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Impact of Changing School Start Times on Teacher Sleep Health and Daytime Functioning
Abstract
Background:
The benefits of delaying school start times for secondary students are well-established. However, no previous study has considered how changing school start times impacts sleep and daytime functioning for K-12 teachers.
Methods:
Teachers in a large suburban school district completed 3 annual surveys (pre-change n = 1687, post-change n = 1857, follow-up n = 1812) assessing sleep and daytime functioning.
Results:
With delayed start times, high school teachers had later rise times (high school [HS]: 28 minutes, middle school [MS]: 14 minutes), increased sleep duration (HS: 22 minutes, MS: 13 minutes), and improved daytime functioning. Improvements for middle school teachers were noted but were not statistically significant. With earlier start times, elementary teachers reported earlier bedtimes (9 minutes) and wake times (9 minutes), with no changes in sleep duration or daytime functioning.
Implications for school health policy, practice, and equity:
Today's school health policies often focus on wellness. Findings from this study reveal that the policy of healthy school start times can have a significant, positive impact on adults who teach in later-starting secondary schools. Later school start times for secondary teachers provide greater parity with their elementary colleagues in terms of sleep opportunity.
Conclusions:
This study extends previous findings on how the policy of later secondary school start times improves the health and well-being of adolescents, highlighting that healthy start times contribute to increased sleep opportunity for MS and HS teachers and improved daytime functioning for HS teachers, with changed start times having no significant negative effect on elementary school teachers.
... Os fatores que interferem na qualidade do sono envolvem a depressão (16,(19)(20)24,28,33,36) , estresse (15,(19)(20)26,28,32,39) , dor (16,25,27,33) , burnout (24,30,37) , sobrecarga (19,28,33) , longas jornadas de trabalho (33,36) , exaustão (30,37) , irregularidade nos horários de dormir e acordar (31,39) , insatisfação no trabalho (32,37) , baixa qualidade de vida (19,24) , experiências de fracasso no trabalho , fadiga (18)(19) , ansiedade (16,33) , ruídos sonoros, poluição do ar, claridade (21) , tontura (23) , vicio em internet (24) , exclusão social, dissonância emocional (29) , obesidade, uso de televisão por longos períodos (>120 min por dia) (33) , angustia (20) , postura ortostática prolongada, exercício físico irregular (27) , aumento do consumo de álcool, uso de medicação psicotrópica e medo (22) , falta de atividade física (15) , jetlag social reduzido; home office (17) , duração do sono insuficiente (18) , violência no local de trabalho (30) , consumo de café próximo ao horário de dormir (34) , sonolência diurna, privação parcial do sono (38) . ...
... Os fatores que interferem na qualidade do sono envolvem a depressão (16,(19)(20)24,28,33,36) , estresse (15,(19)(20)26,28,32,39) , dor (16,25,27,33) , burnout (24,30,37) , sobrecarga (19,28,33) , longas jornadas de trabalho (33,36) , exaustão (30,37) , irregularidade nos horários de dormir e acordar (31,39) , insatisfação no trabalho (32,37) , baixa qualidade de vida (19,24) , experiências de fracasso no trabalho , fadiga (18)(19) , ansiedade (16,33) , ruídos sonoros, poluição do ar, claridade (21) , tontura (23) , vicio em internet (24) , exclusão social, dissonância emocional (29) , obesidade, uso de televisão por longos períodos (>120 min por dia) (33) , angustia (20) , postura ortostática prolongada, exercício físico irregular (27) , aumento do consumo de álcool, uso de medicação psicotrópica e medo (22) , falta de atividade física (15) , jetlag social reduzido; home office (17) , duração do sono insuficiente (18) , violência no local de trabalho (30) , consumo de café próximo ao horário de dormir (34) , sonolência diurna, privação parcial do sono (38) . ...
O sono é caracterizado como uma necessidade humana básica sendo um tema relevante e emergente pois, a privação ou os distúrbios a ele relacionados ocasionam implicações aos processos metabólicos e inflamatórios, causando impactos negativos a saúde. A saúde dos professores da Educação Básica provoca forte preocupação principalmente no que diz respeito a qualidade do sono e saúde mental por consequência dos desafios e responsabilidades que muitas vezes ultrapassam o ato de lecionar. Objetivo sintetizar as evidências científicas existentes na literatura sobre os fatores que interferem na qualidade do sono de professores da educação básica. Método: revisão integrativa sustentada pela questão de pesquisa “quais são os fatores que interferem na qualidade do sono de professores da educação básica?”, realizada em 14 janeiro de 2023 nas fontes de informação: US National Library of Medicine National Institutes Database Search of Health, Literatura Latino Americana e do Caribe em Ciências da Saúde, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase e SciVerse Scopus. Resultados: O estresse e a depressão foram os fatores que mais interferiram na qualidade do sono seguido da dor identificada em quatro estudos, porém burnout, longas jornadas de trabalho, irregularidade nos horários de dormir e acordar, insatisfação no trabalho, fadiga, ruídos, poluição do ar, claridade, vicio em internet, exclusão social, dissonância emocional, ansiedade, obesidade, uso de televisão por longos períodos, angustia, exercício físico irregular, aumento do consumo de álcool, uso de medicação psicotrópica, medo, falta de atividade física, jetlag social reduzido; home office, duração do sono insuficiente, violência no local de trabalho, consumo de café próximo ao horário de dormir, sonolência diurna e a privação parcial do sono também foram considerados como fatores que interferem na qualidade do sono. Conclusão: Dentre os achados nesse trabalho, os fatores mais preponderantes que interferiram de forma significativa na qualidade do sono são a depressão, o estresse e a dor.
... 19 Finally, delaying school start times in middle and high school increases sleep time, academics outcomes, and quality of life. [20][21][22][23][24][25][26][27] While the pandemic is no longer central in our lives, it led to a proliferation of hybrid instructional models, with some families continuing in virtual instruction. 5,28 With this new status quo, the current study examined how sleep contributed to cognitive and academic function in adolescents across instructional approaches. ...
Introduction/Objective:
The transdiagnostic construct of aggression in children and adolescents is often characterized by distinct mental phenomena, such as irritability, emotional dysregulation (ED), anger, and outbursts. However, these terms are frequently interchanged in clinical settings despite their distinct semantic nuances. Therefore, it is critical to delve into the complex dynamics of aggression, irritability, and emotional dysregulation in the child and adolescent population.
Methods:
An extensive search was conducted across diverse databases using the keywords "Aggression," "Violence," "Irritability," and "Emotional dysregulation." This search encompassed articles on childhood aggression, covering its prevalence, risk factors, clinical manifestations, assessment methods, treatment modalities, and prognostic indicators. Initial screening identified 261 articles, with 40 selected for the initial draft and an additional 15 included later, either manually or via reverse citations.
Results:
The appraisal of aggression is challenging due to its terminology and diagnostic complexities, especially in distinguishing normative behavior from psychopathological impairments. There is a significant lack of empirical evidence, like systematic reviews concerning the heterogenous dimensional understanding of aggression, including its social determinants, comorbidities, and targeted interventions. Likewise, there is a crucial need to assess comorbid conditions like ADHD, DMDD, and ODD to gain deeper insights into their developmental, social, and biological determinants. Emphasizing comorbidity assessment and age of onset during initial diagnostic evaluations is vital, followed by a structured approach to interventions encompassing behavioral and pharmacological strategies.
Conclusion:
There is a need for a stepwise multidimensional assessment towards contextual understanding of aggression and sequencing the treatment of aggression in children and adolescents. It is paramount to incorporate tailored interventions with shared decision-making.
One of the main challenges in translating chronobiology research into clinical practice is represented by differences in how basic scientists and clinicians evaluate evidence. The workshop "Assessing Evidence in Translational Chronobiology," which was held at the University of Surrey in June 2023, addressed this issue by bringing together basic scientists and clinicians to evaluate evidence on two specific topics: the impact of Daylight Saving Time (DST) on road traffic accidents and the relationship between delayed school start times (SSTs) and sleep duration in high school students. A comprehensive literature search was conducted for discussions during the workshop, which is presented in this review. The studies on both topics were analyzed from varying perspectives, including that of a chronobiologist and a transportation engineer for the DST-centered question, and that of a chronobiologist and an evidence-based medicine expert for the SSTs-centered question. The workshop audience, acting as a Delphi panel, attempted to produce statements/recommendations. It was concluded that most studies suggest that sleep duration benefits from delayed SSTs in high school, while less obvious results were obtained regarding the effect of DST on road safety.
Importance: Amid and following the COVID-19 pandemic, there has been a growing focus on understanding the underlying etiology of the mental health crisis in children and youth. However, there remains a dearth of empirically driven literature to comprehensively explore these issues. This narrative review delves into current mental health challenges among children and youth, examining perspectives from both pre-pandemic and pandemic periods. Observations: Research highlights reveal concerning statistics, such as 1 in 5 children experience mental health disorders. The pandemic exacerbated these issues, introducing stressors such as job losses and heightened anticipatory anxiety. Race relations have emerged as a significant public health concern, with biases impacting students, particularly affecting Asian, black, and multiracial individuals. Substance use trends indicate a rise in overdose deaths, particularly among adolescents, with cannabis use linked to adverse outcomes. Increased screen time and income disparities further compound mental health challenges. Conclusions and Relevance: Proposed public health mitigation strategies include improving access to evidence based treatments, implementing legislative measures for early identification and treatment of developmental disorders, and enhancing suicide prevention efforts. School-based interventions and vocational-technical education are crucial, alongside initiatives targeting sleep hygiene, social media usage, nutrition, and physical activity. Educating health care professionals about both physical and mental health is essential to address workforce burnout and effectively manage clinical complexities. Prim Care Companion CNS Disord 2024;26(5):24nr03747. Author affiliations are listed at the end of this article.
Two proposed public policies, ending seasonal clock change with a transition to permanent Standard Time and moving middle school and high school start times later, are population-based initiatives to improve sleep health. Daylight Saving Time and early school start times are associated with reduced sleep duration and increased circadian misalignment, the effects of which impact not only long-term health outcomes including obesity, cerebrovascular and cardiovascular disease, and cancer, but also mental health, academics, workforce productivity, and safety outcomes. This article highlights studies that led to the endorsement of these public policies by multiple scientific and medical organizations. Neurologists should advocate at the state and federal levels and educate the population about the importance of sleep health.
Study objectives:
To examine the impact of changing school start times on sleep for primary (elementary school: ES) and secondary (middle and high school: MS/HS) students.
Methods:
Students (grades 3-12) and parents (grades K-12) were surveyed annually, before and for 2 years after school start time changes (ES: 60 min earlier, MS: 40-60 min later; HS: 70 min later). Student sleep and daytime sleepiness were measured with school-administered student surveys and parent-proxy online surveys.
Results:
Approximately 28,000 students annually completed surveys (~55% White, ~21% free/reduced lunch [FRL]). One-year post-change, weekday bedtimes and wake times were slightly earlier for ES students, with an 11-min decrease in sleep duration. MS and HS students reported slightly later weekday bedtimes, significantly later wake times, and significantly longer sleep duration (MS: 29 min; HS: 45 min). The percent of ES students reporting sufficient sleep duration, poor sleep quality, or daytime sleepiness did not change, but the percent of MS and HS students reporting sufficient sleep duration significantly increased and clinically significant daytime sleepiness decreased. All results were maintained at the 2-year follow-up. Benefits of later start times were similar across racial and free/reduced lunch groups.
Conclusions:
This is the first large scale, longitudinal, and representative study to concurrently examine the impact of changing school start times across students in primary/secondary school. Findings suggest a minimal impact of earlier start times on ES students' sleep or daytime sleepiness, while further supporting the significant benefits of delaying MS and HS start times on student sleep and daytime sleepiness.
Importance
Sleep is a resource that has been associated with health and well-being; however, sleep insufficiency is common among adolescents.
Objective
To examine how delaying school start time is associated with objectively assessed sleep duration, timing, and quality in a cohort of adolescents.
Design, Setting, and Participants
This observational cohort study took advantage of district-initiated modifications in the starting times of 5 public high schools in the metropolitan area of Minneapolis and St Paul, Minnesota. A total of 455 students were followed up from grade 9 (May 3 to June 3, 2016) through grade 11 (March 15 to May 21, 2018). Data were analyzed from February 1 to July 24, 2019.
Exposures
All 5 participating schools started early (7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), 2 schools delayed their start times by 50 and 65 minutes, whereas 3 comparison schools started at 7:30 am throughout the observation period.
Main Outcomes and Measures
Wrist actigraphy was used to derive indices of sleep duration, timing, and quality. With a difference-in-difference design, linear mixed-effects models were used to estimate differences in changes in sleep time between delayed-start and comparison schools.
Results
A total of 455 students were included in the analysis (among those identifying sex, 225 girls [49.5%] and 219 boys [48.1%]; mean [SD] age at baseline, 15.2 [0.3] years). Relative to the change observed in the comparison schools, students who attended delayed-start schools had an additional mean 41 (95% CI, 25-57) objectively measured minutes of night sleep at follow-up 1 and 43 (95% CI, 25-61) at follow-up 2. Delayed start times were not associated with falling asleep later on school nights at follow-ups, and students attending these schools had a mean difference-in-differences change in weekend night sleep of −24 (95% CI, −51 to 2) minutes from baseline to follow-up 1 and −34 (95% CI, −65 to −3) minutes from baseline to follow-up 2, relative to comparison school participants. Differences in differences for school night sleep onset, weekend sleep onset latency, sleep midpoints, sleep efficiency, and the sleep fragmentation index between the 2 conditions were minimal.
Conclusions and Relevance
This study found that delaying high school start times could extend adolescent school night sleep duration and lessen their need for catch-up sleep on weekends. These findings suggest that later start times could be a durable strategy for addressing population-wide adolescent sleep deficits.
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 original description, the field has moved forward with remarkable pace, and this review aims to summarize recent progress and describe how this new work informs our understanding of sleep regulation and sleep behavior during this developmental time frame.
The extensive workload of teachers inside and outside the classroom may contribute to sleep problems. Such problems may occur more frequently in women due to the combination of professional demands, domestic tasks, and their relatively greater sleep needs compared to men. The objective of this cross-sectional study was to evaluate the influence of gender on sleep habits and quality, and daytime sleepiness in a sample of 243 teachers (77 men and 166 women) using questionnaires. Linear regression models were used to examine the effect of gender on sleep measures; the unadjusted model considered only gender and the adjusted model considered chronotype and work characteristics as potential confounders. Bedtimes of women were significantly earlier than men during the week, but not on weekends, in the unadjusted and adjusted models. Time in bed was longer for women throughout the week and weekend in the unadjusted model. However, in the adjusted model, this statistical significance disappeared, and longer time in bed during the week was associated with teaching in one shift and for both levels of education. In addition, the female gender was associated with higher sleepiness scores compared to males in both models, and worse sleep quality in the adjusted model. Also, sleep quality was worse in subjects working in three shifts and in both types of schools (public and private). The tendency to eveningness was associated with later bedtimes and wake up times during both week days and weekends, higher irregularity of bedtimes and wake up times, and higher sleepiness scores in the adjusted model. Therefore, we suggest that female teachers do not fulfill their sleep needs and show higher levels of diurnal sleepiness and poor sleep quality that can be modulated by chronotype and some work characteristics. More studies are needed to evaluate the role of double workload on this pattern.
Besides dealing with high workload, being a teacher is challenging with respect to the social context. There is increasing evidence that adverse social job characteristics challenge sleep quality. The current study tests whether restraint sleep quality (defined as worse sleep quality before than during vacation) is related to time-related job stressors, job resources, and social job characteristics.
Forty-eight elementary school teachers (42% female) participated both during the last week before and the first week after vacation. Before vacation, teachers were asked for demographics and working conditions with reference to the last 30 days, and sleep quality with reference to the last 7 days. After vacation sleep quality during vacation was assessed and used as reference for working time sleep quality.
Results showed mean levels of sleep quality increased during vacation. In teachers with restrained working time sleep quality (38%), experiences of failure at work, social exclusion, and emotional dissonance were more frequent than in teachers with unrestrained working time sleep quality (Ps < .05). Groups did not differ in time-related stressors, time control and social support from supervisors.
Emotion work, social exclusion and individual experience of failure seem to challenge sleep quality in teachers.
The influence of a sleep education program (SEP) on the knowledge, habits, quality of sleep, and daytime sleepiness was evaluated in 40 Brazilian elementary and high school teachers [Groups: Experimental (EG=26)/Control (CG=14)]. The Health and Sleep questionnaire, Pittsburgh Sleep Quality Index and sleep logs were applied to both groups, at baseline and in reassessment three weeks after a SEP with the EG. The methodology of the SEP was based on the Meaningful Learning theory proposed by Ausubel, consisting of four fortnightly meetings, lasting 4h each. After the program, the EG showed an increase in sleep knowledge and a reduction in coffee consumption near bedtime. Besides, 17% of teachers improved sleep quality in this group. However, no changes occurred in sleep schedules and sleepiness. Nevertheless, the positive results reinforce the need for sleep education programs with teachers to spread sleep knowledge in schools and improve the sleep quality in these professionals.
The effects of randomization to a workplace mindfulness training (WMT) or a waitlist control condition on teachers’ well-being (moods and satisfaction at work and home), quantity of sleep, quality of sleep, and sleepiness during the day were examined in 2 randomized, waitlist controlled trials (RCTs). The combined sample of the 2 RCTs, conducted in Canada and the United States, included 113 elementary and secondary school teachers (89% female). Measures were collected at baseline, postprogram, and 3-month follow-up; teachers were randomly assigned to condition after baseline assessment. Results showed that teachers randomized to WMT reported less frequent bad moods at work and home, greater satisfaction at work and home, more sleep on weekday nights, better quality sleep, and decreased insomnia symptoms and daytime sleepiness. Training-related group differences in mindfulness and rumination on work at home at postprogram partially mediated the reductions in negative moods at home and increases in sleep quality at follow-up.
Background:
Insufficient sleep in adolescents has been shown to be associated with a wide variety of adverse outcomes, from poor mental and physical health to behavioral problems and lower academic grades. However, most high school students do not get sufficient sleep. Delaying school start times for adolescents has been proposed as a policy change to address insufficient sleep in this population and potentially to improve students' academic performance, reduce engagement in risk behaviors, and improve health.
Methods:
This article reviews 38 reports examining the association between school start times, sleep, and other outcomes among adolescent students.
Results:
Most studies reviewed provide evidence that delaying school start time increases weeknight sleep duration among adolescents, primarily by delaying rise times. Most of the studies saw a significant increase in sleep duration even with relatively small delays in start times of half an hour or so. Later start times also generally correspond to improved attendance, less tardiness, less falling asleep in class, better grades, and fewer motor vehicle crashes.
Conclusions:
Although additional research is necessary, research results that are already available should be disseminated to stakeholders to enable the development of evidence-based school policies.
ABSTRACT: Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine.
Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine.
© 2015 Associated Professional Sleep Societies, LLC.
In response to the scientific evidence documenting both profound developmental changes in sleep and circadian biology during adolescence and the myriad of negative health, performance, and safety outcomes risks associated with chronic sleep loss, at least 70 public school districts in the United States, representing approximately 1,000 schools, have successfully implemented a delay in high school start times. However, despite the compelling evidence supporting school start time change as a key strategy in addressing the epidemic of adolescent sleep loss, many school districts across the country with early high school start times have not considered the option to implement later bell schedules for adolescents. Moreover, while the current scientific literature has clearly documented the positive outcomes associated with delayed high school start times, these studies contain limited information regarding the process by which school districts consider, approve and implement bell schedule changes. Thus, this in-depth examination of those school districts that have been successful in changing their bell schedules is intended to support the efforts of other districts in various stages of contemplating this measure. We utilized a multi-pronged approach (literature review, case studies, telephone interviews, online survey) to summarize the experiences of school districts across the United States in regard to challenges faced, strategies employed, and lessons learned in the hope that this information will be a useful tool for other school districts looking to chart a course forward to promote the health, safety, and academic opportunities of their students.
The aim of this study was to characterize the sleep-wake cycle, daytime sleepiness and sleep quality of high school teachers. Ninety-eight high school teachers participated in this study. They were asked to complete the Health and Sleep, Horne & Ostberg, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index questionnaires and to keep a 14-day sleep diary. This study showed that high-school teachers wake up on average 1 h 12 min earlier (ANOVA; p < 0.05) and go to bed on average 34 min earlier (ANOVA; p < 0.05) during the week than on the weekend. This results in an average of 42 min less time in bed (ANOVA; p < 0.05) on weekdays and characterizes partial sleep deprivation. Moreover, 46% and 51% of teachers were diagnosed with excessive daytime sleepiness and poor sleep quality (χ2; p > 0.05), respectively. Therefore, high-school teachers show characteristics of partial sleep deprivation that may contribute to excessive daytime sleepiness and poor sleep quality. This situation may compromise health and quality of life, in addition to teaching performance that can affect the education of their students.
Purpose
– To compare the experience of occupational stress across a large and diverse set of occupations. Three stress related variables (psychological well‐being, physical health and job satisfaction) are discussed and comparisons are made between 26 different occupations on each of these measures. The relationship between physical and psychological stress and job satisfaction at an occupational level is also explored.Design/methodology/approach – The measurement tool used is a short stress evaluation tool which provides information on a number of work related stressors and stress outcomes. Out of the full ASSET database 26 occupations were selected for inclusion in this paper.Findings – Six occupations are reporting worse than average scores on each of the factors – physical health, psychological well‐being and job satisfaction (ambulance workers, teachers, social services, customer services – call centres, prison officers and police). Differences across and within occupational groups, for example, teaching and policing, are detailed. The high emotional labour associated with the high stress jobs is discussed as a potential causal factor.Research limitations/implications – This is not an exhaustive list of occupations and only concerns employees working within the UK.Originality/value – There is little information available that shows the relative values of stress across different occupations, which would enable the direct comparison of stress levels. This paper reports the rank order of 26 different occupations on stress and job satisfaction levels.
This article reports on the development of short forms from the Patient-Reported Outcomes Measurement Information System (PROMIS™) Sleep Disturbance (SD) and Sleep-Related Impairment (SRI) item banks. Results from post-hoc computerized adaptive testing (CAT) simulations, item discrimination parameters, item means, and clinical judgments were used to select the best-performing 8 items for SD and SRI. The final 8-item short forms provided less test information than the corresponding full banks, but correlated strongly with the longer forms. The short forms had greater measurement precision than the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), as indicated by larger test information values across the continuum of severity, despite having fewer total items--a major advantage for both research and clinical settings.
To develop an archive of self-report questions assessing sleep disturbance and sleep-related impairments (SRI), to develop item banks from this archive, and to validate and calibrate the item banks using classic validation techniques and item response theory analyses in a sample of clinical and community participants.
Cross-sectional self-report study.
Academic medical center and participant homes.
One thousand nine hundred ninety-three adults recruited from an Internet polling sample and 259 adults recruited from medical, psychiatric, and sleep clinics.
None.
This study was part of PROMIS (Patient-Reported Outcomes Information System), a National Institutes of Health Roadmap initiative. Self-report item banks were developed through an iterative process of literature searches, collecting and sorting items, expert content review, qualitative patient research, and pilot testing. Internal consistency, convergent validity, and exploratory and confirmatory factor analysis were examined in the resulting item banks. Factor analyses identified 2 preliminary item banks, sleep disturbance and SRI. Item response theory analyses and expert content review narrowed the item banks to 27 and 16 items, respectively. Validity of the item banks was supported by moderate to high correlations with existing scales and by significant differences in sleep disturbance and SRI scores between participants with and without sleep disorders.
The PROMIS sleep disturbance and SRI item banks have excellent measurement properties and may prove to be useful for assessing general aspects of sleep and SRI with various groups of patients and interventions.
A total of 704 general practitioners and 588 teachers responded to a questionnaire about their health and lifestyle in 1991 (response rates 82% and 87%, respectively). The results for lifestyle measures were compared with those of a similar questionnaire completed by about half of each group two years before--there were no changes in the answers of either occupational group in the intervening two years. In 1991, 9% of general practitioners and 15% of teachers drank 22 units of alcohol per week or more; 13% of general practitioners and 23% of teachers reported troublesome depression and 31% of doctors and 37% of teachers excessive anxiety in the preceding 12 months. Teachers had more sickness absence, and significantly more experienced a need for daily alcohol and binge eating, and reported sleep difficulties, depression and anxiety than general practitioners. Self-medication among general practitioners was common and overall accounted for 83% of the medication taken by doctors. A follow-up survey of non-respondents found that only 11% of general practitioners and 11% of teachers indicated they had a health problem they wished to conceal or that they felt the questions were too intimate. General practitioners' lifestyle habits are better than those of teachers and published figures for the general population. The frequency of reported mental health problems in both professions gives cause for concern.
BACKGROUND
Most adolescents in the United States do not obtain sufficient sleep. Early school start times play a significant role in adolescent sleep deprivation. Most primary and secondary schools begin classes earlier than the 8:30 am. Perceived barriers to implementing a delayed school start time have been suggested in the literature but have not been quantified. This study explored perceived barriers and facilitating factors for implementing delayed high‐school start times.
METHODS
A cross‐sectional study. School administrators who had delayed their school start times were invited to complete an online questionnaire ranking the perceived barriers and facilitating factors for implementing the delayed start times.
RESULTS
Most commonly cited perceived barriers were lack of a tiered bus system, school athletes missing more afternoon classes, and less time after school for athletics. Most commonly cited facilitating factors were school‐administrator involvement in the decision‐making process and sleep education for family members and school administrators.
CONCLUSIONS
Participants found that providing sleep education to fellow administrators, teachers, school staff members, families, and students and including them in the decision‐making process positively facilitated the implementation of delayed school start times. Perceived barriers to implementation may be overcome with support from stakeholders and planning committees.
The present study examined the impact of sleep, stress, and negative activating emotions of high‐school teachers on their students’ affective experience, academic motivation, and in‐class satisfaction. It is hypothesized that teachers’ sleep quality and stress have a positive influence on their own nervousness and irritability. With reference to the emotional crossover theory, teachers’ nervousness and irritability are hypothesized to intensify students’ nervousness and irritability and subsequently dampen their academic motivation and in‐class satisfaction. Experience‐sampling data were collected from 17 teachers and 437 students from two local high schools in Hong Kong across a 10‐school‐day period. Multilevel path analysis results revealed that teachers’ stress was significantly associated with teachers’ nervousness and irritability. Teachers’ nervousness, rather than irritability, was subsequently associated with higher levels of nervousness and irritability among students, which, in turn, impaired their in‐class satisfaction. There was also a significant negative association between students’ irritability and their academic motivation. Results further showed that teachers’ stress arising from poor sleep quality was a significant antecedent of the teacher–student emotional crossover, subsequently affecting students’ academic motivation and in‐class satisfaction. The findings highlight the detrimental effects of teachers’ poor sleep and the resulting stress on students’ academic and affective experience. Discussion focuses on how to improve teachers’ sleep and manage their stress so as to enhance students’ in‐class emotions and academic motivation.
Despite growing evidence of the positive impact of later school start times on adolescent health and academic outcomes, relatively few districts have changed start times due to concerns about transportation, child care, and athletics/extracurricular activities. This paper provides a case study of the Cherry Creek School District's (CCSD) successful efforts to change start times. The CCSD is a diverse district with an enrollment of almost 55,000 students in suburban Denver. As part of CCSD's strategic plan, a multi-disciplinary task force was formed to examine the impact of start times on student achievement, and recommend a start time schedule driven by best practices on adolescent sleep patterns, balanced with family and community needs. Over 18 months the task force's work included engaging the community through meetings, as well as conducting a large survey (n = 24,574) of parents, teachers, and students, and gathering online feedback. An iterative process utilized feedback at every stage to refine the final recommendation given to the Board of Education. Survey results, implementation considerations, outcome evaluation plans, and lessons learned are discussed.
Objective
To determine whether simultaneous school start time changes (delay for some schools; advance for others) impact adolescents' sleep.
Design
Quasi-experimental study using cross-sectional surveys before and after changes to school start times in September 2015.
Setting
Eight middle (grades 7-8), 3 secondary (grades 7-12), and 8 high (grades 9-12) schools in Fairfax County (Virginia) public schools.
Participants
A total of 2017 (6% of ~34,900) students were surveyed before start time changes, and 1180 (3% of ~35,300) were surveyed after.
Intervention
A 50-minute delay (7:20 to 8:10 am) in start time for high schools and secondary schools and a 30-minute advance (8:00 to 7:30 am) for middle schools.
Measurements
Differences before and after start time changes in self-reported sleep duration and daytime sleepiness.
Results
Among respondents, 57.5% were non-Hispanic white, and 10.3% received free or reduced-priced school meals. Before start time changes, high/secondary and middle school students slept a mean (SD) of 7.4 (1.2) and 8.4 (1.0) hours on school nights, respectively, and had a prevalence of daytime sleepiness of 78.4% and 57.2%, respectively. Adjusted for potential confounders, students with a 50-minute delay slept 30.1 minutes longer (95% confidence interval [CI], 24.3-36.0) on school nights and had less daytime sleepiness (−4.8%; 95% CI, −8.5% to −1.1%), whereas students with a 30-minute advance slept 14.8 minutes less (95% CI, −21.6 to −8.0) and had more daytime sleepiness (8.0%; 95% CI, 2.5%-13.5%).
Conclusions
Both advances and delays in school start times are associated with changes in adolescents' school-night sleep duration and daytime sleepiness. Larger changes might occur with later start times.
The weekend is usually seen as a window of recovery. Thus, sleep before a day off may be less impaired than that before a workday. However, very few polysomnographical studies have investigated this hypothesis. Therefore, the aim of the present study was to compare sleep before a workday with that before a weekend. Seventeen teachers participated. Sleep was recorded with polysomnography on one weekday night during the workweek, and on a workday (Friday) followed by a day off. Sleep diaries and actigraphs were also used. Weekend sleep showed delayed bedtime and time of rising, a longer total sleep time (45 min), increased N3 and N1, and decreased N2 and REM. Sleep spindles were reduced. The results remained after truncation to the shortest common sleep duration (5 h). The increase in N3 from weekday sleep to Friday night sleep was positively correlated with N1 change (r = 0.853, P ≤ 0.001), and negatively correlated with N2 change (r = -0.614, P ≤ 0.001). Subjective ratings showed that weekend sleep was associated with less awakening problems and lower subjective arousal during the day. The authors concluded that weekend sleep was longer, and showed increased N3 and N1. The authors suggest that the N3 increase before the day off is a result of lower stress, while the N1 increase may be an effect of sleep spindle suppression via the increase of N3 (which would suppress sleep spindles), thus reducing N2 and enhancing N1.
The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation's middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students' ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8: 30 AM) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5-9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life.
In the early 1990s, medical research found that teenagers have biologically different sleep and wake patterns than the preadolescent or adult population. On the basis of that information, in 1997 the seven comprehensive high schools in the Minneapolis Public School District shifted the school start timefrom 7:15 a. m. to 8:40 a. m. This article examines that change, finding significant benefits such as improved attendance and enrollment rates, less sleeping in class, and less student-reported depression. Policy implications are briefly discussed, acknowledging this to be a highly charged issue in school districts across the United States.
Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness.
Good sleep is essential to good health. Yet for most of its history, sleep medicine has focused on the definition, identification, and treatment of sleep problems. Sleep health is a term that is infrequently used and even less frequently defined. It is time for us to change this. Indeed, pressures in the research, clinical, and regulatory environments require that we do so. The health of populations is increasingly defined by positive attributes such as wellness, performance, and adaptation, and not merely by the absence of disease. Sleep health can be defined in such terms. Empirical data demonstrate several dimensions of sleep that are related to health outcomes, and that can be measured with self-report and objective methods. One suggested definition of sleep health and a description of self-report items for measuring it are provided as examples. The concept of sleep health synergizes with other health care agendas, such as empowering individuals and communities, improving population health, and reducing health care costs. Promoting sleep health also offers the field of sleep medicine new research and clinical opportunities. In this sense, defining sleep health is vital not only to the health of populations and individuals, but also to the health of sleep medicine itself.
Buysse DJ. Sleep health: can we define it? Does it matter? SLEEP 2014;37(1):9-17.
Chronic insufficient sleep is a growing concern among adolescents and is associated with a host of adverse health consequences. Early school start times may be an environmental contributor to this problem. The purpose of this study was to examine the impact of a delay in school start time on sleep patterns, sleepiness, mood, and health-related outcomes.
Boarding students (n = 197, mean age = 15.6 yr) attending an independent high school completed the School Sleep Habits Survey before and after the school start time was experimentally delayed from 8:00 a.m. to 8:25 a.m.
The delay in school start time was associated with a significant (29 min) increase in sleep duration on school nights. The percentage of students receiving 8 or more hours of sleep on a school night increased to more than double, from 18% to 44%. Students in 9th and 10th grade and those with lower baseline sleep amounts were more likely to report improvements in sleep duration after the schedule change. Daytime sleepiness, depressed mood, and caffeine use were all significantly reduced after the delay in school start time. Sleep duration reverted to baseline levels when the original (earlier) school start time was reinstituted.
A modest (25 min) delay in school start time was associated with significant improvements in sleep duration, daytime sleepiness, mood, and caffeine use. These findings have important implications for public policy and add to research suggesting the health benefits of modifying school schedules to more closely align with adolescents' circadian rhythms and sleep needs.
In the early 1990s, medical research found that teenagers have biologically different sleep and wake patterns than the preadolescent or adult popula- tion. On the basis of that information, in 1997 the seven comprehensive high schools in the Minneapolis Public School District shifted the school start time from 7:15 a.m. to 8:40 a.m. This article examines that change, find- ing significant benefits such as improved attendance and enrollment rates, less sleeping in class, and less student-reported depression. Policy implica- tions are briefly discussed, acknowledging this to be a highly charged issue in school districts across the United States. Recent research information about the sleep needs of adolescents and the influence of sleep on learning and behavior has captured the atten- tion of school districts across the United States. Physicians, parents, school board members, and others are asking school administrators and policymak- ers to acknowledge the medical evidence about the biological sleep patterns of teenagers and to adjust school schedules accordingly. The discussions and debates have been intense because this is a multifaceted issue. School admin- istrators are being asked to weigh the factual information about the biology of adolescents' sleep patterns against the competing demands of teachers' work preferences, athletic and afterschool activity schedules, and bus trans- portation schedules. This article presents findings from a 4-year study in a large, urban school district that altered high school start times significantly from 7:15 a.m. to 8:40 a.m. This change affected more than 12,000 secondary students within a total K-12 population of nearly 51,000 students.
Background: Sleep deprivation is a world-wide health concern. Few studies have examined the sleep behaviors of those employed in the education field. Purpose: To describe the sleep habits and concerns of school personnel in a Midwest school corporation. Methods: A cross-sectional survey design was used to collect data about demographics, the Medical Outcomes Study (MOS) Sleep Measure, the Epworth Sleepiness Scale (ESS) and sleep concerns. Data were analyzed using univariate and bivariate procedures. Results: Almost 25% of teachers reported daily activities were impaired by sleepiness and 43% slept an average of six hours or less per night. Female respondents reported significantly poorer sleep. Overall, school employees experienced more sleep problems than reported by the general U.S. population. Discussion: This study confirmed the existence of sleep deprivation among school personnel. Sleepy teachers are at higher risk of providing insufficient supervision and inferior instruction. They also report more mood swings and are at higher risk for health problems. Little attention has been given to the sleep concerns and behaviors of school personnel, and there is a need for further research. Translation to Health Education Practice: Education regarding the importance of sleep and how to get a good night's sleep should be included in employee wellness programming.
The objectives of this study were, firstly, to examine the association between job strain and sleep quality in a sample of primary and secondary school teachers and, secondly, to assess whether the relationship between job strain and sleep quality is mediated or moderated by an individual's inability to “switch-off ” from work-related issues during leisure time. School teachers (N = 143) completed an hourly record of their work-related thoughts over a workday evening between 5 p.m. and bedtime, and then rated their sleep quality the following morning. Individuals were classified as reporting high (n = 46) or low (n = 52) job strain using predetermined cut-off scores. Consistent with previous research, the results showed that both groups demonstrated a degree of unwinding and disengagement from work issues over the evening. However, compared to the low job strain group, the high job strain teachers took longer to unwind and ruminated more about work-related issues, over the whole evening, including bedtime. There was no difference in total sleep time between the groups, but high job strain individuals reported poorer sleep quality compared to low job strain individuals. With respect to the second objective, across the whole sample (N = 143), work rumination and job strain were significantly correlated with sleep quality, but work rumination was not found to mediate, or moderate the relationship between job strain and sleep quality. It was speculated that the initial low contribution of job strain to sleep quality (r = −.18) may have contributed to this null finding. The current findings may have implications for how we assess and manage sleep disturbance in stressed workers.
To examine the impact of a 30-minute delay in school start time on adolescents' sleep, mood, and behavior.
Participants completed the online retrospective Sleep Habits Survey before and after a change in school start time.
An independent high school in Rhode Island.
Students (n = 201) in grades 9 through 12. Intervention Institution of a delay in school start time from 8 to 8:30 am.
Sleep patterns and behavior, daytime sleepiness, mood, data from the Health Center, and absences/tardies.
After the start time delay, mean school night sleep duration increased by 45 minutes, and average bedtime advanced by 18 minutes (95% confidence interval, 7-29 minutes [t(423) = 3.36; P < .001]); the percentage of students getting less than 7 hours of sleep decreased by 79.4%, and those reporting at least 8 hours of sleep increased from 16.4% to 54.7%. Students reported significantly more satisfaction with sleep and experienced improved motivation. Daytime sleepiness, fatigue, and depressed mood were all reduced. Most health-related variables, including Health Center visits for fatigue-related complaints, and class attendance also improved.
A modest delay in school start time was associated with significant improvements in measures of adolescent alertness, mood, and health. The results of this study support the potential benefits of adjusting school schedules to adolescents' sleep needs, circadian rhythm, and developmental stage.
With the onset of adolescence, teenagers require 9.2 hr of sleep and experience a delay in the timing of sleep. In the "real world" with early school start times, however, they report less sleep, striking differences between their school-weekend sleep schedules, and significant daytime sleepiness. Prior studies demonstrated that high schoolers with later school starts do not further delay bedtime but obtain more sleep due to later wake times. This study examined sleep-wake patterns of young adolescents attending urban, public middle schools with early (7:15 a.m.) versus late (8:37 a.m.) start times. Students (N = 205) were assessed at 2 time periods. Students at the late-starting school reported waking up over 1 hr later on school mornings and obtaining 50 min more sleep each night, less sleepiness, and fewer tardies than students at the early school. All students reported similar school-night bedtime, sleep hygiene practices, and weekend sleep schedules.
Examining the Impact of Later School Start Times on the Health and Academic Performance of High School Students: A Multi‐Site Study
- K Wahlstrom
- B Dretzke
- M Gordon
- K Peterson
- K Edwards
- J Gdula
Effect of a sleep education program on sleep knowledge and habits in elementary and high school teachers
- JC Souza
- SD Galina
- IC Sousa
- CVM Azevedo