On November 14, nationally-known sleep expert Dr. Jerold Kram spoke to 250 Piedmont High School and Millennium High School students about the critical importance of getting adequate, healthy sleep. The student assembly, as well as the parent education program on the same topic held on November 18, were planned in conjunction with the new bell schedule that is being tested this year at both PHS and MHS. A principal objective of the new bell schedule is to allow for a later start to the school day two days each week, to encourage students to get more sleep.
In August 2014, the American Academy of Pediatrics reported that “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.” (See the full AAP report, “Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences” athttp://pediatrics.aappublications.org) A November 11, 2014 article from the Washington Post, “Why High Schools Should Let Kids Sleep In” discusses the benefits to adolescent health of starting the school day at 8:30 or later. (http://www.washingtonpost.com/blogs/wonkblog/wp/2014/11/11/why-high-schools-should-let-kids-sleep-in/?tid=hpModule_9d3add6c-8a79-11e2-98d9-3012c1cd8d1e&hpid=z11)
Piedmont students are not immune to the problem of adolescent sleep loss. In a recent survey of more than 700 Piedmont High School students, students reported getting on average a little more than 6.5 hours of sleep per night. This is three hours less than the recommended 9.25 to 9.5 hours per night for adolescents.
To help students understand the sleep research underlying the new bell schedule, nationally-known sleep specialist Dr. Jerrold Kram explained what happens when students aren’t well-rested. Dr. Kram, Director of the California Center for Sleep Disorders and Board Member of the National Sleep Foundation, has more than 35 years of experience treating adolescents and adults with a range of disordered sleep issues.
What follows is a summary of Dr. Kram’s presentation and the Questions & Answers that followed.
All kids want to perform better, academically, in sports. Good sleep improves performance in everything. Even if you think you are getting enough, you’re not. Good sleep is as essential as good nutrition, hydration and exercise, as discussed in recent SF Chronicle article. Eight hours is recommended for adults (some need more), and a minimum of 9 ¼ hours is recommended for adolescents.
Stanford University study of basketball team measured player speed, accuracy, concentration as baseline. Players kept sleep logs for several weeks, required to be in bed ten hours. Not required to actually sleep 10 hours, but the opportunity to sleep leads to more sleep. Players re-tested, and speed, accuracy, and concentration improved. Immediate and measurable improvement in athletic performance. Even though they thought they got enough sleep, it wasn’t enough.
Importance of understanding the natural circadian rhythms and stages of sleep, and not disrupt them. Importance of understanding that sleep needs change throughout life, and adolescents have distinct sleep needs. At least 9 ¼ hours is needed.
The circadian biological clock is sensitive to light and dark. All cells and biological systems operate on this clock. Normal sleep involves roughly two-hour cycles of sleep. This was first discovered in plants, as leaves open and close reflecting an internal clock. In humans, if the rhythmic pattern is disrupted, it can lead to worse problems than poor performance — it can lead to obesity, other health problems, and depression.
REM sleep is deep sleep, typically involves a form of paralysis — the body is limp, otherwise you might act out your dreams, which might be dangerous. If you get insufficient REM sleep, your ability to form memories is impaired. Learning and memory impacted. For this reason, staying up late to study is counterproductive. Adequate sleep is needed not only for cognitive and social function and physical performance, it is needed for immune response. Sleep deprivation leads — quickly — to reduced immune response. Innume health may not be quickly recovered by catching up on sleep.
In adolescence, the circadian clock shifts. “Delayed phase syndrome.” Typically, adolescents feel more awake at night, not sleepy until later, fall asleep later, need to sleep later to get adequate sleep. If late to sleep but early to rise, daytime sleepiness and impairment, even if not self-perceived. This impacts ability to concentrate, learn, perform, and impairs mood, increases risk of injury and accidents. Significant issue is drowsy driving.
In addition to staying up later, adolescents often use LED devices that emit blue light, which is alerting — it mimics morning light, which signals to the body to wake up. Counter to natural light, which dims over the course of the afternoon and evening, signaling to the body to wind down to sleep. The winding-down process naturally takes hours, not an on-and-off switch. Artificial light can interfere with the natural circadian cycles, but blue light is particularly confusing to the body. Blind people with no light perception often have disrupted sleep cycles because they cannot perceive cues from bright and dim light.
Adolescents who cannot avoid staying up late working on a computer should eliminate blue light. There is a free app F.Lux that eliminates blue light on some devices.
Case study of high school student who could not get out of bed in time for the start of school. Could not fall asleep until 4 am, needed to sleep until the afternoon. Extreme, but just an extreme example of what happens with most adolescents with delayed phase syndrome. Student was successfully treated by “resetting” his biological clock. This was done gradually over several weeks, adjusting bedtime and wake time gradually each day in a controlled environment.
Need to understand normal variants in the circadian cycle, and avoid disruptions in the cycle.
Avoid blue light before bedtime. Allow natural day light in to help wake up in the morning. Avoid stimulants, caffeine is a drug and should always be thought of as a drug.
Are naps beneficial or a further disruption of natural sleep cycles?
Naps are usually good because your body needs the sleep. One exception is insomnia — naps can exacerbate insomnia.
Should everyone have siesta time in the afternoon?
It’s better to get adequate, deep, REM sleep at night, and not rely on afternoon naps for REM sleep.
How do you treat insomnia?
This is a complex problem to solve and many involve other problems, may involve psychological issues or medical issues.
Can I just dim my phone to cut blue light? Or change the screen settings?
Dimming will help, but dimming may not be as effective as F.Lux.
What are other examples of sleep problems not caused by disruption in circadian cycles?
Strange nighttime behaviors like sleep walking, sleep eating, even sleep driving and violent, aggressive behavior, sleep terros. These can be very dangerous. The person seems to be awake but isn’t.
Is it OK to take melatonin to help fall asleep?
The effect of melatonin must be timed properly. Melatonin is not a sleeping pill, but it helps signal to the body that it is time to start winding down for the day. It must be taken several hours before the target bed time, and in tiny doses. More than a tiny dose is actually counter-productive.
What is the effect of caffeine on sleep?
Caffeine is a potent stimulant and should be considered a drug, and used carefully and sparingly.
Why do some people move a lot in their sleep? What is restless sleep?
Hard to say why some people move around more than others, it may be that they are repositioning to get comfortable. Restless sleep is not a medical term, may just mean sleep without deep, REM sleep, or sleep interrupted by outside stimulus, cold, heat, or a medical issue such as sleep apnea.
What are the effects of alcohol on sleep?
There is a common misperception that drinking alcohol helps you sleep, because it can make you sleepy. But if you do get drowsy from alcohol and fall asleep, you’ll wake up too soon, not get good REM sleep.
Is there a State-wide mandate about a later start to the school day? Why not?
No. Individual schools and districts are experimenting with their schedules to allow a later start.