Monday, December 1, 2014

Healthy People 2020 Focus: Sleep Health


High school and college students are identified as a group greatly affected by sleep difficulties (Buboltz, Brown, & Soper, 2001). Sue Adams’ study, on more than 200 students at a university, found students only get 7 hours of sleep when they actually need 9 hours and 15 minutes of sleep each night (Rice, 2011). Rice also mentions that students lose 45 minutes of sleep a night due to cell phone usage adding to the sleep deprivation (Rice, 2011). Lack of sleep is associated with higher rates of anxiety and depression among other symptoms (Rice, 2011). Poor sleep habits also attribute to academic difficulties, such as lower test scores and problems with concentration (Buboltz et al., 2001).


        Among a study of 1941 high school students, Ming et al. found that 94.2% of students reported 8 hours or less of sleep a night, compared to the recommended 9 hours of sleep (Ming et al., 2011). Ming et al. identified a trend with increased deprivation as students aged. Fifty percent of Juniors and Seniors slept less than 6.5 hours on school nights, while only 30% of Freshman and 39% of Sophomores reported sleeping the same amount (Ming et al., 2011). Poor sleep habits reported in both high school and college students indicate that both groups are sleep deprived.  

            A study was conducted to determine sleep issues in South Korea, with a population size of 1,007 participants, and Taiwan, with a population size of 785 participants. Questionnaires were administered to clarify social determinants of insomnia within the two countries. (Nomura, Yamaoka, Nakao, & Yano, 2010, p. 435) Results show that the social determinants linked with insomnia within the two countries included individuals low income, having few persons to consult with, and increasing age as well. Statistically, the study showed that the percentage of low household income was significantly larger than that of middle and high income for cases of insomnia. Low income had a 17.3% prevalence compared to 5.4% and 4.8% for middle and high income, respectively. The results were similar as well for educational status. For those with family members to consult the prevalence was at 8.0% while those under the “other/none” category showed a 16.1% prevalence for insomnia. “Low household income and low education level were significantly associated with sleep problems, a finding that agrees with the results of previous health inequality studies [13] and [14]” (Nomura, Yamaoka, Nakao & Yano, 2010, p. 437) Within  the studies, it is obvious that social determinants that can be applied to other countries can show whether they have an impact on sleep health; including; social status, educational level, interpersonal relations, income, etc.  In further studies, based in Taiwan, factors including gender impact sleep health as well. These studies show that females exhibit more disturbance during night time sleep. [Chen, Kawachi, Subramanian, Garcia, & Lee, 2005, p. 490)

Considering all of the social determinants for achieving proper sleep health for adolescents, the next step is finding evidence-based policy or programs that are in place for effective change. Key evidence discovered by the American Academy of Pediatrics (AAP) target early start times as the major contributor in insufficient sleep among students (American Academy of Pediatrics [AAP], 2014). Research done by the AAP indicates that delaying school start times to combat chronic sleep loss. Further still, the University of Minnesota studied eight high schools in three states that had altered their start times to later ones. The findings indicated that “the later a school’s start time, the better off the students were on many measures, including mental health, car crash rates, attendance and, in some schools, grades and standardized test scores” (Hoffman, 2014, para. 7).
Due to the latter release of the hormone melatonin in adolescents, they are generally not tired until 11pm and tend to rise no earlier than 8pm (Hoffman, 2014). Throughout several studies, delaying school start times increases sleep duration while providing several benefits. Benefits include those listed in research by University of Minnesota and also include less daytime fatigue and absences from first-period classes (AAP, 2014). Given these studies, improvement in health and academic success from later school start times appears to be a significant and effective change for sleep health.

Chronic sleep loss continues to increase worldwide for many reasons, either from societal changes or lifestyle choice. Insufficient sleep can lead to obesity, “excessive daytime sleepiness and, therefore, links to problems with attention, concentration, impulsivity, mood regulation, and cognitive functioning” (“A Sleep Series Study in China”, Introduction, 2013). Sleep is very important and should be made a high priority among everyone. One should take action in promoting sleep health with sleep interventions, such as reforms of public policies with school/work schedule modification. A sleep series study in china on a school-based intervention among school-aged children was performed on 525 children in six primary schools in Shanghai China. These children’s ages varied from 9-12 years and were placed in two interventions and on controlled group/school. This study started on September 2007 and ended September 2009. Intervention one school starting time was delayed by 30 minutes, from 7:30 am to 8 am. Intervention two school staring time was delayed 60 minutes, from 7:30am to 8:30 am. The controlled group/school starting time was not changed, keeping its 7:30 am starting time. These series of studies were aimed to show sleep patterns, the association of sleep with school performance, and a view on a practical intervention strategy (“A Sleep Series Study in China”, Abstract: Background, 2013”). The delaying of school start time by 30 and 60 minutes increased sleep duration by 15.6 and 22.8 minutes, which significantly improved sleep duration and daytime sleepiness, thus reducing the negative side effects of sleep loss. The study of the sleep intervention also showed a stronger change in intervention 2, emphasizing on having more sleep with the 60 minute starting time delay. Even though this studies enlarged benefits were not very encouraging due to the sample size, and that only a minority of the children got the recommended 10 or more hours of sleep, as stated in the article (“A Sleep Series Study in China”, School-based sleep intervention evaluation, 2013); overall this study showed that school, and even work schedule, can be a great target for sleep intervention. Sleep intervention is important and effective and could significantly improve one’s well-being, “Sufficient sleep during childhood is essential to ensure a transition into a healthy adulthood” (“A Sleep Series Study in China”, Abstract: Introduction, 2013).Even though this study wasn’t performed on adolescents, but did refer to different studies that did, it did showcase the positive effectiveness and similar evidence/results of sleep interventions.
It is very possible to win the battle on sleep health. It is impossible however to expect every student to achieve the required amount of sleep each night due to the outside influences of each student’s personal life. But it is possible to increase the awareness of the effects of poor sleep and the overall education of the importance of sleep health. With a better understanding on sleep health, a student can make the choice to improve their sleeping patterns in order to get close or completely get the required amount of sleep a person should get each night. In a study researching sleep health in students, “the results from this three-year research study, conducted with over 9,000 students in eight public high schools in three states, reveal that high schools that start at 8:30 AM or later allow for more than 60% of students to obtain at least eight hours of sleep per school night” (Wahlstrom, 2014). Most public schools start at 7:30 am. This change in start time of schools is one of the ways the public health policy makers are trying to win the battle of sleep health.



References

American Academy of Pediatrics. (2014, August 25). School Start Times for Adolescents. Pediatrics, 642-649. Retrieved from http://pediatrics.aappublications.org

Buboltz Jr, W. C., Brown, F., & Soper, B. (2001). Sleep Habits and Patterns of College Students: A Preliminary Study. Journal of American College Health, 50(3), 131-135.

Chen, Y. Y., Kawachi, I., Subramanian, S. V., Acevedo-Garcia, D., & Lee, Y. J. (2005). Can social factors explain sex differences in insomnia? Findings from a national survey in Taiwan. Journal of epidemiology and community health, 59(6), 488-494.

Hoffman, J. (2014, March 13). To Keep Teenagers Alert, Let Them Sleep In. The New York Times. Retrieved from http://well.blogs.nytimes.com

Li, S., Arguelles, L., Jiang, F., Chen, W., Jin, X., Yan, C., … Shen, X. (2013). Sleep, School Performance, and a School-Based Intervention among School-Aged Children: A Sleep Series Study in China. PLoS ONE, 8(7), e67928. doi:10.1371/journal.pone.0067928

Ming, X., Koransky, R., Kang, V., Buchman, S., Sarris, C. E., & Wagner, G. C. (2011). Sleep Insufficiency, Sleep Health Problems and Performance In High School Students. Clinical medicine insights. Circulatory, respiratory and pulmonary medicine, 5, 71.

Nomura, K., Yamaoka, K., Nakao, M., & Yano, E. (2010). Social determinants of self-reported sleep problems in South Korea and Taiwan. Journal of psychosomatic research, 69(5), 435-440.

Rice, A. (2011). Bleary-Eyed Students Can’t Stop Texting, Even to Sleep, A Researcher Finds. The Chronicle of Higher Education.

Wahlstrom, K., Dretzke, B., Gordon, M., Peterson, K., Edwards, K., & Gdula, J. (2014).  Examining the impact of later school start times on the health and academic performance of  high school students: A multi-site study. Center for Applied Research and Educational Improvement. St Paul, MN: University of Minnesota.

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