Amy R. Wolfson

Understanding adolescent's sleep patterns and school performance: a critical appraisal

The present paper reviews and critiques studies assessing the relation between sleep patterns, sleep quality, and school performance of adolescents attending middle school, high school, and/or college. The majority of studies relied on self-report, yet the researchers approached the question with different designs and measures. Specifically, studies looked at (1) sleep/wake patterns and usual grades, (2) school start time and phase preference in relation to sleep habits and quality and academic performance, and (3) sleep patterns and classroom performance (e.g., examination grades). The findings strongly indicate that self-reported shortened total sleep time, erratic sleep/wake schedules, late bed and rise times, and poor sleep quality are negatively associated with academic performance for adolescents from middle school through the college years. Limitations of the current published studies are also discussed in detail in this review.

The Relationship Between Reported Sleep Quality and Sleep Hygiene in Italian and American Adolescents

Objective. The purpose of the study was to examine the relationship between self-reported sleep quality and sleep hygiene in Italian and American adolescents and to assess whether sleep-hygiene practices mediate the relationship between culture and sleep quality. Methods. Two nonprobability samples were collected from public schools in Rome, Italy, and Hattiesburg, Mississippi. Students completed the following self-report measures: Adolescent Sleep-Wake Scale, Adolescent Sleep Hygiene Scale, Pubertal Developmental Scale, and Morningness/Eveningness Scale. Results. The final sample included 776 Italian and 572 American adolescents 12 to 17 years old. Italian adolescents reported much better sleep hygiene and substantially better sleep quality than American adolescents. A moderate-to-strong linear relationship was found between sleep hygiene and sleep quality in both samples. Separate hierarchical multiple regression analyses were performed on both samples. Demographic and individual characteristics explained a significant proportion of the variance in sleep quality (Italians: 18%; Americans: 25%), and the addition of sleep-hygiene domains explained significantly more variance in sleep quality (Italians: 17%; Americans: 16%). A final hierarchical multiple regression analysis with both samples combined showed that culture (Italy versus United States) only explained 0.8% of the variance in sleep quality after controlling for sleep hygiene and all other variables. Conclusions. Cross-cultural differences in sleep quality, for the most part, were due to differences in sleep-hygiene practices. Sleep hygiene is an important predictor of sleep quality in Italian and American adolescents, thus supporting the implementation and evaluation of educational programs on good sleep-hygiene practices.

Helplessness in children of depressed and nondepressed mothers.

Helpless behaviors in 5- to 7-year-old children of depressed and nondepressed mothers were assessed through direct observation, interviews, and teacher ratings. The affective tone the mothers set in a joint puzzle task and their tendency to encourage mastery or become intrusive when their children became furstrated at the task were also assessed. Although depressed mothers set a more negative affective tone than nondepressed mothers during solvable puzzles, there were few significant differences between the 2 groups of mothers and children. Still, mothers who were more negative and hostile and less able to encourage mastery in their children had children who exhibited more helpless behaviors in the puzzle task, who were less likely to endorse active problem-solving approaches to frustrating situations, and whose teachers rated the children as less competent and more prone to helpless behaviors

Middle School Start Times: The Importance of a Good Night's Sleep for Young Adolescents

With the onset of adolescence, teenagers require 9.2 hr of sleep and experience a delay in the timing of sleep. In the “real world” with early school start times, however, they report less sleep, striking differences between their school-weekend sleep schedules, and significant daytime sleepiness. Prior studies demonstrated that high schoolers with later school starts do not further delay bedtimes but obtain more sleep due to later wake times. This study examined sleep–wake patterns of young adolescents attending urban, public middle schools with early (7:15 a.m.) versus late (8:37 a.m.) start times. Students (N = 205) were assessed at 2 time periods. Students at the late-starting school reported waking up over 1 hr later on school mornings and obtaining 50 min more sleep each night, less sleepiness, and fewer tardies than students at the early school. All students reported similar school-night bedtimes, sleep hygiene practices, and weekend sleep schedules.

School start times for adolescents

The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation’s middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students’ ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 am) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5–9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life.

Changes in Sleep Patterns and Depressive Symptoms in First-Time Mothers: Last Trimester to 1-Year Postpartum

Thirty-eight 1st-time mothers were recruited from childbirth classes and were assessed at 4 different time periods: the last trimester of pregnancy, 2-4 weeks postpartum, 12-16 weeks postpartum, and 12-15 months postpartum. Measures included a daily sleep-wake diary and a depression scale (Center for Epidemiological Studies Depression Scale, CES-D). Results reveal significant differences in weekday night sleep schedules (rise time, time awake due to disruptions, and nap time) at 2-4 weeks postpartum in comparison to other times of measurement. Total sleep time and bedtime was not significantly different between times of measurement. More depressive symptoms were reported at 2-4 weeks postpartum than at later postpartum measurements. Mothers who developed clinically elevated depressive symptoms (CES-D 16) at 2-4 weeks postpartum reported more total sleep time, later rise times, and more time napping at the end of pregnancy in comparison to those mothers that reported fewer depressive symptoms (CES-D < 16) at 2-4 weeks postpartum.

Understanding Adolescent Caffeine Use: Connecting Use Patterns With Expectancies, Reasons, and Sleep

Little is known about adolescents’ caffeine use, yet caffeinated soda, and more recently coffee and energy drinks, are part of youth culture. This study examines adolescents’ caffeine use and, using cluster analysis, identifies three groups of caffeine users who differed in their reasons for use, expectancies, and sleep behaviors. In this high school student sample (N = 197), 95% of participants reported recent caffeine use—most often soda—where typical first use of the day was in the evening. Results reveal that adolescents in the mixed use and high soda use groups consumed similar amounts of soda, reporting significantly more use than the low caffeine use group. In contrast with high soda users, mixed users drank more coffee, expected more dependence symptoms and energy enhancement from caffeine, and were more likely to report getting up early, daytime sleepiness, and using caffeine to get through the day.

A Cross-Cultural Comparison of Sleep Duration Between U.S. and Australian Adolescents The Effect of School Start Time, Parent-Set Bedtimes, and Extracurricular Load

STUDY OBJECTIVE To test whether sleep duration on school nights differs between adolescents in Australia and the United States and, if so, whether this difference is explained by cultural differences in school start time, parental involvement in setting bedtimes, and extracurricular commitments. PARTICIPANTS Three hundred eighty-five adolescents aged 13 to 18 years (M = 15.57, SD = 0.95; 60% male) from Australia and 302 adolescents aged 13 to 19 years (M = 16.03, SD = 1.19; 35% male) from the United States. METHODS Adolescents completed the School Sleep Habits Survey during class time, followed by an 8-day sleep diary. RESULTS After controlling for age and gender, Australian adolescents obtained an average of 47 minutes more sleep per school night than those in the United States. Australian adolescents were more likely to have a parent-set bedtime (17.5% vs. 6.8%), have a later school start time (8:32 a.m. vs. 7:45 a.m.), and spend less time per day on extracurricular commitments (1 h 37 min vs. 2 h 41 min) than their U.S. peers. The mediating factors of parent-set bedtimes, later school start times, and less time spent on extracurricular activities were significantly associated with more total sleep. CONCLUSIONS In addition to biological factors, extrinsic cultural factors significantly affect adolescent sleep. The present study highlights the importance of a cross-cultural, ecological approach and the impact of early school start times, lack of parental limit setting around bedtimes, and extracurricular load in limiting adolescent sleep.Study Objective. To test whether sleep duration on school nights differs between adolescents in Australia and the United States and, if so, whether this difference is explained by cultural differences in school start time, parental involvement in setting bedtimes, and extracurricular commitments. Participants. Three hundred eighty-five adolescents aged 13 to 18 years (M = 15.57, SD = 0.95; 60% male) from Australia and 302 adolescents aged 13 to 19 years (M = 16.03, SD = 1.19; 35% male) from the United States. Methods. Adolescents completed the School Sleep Habits Survey during class time, followed by an 8-day sleep diary. Results. After controlling for age and gender, Australian adolescents obtained an average of 47 minutes more sleep per school night than those in the United States. Australian adolescents were more likely to have a parent-set bedtime (17.5% vs. 6.8%), have a later school start time (8:32 a.m. vs. 7:45 a.m.), and spend less time per day on extracurricular commitments (1 h 37 min vs. 2 h 41 min) than their U.S. peers. The mediating factors of parent-set bedtimes, later school start times, and less time spent on extracurricular activities were significantly associated with more total sleep. Conclusions. In addition to biological factors, extrinsic cultural factors significantly affect adolescent sleep. The present study highlights the importance of a cross-cultural, ecological approach and the impact of early school start times, lack of parental limit setting around bedtimes, and extracurricular load in limiting adolescent sleep.

Sleep Hygiene and Sleep Quality in Italian and American Adolescents

Abstract: This study investigated cross‐cultural differences in adolescent sleep hygiene and sleep quality. Participants were 1348 students (655 males; 693 females) aged 12‐17 years from public school systems in Rome, Italy (n= 776) and Southern Mississippi (n= 572). Participants completed the Adolescent Sleep‐Wake Scale and the Adolescent Sleep Hygiene Scale. Reported sleep hygiene and sleep quality were significantly better for Italian than American adolescents. A moderate linear relationship was observed between sleep hygiene and sleep quality in both samples (Italians: R= .40; Americans: R= .46). Separate hierarchical multiple regression analyses showed that sleep hygiene accounted for significant variance in sleep quality, even after controlling for demographic and health variables (Italians: R2= .38; Americans: R2= .44). The results of this study suggest that there are cultural differences in sleep quality and sleep hygiene practices, and that sleep hygiene practices are importantly related to adolescent sleep quality.

Defining, Assessing, and Treating Adolescent Insomnia and Related Sleep Problems

As parents, teachers, coaches, health care providers, and teenagers themselves know, adolescence is filled with significant physical, cognitive, emotional, and social change. Sleep is a crucial and often ignored aspect of adolescents’ lives as it changes and influences factors in their overall development, as well as in their daily lives. The quality and quantity of adolescents’ sleep significantly influences their ability to think, behave, and feel in school, on the playing field, at work, as well as in a variety of other situations. Over the last two decades, laboratory data have demonstrated that adolescents have an increased need for sleep and experience a phase delay during puberty (1, 2, 3, 4, 5). Despite this need, survey and field studies indicate that as early as sixth grade, adolescents obtain less sleep, report increased morning drowsiness, and have more spontaneous daytime naps than do younger children (6, 7, 8). School schedules, work and extracurricular hours, and other environmental constraints are not beneficial to adolescents’ sleep schedules and requirements (2,4,7,9). In fact, teenagers develop a sleep debt by getting a minimal amount of sleep on school nights and making up for this by sleeping longer on the weekends (7). Sleep debt results in frequent absences or tardiness from school, sleepiness and emotional lability, attention difficulties, and academic struggles (7,10, 11, 12, 13). Other adolescents may develop sleep disorders such as insomnia, phase-delay disorder, sleep apnea, or other sleep problems that also impair ability to function during the day. Recently, the National Institutes of Health recognized adolescents and young adults (12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 years) as a population at high risk for problem sleepiness based on “evidence that the prevalence of problem sleepiness is high and increasing with particularly serious consequences” (14). This chapter focuses on insomnia and phase-delay disorders in adolescents.