Dr. Carskadon’s presentation focuses on the biological causes of the delay in sleep timing that occurs during adolescence, whereby the natural sleep-wake cycle shifts later in the day.  Dr. Carskadon explains that the human brain undergoes enormous structural changes during adolescence and discusses the changes that occur in the circadian timing system and the homeostatic system that regulate sleep.  To underscore the biological source of this change, Dr. Carskcadon notes that a sleep-timing delay also occurs during adolescence and pubertal onset in other species of mammals. 

Dr. Carskadon presents research that demonstrate that the release of melatonin, “the hormonal gateway to sleep,” shifts later in the day during adolescence, while the amplitude of the melatonin signal falls.  Research has also found that adolescents experience a greater sensitivity to evening light, associated with  a delay in circadian timing.  

As it relates to homeostatic drive, or sleep pressure, Dr. Carskadon  presents research measuring slow brain wave activity and sleep propensity showing that the homeostatic system also undergoes significant changes during adolescence, resulting in a slower accumulation of sleep pressure during the course of the day.

The conclusion is that sleep’s two main bio-regulatory systems both undergo changes during adolescence that operate to shift the natural sleep-wake cycle later in the day.

Mary A. Carskadon, PhD
Professor of Psychiatry and Human Behavior and Adjunct Professor of Cognitive, Linguistic and Psychological Sciences at Brown University, Mary Carskadon received a BA in psychology from Gettysburg College (1969) and is a distinguished alumna of that institution. She holds a doctorate with distinction in neuro- and biobehavioral sciences from Stanford University (1979), earned under the mentorship of William C. Dement, MD, PhD. Dr. Carskadon’s current research includes evaluating how sleep and circadian timing influence smell, taste, food choices, and food consumption in overweight and normal weight teens and development of “smart lighting” to improve academic outcomes in secondary school students. Her awards include a Lifetime Achievement Award from the National Sleep Foundation and an Outstanding Educator and Distinguished Scientist Award from the Sleep Research Society.  She is an elected Fellow of the Association for Psychological Science and Fellow of the American Association for the Advancement of Science.

Q1: Discuss the changes to the sleep cycle that happen during adolescence. What other species besides humans also see this effect?

Q2: Melatonin has been called “the hormonal gateway to sleep.” How do changes in when melatonin is produced affect the sleep cycle?

Q3: The urge to fall asleep, or sleep pressure, is different from just being tired. Name some of the research findings, such as seen when studying brain waves, about how sleep pressure is different in adolescents than in adults.

Brian Tefft presents the results of research conducted by the American Automobile Association and other safety organizations related to sleep and teen drivers. Automobile crashes are the leading cause of death for teens aged 16 to 20 years old.  In fact, for every mile driven teen driver crash rates range between 3 to 6 times the crash rates of drivers 30 years old.

Mr. Tefft reports research estimating that about 40% of teens routinely get less than 6 hours a sleep at night and that approximately 25% of teen drivers self-report having driven while drowsy during the previous 30 days.  These sleep deficits clearly impair driver safety.  The AAA Foundation estimates that driving on even 1 hour less sleep than the recommended amount results in a significant increase in crash risk and driving on 2-3 hours less sleep than recommended results in a crash risk that is equivalent to that of driving while intoxicated. 

Mr. Tefft provides a AAA Foundation estimate that drowsy driving accounts for 8% of all teen crashes and 13% of all teen crashes resulting in a fatality.

Q1: Name some key statistics about car crashes among teen drivers compared with adult drivers. Discuss some of the contributors to the differences in the rate of crashes in younger compared with older drivers.

Q2: What role does insufficient sleep play in car crashes among teen drivers? Discuss how driving with very little sleep compares to some other kinds of impaired driving, like driving while drunk.

Dr. Czeisler discusses why the body needs sleep and presents a comprehensive overview of the impact of insufficient sleep on the health.  He begins by describing the 5 stages of sleep, emphasizing that different functions are performed during the various stages of sleep.  This differentiated structure makes it important for the body to complete the entire sleep process. For example, new memories are integrated with previous memories to facilitate problem solving and creativity during the REM stages of the sleep cycle, which tend to cluster in the later stages of sleep. If the sleep cycle is consistently truncated by an alarm clock before the REM stages have been completed, these critical learning processes are not allowed to take place.

Dr. Czeisler explains how poor, irregular sleep impairs brain function and creates adverse health consequences by disrupting the timing and operation of important physiological processes.  Sleep allows the body to restore the brain’s energy stores, to repair brain cells, and to flush neurotoxins from the brain.  He discusses an array of serious metabolic, cardiovascular, immunological, and mental health problems that stem from lack of sleep, and explains the channels through which these problems occur.

Charles Czeisler, MD, PhD, FRCP
Charles Czeisler is the Director of the Sleep Health Institute, Senior Physician and Chief of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, and the Frank Baldino Jr., PhD. Professor of Sleep Medicine at the Harvard Medical School’s Division of Sleep Medicine. His research group focuses on understanding the neurobiology of the human circadian pacemaker, located in the suprachiasmatic nuclei (SCN) of the hypothalamus, and applying that knowledge to clinical medicine and occupational health. Their earliest work revealed that sleep duration and structure were regulated by the output of this pacemaker. Since then, Dr. Czeisler’s lab has unmasked the endogenous circadian component of various neuroendocrine, metabolic, thermoregulatory and behavioral rhythms controlled by the pacemaker by studying human subjects under constant environmental and behavioral conditions. Current research focuses on the neurobiology of circadian photoreception in humans; the interaction of circadian and homeostatic processes in regulating sleep and neurobiological function during wakefulness; the role of melatonin in the organization of sleep and circadian rhythms;  functional magnetic imaging, quantitative analysis of sleep and waking EEG; and the influence of sleep loss on the deployment of visual attention.

Q1: Why do we need to sleep?

Q2: What are the 5 stages of sleep? What are the different functions performed in each stage?

Q3: What happens with insufficient sleep – that is, sleep of short duration or sleep that’s happening at the wrong time or that is interrupted? What specific physical problems have been associated with insufficient sleep?

Dr. Wolfson reviews literature on the relationships linking school start times, sleep, and academic performance.  The main focus is on: associations between insufficient and delayed sleep patterns and academic performance, with performance indicators including student GPAs and self-reported grades, test scores, time spent on homework, attendance, and tardiness.   Research addressing these questions include cross-sectional studies and a longitudinal study of school districts in various regions of the US;  results of a large study conducted in Norway (2016) that looked at the predicitive quality of sleep duration and sleep deficits on test scores was also presented.   

In addition to reporting results of studies on overall student measures of academic performance, Dr. Wolfson also discusses studies that explored several sub-topics of the issue:  a study that compared student test scores in the same core course taken in the first period versus later in the day; an experiment that compared the test performance of students who were well-slept compared to students who were sleep deficient;  research data that addressed whether students at the lower end of the distribution of academic performance benefit more or less from later start times than those at the higher end of the distribution; studies that looked at next-day academic performance when students sacrificed sleep in order to study more than usual.

Amy R. Wolfson, PhD
Amy R. Wolfson is Vice President for Academic Affairs and Professor of
Psychology at Loyola University Maryland. Wolfson came to Loyola from the College of the Holy Cross, where she chaired the psychology department from 2008-2010 and served as associate dean in from 2010-2014. She has been published in numerous prestigious peer-reviewed journals and is the author of two books, The Woman’s Book of Sleep: A Complete Resource Guide and The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior.

Wolfson was awarded a six-year $1.1 million grant from the National Institutes of Health (NIH) in 2005 for her Young Adolescent Sleep-Smart Pacesetter Program—the largest individual grant awarded to a College of the Holy Cross faculty member. Dr. Wolfson recently completed the Sleep-Smart study, a longitudinal study of urban, middle-school students’ sleep patterns and hygiene, behavioral well-being, and academic performance, funded by the NIH. She is co-editing a special issue for Sleep Health on Sleep Science and Policy: a Focus on School Start Times, and her current research is focused on addressing the implications of emotional and physical health practices on adolescents’ sleep. She has taught courses on gender and leadership, mental health, health psychology, women’s studies, and sleep and circadian rhythms.

Q1: What is some of the evidence Dr. Wolfson discussed that insufficient sleep has a negative affect on academic performance and school success? What are some of the aspects of school success that Dr. Wolfson mentions, aside from just grades?

Q2: Does the time of day at which students take a test affect how they perform? What about having a good night’s sleep the night before an exam, compared with staying up very late to cram?

Dr. Wheaton discusses the CDS’s contribution to the national conversation on adolescent sleep.  The CDC’s Sleep Health Program goals are to increase public awareness of the importance of healthy sleep, promote healthy sleep policies, and improve sleep-related national surveillance survey data at the state and national levels.  The US Department of Health and Human Services’ initiative, “Healthy People 2020,”  introduced the goal of raising the percentage of high school students who get at least 8 hours of sleep at night.  A 2015 baseline indicated that only about 25% of high school students currently achieve that goal.  

Dr. Wheaton presents the results of the CDC Youth Risk Behavior Survey that found a positive association between short sleep duration and obesity, suicide ideation, and health-risk behaviors such as cigarette, alcohol, and marijuana use.  The CDC also reports a positive association between short sleep duration and injury-related behaviors such as drinking and driving, and texting and driving.

With respect to school start times, Dr. Wheaton presents results of a CDC survey of school start times on a state-by-state basis.  In aggregate, 83% of middle school and high schools in the US start before the medically recommended time of 8:30am, with a 2014 CDC survey indicating that 93% of US high schools start before 8:30am.

Dr. Wheaton succinctly states the  CDC’s view on the role changing school start times can play in improving adolescent sleep health:  “Among the possible public-health interventions for increasing efficient sleep among adolescents, delaying school start times provides the potential for the greatest population impact by changing the environmental context for students in entire school districts.”  

Anne Wheaton, PhD, Senior Service Fellow/Epidemiologist, Centers for Disease Control and Prevention

Dr. Wheaton discusses the CDS’s contribution to the national conversation on adolescent sleep.  The CDC’s Sleep Health Program goals are to increase public awareness of the importance of healthy sleep, promote healthy sleep policies, and improve sleep-related national surveillance survey data at the state and national levels.  The US Department of Health and Human Services’ initiative, “Healthy People 2020,”  introduced the goal of raising the percentage of high school students who get at least 8 hours of sleep at night.  A 2015 baseline indicated that only about 25% of high school students currently achieve that goal.  

Dr. Wheaton presents the results of the CDC Youth Risk Behavior Survey that found a positive association between short sleep duration and obesity, suicide ideation, and health-risk behaviors such as cigarette, alcohol, and marijuana use.  The CDC also reports a positive association between short sleep duration and injury-related behaviors such as drinking and driving, and texting and driving.

With respect to school start times, Dr. Wheaton presents results of a CDC survey of school start times on a state-by-state basis.  In aggregate, 83% of middle school and high schools in the US start before the medically recommended time of 8:30am, with a 2014 CDC survey indicating that 93% of US high schools start before 8:30am.

Dr. Wheaton succinctly states the  CDC’s view on the role changing school start times can play in improving adolescent sleep health:  “Among the possible public-health interventions for increasing efficient sleep among adolescents, delaying school start times provides the potential for the greatest population impact by changing the environmental context for students in entire school districts.”  

Dr. Pelayo answers the most common questions most people have on adolescent sleep and school start times, while debunking many common myths and misconceptions in the process.  Do students fall asleep in school because they are bored?  Can students catch up on sleep on the weekends and is that a good practice?  What is “microsleep” and how does it impact driver safety?   If schools start later, will students just stay up later?  What is the relationship between sleep and athletic performance?  How does sleep impact the part of the brain that governs risky behavior and suicide ideation?  What is the role of electronics in causing sleep problems?

Dr. Pelayo concludes by describing an award-winning program in which Stanford University collaborates with local high schools to educate students on sleep and the critical role it plays in health and performance. 

Rafael Pelayo, MD
Rafael Pelayo, MD is a clinical professor at Stanford University School of Medicine. He has been treating sleep disorders in children and adults at the Stanford Sleep Disorders Clinic since 1993. He was elected and currently serves on the board of the California Sleep Society. Along with Dr. William Dement he teaches the Stanford University Sleep and Dreams course to hundreds of undergraduate students. Together they wrote the course’s textbook. Students in this class are required to perform outreach projects to increase awareness of the importance of sleep. He has previously served as chair of the Sleep Disorders Research Advisory Board of the National Center for Sleep Disorders Research at the National Heart Lung Blood Institute at the NIH. He chaired of the pediatric special interest section of the American Academy of Sleep Medicine. He has lectured nationally and internationally on sleep disorders. He has done multiple television, radio, and print interviews. He is originally from New York City.

This panel presentation addressed the “nuts and bolts” challenges of changing school start times from three different perspectives.  Ms. Sandy Evans is the Chair of the Fairfax County School Board in Fairfax, VA and led the successful effort of that school district in changing to later school start times.  Darrel Drobnich, President of MidAmr Group and former Chief Program Officer of the National Sleep Foundation, has advised school districts on successfully implementing school start times changes.  Terra Ziporyn Snider is the Co-Founder of Start School Later, Inc., a nonprofit organization, with 101 chapters in 27 states and Washington D.C., dedicated to increasing public awareness about the relationship between adolescent sleep and school start times. 

The Fairfax County School District Case Study:  With 188,000 students, Fairfax County School District is the 10th largest school district in the United States and it has the largest school bus fleet in the country with 1,640 buses.  In 2015, Fairfax County School District moved to later school start times to provide middle school and high school students the opportunity to get more sleep.  Ms Sandra Evans was the Chair of the School Board that led the change.

Ms. Evans presents the step-by-step approach taken in Fairfax to change school start times.  She emphasizes the important role the Board of Education plays in establishing clearly the policy goal of changing school start times as an important student health priority, and then to have a capable school administration leadership team committed to pursue that goal.   At that point, the focus of the initiative can move from “WHETHER to change to HOW to change.” She discusses the process by which Fairfax County School Board hired consultants to develop alternative plans for implementation and the importance of engaging school stakeholders early in the planning process to both educate them on the health issue and to take their interests into account prior to finalizing a plan.

Getting to YES:  Mr. Drobnich discusses the strategy for “Getting to YES” on a policy to change school start times.  He argues that having an overwhelming scientific rationale for changing school start times is not sufficient for the change to be made.  Rather, advocates need to engage with school stakeholders, particularly school board members and superintendents, and seek to understand and address any objections they may have.  The goal is to move them from to “No” to “Maybe” to “Yes” over time.  In this context, changing school start times sometimes needs to become an important school board election issue. 

With a committed leadership team in place, the focus can be on how best to implement the change.  At this stage, the exercise involves developing alternative scenarios and to elicit feedback from school stakeholders to iterate to the best overall solution.  The emphasis in this stage should be to ask people identifying problems to also suggest possible solutions so as to keep the dialogue constructive and moving forward.  Mr. Drobnich emphasizes the difficulty of asking the same people who created the status quo to change the status quo, and argues that having an independent consultant or an appointed change agent to spearhead the process is important.

Building Political Will:  With a bird’s eye view of the school start-time change movement in over 100 Start School Later chapters throughout the United States, Terra Ziporyn Snider, the Co-Founder of Start School Later Inc., highlights three underlying obstacles that stand in the way of changing school start times: (1) the bias of the status quo; (2) the failure of creativity and imagination to envision new possibilities and to solve problems; (3) a pervasive ignorance about the importance of sleep to adolescent health. 

Dr. Ziporyn Snider observes that school districts that have overcome these obstacles have one thing in common:  the political will to explicitly prioritize health and learning and to find creative and affordable ways to make the change.

Turning to how to build political will, Dr. Ziporyn Snider explains that the goal is to correctly reframe the issue as a critical matter of public health instead of one focused on inconvenience, logistics and expense.   She  makes the case for a multi-level approach by a diversity of players who work together on a local, state and national level. The players would include health organizations, health professionals, civic organizations, sleep researchers, parent and student advocates, school policy makers and teachers, and legislators, all working to share resources and augment one another’s efforts. This team effort on a national level is made possible by the reach and leverage of social media.

Sandy Evans
Sandy Evans is a Fairfax County School Board member representing Mason District, and currently serves as Chair of the School Board.  A journalist by profession, she is a former reporter and staff writer for The Washington Post. In 2004, she and Phyllis Payne co-founded Start Later for Excellence in Education Proposal (SLEEP), a grassroots group created to advocate for later middle and high school start times in Fairfax County, VA. Ms. Evans has a bachelor of science in journalism from the  University of Maryland-College Park. Before being elected to the School Board in March 2010 in a special election, Evans had served on the Board’s School Health Advisory Committee (chairman) and Transportation Task Force; Northern Virginia Healthy Kids Coalition (steering committee member); Fairfax Education Coalition (founding member); Fairfax County Council of PTAs (legislation committee chairman); and Sleepy Hollow Elementary School PTA (former PTA president). She was reelected to four-year terms on the School Board in 2011 and 2015, with her current term ending in December 2019. She is married to attorney Steven K. Hoffman and has two daughters.

Darrel Drobnich
Darrel Drobnich is a president of the MidAmr Group, a consulting firm in Washington, DC, and has over 25 years of experience translating scientific findings into public health messages, educational programs, public policy, and advocacy initiatives in both the U.S. Senate and the non-profit sector. As former Chief Program Officer of the National Sleep Foundation (NSF),  he created and oversaw public policy initiatives and award-winning national public awareness and research programs, bringing the issue of adolescent sleep and starting a national conversation on the issue. In 1998, he formed a partnership with Congresswoman Zoe Lofgren (D-CA) to introduce a Congressional resolution (H.C. Res. 135 or “Z’s to A’s,”) to encourage schools to move start times to no earlier than 8:30 a.m. Most recently, Mr. Drobnich helped lead a multi-disciplinary team to overturn 20 years of failed attempts to change unhealthy school start times for 57,000 high students in Fairfax County Public Schools, VA, the 10th largest school system in the country and is currently consulting with York County School Division in Virginia.

Terra Ziporyn Snider, PhD
Terra Ziporyn Snider is the Executive Director and Co-Founder of Start School Later, a nonprofit dedicated to increasing public awareness about the relationship between sleep and school hours and to ensuring school start times compatible with health, safety, education, and equity. An award-winning author of numerous popular health and medical books including The New Harvard Guide to Women’s Health, The Women’s Concise Guide to Emotional Well-Being, Alternative Medicine for Dummies, and Nameless Diseases, she was an associate editor at The Journal of the American Medical Association (JAMA) and has written extensively on a wide range of health and medical issues in publications including The Harvard Health Letter, JAMA, The Huffington Post, Consumer Reports, Weight Watchers Magazine, and Business Week. Dr. Snider is a graduate of Yale College and a former Searle Fellow at the University of Chicago, where she earned a doctorate in the history of science and medicine. She has been awarded science-writing fellowships by the American Association for the Advancement of Science, the American Chemical Society, and the Marine Biological Laboratory at Woods Hole.