Mary A Carskadon

Mary A Carskadon
Brown University · Department of Psychiatry and Human Behavior

PhD

About

342
Publications
87,691
Reads
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38,176
Citations
Citations since 2017
89 Research Items
13185 Citations
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Introduction
I am the Director of Chronobiology/Sleep Research at the E.P. Bradley Hospital and Professor of Psychiatry and Human Behavior at Brown Medical School in Providence, RI. My scientific activities include research examining the interrelation between the circadian timing system and sleep/wake patterns of children and adolescents. Findings of my research have raised public health issues regarding the consequences of insufficient sleep in adolescents as well as concerns about early starting times of schools, prompting many school districts to delay start times. My new research initiatives assess sleep's impact on mood and epigenetic changes, as well as the influence of sleep and circadian timing on food choices of adolescents.
Additional affiliations
September 1985 - present
E.P. Bradley Hospital
Position
  • Managing Director
September 1985 - present
Alpert Medical School - Brown University
Position
  • Professor
Education
August 1976 - May 1979
Stanford University
Field of study
  • Neuro and Biobehavioral Science
August 1965 - May 1969
Gettysburg College
Field of study
  • Psychology

Publications

Publications (342)
Article
Full-text available
Sleep problems are common in individuals with autism spectrum disorder (ASD). How sleep problems reflect specific ASD phenotypes is unclear. We studied whether sleep problems indexed functional impairment in a heterogeneous community sample of individuals with ASD. We analyzed 977 probands (233 females; age = 11.27 ± 4.13 years) from the Rhode Isla...
Article
Full-text available
Background: Daily rhythms are observed in humans and almost all other organisms. Most of these observed rhythms reflect both underlying endogenous circadian rhythms and evoked responses from behaviours such as sleep/wake, eating/fasting, rest/activity, posture changes and exercise. For many research and clinical purposes, it is important to unders...
Article
Full-text available
Using light-emitting devices before bed is a modifiable behaviour that may affect adolescent sleep. We investigated the daily associations between device use before bed and sleep-wake timing, duration, and quality in early adolescence. Participants were 168 Year 7 students (M±SD=12.82±0.42 years, 56% females) in Australia. Sleep-wake timing, sleep...
Article
Full-text available
Background Circadian phase and sleep-wake timing delays are hallmark adolescent development features. These delays contribute to shorter sleep duration in combination with early school schedules. Both delayed circadian phase and insufficient sleep are associated with increased prevalence/severity of mood problems. This study examined associations b...
Poster
Introduction Many adolescents experience variable sleep timing and restricted duration attributable to biopsychosocial influences. The Sleep Regularity Index (SRI) captures inter-daily stability of sleep/wake intervals as the likelihood of being asleep/awake at consistent times day-to-day. The SRI may capture unique dimensions of adolescent sleep g...
Article
Introduction Alcohol use before bedtime has been shown to alter sleep including decreasing sleep latency, decreasing sleep efficiency, and fragmenting sleep stage distribution. Few studies manipulate pre-sleep alcohol concentration, instead focusing on a target dose or peak alcohol concentration during the night. Thus, we investigated how presleep...
Article
Introduction Meal timing has been linked to obesity in adults and children; however, evidence for an endogenous influence of the circadian system on food intake is unknown. We measured food intake during forced desynchrony (FD) in adolescents with healthy weight (HW) or overweight (OW), hypothesizing that circadian timing would affect food intake i...
Article
Introduction Despite the growing body of evidence linking child maltreatment to compromised sleep health in adulthood, links in emerging adults are understudied. We examined associations between child maltreatment (CM) and multidimensional sleep health among emerging adults undergoing the major life transition of starting college. Methods First-ye...
Article
Introduction The COVID-19 pandemic has challenged researchers to use remote data collection. Our project includes determining DLMO phase, requiring a family-friendly without face-to-face interaction. We describe here our protocol, experiences, lessons learned, and findings from the first 15 participants. Methods Fifteen urban-dwelling children wit...
Article
Full-text available
Background: During adolescence, sleep and circadian timing shift later, contributing to restricted sleep duration and irregular sleep-wake patterns. The association of these developmental changes in sleep and circadian timing with cognitive functioning, and consequently academic outcomes, has not been examined prospectively. The role of ambient li...
Article
Short sleep is associated with obesity risk. Experimental studies with adults and observational studies with children demonstrate that changes in eating, including increased caloric intake from energy-dense foods and sugar-sweetened beverages as well as increased caloric intake in the evening, may partially account for this increased risk. We there...
Article
Full-text available
Study Objectives Using data from a large, prospective study of sleep in first-year college students, we examined whether students’ sleep regularity is associated with body mass index (BMI) and BMI change (∆BMI) during their first college semester. In a subset of participants, we also tested whether dim light melatonin onset (DLMO) phase and DLMO-be...
Article
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Study Objectives We describe research methods developed to examine effects of sleep disruption on changes in immune balance, lung function, and cognitive performance in a sample of urban, ethnically diverse children with persistent asthma. Two case examples (8- and 10-year-old males) are presented to highlight methods of the current study and illus...
Article
In fall 2019, California passed and signed into law SB328, the first US statewide legislation explicitly designed to protect adolescent sleep health by requiring most California public school districts to start no earlier than 8:00 AM for middle schools and 8:30 AM for high schools. Recognizing the unique opportunity presented by the bill's 3-year...
Article
Full-text available
Background Sleep disturbance is common among individuals with Tourette’s Disorder (TD). Given that sleep is influenced by the circadian system, this study examined circadian rhythms and sleep in adults with TD, and explored the possible benefit of short-wavelength wearable morning light therapy. Methods Participants were 34 adults with TD (n = 14)...
Article
Full-text available
The present study assessed the efficacy of a behavioral intervention to enhance children’s sleep and reduce caloric intake and body mass index (BMI) change. Seventy-eight children 8–11 years old who slept 9.5 h/night or less were randomized to the sleep intervention or to no treatment control. The primary outcome was 2-month change in the actigraph...
Article
Full-text available
During the COVID-19 pandemic, schools rapidly transitioned from in-person to remote learning. We examined sleep- and mood-related changes in early adolescents, before and after this transition to assess the impact of in-person vs. remote learning. Sleep-wake timing was measured using wrist-actigraphy and sleep diaries over 1–2 weeks in Year 7 stude...
Article
Study Objectives To examine associations among instructional approaches, school start times, and sleep during the COVID-19 pandemic in a large, nationwide sample of U.S. adolescents. Methods Cross-sectional, anonymous self-report survey study of a community-dwelling sample of adolescents (grades 6–12), recruited through social media outlets in Oct...
Article
During the COVID-19 pandemic, schools around the world rapidly transitioned from in-person to remote learning, providing an opportunity to examine the impact of in-person vs. remote learning on sleep, circadian timing, and mood. We assessed sleep-wake timing using wrist-actigraphy and sleep diaries over 1-2 weeks during in-person learning (n=28) an...
Article
Introduction College students often experience irregular sleep timing, short sleep duration, and weight gain. Using data from a large, prospective study on sleep in first-year college students, we examined whether students’ sleep regularity index (SRI; Phillips et al., 2017) was associated with body mass index (BMI) and BMI change (∆BMI) during the...
Article
Introduction The effects of a moderate dose of alcohol one hour before bedtime on sleep have not often been studied nor is the effect across nights well known. We therefore sought to test whether such effects as sleep disruption, increased early-night slow wave sleep (SWS), and reduced early-night REM sleep would be sustained across nights. Method...
Article
Introduction Numerous studies interrogated the relationship between alcohol and a single night of sleep. Yet, many adults engage in cumulative days of drinking. Previous studies show alcohol on a single night increases slow wave sleep in the first third of night. Similarly, sleep has been associated with the success of daytime learning. Our goal wa...
Article
Introduction Among adolescents, sleep health has been associated with emotional and mood regulation, cognitive functioning, and behavior. Few studies, however, have examined the Sleep Regularity Index (SRI, Phillips et. al, 2017) and its associations with mental health and well-being in this age group. For this study, we examined whether SRI in 15-...
Article
Introduction Wrist actigraphy is a gold-standard method for estimating sleep patterns in the field. Actigraphy adherence is limited when participants remove the device for daily activities (e.g., showers, exercise). Here we evaluate the validity of a novel water-resistant wearable, the “Actigpatch,” compared to polysomnography and traditional actig...
Article
Introduction Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578), we investigated if race/ethnicity (64.6% were White and 35.4% identified as a racial/ethnic minority, mixed, or “other”) and community social vulnerability affected the association between COVID stress and sleep disturbance. Methods Data...
Article
Introduction COVID-19 fundamentally altered education in the United States. A variety of in-person, hybrid, and online instruction formats took hold in Fall 2020 as schools reopened. The Nationwide Education and School in TEens During COVID (NESTED) study assessed how these changes impacted sleep. Here we examined how instruction format was associa...
Article
Introduction The COVID-19 pandemic significantly disrupted how and when adolescents attended school. This analysis used data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study to examine the association of instructional format (in-person, virtual, hybrid), school start times, and sleep in a large diverse sample of adolesce...
Article
Introduction Adolescents are vulnerable to short, insufficient sleep stemming from a combined preference for late bedtimes and early school start times, and also circadian disruptions from frequent shifts in sleep schedules (i.e., social jetlag). These sleep disruptions are associated with poor mental health. The COVID-19 pandemic has impacted educ...
Article
The high prevalence of chronic sleep restriction in adolescents underscores the importance of understanding how adolescent sleep is regulated under such conditions. One component of sleep regulation is a homeostatic process: if sleep is restricted, then sleep intensity increases. Our knowledge of this process is primarily informed by total sleep de...
Article
Despite the high co-occurrence of sleep and mood disturbances, day-to-day associations between sleep characteristics (sleep duration, continuity, and timing) and dimensions of mood (positive affect and negative affect) remain unclear. The present study aimed to test whether there is a daily, bidirectional association between these sleep characteris...
Article
The two‐process model of sleep posits that two processes interact to regulate sleep and wake: a homeostatic (Process S) and a circadian process (Process C). Process S compensates for sleep loss by increasing sleep duration and intensity. Process C gates the timing of sleep/wake favouring sleep during the circadian night in humans. In this study, we...
Article
Study Objectives This study examines the relationship between experimentally manipulated sleep duration and mood in adolescents. Methods Thirty-four adolescents (20 male), aged 15 to 17 years, lived in a sleep laboratory for ten days and nine nights. They were allocated to one of three sleep “doses” for five consecutive nights for :5 hours’, 7.5 h...
Article
Full-text available
The negative effects of sleep loss on sleepiness, performance, and mood have been well-documented. Less is known, however, about possible negative effects of sleep extension and findings are inconsistent. This study investigated the Rip Van Winkle effect, comparing the effects of a single night of sleep extension (11 h time-in-bed, TIB) to control...
Article
As many other facets of life-biological, behavioral, psychological, cognitive, and social-undergo change during adolescence, so too does sleep. The context of sleep behavior is modified by alterations to underlying bioregulatory processes that challenge sleep's timing, regularity, and quantity. The buildup of sleep pressure during the day gets slow...
Article
Introduction Despite the high co-occurrence of sleep and mood disturbances, day-to-day associations between sleep characteristics (sleep duration, continuity, timing) and dimensions of mood (positive affect, PA, and negative affect, NA) remain unclear. Few field studies have tested whether sleep changes may affect mood by altering people’s emotiona...
Article
Introduction Sleep quantity and quality influence attentional bias, and attentional bias for food cues has been associated with body weight. Whether the endogenous circadian cycle and/or time from awakening to bedtime contribute to attentional bias for food and differences in weight remain unclear. Using a 28-h forced desynchrony (FD) design, we hy...
Article
Introduction Individuals with autism spectrum disorder (ASD) often experience sleep problems. A reliance on case-control studies rather than dimensional samples limit our ability to understand how sleep problems distinguish diagnosis and severity of ASD. To address this need, we present preliminary findings from a large community sample of individu...
Article
Introduction Short sleep contributes to attention failure in conditions such as ADHD. Whether sleep loss affects attentional processes as a task varies in cognitive interference is unclear. We used a multi-source interference task (MSIT) in a sleep restriction paradigm in children with a range of ADHD symptoms to examine how short sleep disrupts at...
Article
Introduction Executive functioning (EF) deficits are a key feature of ADHD, and sleep disturbances may be an important contributor. Specifically, disturbed sleep is prevalent in ADHD and similar EF deficits are observed in ADHD and sleep disorders. Associations between disrupted sleep and EF in ADHD are poorly understood, particularly during adoles...
Article
Introduction Sleep is vital for healthy development from infancy through adolescence. Despite its importance, false beliefs that conflict with scientific evidence (myths) may be common among caregivers and impair sleep health during these crucial stages. Methods Researchers compiled a list of potential myth statements using internet searches of po...
Article
Full-text available
Background DNA methylation (DNAm) has been implicated in the biology of sleep. Yet, how DNAm patterns across the genome relate to different sleep outcomes, and whether these associations overlap with mental health is currently unknown. Here, we investigated associations of DNAm with sleep and mental health in a pediatric population. Methods This c...
Article
Research examining connections between BMI and smell and taste sensitivity in adolescents has been minimal, methodologically inconsistent, and inconclusive. We sought to address this issue with an exploratory study of smell and taste sensitivity in overweight-obese (high BMI) and normal BMI male and female adolescents (ages 12-16 years), using prev...
Article
Prior research on alcohol use disorder (AUD) has focused primarily on men, but psycho-social-cultural changes have led to more women drinking or binge drinking, thus highlighting sex differences observed in alcohol use. In parallel, recent evidence indicates bidirectional links between alcohol use and sleep disruption, offering a burgeoning field o...
Article
Purpose: This project investigated internal consistency and test–retest reliability of the frequently used Pubertal Development Scale (PDS) and compared parent and child reports with clinician-rated Tanner staging. Methods : Using a repository of data collected from 1995 to 2016, 252 participants (aged 7.8–17.7 years) provided self- and parent-repo...
Article
Full-text available
Objective: Molecular markers in DNA methylation at a subset of CpG sites are affected by the environment and contribute to biological (epigenetic) age. We hypothesized that shorter sleep duration and possibly irregular sleep would be associated with accelerated epigenetic aging. We examined epigenetic vs. chronological age in 12 young women select...
Article
Full-text available
Purpose of Review The purpose of this review is to synthesize the current evidence regarding biological changes to the regulation of sleep-wake behavior in adolescence, summarize the impact of environmental factors (e.g., media use, school start times) on sleep, and discuss the implication of these biological and behavioral changes for adolescent e...
Article
Introduction DNA methylation is affected by the environment and provides an index of biological (epigenetic) age. Factors associated with poor health (e.g., smoking, inactivity) accelerate epigenetic aging. We hypothesize that shorter and irregular sleep impact epigenetic age. Methods Twelve women (chronological ages 18.2 to 19.8 y) were selected...
Article
Full-text available
Introduction Earlier (circadian) meal timing is associated with more favorable weight outcomes. Whether control of caloric intake across the endogenous circadian cycle and/or time from awakening to bedtime differs depending on body weight is unknown. We addressed these questions in adolescents with a 28-h forced desynchrony (FD), hypothesizing that...
Article
Introduction Sleep supports processes necessary for hippocampus-dependent memory consolidation. While experimental paradigms for sleep-dependent memory consolidation commonly involve comparing sleep/wake delays at opposing diurnal phases, whether the memory benefit of sleep is influenced by circadian phase is unclear. Using forced desynchrony (FD),...
Article
Introduction In children, attention-deficit/hyperactivity disorder (ADHD) has been associated with poor sleep, yet few studies have objectively measured sleep patterns in this population. Our goal was to test the hypothesis that reduced sleep regularity indexes ADHD symptoms in children. Methods The sleep-wake patterns of thirteen middle-school st...
Article
Introduction Sleep disruption is a proposed mechanism underlying disinhibition in attention-deficit/hyperactivity-disorder (ADHD); however, whether ADHD symptoms bestow increased vulnerability to sleep loss is unknown. Thus, we combined a behavioral go/no-go paradigm with functional neuroimaging in a dimensional sample of child ADHD to test whether...
Article
Introduction Although mounting evidence suggests that a good night’s sleep has beneficial effects on children’s executive, behavioral, and emotional functioning, many US school-aged children do not achieve recommendations for sleep duration. We previously demonstrated that a brief behavioral intervention can improve children’s objectively estimated...
Article
Objective: To determine associations among objectively-measured nocturnal sleep time, bedtime and obesogenic behaviors, including dietary intake, timing of intake, and physical activity, in a diverse sample of school-aged children who presented for behavioral treatment to enhance sleep duration. Methods: Eighty-seven children (8-11 y, 66.7% fema...
Article
Study Objectives Provide actigraphic reference values for motor activity during sleep for children and adolescents ages 8–17 years. Methods Participants were 671 healthy community-dwelling children and adolescents (52% female, mean age 13.5+2.4 years) from the United States (64%) and Australia (36%). All participants wore an Ambulatory-Monitoring...
Chapter
Full-text available
This textbook chapter (Number 120 of the 4th edition of Principles and Practice of Sleep Medicine) discusses principles of measurement pertaining to the clinical evaluation of patients with the signs and symptoms of excessive sleepiness. Available normative data are described in relation to representative findings for patients with various forms of...
Chapter
Full-text available
Excessive sleepiness during work activities is a serious, potentially life-threatening condition that affects not only sleepy individuals but also their families, co-workers, and society in general. The current conceptualization of sleep regulation involves two processes: one process is circadian, and the other is homeostatic. The effect of these p...
Article
The maturation of sleep regulatory systems during adolescence in combination with psychosocial and societal pressures culminate in a "Perfect Storm" of short and ill-timed sleep and the associated consequences for many youngsters. This model, first described by Carskadon in 2011, guides our current thinking of adolescent sleep behavior. Since the o...
Article
Introduction Many high school students report late bedtimes due to sleep homeostatic and circadian bioregulatory changes and insufficient sleep due to school start time constraints. In college, most students have greater freedom to shape daily routines including sleep schedules.This study examined predictors of the shift from high school to college...
Article
Introduction Our aim was to assess students’ self-reported sleep before and after a 27-minute delay in school day timing and to examine differences in sleep patterns between students who were initially “in favor” or “against” the planned time changes. Methods Adolescents in a suburban middle school (~640 students, grades 6–8) and its sister high s...
Conference Paper
Full-text available
Introduction Shiftwork can negatively impact on performance, safety and health. Importantly, while some shiftworkers are profoundly affected, others cope very well. The aim of this project was to identify healthy shiftworkers (across measures of physical, behavioural and psychosocial health) in a group of Australian nurses and midwives, and to exam...
Article
Full-text available
Study Objectives This study will, (a) estimate the nightly sleep need of human adolescents, (b) determine the time course and severity of sleep-related deficits when sleep is reduced below this optimal quantity, and (c) determine whether sleep restriction perturbs the circadian system as well as the sleep homeostat. Methods Thirty-four adolescents...
Article
Olfactory sensitivity has traditionally been viewed as a trait that varies according to individual differences but is not expected to change with one's momentary state. Recent research has begun to challenge this position and time of day has been shown to alter detection levels. Links between obesity and the timing of food intake further raise the...
Article
The human circadian system regulates internal 24-h rhythmicity and plays an important role in many aspects of human health and behavior. To investigate properties of the human circadian pacemaker such as intrinsic period and light sensitivity, experimental researchers have developed forced desynchrony (FD) protocols in which manipulations of the li...
Article
Study Objectives Napping is a useful countermeasure to the negative effects of acute sleep loss on alertness. The efficacy of naps to recover from chronic sleep loss is less well understood. Methods Following 2 baseline nights (10 hours TIB), participants were restricted to 7 nights of 5-hour sleep opportunity. Ten adults participated in the No Na...
Article
Depressive mood in youth has been associated with distinct sleep dimensions, such as timing, duration and quality. To identify discrete sleep phenotypes, we applied person-centred analysis (latent class mixture models) based on self-reported sleep patterns and quality, and examined associations between phenotypes and mood in high-school seniors. St...
Article
Full-text available
Introduction Observational and experimental studies provide compelling evidence for enhancing children’s sleep to decrease obesity risk. The purpose of the present study was to evaluate the relative efficacy of a brief behavioral intervention to enhance children’s sleep and thus improve weight status. Methods Seventy-eight 8 to 11 year-old childre...
Article
Introduction Napping is a useful countermeasure to sleepiness resulting from acute sleep loss; however, the efficacy of naps to reduce sleepiness resulting from chronic sleep restriction is less well understood. This study assessed the impact of an afternoon nap on subjective and objective sleepiness during chronic sleep restriction. Methods Follo...
Article
Introduction Evidence suggests that short sleep duration associates with impaired self-control, yet very few studies have assessed the efficacy of a sleep intervention for improving this behavioral domain. Our project measured the impact of a sleep intervention on self-control in school-aged children. Methods Sixty-six children (8–11 y, 68.2% fema...
Article
Introduction Actigraphy is widely used in pediatric sleep research and clinics. Yet no normative values have been established to help researchers and clinicians identify normal vs. poor quality sleep. The purpose of this study is to provide normative values for activity during sleep and percent scored sleep for children and adolescents ages 8–18 ye...
Article
Introduction Circadian disruption and short sleep are associated with fertility problems in women. Menstrual cycle lengths shorter than 25 days or longer than 30 days are more likely to be anovulatory (infertile menstrual cycle). We examined whether 1) sleep patterns and 2) the congruence between circadian phase preference and sleep patterns are as...
Article
Introduction Previous theoretical work has been used to optimize the extended day forced desynchrony (FD) protocol for reliable estimation of intrinsic circadian period in humans. Recently investigators have introduced ultradian FD protocols that require less time in the lab and are cost effective compared to longer FD protocols. However, a standar...
Article
Introduction This study aims to determine in adolescents (i) the time course and severity of deficits to sustained attention across three “doses” of sleep and (ii) whether sleep restriction perturbs circadian system in addition to the sleep homeostat, resulting in differing time-of-day effects across the three sleep doses. Methods Thirty-three ado...
Article
Full-text available
Introduction Regularity is an important feature of sleep with associations with important domains of young-adult functioning, including mood, weight gain, and academic performance. Quantifying regularity can be challenging. The Sleep Regularity Index (SRI) compares the sleep/wake state across adjacent 24 hour periods. The index ranges from 0 (rando...
Article
Study Objectives We aimed to test a combined approach to identify conserved genes regulating sleep and to explore the association between DNA methylation and sleep length. Methods We identified candidate genes associated with shorter versus longer sleep duration in college students based on DNA methylation using Illumina Infinium HumanMethylation4...