
in school, we now see that it helps prevent sports injuries.“
- Dr. Matthew Milewski, Reuters interview, 10/23/12

Farm Families
Agricultural work is more hazardous than non-
agricultural occupations, with increased risk to
young workers. (Chapman et al, 1998; Myers et al 2002)
“Sleep deprivation is of particular concern among
adolescents residing and working on farms”
(Chapman, 2006)

School start times for 6th
- 12th
grades
(and even into college) after 8:30
am or ideally after 9:00am.
(Bergin and Bergin, 2009; Carskadon, et al 1998; National Sleep Foundation,
2009; Noland et al, 2009; Wahlstrom, 2003; Wolfson et al, 2007; and many
more…)
So what do the experts say?

Schools that have acted:
Hundreds, if not now thousands, of schools have changed in
response to the research. Here are two sites that provide a
sampling:
http://schoolstarttime.org/2011/06/12/schools-recently-
delaying-start-times/
http://www.startschoollater.net/success-stories.html

And here’s just a few examples of the
measured benefits:

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)

In a study 4 year after changes:
“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)

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)

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)

Rhode Island Comparison:
Late Starting (8:37 am) compared to
Early Starting (7:25 am) Middle Schools:
(Wolfson et al, 2007)

Rhode Island Comparison:
Late Starting (8:37 am) benefits compared to
Early Starting (7:25 am) Middle Schools:
– Increased total sleep times
– Less daytime sleepiness
– Improved grades among females in 7th
grade
(no statistical difference among males)
– Improved grades among both genders in 8th
grade
(Wolfson et al, 2007)

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

Even US Air Force Academy cadets (remember,
puberty extends a few years beyond high school)
benefited greatly from later class start times. A quote
from the researchers is on the next slide, and a link to
the study is here:
http://teensneedsleep.files.wordpress.com/2011
/05/carrell.pdf

“Our findings have important implications for
education policy; administrators aiming to improve
student achievement should consider the potential
benefits of delaying school start time. A later start
time of 50 minutes in our sample has the equivalent
benefit as raising teacher quality by roughly one
standard deviation. Hence, later start times may be a
cost-effective way to improve student outcomes for
adolescents.”
Carrell et al, A’s from Zzz’s,
American Economic Journal: Economic
Policy 3 August 2011): 62–81, pg 80

The Brookings Institute’s Hamilton Project
Policy Brief 2011-08: ‘Organizing Schools to Improve Student
Achievement’ is a report written by economists who estimate
a ‘conservative’ 9 to 1 benefit to cost ratio in moving middle
and high schools one hour later.
That means communities get back $9 (or more) for every $1
spent on making the basic change. Most communities don’t
have to spend anything, so the benefits can be limitless.
Here is a link to that report:
http://www.hamiltonproject.org/files/downloads_and_links/092011_organiz
e_jacob_rockoff_paper.pdf

Options for Schools
1) Delay all school start and end times
2) Exchange high school/middle school times with
elementary school times
– Elementary age students can adapt better to earlier
bedtimes and waking times
– No scientific reasons found in the literature on why
districts tend to start high schools earlier than elementary
schools
3) Compress high school and middle school days to
delay the start time but retain current end time
4) Synchronize all school start and end times
5) Other? Come on – we can be creative for our kids!

Transportation Costs
• Minneapolis, MN
– No increase in cost
– Shifted the same bus routes to later
• Edina, MN
– No increase in cost
– Shifted the same bus routes to later
• Hudson, OH
– Decreased cost
– Moved from 3-tier to 2-tier system
– Changed to an external vendor
– Consolidated routes, altered some pick-ups

Transportation Considerations
• Transportation to Private Schools
– In Hudson, a private school changed start time to
coincide with Hudson schools
• Transportation to Joint Vocational Schools
– Many schools are looking at changing start times due
to overwhelming research – ideally entire counties
change times
• Transportation to Alternative Schools
– Seek cooperation, or even changes, from the
alternative schools

And the million dollar question:
What about sports?

Smart coaches remember that sleep deprivation
increases sports injuries, reduces endurance,
reduces speed, and reduces accuracy.
But coaches also want to know what has
happened to sports among schools that
changed start times.
So I contacted schools around the country and
asked the people at the front lines and the
sidelines, and these are some responses
(shared with permission):

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)
In Wilton, Connecticut
‘a self-described sports town’:

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.

Fayette County, Kentucky
“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 email

Lexington, Kentucky
“The first question you asked was ‘do we have to get off the
golf course before leagues?’ We have a great relationship
with our home course. They give us four tee times Monday to
Thursday. Typically, any leagues start after our practices.
…For bowling the additional time has not been an issue… In
Lexington our leagues usually start around 6:30 and we have
been able to practice for two hours before then.”
- Bob Farquhar, Bowling and Golf Coach
Lexington High School
5/15/12 email

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 Director
Hudson Public High Schools
12/8/2011 and 5/13/2012 emails

Two Main Issues in Minneapolis, MN:
1) “Middle School students get out over an hour later than high
school students. Basically, if a 7/8th grade student
participates on a high school team then they are forced to
miss class on game days (the latter part of the day). Also, they
miss practice because the times are staggered. If high schools
and middle schools started/stopped at the same time we
would not have this issue.”
2) “We utilize our Minneapolis Public Parks for athletic fields. We
are forced to be off most of them by 5:45pm. We don't start
many of our games until 4pm so this proves to be a big
challenge.”
- Darren Ginther, Athletics Director
Edison High School (12/8/11 email)

One solution in Minnesota:
“Make connections.”
- Al Frost, Athletics Director
Roosevelt High School, Minnesota
(12/9/11 phone conversation)
Mr. Frost made a deal with the park system, on whom the
school relied for baseball and softball fields, to push the adult
softball leagues a little later in exchange for the use of the
school’s football field by the park system’s pee-wee football
league.

Counterproductive Responses
Changes that defeat the purpose of early start-times
or minimize the focus of education within the
educational system:
– Shifting athletic practices or club meetings to before
school
– Extending extra-curricular activities past 9pm
(not recommended by researchers)
– Having students leave during the last period(s) of school to
get to athletic or club events

Childcare
– Schools need to give adequate notice
– Collaborate with daycares and extracurricular programs
– Develop tutoring programs after school for younger
children if elementary is moved earlier
– Think outside the box: allow young students to ride the
bus home with older siblings if schools choose to ‘flip-
flop’ high school with elementary

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 2-3 hours past
normal wake time is not recommended
(Hansen, et al 2005; Wolfson and Carskadon, 2005)

Get Involved!
• Ask your school to look at the research.
• Ask groups in your area to write letters of
endorsement.
• Start or sign local petitions. Go to www.signon.org to
see if a petition already exists for your area – such as
Northeast Ohio or Seattle.
• Check out the national group Start School Later on
FaceBook or at their website, where you can find a
national petition: www.startschoollater.net

For more information:
www.schoolstarttime.org
www.startschoollater.net
www.sleepfoundation.org

References
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44-47. Retrieved from Academic Search Complete database.
• Carskadon, Mary. 2002. Frontline Interview. Available at:
http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/interviews/carskadon.html
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