Adolescent Adolescent Health and Later Health and Later

School Start School Start TimesTimes

Ashland School Start Times Committee

Isha Ann Emhoff, MD FACS

Later School Later School Start TimesStart Times

“Given that the primary focus of education is to maximize human potential, then a new task before us is to ensure that the conditions in which learning takes place addresses the very biology of our learners.” Mary Carskadon, PhD Brown University

Circadian RhythmCircadian Rhythm• Circa Diem: around the day• Biologic endogenous time: “built in clock”

o Genetico Brain hypothalamus

• Suprachiasmatic Nucleus (SCN)

• What is the purpose?o Allows anticipation and preparation for precise and regular

environmental changeso Regulates metabolic processeso Brain wave activityo Temperature regulationo Hormone production (cortisol)

Melatonin Secretion Melatonin Secretion Changes Changes

Child to AdolescentChild to Adolescent

Rhythmic Sleepy TimeRhythmic Sleepy Time

Source: Adapted from data given by National Sleep Foundation

Why Does Melatonin Why Does Melatonin Rhythm Matter?Rhythm Matter?

• Waking a teenager at 7:00 am is like waking an adult at 4:00 am

Pubertal Pubertal Time BendingTime Bending

• Sleep-Wake Phase Delayo 2 hour delay relative to mid-childhoodo Fall asleep later and wake up later

• Delayed nocturnal melatonin secretiono Shift in circadian phase preferenceo Cannot just go to bed earlier – they cannot fall asleepo High level of alertness at 8 PM, even higher at 10 PM

• Altered sleep driveo Pressure to fall asleep accumulates more slowlyo Takes longer to fall asleepo Difficulty falling asleep until after 11:00 PM

Sleep Time DelaySleep Time Delay• Students lose up to 120 minutes of sleep per

school night1

• Weekend Catch-up Sleepo Moves their inner clock even further away from the external clocko Worsens morning sleepiness at school

• Keep the weekday schedule on weekends• No napping• Equivalent to 5 hours jet lag on Monday morning

1. Martha Hansen, et al. The Impact of School Daily Schedule on Adolescent SleepPediatrics 2005; 115:6 1555-1561

Optimal TimingOptimal Timing• 8.5-9.5 hours per

night• 11:00 PM bedtime• 8:00 AM wake time

Where do the Hours Where do the Hours Go?Go?

Late school start time schedule

o Alarm sounds at 7:30amo Bus stop 8:20amo School 9:00am to 3:50pmo Stay at schoolo Load buses for travel to away

game at 4:30pmo Game 7:00pm to 9:00pmo Home between 9:45 pm to

10:30pmo Homework 10:30pm to

12:30amo Bed 12:30 am or 1:00am

•Sleep 6.5 to 7 hours

Early school start time schedule

o Alarm sounds 5:30amo Bus stop 6:20amo School 7:00am to 1:50pmo Return home on bus 2:15pmo Back to school to travel to

away game 4:30pmo Game 7:00pm to 9:00pmo Home between 9:45pm to

10:30pmo Homework 10:30pm to

12:30amo Bed 12:30 or 1:00am

•Sleep 4.5 to 5 hours

AcademicsAcademics

Data from USAFA Policy Data from USAFA Policy

ChangesChanges

• Starting the school day 50 minutes later has a significant positive effect on student achievement

• Improved performance is not just a “wake up” effect from later start.

• Improvement persists in all classes throughout the day.

Carrell, Scott E., Teny Maghakian, and James E. West. "A's from Zzzz's? The causal effect of school start time on the academic achievement of adolescents." American Economic Journal: Economic Policy 3, no. 3 (2011): 62-81.

Teen SafetyTeen Safety• Automotive Crash

Rateso Crash rates reduced 65-70%

(Wahlstrom et al, Univ. MN, 2014)

o Crash rates reduced 16.5% while rest of state actually increased 7.8% over the same period. (Danner & Phillips, J. Clin Sleep Med, 2008)

Teen InjuriesTeen Injuries

• Less than 8 hours sleep 1.7 times more likely to suffer sports injury

• Risk increases 1.4 times for each year grade increase (7-12)o Milewski J Pediatr Orthop. 2014

ADOLESCENT SLEEP WORKING GROUP, COMMITTEE ON ADOLESCENCE and COUNCIL ON SCHOOL HEALTHPediatrics 2014;134;642; originally published online August 25, 2014; DOI: 10.1542/peds.2014-1697http://pediatrics.aappublications.org/content/134/3/642.full.html

• Aim for 8.5 – 9 .5 hours of sleep

• Middle and high school start 8:30 a.m. or later

“The AAP is making a definitive and powerful statement about the importance of sleep to the health, safety, performance and well-being of our nation's youth,” “By advocating for later school start times for middle and high school students, the AAP is both promoting the compelling scientific evidence that supports school start time delay as an important public health measure, and providing support and encouragement to those school districts around the country contemplating that change. Judith Owens, MD, FAAP, lead author of the policy statement

Ohio Schools and Cost-Savings or Cost-Neutrality in Moving toward Healthier Start Times(2013 data, per school websites) Hudson City Schools, Ohio: Suburban NE Ohio - total student enrollment: 4,7004 elementary schools, 1 middle school, 1 high schoolPercentage of graduates attending college or university: 95%In 2010 school year: Moved high school from 7:30 to 8:00 and middle school from 7:20 to 7:50 amSaved money by moving from three bus tiers to two, consolidating runs, and switching to an external vendor Dublin City Schools, Ohio: Suburban Central Ohio (near Columbus) - student enrollment in excess of: 14,50010th largest district in the state12 elementary schools, 4 middle schools, 3 high schoolsMinority student population: 30.7%Average ACT score of 25.2In 2011 school year: Moved middle school from 8:15 am to 8:43am, high school from 7:25 am to 8am The move was cost-neutral in relation to start times, but saved money due to other transportation changes made Kenston Local Schools, Ohio: Rural NE Ohio - total student enrollment: 3,1403 elementary schools, 1 middle school, 1 high schoolPercentage of graduates attending college or university: 94%In 2012 school year: Moved middle and high school start times from 7:20 am to 7:50 am The end of the school day for middle and high school was moved to 5 minutes laterThe move was cost-neutral  Westlake City Schools, Ohio: Suburban NE Ohio (Greater Cleveland Metropolitan Area) - student enrollment approximate: 4,0004 elementary schools, 1 intermediate school, 1 middle school, 1 high schoolIn top 4% of districts in state scorecard rankingsIn 2011 school year: Moved high school start times from 7:30 to 7:55amThe move was cost-neutral Perrysburg Schools, Ohio: Suburban NW Ohio - student enrollment in excess of: 4,9004 elementary schools, 1 junior high school, 1 high schoolAverage ACT score 23.8In 2011 school year: Moved high school from 7:40 to 8:00am, middle school from 7:25 to 7:45 amThe move was cost-neutral Parma City School District:Suburban NE Ohio (Greater Cleveland Metropolitan Area) - total student enrollment: 11,4708 elementary schools, 3 middle schools, 3 high schoolsIn 2012 school year: High school moved from 7:35 to 8:10 am, middle school from 8:00 to 8:20 amMove was driven by financial considerations and building consolidation, not driven by the research, although the research was ‘not discouraging’ in decision-making processes