Sleep for School Success

Use sleep health for cognitive ability and academic success

Note: I’d like this newsletter to be as useful to you as possible. At the bottom there’s a list of possible topics, please comment which would be of most use to you, or add a topic / question you’ve been wondering about. Thanks!

It's mid-August now. Lots of kids are starting the school year. Many parents look forward to getting back into a regular routine. A schedule that allows healthy sleep will make all the difference for the school year, in terms of learning, behavior, and safety. Today let’s talk about children’s sleep needs, how sleep shapes school success, and what do to about it in your own family.

Sleep in Children and Teens
Over the course of childhood and adolescence, there are some critical sleep and circadian changes that alter the experience of sleep. First, slow wave sleep, otherwise called deep sleep, declines significantly from childhood to adolescence. This is one of the reasons that teens have the sensation that they're just not sleeping as well as they previously did. Nightly sleep need declines somewhat, from 9 to 12 hours nightly for children ages 6 to 12 years old, to 8 to 10 hours nightly for teenagers. It's important to figure out "how much sleep does my child do best with?" Remember, the idea of making up for lost sleep on the weekends after five nights of insufficient sleep is a myth. Performance data shows that although there might be a small improvement on Monday, performance deteriorates week by week on this schedule (van Dongen reference)

Circadian Rhythms in Children and Teens
The circadian pattern also changes from childhood to adolescence. The inherent body clock that determines whether we're a morning type, a night type, or neither, shifts dramatically later during the adolescent years. This starts around 10 years old, before other signs of puberty. That shift lasts until about age 20-21 in women, and 21-22 in men. This is found in cultures all around the world, and before smart phones or social media were introduced. For this reason, it’s recommended that middle and high schools start at 8:30am or later (1). Another circadian change is that nocturnal pineal melatonin secretion declines significantly over puberty. That nocturnal melatonin pulse helps us feel drowsy. Unfortunately, even small amounts of light, particularly blue light from LED lightbulbs or screens, will suppress melatonin secretion. This is particularly important for children, as they have a much greater sensitivity to light in the evening than adults do (2). So know that if the TV is on before bed, your child's sleep is going to be more negatively impacted than yours will be.

Childhood Sleep Disorders
Most sleep disorders found in adults can also be found in the pediatric population. Today I’d like to highlight those disorders that are particularly relevant for school success, and a future newsletter will focus on pediatric sleep disorders. Obstructive sleep apnea is known to have an impact on learning (3), which is likely due to the repeat low oxygen levels in the night. This has an impact on the typical neuroplasticity seen in childhood that is necessary for learning. Two common childhood disorders that have a sleep component are ADHD (Attention Deficit Hyperactivity Disorder) and Autism Spectrum Disorder. Children with ADHD have both challenges in the classroom, and higher rates of obstructive sleep apnea and restless legs syndrome. In autism, there are changes to the melatonin system which impact sleep. Note that melatonin supplements are not recommended as a first line therapy for children’s sleep problems, the American Academy of Sleep Medicine put out an advisory against this practice recently. The recommendation is to treat melatonin as any other medication, by getting personalized care from a licensed healthcare provider (4).

Cognitive Abilities
There's an elegant, well-done study that I love from the early 2000s, where they took sixth grade students and sleep deprived them by one hour for three nights in a row (5). The students then took some cognitive tests. That one hour of sleep deprivation reduced their cognitive abilities to that of a fourth grader. They lost two years of cognitive development with just one hour of sleep deprivation! There are many studies since then that further demonstrate the relationship between sleep and learning in young people of all ages.

Grades and Standardized Tests
When teens get more sleep, they get better grades. Students who earn As typically get 15 minutes more sleep each night than those who get Bs. Those who get Bs get 11 minutes more sleep than those who get Cs. The same is true for standardized tests, those students with the most sleep get the best scores. Not only is there a relationship between sleep and academic performance, but also a relationship with the circadian rhythm. Because many schools start before high school students are ready to be awake and alert, first period grades are often lowest, and standardized test performance is better for topic studied in the afternoon than in the morning. For this reason, you may want to shape your students class schedule so that their most important or challenging classes are taken in the afternoon or at times when they will be more alert.

Sleep Skills
Use sleep to make the school year a success with these skills:
1.     Note how much sleep your child gets when they are on their own schedule and can just sleep as much as they need to. How much sleep were they getting this summer during unscheduled times? Schedule those hours to sleep every night of the week. If they are sleeping more on weekends, that’s a sign they aren’t getting enough sleep on school nights, which spills over to learning problems.
2.     Honor your child’s circadian preference as much as possible. Especially for teens, allowing them to sleep to the last possible moment, rather than do before school activities, will make a big difference.
3.     Treat any sleep disorders with their healthcare provider. Whether it be insomnia, obstructive sleep apnea, restless legs syndrome, all of them will have a negative impact on school. (In future newsletters we will discuss sleep disorders in children).
4.     If your child has ADHD or autism, include sleep focused therapies as part of a comprehensive treatment plan.
5.     Lastly, advocate for evidence-based school start times of no earlier than 8:30am for middle and high schools. You can get more information, and find (or start!) an advocacy group at startschoollater.net.
6. Is your child sleep deprived? Join the Skilled Sleeper community as a paid subscriber to download the worksheet and find out.

Sleep is essential for us to truly thrive. I hope this helps you and your family have a happy, successful school year.

Dr. Catherine

Note: I’d like this newsletter to be as useful to you as possible. Please comment below which three topics are of most interest, or add a topic / question you’ve been wondering about. Thanks!

How Does the Circadian System Work?
Designing Optimal Light and Darkness
Women’s Sleep Disorders
Exercise routines to improve sleep
Dangers of Artificial Light at Night
How to Use Blue Blocking Glasses
Foods and Meal timing for sleep
Wild Fires and Pollution impact sleep
Sleep in ADHD
When (and when not) to use Melatonin
What is Cognitive Behavioral Therapy for Insomnia?
What’s Polyphasic Sleep, and is it right for you?

Listen in: Podcast on Sleep and Aging

Select References:
1.     aasm_position_statement_on_delaying_school_start_times.pdf (startschoollater.net)
2.     High sensitivity of melatonin suppression response to evening light in preschool-aged children - PubMed (nih.gov)
3.     Predictive Power of Oxygen Desaturation Index (ODI) and Apnea-Hypopnea Index (AHI) in Detecting Long-Term Neurocognitive and Psychosocial Outcomes of Sleep-Disordered Breathing in Children: A Questionnaire-Based Study - PubMed (nih.gov)
4.     Health advisory: melatonin use in children | Journal of Clinical Sleep Medicine (aasm.org)
5.     The effects of sleep restriction and extension on school-age children: what a difference an hour makes - PubMed (nih.gov)
6.     final_version_3-11-14_start_time_report.pdf (spps.org)

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Is your child sleep deprived? Fill out this worksheet to find out, and make a plan for getting adequate sleep night after night. It will be so worth it! Thank you for being a paid subscriber.