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Saletin JM, Wolfson AR, Wahlstrom KL, Honaker SM, Owens JA, Seixas AA, Wong P, Carskadon MA, Meltzer LJ. Instructional approach, sleep, and perceived academic well-being in adolescents during COVID-19: Evidence from the NESTED study. Sleep Health 2024; 10:485-492. [PMID: 38876932 DOI: 10.1016/j.sleh.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES At the peak of COVID-19, adolescent life was disrupted as schools adapted their instructional approaches such as online, in-person, or hybrid instruction. We and others have previously commented on how these shifts facilitated longer, later and (more developmentally appropriate) sleep. Here, we report how sleep contributed to associations between remote instruction and broader academic well-being (e.g., cognitive function, school connectedness, and stress). METHODS Adolescents from all 50 U.S. states (n = 4068) completed online self-report surveys in fall 2020. Instructional approach was operationalized from fully in-person instruction to fully asynchronous online education. Sleep parameters included sleep timing and duration, sleep disturbances, and sleep-related impairments. Perceived academic well-being was defined as cognitive function, school connectedness, and school-related stress. Sleep and perceived academic well-being are examined across instructional approaches, in their association, and in structural models. RESULTS Sleep and perceived academic well-being differed between hybrid and online instruction groups. Less variable or disturbed sleep was associated both with in-person instruction, and with positive outcomes in cognitive function, school connectedness, and stress domains. Sleep mediated a substantial portion of variance in perceived academic well-being attributable to instructional approach. CONCLUSION These data highlight the need to protect both healthy sleep and in-person instruction. Appropriate sleep timing and duration, fewer sleep disturbances and sleep-related impairments accounted for a substantial degree of variance in the association between remote instruction on academic outcomes. While many students experienced "lost learning" because of COVID-19, this study joins a broader discussion of ensuring developmentally appropriate school-start times to support both sleep and achievement.
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Affiliation(s)
- Jared M Saletin
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, USA; E.P. Bradley Hospital, East Providence, Rhode Island, USA.
| | - Amy R Wolfson
- Department of Psychology, Loyola University Maryland, Baltimore, Maryland, USA
| | - Kyla L Wahlstrom
- Department of Organizational Leadership, Policy, and Development, University of Minnesota, St. Paul, Missouri, USA
| | - Sarah M Honaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Judith A Owens
- Department of Neurology, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts, USA
| | - Azizi A Seixas
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida, USA
| | - Patricia Wong
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, USA; E.P. Bradley Hospital, East Providence, Rhode Island, USA
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, USA; E.P. Bradley Hospital, East Providence, Rhode Island, USA
| | - Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
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Mathew GM, Reichenberger DA, Master L, Buxton OM, Chang AM, Hale L. Actigraphic sleep dimensions and associations with academic functioning among adolescents. Sleep 2024; 47:zsae062. [PMID: 38442263 PMCID: PMC11236952 DOI: 10.1093/sleep/zsae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
STUDY OBJECTIVES There is mixed evidence regarding associations of sleep duration with academic functioning in adolescents and a lack of research on other sleep dimensions, particularly using objective sleep measures. We examined associations of multiple actigraphic sleep dimensions with academic functioning among adolescents. METHODS Data were from the sleep sub-study of the age 15 wave of the Future of Families and Child Wellbeing Study (n = 774-782; 52% female), a national, diverse sample of teens. Adolescents wore wrist-actigraphs for ~1 week and completed a survey reporting academic performance and school-related behavioral problems. Regression models assessed whether average sleep duration, timing, maintenance efficiency, and SD-variability were associated with self-reported academic functioning in cross-sectional analyses adjusted for demographic characteristics, depressive symptoms, and anxious symptoms. RESULTS Later sleep timing (hours) and greater sleep variability (SD-hours) were associated with poorer academic outcomes, including sleep onset variability with higher odds of receiving a D or lower (OR = 1.29), sleep onset (β = -.07), sleep offset (β = -.08), and sleep duration variability (β = -.08) with fewer A grades, sleep offset with lower GPA (β = -.07), sleep offset (OR = 1.11), sleep duration variability (OR = 1.31), and sleep onset variability (OR = 1.42) with higher odds of being suspended or expelled in the past 2 years, and sleep duration variability with greater trouble at school (β = .13). Sleep duration, sleep maintenance efficiency, and sleep regularity index were not associated with academic functioning. CONCLUSIONS Later sleep timing and greater sleep variability are risk factors for certain academic problems among adolescents. Promoting sufficient, regular sleep timing across the week may improve adolescent academic functioning.
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Affiliation(s)
- Gina Marie Mathew
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, 101 Nicolls Road, Health Sciences Center, Stony Brook, NY, USA
| | - David A Reichenberger
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, USA
| | - Lindsay Master
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, USA
| | - Orfeu M Buxton
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, USA
| | - Anne-Marie Chang
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, USA
| | - Lauren Hale
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, 101 Nicolls Road, Health Sciences Center, Stony Brook, NY, USA
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Ingham-Hill E, Hewitt A, Lester A, Bond B. Morning compared to afternoon school-based exercise on cognitive function in adolescents. Brain Cogn 2024; 175:106135. [PMID: 38306762 DOI: 10.1016/j.bandc.2024.106135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/11/2023] [Accepted: 01/20/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE Adolescents may be less ready to learn in the mornings due to a propensity for waking up later. High-intensity interval exercise (HIIE) has been shown to acutely improve cognitive functioning in teenagers. This within-measures study explored whether the benefit of HIIE differs when delivered in the morning or afternoon. METHODS 37 teenagers (19 boys, 13.7 ± 0.4 years) each completed 3 trials in school; morning HIIE (MORN), afternoon HIIE (AFTER) and a no-exercise control trial (CON). The HIIE involved 10x10 second sprints, interspersed by 50 s of walking. Cognitive function was assessed using a battery of computerised tasks four times over the course of the day. RESULTS Z scores for reaction time, but not proportion of correct responses, were improved 45 min post exercise in the MORN trial (P < 0.01, d = 0.47), and this improvement persisted until the third (P = 0.04, d = 0.34), but not final (P = 0.93, d = 0.01), time point. Global reaction time was not improved 45 min post exercise in the AFTER trial (P = 0.17, d = 0.20). Global reaction time was quicker 45 min post morning exercise compared to the same time point in CON (P = 0.02, d = 0.56) and AFTER (P = 0.01, d = 0.72). CONCLUSION HIIE may be more effectual in improving cognitive functioning when delivered in the morning.
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Affiliation(s)
- E Ingham-Hill
- The Children's Health and Exercise Research Centre (CHERC), University of Exeter, United Kingdom
| | - A Hewitt
- The Children's Health and Exercise Research Centre (CHERC), University of Exeter, United Kingdom
| | - A Lester
- The Children's Health and Exercise Research Centre (CHERC), University of Exeter, United Kingdom
| | - B Bond
- The Children's Health and Exercise Research Centre (CHERC), University of Exeter, United Kingdom.
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4
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Hasler BP, Wallace ML, Graves JL, Witt R, Guo K, Buysse DJ, Siegle GJ, Clark DB. Pre-pandemic circadian phase predicts pandemic alcohol use among adolescents. J Sleep Res 2024; 33:e13905. [PMID: 37039532 PMCID: PMC10564965 DOI: 10.1111/jsr.13905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
Later circadian timing during adolescence is linked to worse sleep, more severe depression and greater alcohol involvement, perhaps due to circadian misalignment imposed by early school schedules. School schedules shifted later during the COVID-19 pandemic, ostensibly reducing circadian misalignment and potentially mitigating problems with depression and alcohol. We used the pandemic as a natural experiment to test whether adolescent drinkers with later circadian timing showed improvements in sleep, depression and alcohol involvement. Participants were 42 adolescents reporting alcohol use. We assessed circadian phase via dim light melatonin onset prior to the pandemic, then conducted remote assessments of sleep, depressive symptoms and alcohol use during the pandemic. Mixed-effects models were used to test for pandemic effects, covarying for age, sex, time since baseline evaluation, and current school/work status. Adolescents with later circadian timing reported less sleep than other teens on school nights, both before and during the pandemic. Although school night sleep increased during the pandemic (F = 28.36, p < 0.001), those increases were not greater for individuals with later circadian timing. Individuals with later circadian timing reported larger increases in alcohol use than other teens during the pandemic (X2 = 36.03, p < 0.001). Depressive symptoms increased during the pandemic (X2 = 46.51, p < 0.001) but did not differ based on circadian timing. Consistent with prior reports, adolescents with later circadian timing obtained less sleep, and later school schedules facilitated increased sleep duration. Nonetheless, individuals with later circadian timing reported the sharpest increases in alcohol use, suggesting that circadian timing contributes to risk for alcohol use beyond the effects of insufficient sleep.
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Affiliation(s)
- Brant P. Hasler
- University of Pittsburgh School of Medicine, Department of
Psychiatry
| | | | - Jessica L. Graves
- University of Pittsburgh School of Medicine, Department of
Psychiatry
| | - Rachel Witt
- University of Pittsburgh School of Medicine, Department of
Psychiatry
| | - Kathryn Guo
- University of Pittsburgh School of Medicine, Department of
Psychiatry
| | - Daniel J. Buysse
- University of Pittsburgh School of Medicine, Department of
Psychiatry
| | - Greg J. Siegle
- University of Pittsburgh School of Medicine, Department of
Psychiatry
| | - Duncan B. Clark
- University of Pittsburgh School of Medicine, Department of
Psychiatry
- School of Pharmacy, Department of Pharmaceutical Sciences,
Pittsburgh, PA, USA
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5
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Budescu M, Reid A, Sisselman-Borgia A, Holbrook N, Valera D, Torino GC. Sleep and mental health among youth experiencing homelessness: A retrospective pilot diary study. Sleep Health 2024; 10:54-59. [PMID: 37989625 DOI: 10.1016/j.sleh.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES The goal of this study was to describe the nightly sleep conditions of youth experiencing homelessness, and examine the association between sleep and mental health, both cross-sectionally and using diary data. METHODS n = 147 youth (ages 16-24) experiencing homelessness completed a baseline survey assessing self-reported sleep and depressive and anxious symptoms. A subsample of n = 49 completed a follow-up 7-day diary study measuring nightly sleep conditions and daily depressive and somatic symptoms. RESULTS According to baseline data, the majority of the sample (71%) reported sleeping less than 7 hours per night on average, and feeling like they did not get adequate sleep, especially among youth identifying as LGBTQ. In a qualitative follow-up question, the plurality attributed poor sleep to mental health woes. Cross-sectionally, youth with lower levels of self-reported sleep quality (more daytime fatigue and insomnia) reported higher levels of depressive and anxious symptoms. The diary data indicated that the most common nightly complaints among shelter utilizers are lack of privacy, noise, and uncomfortable temperatures. Multilevel models suggest that poor sleep conditions predicted higher levels of somatic symptoms the following day, after controlling for baseline levels of depressive and anxious symptoms. CONCLUSIONS This study highlights the role environmental context plays in sleep health and its subsequent impacts. Individuals experiencing homelessness lack autonomy over their sleeping environments, and thus cannot make adjustments such as reducing disruptions such as noise, temperature, and light. Importantly, these less-than-ideal sleeping conditions contribute to pre-existing health disparities and may have long-term implications.
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Affiliation(s)
- Mia Budescu
- Department of Psychology, Lehman College of the City University of New York, Bronx, New York, USA.
| | - Anne Reid
- Department of Psychology, Lehman College of the City University of New York, Bronx, New York, USA
| | - Amanda Sisselman-Borgia
- Department of Social Work, Lehman College of the City University of New York, Bronx, New York, USA
| | - Nicole Holbrook
- Department of Psychology, Lehman College of the City University of New York, Bronx, New York, USA
| | - Dania Valera
- Department of Psychology, Lehman College of the City University of New York, Bronx, New York, USA
| | - Gina C Torino
- Department of Human Development, Empire State College, Staten Island, New York, USA
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6
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Hale L, Mathew GM. Emerging research on circadian misalignment and cardiometabolic health of adolescents. Sleep 2024; 47:zsad291. [PMID: 37982412 DOI: 10.1093/sleep/zsad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Lauren Hale
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Gina Marie Mathew
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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7
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Gorovoy SB, Tubbs AS, Grandner MA. Sleep disorders symptoms in children, adolescents, and emerging adults: Reducing mortality and population health burden through improved identification, referral, and treatment. Sleep Health 2023; 9:991-992. [PMID: 37648647 PMCID: PMC11041109 DOI: 10.1016/j.sleh.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Suzanne B Gorovoy
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA.
| | - Andrew S Tubbs
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
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8
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Fazel M, Soneson E. Current evidence and opportunities in child and adolescent public mental health: a research review. J Child Psychol Psychiatry 2023; 64:1699-1719. [PMID: 37771261 DOI: 10.1111/jcpp.13889] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents. METHODS This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions. RESULTS In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements. CONCLUSIONS There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
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9
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Johnson KG, Malow BA. Implications of Sleep Health Policy: Daylight Saving and School Start Times. Continuum (Minneap Minn) 2023; 29:1253-1266. [PMID: 37590832 DOI: 10.1212/con.0000000000001331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
ABSTRACT 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.
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Widome R, Erickson DJ, Laska MN, Berger AT, Lenk KM, Iber C, Kilian G, Lammert S, Wahlstrom KL. Impact of delaying high school start times on weight and related behaviors - the START study. Prev Med 2023; 172:107548. [PMID: 37201593 PMCID: PMC10319406 DOI: 10.1016/j.ypmed.2023.107548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
In the US, few adolescents get adequate school night sleep, largely due to early school start times. In the START study we aimed to test the following hypothesis: That following the implementation of later high school start times students have lesser longitudinal increases in body mass index (BMI) and shift to more healthful weight-related behaviors relative to students attending schools that retain early start times. The study enrolled a cohort of students (n = 2426) in five high schools in the Twin Cities, MN metro. Heights and weights were measured objectively, and surveys were administered annually from 9th through 11th grades (2016-2018). All study schools started early (either 7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), two schools delayed their start times by 50-65 min, while three comparison schools started at 7:30 am throughout the observation period. Using a difference-in-differences natural experiment design, we estimated differences in changes in BMI and weight-related behaviors over time between policy change and comparison schools. Students' BMIs increased in parallel in both policy change and comparison schools over time. However relative to changes in comparison schools after the start time shift, students in policy change schools had a modestly more healthful profile of weight-related behaviors - for instance they had a relatively greater probability of eating breakfast, having supper with their family, getting more activity, eating fast food less frequently, and eating vegetables daily. Later start times could be a durable, population-wide strategy that promotes healthful weight behaviors.
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Affiliation(s)
- Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA.
| | - Darin J Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Aaron T Berger
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Kathleen M Lenk
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Conrad Iber
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, MN, USA
| | - Gudrun Kilian
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Sara Lammert
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Kyla L Wahlstrom
- Department of Organizational Leadership, Policy and Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
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11
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Barley BK, Gao C, Luster T, Porro A, Parizi-Robinson M, Quigley D, Zinke P, Scullin MK. Chronotype in college science students is associated with behavioral choices and can fluctuate across a semester. Chronobiol Int 2023; 40:710-724. [PMID: 37080776 DOI: 10.1080/07420528.2023.2203251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
Many students self-report that they are "night owls," which can result from neurodevelopmental delays in the circadian timing system. However, whether an individual considers themselves to be an evening-type versus a morning-type (self-reported chronotype) may also be influenced by academic demands (e.g. class start times, course load) and behavioral habits (e.g. bedtime social media use, late caffeine consumption, daytime napping). If so, then chronotype should be malleable. We surveyed 858 undergraduate students enrolled in demanding science courses at up to three time points. The survey assessed morning/evening chronotype, global sleep quality, academics, and behavioral habits. Evening and morning-type students showed similar demographics, stress levels, and academic demands. At baseline measurements, relative to morning-types, evening-types showed significantly worse sleep quality and duration as well as 22% greater bedtime social media usage, 27% greater daytime napping duration, and 46% greater likelihood of consuming caffeine after 5pm. These behavioral habits partially mediated the effects of self-reported chronotype on sleep quality/duration, even after controlling for demographic factors. Interestingly, 54 students reported switching from being at least moderate evening-types at baseline to being at least moderate morning-types later in the semester and 56 students showed the reverse pattern (6.3% of students switched from "definitely" one chronotype to the other chronotype). Evening-to-morning "chrono-switchers" consumed less caffeine after 5pm and showed significantly better sleep quantity/quality at the later timepoint. Thus, some students may consider themselves to be night owls in part because they consume caffeine later, take more daytime naps, or use more social media at bedtime. Experimental work is needed to determine whether nudging night owls to behave like morning larks results in better sleep health or academic achievement.
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Affiliation(s)
- Blake K Barley
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Chenlu Gao
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Taylor Luster
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Abbye Porro
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | | | - Dena Quigley
- Department of Biology, Baylor University, Waco, Texas, USA
| | - Paul Zinke
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, USA
| | - Michael K Scullin
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
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12
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Wesley KL, Cooper EH, Brinton JT, Meier M, Honaker S, Simon SL. A National Survey of U.S. Adolescent Sleep Duration, Timing, and Social Jetlag During the COVID-19 Pandemic. Behav Sleep Med 2023; 21:291-303. [PMID: 35699363 PMCID: PMC9747982 DOI: 10.1080/15402002.2022.2086871] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess changes in duration, timing, and social jetlag in adolescent sleep during the COVID-19 pandemic and evaluate the impact of mood, physical activity, and social interactions on sleep. STUDY DESIGN An online survey queried adolescents' sleep before (through retrospective report) and during the initial phase of COVID-19 in May 2020. Adolescents (N = 3,494), 13-19 years old, in the United States (U.S.) answered questions about their current and retrospective (prior to COVID-19) sleep, chronotype, mood, and physical and social activities. Linear regression models were fit for time in bed, reported bed and wake times, and social jetlag during COVID-19, accounting for pre-COVID-19 values. RESULTS Total reported time in bed (a proxy for sleep duration) increased on weekdays by an average of 1.3 ± 1.8 hours (p < .001) during COVID-19, compared to retrospective report of time in bed prior to COVID-19. During COVID-19, 81.3% of adolescents reported spending 8 hours or more in bed on weekdays compared to only 53.5% prior to COVID-19. On weekdays, bedtimes were delayed on average by 2.5 hours and wake times by 3.8 hours during COVID-19 compared to prior to COVID-19. On weekends, bedtimes were delayed on average by 1.6 hours and waketimes by 1.5 hours (all p's < 0.001). Social jetlag of >2 hours decreased to 6.3% during COVID-19 compared to 52.1% prior to COVID-19. Anxiety and depression symptoms and a decline in physical activity during COVID-19 were associated with delayed bed and wake times during COVID-19. CONCLUSIONS During COVID-19, adolescents reported spending more time in bed, with most adolescents reporting 8 hours of sleep opportunity and more consistent sleep schedules. As schools return to in-person learning, additional research should examine how sleep schedules may change due to school start times and what lessons can be learned from changes that occurred during COVID-19 that promote favorable adolescent sleep.
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Affiliation(s)
- Katherine L. Wesley
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
| | - Emily H. Cooper
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
| | - John T. Brinton
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
| | - Maxene Meier
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
| | - Sarah Honaker
- Department of Pediatrics, Indiana University School of Medicine
| | - Stacey L. Simon
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
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13
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Yeo SC, Lai CKY, Tan J, Lim S, Chandramoghan Y, Tan TK, Gooley JJ. Early morning university classes are associated with impaired sleep and academic performance. Nat Hum Behav 2023; 7:502-514. [PMID: 36806401 PMCID: PMC10129866 DOI: 10.1038/s41562-023-01531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/17/2023] [Indexed: 02/22/2023]
Abstract
Attending classes and sleeping well are important for students' academic success. Here, we tested whether early morning classes are associated with lower attendance, shorter sleep and poorer academic achievement by analysing university students' digital traces. Wi-Fi connection logs in 23,391 students revealed that lecture attendance was about ten percentage points lower for classes at 08:00 compared with later start times. Diurnal patterns of Learning Management System logins in 39,458 students and actigraphy data in 181 students demonstrated that nocturnal sleep was an hour shorter for early classes because students woke up earlier than usual. Analyses of grades in 33,818 students showed that the number of days per week they had morning classes was negatively correlated with grade point average. These findings suggest concerning associations between early morning classes and learning outcomes.
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Affiliation(s)
- Sing Chen Yeo
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Clin K Y Lai
- Institute for Applied Learning Sciences and Educational Technology, National University of Singapore, Singapore, Singapore
| | - Jacinda Tan
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Samantha Lim
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Yuvan Chandramoghan
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Teck Kiang Tan
- Institute for Applied Learning Sciences and Educational Technology, National University of Singapore, Singapore, Singapore
| | - Joshua J Gooley
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore.
- Institute for Applied Learning Sciences and Educational Technology, National University of Singapore, Singapore, Singapore.
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14
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Crowley SJ, Velez SL, Killen LG, Cvengros JA, Fogg LF, Eastman CI. Extending weeknight sleep of delayed adolescents using weekend morning bright light and evening time management. Sleep 2023; 46:zsac202. [PMID: 36006948 PMCID: PMC9832518 DOI: 10.1093/sleep/zsac202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/13/2022] [Indexed: 01/14/2023] Open
Abstract
STUDY OBJECTIVES Shift sleep onset earlier and extend school-night sleep duration of adolescents. METHODS Forty-six adolescents (14.5-17.9 years; 24 females) with habitual short sleep (≤7 h) and late bedtimes (≥23:00) on school nights slept as usual for 2 weeks (baseline). Then, there were three weekends and two sets of five weekdays in between. Circadian phase (Dim Light Melatonin Onset, DLMO) was measured in the laboratory on the first and third weekend. On weekdays, the "Intervention" group gradually advanced school-night bedtime (1 h earlier than baseline during week 1; 2 h earlier than baseline during week 2). Individualized evening time management plans ("Sleep RouTeen") were developed to facilitate earlier bedtimes. On the second weekend, Intervention participants received bright light (~6000 lux; 2.5 h) on both mornings. A control group completed the first and third weekend but not the second. They slept as usual and had no evening time management plan. Weekday sleep onset time and duration were derived from actigraphy. RESULTS Dim light melatonin onset (DLMO) advanced more in the Intervention (0.6 ± 0.8 h) compared to the Control (-0.1 ± 0.8 h) group. By week 2, the Intervention group fell asleep 1.5 ± 0.7 h earlier and sleep duration increased by 1.2 ± 0.7 h; sleep did not systematically change in the Control group. CONCLUSIONS This multi-pronged circadian-based intervention effectively increased school-night sleep duration for adolescents reporting chronic sleep restriction. Adolescents with early circadian phases may only need a time management plan, whereas those with later phases probably need both time management and morning bright light. CLINICAL TRIALS Teen School-Night Sleep Extension: An Intervention Targeting the Circadian System (#NCT04087603): https://clinicaltrials.gov/ct2/show/NCT04087603.
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Affiliation(s)
- Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Sabrina L Velez
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Logan G Killen
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Jamie A Cvengros
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Louis F Fogg
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Charmane I Eastman
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
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15
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Virtual special issue: Updates on school start times and adolescent sleep health. Sleep Health 2022; 8:567-568. [PMID: 36280587 DOI: 10.1016/j.sleh.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Bedtime procrastination and chronotype differentially predict adolescent sleep on school nights and non-school nights. Sleep Health 2022; 8:640-647. [PMID: 36272919 DOI: 10.1016/j.sleh.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/19/2022] [Accepted: 09/16/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Bedtime procrastination (BTP) refers to the tendency to delay sleep beyond an intended bedtime, in favor of continuing evening activities. BTP has been associated with negative sleep outcomes (later timing, shorter duration, poorer quality), and is viewed as a problem of exercising self-control. BTP could be particularly challenging in adolescents, given the combined effects of increasing bedtime autonomy, later chronotype, and a still developing self-control capacity. Thus far, research on BTP has only been based on self-report measures. Here we examined the influence of BTP on adolescent sleep, using objective measures of sleep. METHODS About 121 adolescents aged 14-19 years completed a survey on BTP, sleep quality, chronotype, and mental health. Subsequently, habitual sleep was actigraphically monitored for up to 2 weeks, and participants completed a temporal discounting task (a proxy for impulsivity). Associations between BTP, chronotype, and actigraphy-measured sleep were examined for school nights and non-school nights separately. RESULTS Greater BTP was associated with poorer subjective sleep, eveningness chronotype, and higher daytime fatigue, as well as higher anxiety/depression scores. Measured using actigraphy, greater BTP predicted later bedtimes and shorter sleep duration on school nights, even when controlling for chronotype. On non-school nights, eveningness chronotype, but not BTP, predicted later bedtimes and wake-up times. BTP was not correlated with temporal discounting. CONCLUSIONS Bedtime procrastination exerts significant influence on subjective and objective sleep measures in adolescents. Its effects are most prominent on school nights and can be separated from the effects of chronotype, which has stronger effects on sleep timing on non-school nights.
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Rynders CA, Bowen AE, Cooper E, Brinton JT, Higgins J, Nadeau KJ, Wright KP, Simon SL. A Naturalistic Actigraphic Assessment of Changes in Adolescent Sleep, Light Exposure, and Activity Before and During COVID-19. J Biol Rhythms 2022; 37:690-699. [PMID: 36124632 PMCID: PMC9726638 DOI: 10.1177/07487304221123455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The majority of high school-aged adolescents obtain less than the recommended amount of sleep per night, in part because of imposed early school start times. Utilizing a naturalistic design, the present study evaluated changes in objective measurements of sleep, light, and physical activity before (baseline) and during the first wave of the COVID-19 pandemic (during COVID-19) in a group of US adolescents. Sixteen adolescents (aged 15.9 ± 1.2 years, 68.8% female) wore an actigraphy monitor for 7 consecutive days during an in-person week of school before the pandemic (October 2018-February 2020) and again during the pandemic when instruction was performed virtually (May 2020). Delayed weekday sleep onset times of 1.66 ± 1.33 h (p < 0.001) and increased sleep duration of 1 ± 0.87 h (p < 0.001) were observed during COVID-19 compared with baseline. Average lux was significantly higher during COVID-19 compared with baseline (p < 0.001). Weekday physical activity parameters were not altered during COVID-19 compared with baseline, except for a delay in the midpoint of the least active 5 h (p value = 0.044). This analysis provides insight into how introducing flexibility into the traditional school schedule might influence sleep in adolescents.
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Affiliation(s)
- Corey A. Rynders
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, Virginia
| | | | - Emily Cooper
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John T. Brinton
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Janine Higgins
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kenneth P. Wright
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,University of Colorado Boulder, Boulder, Colorado
| | - Stacey L. Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Stacey L. Simon, Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Avenue, Box B395, Aurora, CO 80045, USA; e-mail:
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18
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McKeever PM, Dodd R, O’Sullivan DM. Delayed high school start times and graduation and attendance rates over 4 years: the impact of race and socioeconomics. J Clin Sleep Med 2022; 18:2537-2543. [PMID: 35903946 PMCID: PMC9622992 DOI: 10.5664/jcsm.10156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The current study was designed to examine if improvements in high school graduation and attendance rates persist 4 years after start times later than 8:30 am. Socioeconomic status and race were accounted for in the graduation analysis. METHODS School-wide attendance and graduation records (n = 28 schools) from 1999-2017 were analyzed in August of 2021 using a repeated-measures analysis of variance at 5 points in time, 1 year predelay and 4 consecutive years postdelay start times. RESULTS Graduation rates for students in grade 12 (n > 47,000) after postdelay year 4 increased from 80% to 90% (P < .001) and attendance rates in grades 9-12 (n > 80,000) improved from 90% to 93% (P = .012). CONCLUSIONS Attendance and graduation rates for all students improved after 4 years following a delayed start. Economically disadvantaged students and Black students showed significant changes in graduation rates postdelay year 4 and White students significantly improved postdelay years 2, 3, and 4. Adolescent students, especially economically and racially disadvantaged students, have a vulnerability for obtaining adequate sleep. Delaying high school start times is a cost-effective intervention that could promote sufficient sleep and boost graduation and attendance rates. CITATION McKeever PM, Dodd R, O'Sullivan DM. Delayed high school start times and graduation and attendance rates over 4 years: the impact of race and socioeconomics. J Clin Sleep Med. 2022;18(11):2537-2543.
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Affiliation(s)
- Pamela Malaspina McKeever
- Hartford HealthCare/Behavioral Health Network/-Institute of Living, The Webb Schools, Hartford, Connecticut
| | - Ralph Dodd
- Hartford HealthCare/Behavioral Health Network/-Institute of Living, The Webb Schools, Hartford, Connecticut
| | - David M. O’Sullivan
- Department of Research Administration, Hartford HealthCare/Hartford Hospital, Hartford, Connecticut
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19
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Carter JR, Knutson KL, Mokhlesi B. Taking to "heart" the proposed legislation for permanent daylight saving time. Am J Physiol Heart Circ Physiol 2022; 323:H100-H102. [PMID: 35622532 PMCID: PMC9208433 DOI: 10.1152/ajpheart.00218.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022]
Abstract
In March 2022, the US Senate passed the Sunshine Protection Act that would abolish the biannual change in clocks each fall and spring and permanently adopt daylight saving time that aligns with the "spring forward" time change each March. A number of scientific and medical societies have endorsed the abolishment of the biannual clock change, but oppose the permanent adoption of daylight saving time. Instead, leading organizations such as the American Academy of Sleep Medicine (AASM) and the Society for Research on Biological Rhythms (SRBR) position statements highlight peer-reviewed evidence in favor of a permanent shift to standard time. The present perspectives will summarize some of the key AASM and SRBR recommendations, with a particular focus on the potential cardiovascular implications of a legislative change that would result in a permanent switch to either standard time or daylight saving time. Collectively, although there is building scientific consensus that abolishing the biannual time change has several sleep and circadian health benefits, the preponderance of evidence is opposite to the current legislation and instead suggests a permanent switch to standard time may offer the maximum health and safety benefits. This scientific evidence should be considered as the United States House of Representatives considers the Sunshine Protection Act.
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Affiliation(s)
- Jason R Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana
| | - Kristen L Knutson
- Department of Neurology and Preventive Medicine, University of Northwestern, Chicago, Illinois
| | - Babak Mokhlesi
- Division of Pulmonary, Department of Internal Medicine, Critical Care and Sleep Medicine, Rush University Medical Center, Chicago, Illinois
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