On Topic with Nathaniel F. Watson: Sleep now, learn later

Delayed school start times can have a big impact on student health

School districts around the country are experimenting with starting classes later to allow students to get extra sleep.

While some dismiss the idea as pampering, Nathaniel F. Watson says there are solid scientific reasons to consider it. As we age, our internal circadian rhythms and biological sleep drives change, resulting in later sleep and wake times. Lack of sleep hampers a student’s preparedness to learn, negatively impacts physical and mental health, and impairs driving.

Watson, a University of Washington professor of neurology and co-director of the UW Medicine Sleep Center, says that changing the start time of the school day can help remedy many of these problems. “Everyone who deals with this issue wants the same thing—for children to be as healthy and happy and as successful as possible in school and life,” Watson says. “This is one way to move in that direction.”

Before reading your report (damag.me/sleep), I was unaware that so many biological and physical conditions that affect teens are tied to a lack of sleep.

Yes. As children age, particularly as they become adolescents, their circadian rhythms get delayed a little bit, and they require later bedtimes and later wake times. We know that these children have difficulty falling asleep before 11 p.m., and they need eight to 10 hours of sleep per night to support optimal health. When you have these early start times, there’s just not enough time for them to get the healthy sleep they need. It’s really tragic because we know that sleep deprivation is associated with obesity, behavioral issues, increased risk for motor vehicle accidents, and reduced academic performance.

Your younger years are when you develop many long-term habits regarding your health. When the system creates this crunch, in which we’re not allowing these adolescents adequate time to sleep, we are, in a sense, setting them up for a lifetime of sleep deprivation, or at the very least, teaching them at an early age that sleep isn’t as important as it actually is to their health and well-being.

Many people assume that our use of smartphones and tablets keeps us from sleeping.

Our physiology is linked to light-dark cycles and much of it has to do with the secretion of melatonin from our pineal gland, which occurs when it gets dark.

It’s a physiological phenomenon, not a social media/smartphone phenomenon as many think—although certainly screens and media and things like that are not necessarily conducive to sleep. The blue wavelengths from these devices can suppress melatonin secretion.

As they go through adolescence, kids naturally get this delay in their circadian rhythms. We have to be sensitive to that at such a crucial time in their growth and development. To respect their physiology and optimize it is really what we’re getting at here.

Your report also lists metabolic dysfunction, cardiovascular morbidity, increased depressive symptoms and suicidal ideations as side effects of sleep deprivation.

Right, and you can take that a step further. In progressive school districts that have changed bell times to 8:30 a.m. or later for middle and high schools, they have higher graduation rates, reduced truancy and improved academic performance. These are tangible benefits that have been observed in school districts that have made these changes.

If I could tell any school board there was one thing they could do—one simple change they could make that would increase graduation rates, reduce truancy, increase mental health, reduce motor vehicle accidents, and, frankly, increase the mood and feeling of well-being in the school—I think they would do it.

Does the current evidence support the idea that later start times result in higher grades?

I think the evidence is strongest for reduced truancy rates and increased graduation rates. The grade-related comment is less strongly supported by the evidence. But, presumably, if graduation rates are increasing, grades are increasing and academic performance is improving. As more school districts make these changes, more evidence will be available.

The objections to changing start times often revolve around transportation
issues and after-school activities.

Any problems with bus schedules or practice schedules or things like that are just issues to be solved. In particular for practice schedules, a well-rested child is going to be far more efficient and attentive and successful in their practice, and, ostensibly, you could have shorter, more effective practices.

Later start times are being discussed in a number of districts, but so far not broadly. Do you think it will catch on nationally?

I’d like to think that we could have legislation that would address this issue, either on a statewide basis or nationally. The California Legislature recently passed a bill to have school start times delayed in accordance with teenage physiology, but unfortunately Gov. Jerry Brown vetoed the measure.

We’re at a point where these changes are made one school district, one school board at a time.

And the only way you get to change is to form an activated community that shows up to school board meetings and that elects school board members who take this issue seriously. That’s what happened here in the Seattle area a few years ago. It was concerned parents, teachers and the medical community—in particular, the sleep medicine community—who got together, gathered all the necessary information, went to school board meetings, pressed the issue, educated school board members, and brought forth this change.

If parents, teachers and the medical community are driving the issue, is the resistance coming from school boards?

I think school boards in general try to avoid controversy, and it takes courage to make these changes. We live in an age in which the zeitgeist, unfortunately, is that sleep is not important. So a lot of school board members, through no fault of their own, are swimming in an ocean of “sleep de-prioritization” and don’t know any better.

You have to educate them about the importance of sleep first, and I think from a societal basis, we’re starting to move the needle on that a bit by getting the word out. We spend a third of our lives sleeping, so it must be important for human physiology.

The transportation problem seems to be a common sticking point.

When it comes to bus schedules, consider this: Younger children have a different physiology. They get up earlier. They can start school earlier. They need to go to bed earlier. So a lot of times, all you have to do is flip it. Oftentimes, school districts will bus the younger elementary school children last and the high school and middle school kids first, and that’s completely antithetical to human physiology. If you just flipped that around, you could go a long way toward solving that problem.

I realize that for some parents, their work schedules and their younger children’s childcare schedules need to be addressed and solved. Those are the roadblocks and they’re real, but they can be solved. That’s what has to be conveyed to school boards.

Another potential criticism of making this change is that we can do this, but it doesn’t necessarily mean that kids are going to sleep more. If we make the change, then kids will just stay up even later at night. But, in fact, there’s a study here in Seattle that showed that middle and high school students were actually getting an additional 30 minutes of sleep when the bell times were moved back.

What can readers do to help sell this idea to their respective school boards?

The American Academy of Sleep Medicine has a position statement (DAmag .me/0219-aasm), which was published in the Journal of Clinical Sleep Medicine. The American Academy of Pediatrics (www.aap.org) has a number of papers on this issue. Bring these resources to the board meetings. There are national organizations, such as StartSchoolLater.net, that are looking into this as well.

This really is a movement that’s going across the country, and it’s a flat-out opportunity. The reason that school leaders do what they do is to optimize the opportunity for success for their students, and this is an opportunity for leaders to really move the needle on that.

Tim Goral is senior editor.

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