What more can we learn about sleep education programs in young people?

Development and psychometric properties of an instrument to measure sleep behavior self-regulation in adolescent students

Background

The prevalence of inadequate sleep among adolescents is a significant worry due to its potential to adversely affect their health and academic performance. Addressing this matter necessitates a comprehensive grasp of the underlying factors influencing sleep regulation and the formulation of evidence-based interventions to counteract its detrimental consequences. Hence, the central objective of this study is to create and assess a dependable questionnaire designed to evaluate adolescents' self-regulation of sleep behavior.

Methods

In this cross-sectional study, data from 401 high school students randomly selected from west Iran were incorporated and subjected to psychometric assessments. The average age of the participants was 16.5 ± 0.92. Initially, 136 preliminary items were formulated, drawing from a contextual framework and comprehensive literature review. The subsequent steps involved specialized analyses, including content validity analysis, item analysis, exploratory and confirmatory factor analysis, as well as convergent validity analysis.

Results

Both exploratory and confirmatory factor analyses support a strong structural model, including factors like self-control, outcome expectation, goal setting, and self-efficacy, which are linked to regulating sleep behavior. The model fit was satisfactory. The instrument had 22 items which demonstrated good internal consistency, adequate test-retest reliability, and evidence of convergent validity.

Conclusion

In future studies exploring sleep behavior, the present questionnaire, which has demonstrated initial validity and reliability, holds the potential to provide valuable assistance in evaluating and enhancing self-regulation in sleep behavior, particularly within school environments.

Perspective: Teenagers and the sleep paradox

STUDY OBJECTIVES

Teenagers experience sleep deficits as they try to manage expectations with school, their social media presence, and increasingly competitive extracurriculars. Late-night screen time is a barrier to sleep hygiene. It is important to acknowledge and understand lifestyle challenges that can prevent teenagers from receiving adequate sleep every night. A teenager perspective on these issues and recommendations can incite better ways to outreach, educate, and support teenagers in maintaining good sleep.

METHODS

We describe what is known and not known about sleep health among teenagers and challenges to maintaining adequate sleep from the perspective of a third-year high school student. We also provide recommendations for outreach to promote early recognition of issues and tools that can support sleep hygiene to reinforce future mental and physical health.

RESULTS

While teenagers enjoy good sleep, this is limited by heavy loads of homework along with increasingly competitive extracurriculars, keeping up with social and cultural demands, and early school starts. Also, teenagers may not understand what adequate sleep entails and the full impact of sleep on well-being.

CONCLUSIONS

Social media provides a channel to extend outreach to teenagers to communicate the importance of consistent quality and quantity of sleep, increase awareness of sleep tracking tools, and highlight the impact of sleep on mental health. Additionally, better engagement is needed with schools and community to manage academic and extracurricular schedules that allow teenagers to schedule consistent bedtimes and wake times.

CITATION

Ramar S, Lloyd RM Perspective: teenagers and the sleep paradox. J Clin Sleep Med. 2023;19(8):1569-1571.

Healthy sleep for healthy schools: A pilot study of a sleep education resource to improve adolescent sleep

ISSUE ADDRESSED

Insufficient sleep and unhealthy sleep practices in adolescents are associated with significant health risks. Sleep education programs in schools aim to improve sleep behaviour. A new eLearning sleep education program, Healthy Sleep for Healthy Schools (HS4HS), was developed focused on these goals and is distinguishable from other sleep education programs because it is delivered by teachers, making it more sustainable and adaptable for schools. We aimed to evaluate if HS4HS would improve student sleep knowledge, healthy sleep practices, sleep duration and reduce sleepiness. We also aimed to understand if this intervention could be successfully implemented by trained teachers.

METHODS

Teachers trained in sleep delivered HS4HS to 64 South Australian students in year 9 (aged 13-14 years) over 6 weeks during regular school curriculum. A sleep education survey assessing sleep patterns (such as healthy sleep practices, time in bed and sleepiness), and a sleep knowledge questionnaire was completed pre- and post-HS4HS delivery. Evaluations were also completed by teachers.

RESULTS

Sleep knowledge and healthy sleep practices significantly improved post intervention. Time in bed on both school days and weekends increased slightly and sleepiness decreased slightly, but these changes were not statistically significant. Teachers found the program useful, comprehensive and easy to incorporate into their curricula.

CONCLUSIONS

After short training, teachers can deliver sleep education during class and improve sleep practices in their students. This suggests that this program may offer potential as an effective and useful resource for teachers wanting to include sleep health in their curriculum. SO WHAT?: Sleep is the foundation of good health and teachers can promote and integrate sleep education into their curricula for the first time with this online teacher focussed program, which has the potential to be a sustainable sleep health promotion resource.

Preventing sleep deficit in adolescents: Long-term effects of a quasi-experimental school-based intervention study

Adolescents are at risk of sleep deficit, which has serious consequences for their daytime functioning. However, school‐based interventions to improve sleep have shown limited success. This might be due to the content of the programmes (e.g., not targeting central factors such as daytime stress and technology use) or because changes have not been captured due to a lack of long‐term follow‐ups. Hence, the aim of this study was to evaluate the long‐term effects of a school‐based sleep education curriculum including time‐management training. The study used a quasi‐experimental design. Participants were 3,622 adolescents (mean age 13.7, 48% girls); 286 were in the intervention group and 3,336 were followed as a natural control group. Data were collected before the intervention and at a 1‐year follow‐up. We divided participants into three groups according to baseline sleep duration (calculated from self‐reported bed‐ and wake times, minus sleep onset latency): insufficient (<7 hr), borderline (7–8 hr) and adequate (>8 hr). Adolescents in the intervention group were ~2 times less likely to report insufficient sleep at follow‐up as compared to controls. Sleep knowledge improved significantly in the intervention group but there were no changes in emotional sleep hygiene (e.g., bedtime worry) and perceived stress. Surprisingly, technology use increased and behavioural sleep hygiene worsened in the intervention group. Although the mechanisms of change need further investigation, the results of this study point to potential long‐term benefits of school‐based sleep programmes.

Study Protocol of Sleep Education Tool for Children: Serious Game "Perfect Bedroom: Learn to Sleep Well"

Promoting a healthy sleep is a big challenge and becomes a strategic priority in public health, due to the severe consequences on children's development and risk to psychiatric diseases. Interventions that promote healthy sleep, such as those that focus on the dissemination of behavioral and environmental recommendations of sleep hygiene with children, are presented as an alternative. Serious game design offers wide-reaching domains in health applications and is increasing in popularity, particularly with children and teens because of it's potential to engage and motivate players differently from other interventions. This study aims to evaluate effects of serious game on sleep hygiene recommendations "Perfect Bedroom: learn to sleep well," on sleep habits and sleep parameters of healthy children. This is an experimental, prospective and quantitative study. We will randomize children in experimental (n = 88) and no intervention groups (n = 88). The experiment has four stages (pre-intervention, intervention, post-intervention, and follow-up), which will count with participation of children and their parents/guardians. In the evaluation stages, the guardians will answer questionnaires and scales to assess sociodemographic and health data, sleep habits and sleep pattern of their child. The children themselves will answer the following: a scale to assess sleepiness levels, a questionnaire to evaluate the serious game and the game itself, will characterize their bedroom and the activities they perform before sleep, with strategies developed by researches. Intervention with experimental group conducted with the serious game "Perfect Bedroom" will happen twice a week, for 3 weeks in a row, resulting in six sessions of 50 min each. Inferential analysis will be conducted for comparisons between groups and intragroups to measure effect of intervention in primary outcomes (sleep habits) and secondary outcomes (sleep parameters). We expect that the intervention with this game can provide valuable evidence to a new approach in promoting healthy sleep habits, with applications in clinical, educational, and familiar settings, which could diminish future health issues and risk at psychiatric diseases, decreasing the social burden of treatments for these conditions in children.