>>WOLFSON: All right, thank you very much,
Nancy. I’m so glad to be here. I’m known for having way too much material. That’s not my
strength as a teacher. So hopefully, I may bust through a few slides and not cover absolutely
everything that I can on covering. This is going to be a real sort of mixture
of ideas and thoughts and material for you this morning. I wanted to both give you a
sense of what’s known today, science-wise, behavioral science-wise in terms sleep and
adolescence, but I also wanted to give you a flavor for some of the things that I do
with my students when I’m teaching, both specifically with regard to adolescence and sleep but more
broadly sleep. I teach undergraduate course specifically on it’s called sleep and behavior,
and so I’m sort of going to dabble a little bit in some of the things I do in that course
as well as the science and what I would be doing if I were speaking to you to just share
some of my research. It’s going to be a real mixture. Bear with me because we’ll do … so
we’re going to go back and forth. I’m also going to get you kind of moving around or
in some small groups before we finish up this morning. All that in 90 minutes, we will see
how that works. For starters, what I’d love for you to do
is one of the handouts … I’m rather old-fashioned. I just yesterday was in an iPad workshop and
yet I’m still kind of paper and pencil and I hand things out. If you could take the sleep
quiz, take just a couple of minutes to fill that out, and this is something you can take
and adapt for your own purposes with your high school students. I’ve been using these
questions for years. I won’t answer all. We won’t go through all of them, but after you
do it, we’re going to just go through a couple of them. And the one handout I have not given
you are the answers, so you can take that on your way out. So if you could just take
a couple of minutes to fill that out, the sleep quiz. [Pause] You should be done by now. So I want to go
through a couple of them, and this is really to get you thinking about sleep and circadian
rhythms. So let’s just take a look at the very first question. Students fall asleep
in classes because professors, because teachers are boring. True or false, and what’s your
explanation for your answer? Why is that false? Yes? Just say your first name just so I … yeah.>>WORKSHOP PARTICIPANT: [Unclear] politics
say that professors are boring and that’s why students are falling asleep.>>WOLFSON: All right. But what’s the scientific
or what’s the explanation for why this …>>WORKSHOP PARTICIPANT: There could be many
other factors involved in why they’re falling asleep.>>WOLFSON: Okay. Can someone say any specific
about sleep just in terms of your knowledge about sleep? Yeah?>>WORKSHOP PARTICIPANT: It depends on what
time of day it is.>>WOLFSON: Well, so it could be time of day,
absolutely, but … yeah?>>WORKSHOP PARTICIPANT: It could be the lack
of sleep that’s going to just make you … and you’re just going to be …>>WOLFSON: Exactly. I mean, I realize that
we’re talking here about teaching psychology courses, but we have a biological drive to
sleep. We can only stay awake so long and we are going to fall sleep. Now, it’s true,
time of day, I mean certainly teaching adolescents, those of you who teach in high schools that
start before 8:30 or so in the morning are going to have the experience of having students,
if you teach first or even second period classes, who may be sleepy relating to the time of
day or getting an inadequate amount to sleep the night before. Those of you who have students
sometimes around the lunch period may find that students are sleepy for other reasons.
So there is time of day can be a factor. Also, lighting can be a factor. So not you
personally, not your teaching style necessarily, but if you teach at 7:30 in the morning and
you show a film in your AP psychology class and you put all the lights off, I don’t care
how exciting the film is, you may have a higher percentage of students who don’t see the film,
so to speak. But by and large, if you have … I think that the main point that I want
to make with this in terms of really your teaching experience, not just the knowledge,
is that if you have a student class after class who falls asleep, that’s a student that
you need to draw attention to. That’s the student that you should be talking to that
student. That’s a student who you should be bringing to the school nurse’s attention and
so on. That would not be sort of within normal range, to do that day after day after day.
That’s not my focus for today, but I’m happy to answer questions about that later on. I’m going to talk a lot about question three
in a couple of minutes, so we won’t talk about that one, but let’s see. How about question
five? Effects of sleep loss add up over the course of several nights and days, true or
false?>>WORKSHOP PARTICIPANT: True.>>WOLFSON: Okay, so that’s absolutely true.
Can someone say anything about that? Yeah?>>WORKSHOP PARTICIPANT: We accumulate what’s
called sleep debt.>>WOLFSON: Exactly. Exactly. Now, you can
do something about it. I mean just assume that you can. We can’t make up for it. We
accumulate our sleep loss unfortunately with our modern 24/7 lives or more than 24/7 lives
no matter what. But we can make up for some sleep loss in the sense that we can sleep
more on the weekends, and teenagers unfortunately do what we call binge sleeping, which is problematic
and then causes other difficulties. Also, being on an erratic schedule, whether
we’re an adolescent or an adult is problematic, and so too much of that sleeping, say, on
one schedule during the week and another schedule on weekends is problematic. And most of the
research suggest, particularly with adolescents, that more than a 90-minute, some research
says only a 60-minute difference in the timing of your sleep, that irregular or erratic schedule
can have negative implications. So, when we’re looking at sleep, we’re not just looking at
sleep duration, but we’re always looking at other sleep-wake variables, and we can talk
more about that. Number nine, over 100,000 car accidents yearly
are related to sleepiness, true or false? It’s true, and it’s probably closer to 200,000
to tell you the truth. And adolescents, particularly male adolescents as well as college-age students
are the age group that is at greatest risk to fall asleep at the wheel, motor vehicle
accidents, and that’s without alcohol. When you combine alcohol in the case, there’s actually
a synergistic effect that puts you even at greater risk. One of the nightmare kinds of stories that
you read about is a college student who at, say, Thanksgiving break and you go to college
in Worcester, Massachusetts but your family lives in Virginia, and your parents have put
great pressure on you to get home for Thanksgiving. Classes end but you want to socialize with
your friends, so you stay on the college campus, if it’s a campus that allows you to do this.
And then you get on the road, say, if it’s Tuesday or Wednesday, regardless of the day,
and you don’t leave campus until 9:00 in the evening, and then you head home to get to
the D.C. area. High-risk situation for two reasons: that
individual is sleep-deprived; that individual may have been drinking, but even without the
alcohol, sleep-deprived. And then the time of day, and we’ll talk about circadian rhythms
in a couple of minutes, but the time of day if you picture sort of that eight-hour or
nine-hour drive, they may be getting into the D.C. area in the dawn hours, and the drive
to sleep in terms of where our circadian clock is, is the greatest in those early dawn hours.
So that’s a very sleepy time similar to the actual natural time that we’re more likely
to be ready to go to sleep. That’s another high-risk period of time. So there’s a combination
– I’m going to talk about this in a couple of minutes – of what we call sleep pressure
or homeostatic sleep pressure and our circadian timing. That sort of creates this awful situation
at that time. So it isn’t just sleep deprivation. What’s that?>>WORKSHOP PARTICIPANT: “I did everything,”
she said, “but I wasn’t dreaming.” And I get a telephone call. So I drove through a traffic
light sound asleep. An intersection, I hit a traffic pole in front of the bank, in front
of the apartment, so I was on my way home. So I was right in front of my apartment when
it happened.>>WOLFSON: Yeah, that’s not uncommon.>>WORKSHOP PARTICIPANT: Yeah, very scary.>>WOLFSON: So something to think about. Number
11: caffeinated sodas, coffee, hot chocolate, and other sources of caffeine can help keep
you awake, true or false? A pretty simple question if you first look at it. Okay. You’d
be surprise the number of adults, I’m sure we’ve all been in this situation where you
have a lovely evening together with some friends; you’ve had a couple of drinks. Dessert time
comes around and your host or hostess says, would you like caffeinated or decaf, and a
number of people say, oh, I want some caffeine. It doesn’t bother me. I don’t notice that
I stay awake having caffeine. Caffeine is a stimulant. And the only reason I bring this
up with regard to your working with high school students and adolescent sleep, it’s really
a new area of research. Actually, I’m doing some work in this area myself. There’s some suggestion that high caffeine
use or caffeine use in adolescence or in late childhood may be an entry drug. My colleague,
Alison Ludden, at Holy Cross is doing some work in this area. I don’t have to tell you
that the number of adolescents, the growing number of adolescents … and I have a couple
of slides about this, and I could have done a whole morning just talking about stimulants
and sleep and adolescent development as well, but I do think it’s something that you need
to be beginning to cover and to talk about, and I’d be happy to talk more about that.
But we’re in a Red Bull culture, unfortunately. And I don’t think … I guess what I will
say is I don’t think it’s coincidental that the attention, the wave of attention that
is now, thankfully, in my opinion, sort of have been covered by the media with regard
to sleep deprivation, both broadly in terms of the general population but specifically
adolescence and college students, and at the same time we have had a growth in the caffeine
industry. I was just in Starbucks now … I should have
brought the packets. Actually, I kind of like it. But it has this new … you go in to most
Starbucks this summer – has anyone seen this – and they’re selling these two types of drinks.
You can get one that’s like a berry flavor and one that’s a lime flavor. And it is not
limeade. It is lime flavored but the actual product is, are the raw coffee beans that
are being used to make this beverage so there’s caffeine in it. And the signs are like: refreshing,
come in for the summer, refresh, you know. And you can buy them powder now. And you would
not know it has caffeine unless you read the fine lines. In other words, it’s not even
being marketed as a caffeine drink. It’s being marketed as a new way of using coffee beans.
So go figure. The teenagers will be drinking that soon as well. I’m not going to do any more of these questions,
but this is a lot of fun. I often start, if it’s a unit relating to sleep, say I’m teaching
a course on abnormal psych or intro psych or in my upper level sleep course, it’s a
great way to just start a conversation on the topics using this approach. I don’t have
to tell you that, but these are some of the questions. I’m not going to go over all the handouts
I’ve given you, but I just wanted to sort of give you a couple of samplings of the kinds
of things that will be fun or useful in the classroom with high school students. I’ve given you a sleep-wake diary. This is
mine. I’ve actually used this in an NIH-funded study with middle school students, and this
is a sample. You’re welcome to make use of it in any way that you’d like. But it’s fun
sometimes to have your students complete a sleep-wake diary, say, for a week. And even
with my college students, I will have them complete a sleep-wake diary for a week and
then write a short kind of paper analysis of the data. It’s a fun way. I’m sure you’ve
come up with different ways that you get students to understand data collection, but a sleep-wake
diary works great because you can have students both pay attention to Likert kinds of scales
but also hours of sleep or their sleep-wake schedule, have them do graphs of it and so
on and then sort of write about that. And I’m happy to sort of talk more about that,
but I wanted to you to see a sample sleep-wake diary. The next thing is the Epworth Sleepiness Scale.
You can get this anywhere online these days, to tell you the truth. But this is used in
sleep labs. This is a standard assessment that’s used as sort of a very preliminary
way of getting at whether someone may in fact have a sleep disorder. But I think, again,
it’s a great way to give your students a sense of measurement with regard to sleepiness. Unfortunately – and, again, it could be a
whole class in and of itself – there is very poor reliability between self-report on sleepiness
and if you were to do what we call an MSLT, which is a way of estimating sleepiness in
the sleep lab. If any of you have family members who have been assessed for sleep apnea, sometimes
they will stay overnight and then do this during the day. It’s where you actually ask
someone to try to fall asleep to see if they are going to fall asleep or not. If you’re
very sleepy, you’ll fall asleep in under 5 minutes. If not, you won’t fall asleep, they
allow about a 20-minute window and also look to see what sleep stage you’ll go into. And what’s interesting is that with someone
with a sleep disorder, like sleep apnea, you’re going to see some pretty high correlation
between filling out the Epworth sleepiness scale and what happens in the lab. But for
the person who’s not suffering from a sleep disorder, there’s actually very poor reliability.
So in other words, an adolescent may be highly sleep-deprived but they might fill this out,
and depending on sort of the time of day and what’s going on, you might look at it or if
you’re doing it from a research perspective, and that person would not look sleepy at all.
So yeah, you can have some fun with it.>>WORKSHOP PARTICIPANT: What did you take
on poor reliability between self-reporting and …>>WOLFSON: And any more objective measure
like using polysomnography in a sleep lab.>>WORKSHOP PARTICIPANT: Okay. Thank you.>>WOLFSON: Yeah.>>WORKSHOP PARTICIPANT: Two kind of related
questions that I’m always mystified by: in apnea things, a person having an apnea episode,
it’s completely disruptive sleep. Wherever they are with the sleep cycle, that point
is completely disrupted. They go back and start again, or even though they don’t fully
wake up, what other things are there? Well, also, when you sleep … if you were in a
sleep study and you’re having your EEG and you wake up, kind of then stumble to the bathroom
and you go back to sleep again kind of half awake. Do you start over? Do you pick up where
you were? Because you said something, you said which sleep cycle they were into when
they fell asleep. So can you say a little more about that?>>WOLFSON: Yeah, yeah. So I actually was not
going to talk about sleep stages at all today, but I’m happy to … I mean only because we
could spend the whole morning talking about polysomnography. But what I will say is that
… does everyone know what the question is referring to? Okay. So in answer to your question,
you don’t necessarily start all over again. Now, whether you return exactly to where you
were varies from individual to individual and how long you were awake. I mean with sleep
apnea, you absolutely sort of go back into whatever stage you were in because those are
… that which is very different than getting up, going to the bathroom, getting back, trying
to fall asleep. That’s a sort of different experience because with sleep apnea, you’re
having … these are seconds that your sleep is grossly inefficient. And in fact, the variable of sleep efficiency
is another interesting variable to have your students calculate, which is the number or
estimate, the percentage of time you’re asleep relative to the time you’re in bed, which
are not necessarily the same. And individuals who have sleep disorders, it might be restless
leg syndrome, periodic limb movement, and sleep apnea have very poor sleep efficiency,
or if you’re just being awakened because of a baby all night long. But with sleep apnea, these are seconds you’re
waking up and then you’re falling back to sleep, and then you’re waking up again. And
someone with a very high severity index in sleep apnea of course is waking up lots and
lots of times, but they’re minimal amounts of time but multiple times throughout the
night. And then those individuals likely, they’re sort of going back to sleep where
they were. There’s pretty minimal REM sleep, though, in sleep apnea. Anyone who is sleep-deprived
has less REM sleep, and what they’ll experience too is sometimes REM onset during the day
if they fall asleep because we crave REM sleep if we’re deprived of REM sleep. The next is one example. There are many of
them of an owl-lark test, and this is terrific to do with your students to give them a little
bit of a flavor for self report on whether they’re more lark, or more owlish; teenagers
developmentally tend to be more owl like than they were previously. That’s not to say it’s
relative to where they were. But the average person, if you were to do thousands and thousands
of morningness-eveningness questionnaires, most of us fall somewhere in the middle, which
is interesting. People often, you will think, they’re lark-like but then they’re really
far less lark-like than they thought they were or vice versa. So these are just … I
just thought I’ll give you some sense of some of the assessment techniques. The final handout is just something very short
that I created a number of years ago to give to middle school students shortly – or not
that many years I’ll say. These are pretty recent numbers. But, Massachusetts is actually
one of the few states that has started to think about sleepy driver issues and what
we should be doing from a policy perspective to try to prevent sleepy driver motor vehicle
accident. So I thought you would find this interesting, and again, largely because you’re
working with teenagers. So that’s what’s in the packet. So I’m going to actually start now and I’ll
go through some materials to give you a sense of what I would be. I think most of this material
is accessible to most of your high school students. You may need to tweak it somewhat,
but also to educate you about what we know about adolescent sleep today. Let’s see if
I got this going the right way. Actually, oh, I have to back up. I need to
have you hear this for a second if I can get to this website. This is a great video that
you can actually purchase. It’s called, “Who Needs Sleep?” I’m not going to say any … just
let you listen for two seconds.>>[Start of video presentation]>>FEMALE VOICE: You need to be human. There
is no animal that tries to sleep-deprive itself.>>[Music] Who needs sleep? Who needs sleep?
I said I’m young, I’m strong, I can work all night long. [Ambulance noise]>>FEMALE VOICE: He lost his life simply for
working hard.>>MALE VOICE: One of the problems with the
movie business is it does seem glamorous, and so there are a lot of people who would
say, oh, I’ll do anything.>>MALE VOICE: When they talk about capitalist
with the human face, it’s an oxymoron. It can’t be.>>MALE VOICE: Nothing good happens when there’s
long hours.>>FEMALE VOICE: For somebody who doesn’t have
regular work, they’re not going to complain about their hours because they can’t afford
to.>>FEMALE VOICE: I have a five-year-old son,
and I’d say that’s where the conflict of this job comes in for me personally.>>MALE VOICE: We’re the only group of industrial
workers in the world fighting for a 14-hour day.>>[Music] Who needs sleep? Who needs sleep?
Who needs sleep?>>[End of video presentation]>>WOLFSON: Let me see if I can get back to
where I was now. Okay. You can just look that up. It’s “Who Needs Sleep?” if you go online,
you can order the DVD. I use parts of it often when I start the semester again or if I’m
teaching my sleep course or for a unit on sleep. You probably wouldn’t end up using
the whole documentary but it really gives students a sense of the real life implications
of understanding problems of sleep deprivation and how that intersects with their lives and
lifestyle, and it’s about the movie industry which I think works great with teaching adolescents. There’s a little bit of historical information.
As I said, I’m going to go back and forth a little bit between adolescent sleep and
some broader topics. This is a really new area, and I feel like I can still say that.
I really felt I could say it when I started teaching in the early 1990s, but it’s amazing
really and I think striking for your students because unlike other dates when you talk about
something, it often … when I teach, of course the 1960s seemed recent too, but this is particularly
recent for your students. In other words, the field was developing while their parents
were starting their jobs in essence. So sleep was certainly first characterized
or described in the early 19th century, but from 1900 to the 1960s, there was virtually
no description of sleep. There is one exception, and that’s with regard to children. There’s
a little bit of discussion about sleep in children around the 1920s or so, but very,
very, very minimal both in the behavioral science literature as well as the clinical
and medical world. REM sleep was first discovered in 1953, and
non-REM sleep and its stages characterized in 1957. 1961 was the founding of what’s still
called today the Sleep Research Society, a great place to get resources. It’s actually
a very minimal membership fee. It’s the organization I belong to. A great website to check out.
Also, 1971, ’72 was sort of the confirmatory discovery of the SCN, our actual biological
clock. I mean that’s not that long ago. It’s really, really striking in that regard. You can really see these numbers. I won’t
go through all of them, but it wasn’t until 1995, 1996 that the American Medical Association
actually recognized sleep medicine as a sleep specialty. Physicians and other healthcare
providers can now get boarded in sleep medicine, and, in fact, there’s a new exam for behavioral
scientists now. That’s been developed in 2012. Just this past June was the very first Society
for Behavioral Sleep Medicine meeting. So it’s a very new field, and I think that that’s
sort of exciting when you’re talking with high school students and undergraduates. These are questions I often use with my students
as I’m starting a class, and I sort of tried to fit them for you all since you teach high
school students. Think back to your middle school years. This is for you guys to think
back, but convert them. When did middle school start? What were your sleeping patterns like
in middle school? Again, this is for your students as well. What were your sleeping
patterns during your first year in high school? What about now? I think it really gets them
to sort of individually get a sense of the developmental changes that occur in sleep.
Worthwhile exercise for yourselves as well. There are really, I would argue today, three
broad areas that determine human sleep. There is some … I think it’s controversial. I’m
someone who has a lot of doubts about the genetic implications of understanding sleep
or whether we really will be able to understand genetics with regard to sleep. That will be
a whole another discussion. But I do want to point out that it is a hot area of research
right now. And there’s some evidence for particularly circadian timing, genetic implications for
those variables. I’m going to talk in a couple of minutes about
the bio-regulatory processes with regard to sleep. I think it’s very important to talk
with your students about that, and particularly when you’re talking about adolescent sleep.
And then of course, all of the behavioral, circumstantial, that is to say clear research
of socioeconomic status or environment or living conditions have implications for one’s
ability to get an adequate amount of sleep or a regular amount of sleep. Life choices,
so again when you’re speaking with adolescents and talking about adolescent development,
whether that’s the time of day and when you do your homework, to caffeine, to all of the
technology that adolescents are using, those are choices that they make that may have negative
implications for getting an adequate amount of sleep; and, again, as adults, occupations
and again back to that documentary about the film industry. So what happens over our life span? I’m just
going to put these three categories up and talk about them a little bit. So some researchers
use different terminology. You’ll see the terms sleep-wake homeostatic process or you’ll
also see the term Process S from Borbély’s work. But this is referring to, basically
we have … there’s a ratio going on throughout the day. Basically, the longer we go from
when we last sleep, our biological drive to sleep, for sleep gets greater, and that’s
what’s really the sleep-wake homeostatic process. So literary, we become more sleepy relative
to when we last slept or the amount of sleep we’ve been getting. At that point, I’m just
talking about processes. I’m not talking about time of day at all. And the best example – I didn’t bring this
picture, but after the Oklahoma City bombings, a number of – just like after any awful disaster
– there were some Red Cross emergency care workers who were photographed, and this photo
ended up all over many, many papers throughout the United States and elsewhere. And it was
three workers I believe who have fallen asleep; they were up against some mesh fencing that
had been put up around the area they were trying to sort of clean up after the awful,
awful disaster. And these three individuals were asleep, and there was a terrible cartoon
note after that, something sarcastic that some journalist wrote, something like asleep
on the job. Well, you know, guess what? It turns out they’ve been awake for more than
36 hours, and it doesn’t matter how motivated you are, although motivation is something
that can override sleep temporarily – I’m certainly good at that myself – but eventually
there is a biological drive to sleep. So that’s Process S. Process C relates to circadian rhythms. And
just a brief, little bit, again I’m not going to spend … again, we could do a whole class
just on circadian rhythms. You could do a whole course or a whole semester on circadian
rhythms. But again, as I said earlier, that relates to our biological clock. And there
are times throughout the day or throughout a 24-hour period, the human clock is about
24.3 but there are individual differences. Chuck Czeisler who’s at Harvard really demonstrated
now, oh goodness, 15 years ago or so; there was a belief that the biological clock, the
SCN, the suprachiasmatic nucleus might vary from 24 to 28 hours. That is not true. It’s
pretty clear that it hovers around 24.3 or so. There is terrific and exciting research
being done on adolescents by my colleague, Mary Carskadon, to try to get a sense developmentally
of whether that clock changes prior to puberty, throughout puberty, and then post-adolescence,
but that’s sort of the number we still talk about, 24.3 or so. But what’s more important is to understand
that depending on where core body temperature is, internal body temperature is, or where
melatonin is, which is a hormone secreted by the pineal gland, as well as other external,
what we calls zeitgebers, other factors out in the environment where your clock is. And
you’re going to be, as I said earlier when we were talking about motor vehicle accidents,
you’re also going to be more sleepy or more alert throughout the day, not just based on
when you last slept, so not just based on Process S, but also based on where your clock
is. And so there are particular times during 24 hours where we’re more alert or we’re more
awake. For example, whatever our individual time
is that we’re most likely to fall asleep in the evening as humans, we are diurnal – so
for me, that’s going to be around 10:00, 10:30 – about an hour to an hour-and-a-half before
that, my melatonin level is peaking. It’s going to be at its highest level, troughing
closer to the ideal time for me when I’m going to wake up in the morning. But then throughout
the 24 hours, melatonin and core body temperature peak and trough as well. So you have the sleep
load that I’ve talked about, the sleep-wake homeostatic process, Process S. You have our
circadian drive for wakefulness as what it’s referred to, again, so this is pointing out
different times throughout the 24-hour period where we’re more likely to be asleep or awake.
And again, this is the evening hour as human beings. And then we have wake propensity, which is
referring to all the other factors that are going to influence our ability to maintain
wakefulness throughout the day, which refers to lighting, which refers to other individual
factors. It might refer to be included, as I said, substances that are in your body,
types of food we’re eating, our moods and so on. This graph works really well. I do think that
high school students can understand it. It’s easy to get. I have the reference here. But I think the key question when you’re talking
to your own high school students and talking to adolescents or my talking to you about
them today is why do adolescents struggle against going to sleep in the evening and
struggling to wake up in the morning? And we’re basically going to talk about that for
a couple of minutes. A couple cartoons of – these are great. I
don’t know those of you, since you teach high school students, if you’re familiar with Zits.
I think anyone who works with adolescents needs to read the Zits cartoon on a regular
basis. A funny story: my colleague who was really one of the preeminent and founders
of understanding adolescents and sleep, Mary Carskadon, who was at Brown. I was at a holiday
party. This is now back I want to say five years ago. And she had little grab bag gifts
that you could pick up, and she did these desk calendars for everybody. And this happened
to be the … I mean, other people picked up all kinds of desktop calendars. I happen
to pick up the Zits calendar. And, literally, this is January 31st of the next year, for
days in a row, the cartoons were about sleep. I mean it was hysterical about adolescent
sleep. So, a couple just great ones that are so poignant
in terms of the questions that we’re talking about today: well, whoa, look at the snow,
whoa, tobogganing, build a snowman, cross-country skiing, make caramel corn. What should we
do first? Well, by first, I assume you mean after going back to bed for five hours or
so … talking with his mother. And then I love this pose. It’s this generational or
developmental. Your generation totally messed up the planet through its greed, incompetence,
and apathy. You’re probably the most arrogant group of people in history. Well, I’m sure
your generation will do a better job should any of you ever manage to get out of bed before
noon. And why do you always have to be so critical? I’ll let you answer that question. And then I have these reversed. I apologize,
but if you sort of look at these from January 9th and January 10th again, it’s just absolutely
hysterical. It’s just one after the next. So he’s yawning. He’s in the kitchen. Poor
baby, you were up late doing homework and you fell asleep on your desk again. Yeah.
How do you know? You can spot the really dedicated students by the spiral notebook marks on their
cheeks or those who are getting insufficient amounts of sleep. And then here we go: so what goes on as we
move on to college? It seems wrong for you to have six hours of homework every night,
Jeremy. It’s not just me, mom. Everybody has it. That’s just the way it is. And the AP
classes only make it worse – not AP psych. Then it’s going to be like this all through
high school. Yeah, most of us are looking forward to starting college so we can get
some rest. [Laughter] I know [laughs]. So what happens? So adolescents … and I don’t know what definition
you use, Nancy. I think, I mean I talk about sort of straight through the college years
as your colleague talks about whether … at what point are the college years emerging,
adulthood, or are they still adolescents, is I think a question. I think you’ve thought
about this before, and it’s probably worthwhile to remind your students of this when you’re
talking. I mean such a vast amount of psychology research as well as health science research
has been done on college age students in the United States and elsewhere, and still to
this day, in a totally age developmental perspective. In other words … and sleep included, we
know far more today about adolescent sleep than we do about sleep in the college years.
And a lot of studies are done on sort of learning and sleep and memory and sleep and so on using
college students as research subjects, without thinking about that from a developmental perspective.
It is starting to change, but it remains a serious concern in my opinion. So one example of that, before I go through
this but while I’m thinking about it, is I’m going to talk about developmental changes
that occur over this period of time with regard to sleep and circadian timing, and yet we
know very little about what happens from age about 18 to 22.
There’s a little bit of research, and I’ll comment on it in a minute, but in other words
when does sleep look more adult-like remains a question. When does that occur? And what
are the factors that influence that? In other words, is that environmental? Is that something
going on that’s physiological or biological? Is that, have to do with the type of lifestyle
you lead over those years and so on? But what we do know is that adolescents report,
self-report as well as using other measurement techniques, less sleep than younger children.
They start to show irregular sleep-wake schedules sometime towards the late elementary school
age years and middle school years. In other words, their sleep schedule looking different
during the week from weekends. That bed and rise times become increasingly more delayed;
that is to say going to bed later and actually waking up later over the same period of time.
That school wake or rise times are constrained, are very much related to the timing of whatever
your school district sets that schedule for; that the amount of sleep or the sleep length
over the adolescent years declines. And I’ll show you some graphs that demonstrate that.
And that the size of the school night to weekend discrepancy, both timing and amount, is tied
to, as I already said, very negative outcomes. The more erratic your sleep-wake schedule
is, has negative implications for cognitive functioning, for emotional well-being, for
risk for substance abuse and so on. These are old graphs but I just keep them
in my battery of numbers of slides because study after study has demonstrated this. This
is data from 3,000 high school students from Rhode Island from back in the late 1990s,
back in the day. And you can see bedtime is getting later over the high school years.
This is self-report data, but actigraphy data, which I’ll comment on in a minute, replicates
these findings. This is data from a study that was published
just about a year-and-a-half ago where they gathered together a number of studies that
have looked at adolescent sleep actually from their early adolescent years through age 18.
And what you can see, although the studies vary in terms of where the populations were
studied across the world – this is worldwide data; the researcher here is actually from
Australia – but you can see the same pattern. Their bedtimes, if you look at the graph in
the broadest perspective, bedtime is getting later. The same with the total amount of sleep,
again, you can see sleep gets … and there’s about a 40-minute difference. This was statistically
significant. Again, this is reported now in study after study. And again, similarly, slightly
less extreme when you pull a number of studies together, but you can see that if you look
a lot of datasets, you see the same findings. There’s some variability country to country,
but the overall pattern is the same. This is actigraphy. Let me see. Are you familiar
with what actigraphy is? Is that something? So let me say a little bit about it. It’s
not something that you would easily be able to do with your … well, I shouldn’t say
that. These days with what’s happening with cell phones and whatnot, you might be able
to. So actigraphy is the way that we estimate sleep in the field. In other words, you can’t
study 200 middle school students and bring them in to a sleep lab to understand their
sleep. So we estimate sleep in a more objective way in adolescents – this is what my lab does
– by using actigraphy, which is based on accelerometer technology. It looks like a watch. Sleep researchers
and other behavioral scientists learned many, many years ago that we can use movement to
estimate sleep. That is to say, we are on average far more active even when you’re sitting
here listening to me when we’re awake than when we’re asleep. So corroborated with sleep-wake
diaries, we use actigraphy to estimate. It’s not measuring sleep. And I always remind my
students, this is not measuring sleep. It is estimating sleep, the same way self-report
is estimating whatever it is that we’re trying to get at. So this looks like a watch band.
These new actigraphs that I’m using in my lab also measure light. So I’m very interested
in the impact of light on adolescent sleep. But this is what it looks like. And now, what?>>WORKSHOP PARTICIPANT: It measures movement
or light?>>WOLFSON: It measures movement. Well, this
one measures movement and light. Accelerometer technology is, for those of
you who are techy folks, is what’s in iPads and cell phones and so on. In fact, there
is an accelerometer in most iPads and smart phones. And in fact, you can get simple and
I would just say experiment yourselves with your students, you can now get apps on their
cell phones and on iPads that would allow you to just do a simple experiment. They could
actually do fill out a sleep-wake diary and use one of the apps if they have a smart phone
or if you have a few that they can share and could actually do a simple experiment comparing
what their self-report of sleep-wake information is by using the accelerometer technology on
an iPad or an iPhone. LARK is the company to look up. If you look
that company up, it’s possible even … they’re very inexpensive. So in addition to your being
able to just play with an app, you could now get some very inexpensive actigraphs. Perhaps
if you have, I don’t know, budget sizes and some of you may be in school districts, so
this would be absolutely impossible, but those of you who are in a school district where
you could pretty minimally. This company called LARK …>>WORKSHOP PARTICIPANT: Can you spell it?>>WOLFSON: L-A-R-K, now makes a device for
the general public that is similar to these thousand-dollar actigraphs that we use in
my lab for just a couple of hundred dollars. So you might be able to even purchase a couple
or over a couple of years slowly purchase them and use them to do some very interesting
projects with your students where they could compare their data from accelerometer technology
to self-report. Neat stuff. And I use this as a segue to talk about … this
is just real data from my lab where we were looking at middle school students. Two different
samples – this is sixth, seventh, and eighth grade from one district and then some seventh
grade data here from Worcester. And again, this is just giving you a sense that it’s
less so in the early middle school years, but what you’re basically seeing is the amount
of sleep that kids are getting over this middle school period of time, and what you’re seeing
is although it looks like these Worcester kids were getting more sleep, the main thing
I want you to look at is how much less sleep eighth graders were getting from sixth and
seventh graders. So, corroborating with self-report. And, same with sleep onset time. We actually
use the term onset when we’re using actigraphy to differentiate that between that’s really
the estimated time someone falls asleep as opposed to bedtime being the time you might
get into bed. So that’s just a slightly different terminology. Again, getting later from sixth
grade versus eighth grade. This is what an actogram looks like. So when
you get data from actigraphy, this is what it looks like. And basically, you’re looking
at a week’s worth of time here on the Y-axis. On the X-axis is time. This is 9:00 in the
morning to … excuse me, yeah, 9:00 in the morning is over here. But basically, what
you’re looking at is the dark area is showing when the person is awake, that’s movement.
And this red area is when sleep is being scored by the program that we use in my lab, but
that’s corroborated. We score that also relative to diary times, and I won’t go into detail
about that. But what I want you to look at here which is, again, something you could
do with your students, and I’ll send you to a website. If you don’t even have actigraphy
and you just want to get samples of this, if you go to either the Ambulatory Monitoring
website, AMI, they’re one of the companies that makes the type of actigraph I’m passing
out. You could also go to the Respironics website, and they have all their product information
but with the product information, they have sample actograms if you just want to show
your students. But what’s most striking about the difference
between these two actograms without even knowing numbers or anything?>>WORKSHOP PARTICIPANT: Regular and irregular
sleep.>>WOLFSON: So, first of all, right, the seventh
grade male has a much more regular sleep-wake pattern. I mean it’s clean as a valve. He’s
falling asleep about the same time and waking up about the same time every single day across
that week. And this female … and I’m not trying to suggest gender differences. I mean
there is research suggesting there may be, but I’m not suggesting that by these two examples.
And then the seventh grade female you can see is getting significantly less sleep, just
eyeballing it, and has a much more erratic sleep-wake schedule. It’s pretty profound.
I’m going to just move on here. Okay. So now, what I’ve mentioned so far has
to do with self-report and actigraphically estimated sleep-wake patterns over this adolescent
period. And as we’ve said, they’re getting less sleep and they’re going to bed later.
Pretty much, if you look at datasets from age 11 or sixth grade through the end of the
high school years, you see this distinct pattern. But what else is going on? There are also
some very striking and remarkable changes that are also occurring. First of all, we
have very clear research that was done all the way back in the 1980s by Mary Carskadon
and colleagues that demonstrate that sleep need does not change over the adolescent years,
or from elementary school through adolescence. That is to say prior to the early 1980s -that’s
not what’s exactly on this graph here – prior to the 1980s, there was a belief that we need
less and less sleep as we get older. People used to imagine literally you would sort of
get to be 75 and you could get by on no sleep. There were these assumptions about a linear
story. That’s just not true at all. A beautiful study done in the early 1980s
by my colleague, Mary Carskadon and Bill Dement, William Dement, who was one of the sort of
grandfathers of modern sleep science in the lab when REM sleep was developed. She was
his graduate student. They did a study where they brought over consecutive years … they
followed the same kids who were Tanner stage zero or one, so prepubescent, through Tanner
stage five, fully developed. They followed these kids both individually and looking at
them as a group over several years. And in this study, they would bring them into a sleep
lab for a week. They were allowed to sleep as long as they could every night, although
they were awakened after about 10 hours every single morning. And what they discovered is regardless of
Tanner stage and regardless of chronological age that the mean amount of sleep over that
period, both following these kids longitudinally as well as individually, was 9.2 hours. And
almost, in fact, they really talk about the standard deviations from that study because
they were virtually nonexistent. There were very little individual differences, both within
individual and over time. And if anything, it was the Tanner stage four and five kids
and the older adolescents around age 15 who actually had to be awakened at the 10-hour
point and not the younger adolescents. It’s a beautiful study. It’s never been entirely
replicated, but it is used to demonstrate sleep need, and most people accept it as,
really, at least understanding the fact that regardless of the exact amount that sleep
need does not change over that period of time. So if you think back to those self-report
graphs I showed you, that means that the younger adolescents, the sixth graders, are probably
getting an adequate amount of sleep or a sufficient amount of sleep, and as kids get older, they
are increasingly more sleep-deprived. They get further from that 9.2-hour mark. Very,
very important study that is still talked about these many years later. What I also want to talk about is some data
from a study that I was a coauthor on, and that was a study that was done … we called
it the sleep start time study. And it was really one of the first studies in a laboratory
setting to demonstrate the problem with early school start times relative to adolescent
sleep need and timing of sleep. And so I’ll say a little bit about this study because
it really gives you a sense of how difficult it is for your students and your high schools
and then the students you’re teaching when you talk about this topic to function with
an early school start time. So in this study, we studied adolescents.
These were ninth graders transitioning to tenth grade in some Rhode Island schools.
And we studied them in the spring of ninth grade, the summer before tenth grade, and
the fall of tenth grade. This was an old-fashioned school district. There aren’t too many like
this anymore where they still called it junior high and the kids were transitioning from
ninth to tenth grade – high school started in tenth grade. But what was key and why we
chose this school district is there was an over-hour difference between the time they
started ninth grade in junior high or middle school and what time they were going to have
to start tenth grade in the fall of tenth grade. And we were interested in seeing what
was going to happen over that period of time both in terms of their real life, so they
were actigraphed for a week. We got a sense based on the actigraphs of what their school
week sleep-wake schedule was, then we brought them into the sleep lab either on a Friday
or a Saturday night, but we kept them on their school night sleep-wake schedule. So if they
went to bed at 11:00 that’s the time they were allowed to go to sleep. And if they had
to be, they were waking up to go to school at 6:00 that’s the time they were awakened
on either Saturday or Sunday morning in the sleep lab. But what we also studied is prior to the time
they were going to sleep, we collected salivary melatonin, which is what’s used to estimate
where their circadian clock is, the timing of their own clock. And I won’t go into all
the details of that, but we did that. So they were spitting to collect saliva before their
estimated sleep onset time and then the following morning again, after they’re awakened, after
they’ve been on their school schedule all week going to school and came into the sleep
lab. We kept them that night. We didn’t let them binge sleep, so they got that, whatever
their number of hours. If they were getting seven hours of sleep, they got seven hours
of sleep that night. And then we did the MSLT – this is what we
called laboratory nap test – during the day at 8:30 AM, 10:30 AM, 12:30, and 2:30 to see
how long it took them to fall asleep. We wanted to get an objective estimate of how sleepy
they were on this short sleep-wake schedule they were on with their various school start
times. And so what we found is that when we compared
– I won’t talk about the summer — but when we compared spring of ninth grade, say March-April
– we always make sure we collect data; we pay attention to when the clocks are being
changed – and then the same thing in the fall after they’ve been in the new high school
schedule for about a month. What you’re seeing here is tenth grade data. So what you’re seeing
is the mean number of minutes that it took them to fall asleep on the 8:30 nap test – that’s
sort of our colloquial name for that – was about five minutes. That is pathological.
And these kids were screened for both their own history of narcolepsy and a family history
of narcolepsy and other sleep disorders. These are kids who are normal, no sleep disorders.
These kids looked like they had narcolepsy. And in fact, 50 percent of these kids on the
8:30 nap test went into REM sleep. This study was published in 1998. I’m not
saying this because of my involvement in it. It has not been replicated, but it is the
study that you really have to come back to when you’re trying to talk to people about
why it is that starting school at 7:00 or 7:30 or even 8:00 in the morning for middle
school and high school students is highly problematic. You’re basically asking kids
to come study calculus or pre-calculus or AP psychology or tenth grade English and read
Shakespeare or whatever you’re doing in your courses, when their drive to sleep, because
they’re so sleep deprived and because there’s a circadian phase delay, which we haven’t
gotten to yet, is problematic. The other thing that’s going on is it isn’t
just that these kids are sleep deprived. It’s also that we know … and I’m not going to
go into all the details of the study, that study I should say that I just talked about.
It also suggested the circadian sleep delay. But what we know is that also over those years,
there’s a delay in the timing of sleep that isn’t just, oh, there’s lots going on; I want
to stay awake to socialize. That’s part of it. That’s absolutely part of it as the slide
suggests, but what we also know is that when you remove the environmental constraints,
there’s a delay in the timing of sleep as well. So what does that mean? On that same study that I mentioned, we found
that the kids that their melatonin over this developmental period of time, that the time
that melatonin was peaking was getting later in the evening regardless of other factors.
And you’re controlling other factors. So that means that the clock is basically shifting,
and the time that you’re going to naturally fall asleep, regardless of all the external
factors, is later in the day. So there are two sort of major variables that are coming
together over this adolescent period to sort of create the perfect storm for why adolescents
are so sleep-deprived and why of course many of us sort of argue that early high school
start times are creating a perfect storm, so to speak, or adding to the perfect storm. Just one second. Can I have just one second? So, between the — if you do the math and
you say, okay, we know from research done all the way back in the 1980s that sleep need
is about nine hours. We all often say 8.5 to 9.5 hours. And you don’t have to be a mathematician
to then look at the time that the average adolescent is likely to be biologically able
to fall asleep, say, is 11:00, 11:30 and then you draw out those nine hours, any of your
school districts that are starting before about 8:30 in the morning are creating or
adding to the perfect storm. Your question? Sorry.>>WORKSHOP PARTICIPANT: You said five minutes
was pathological.>>WOLFSON: Yes, falling asleep in under five
minutes. Okay. If you should’ve gotten an adequate amount of sleep during the night,
suggests sleep deprivation.>>WORKSHOP PARTICIPANT: So, like for kids.
What about for adults, this works as well?>>WOLFSON: Absolutely. The amount of sleep
is different. The sleep need for adults is more, about eight hours, and there have been
similar research to demonstrate that.>>WORKSHOP PARTICIPANT: [unclear]>>WOLFSON: Absolutely, yeah. And so this is
just showing you the sleep-wake schedule of an adult versus a teenager, and the red line
showing you the delayed timing of the clock. So just one more study I want to mention that’s
really interesting. A lot of people ask, and your high school students might ask you this,
all these changes are going on if you’re talking about adolescent development. Well, what comes
first? Because a lot of kids will say, “Well, I remember feeling like I could stay up later
and I was only in sixth grade, and I don’t think I was very developed, Professor Wolfson.
I think I still looked like,” I don’t think any boys will say this, “but I still looked
like I was 10 even though I was 14, but I think I was staying up later.” So what’s the order of this? And we don’t
really know this. It’s possible from a study done by some colleagues of mine, Avi Sadeh
who’s at the University of Tel Aviv and Ron Dahl and some others, studied youngsters,
9- to 11-year-olds, boys and girls. And what they were able to demonstrate in this study,
but it has not been replicated, is it looked like pubertal changes in sleep, as they called
them, that is to say more disruptive sleep, more erratic sleep, more delayed sleep, less
sleep, these variables that I’m talking about, using actigraphy seemed to actually precede
bodily changes, so Tanner staging. And so it’s possible that some of the sleep changes
may almost be precursors to the onset or adolescent development. It is not been replicated, and
there’s a number of holes that can be punched in the study, although it’s an elegant study,
but I think it’s important to keep in mind. The other, and this field, there’s a new study
published constantly now in the field, but another really interesting 2005 study by Oskar
Jenni and actually Mary Carskadon was involved in this study and others also suggest – remember
back to Process S — also suggest that there might be a slower accumulation of the sleep-wake
homeostatic pressure, this drive to sleep, this biological drive to sleep over the adolescent
period of time, which may almost create a myth for adolescents because they think they
can stay up later because they’re able to kind of push against that biological drive
to sleep more than they could when they were younger. That’s not to say they don’t still
need that sleep, but we, as adults, get basically better and better at holding off that biological
drive to sleep even though we need to sleep. And I call this the sleepover problem – my
own name. And many of you may be parents or currently have kids in your home. It’s the
famous case of when you have a 10-year-old or let’s just say a 7-year-old. And I don’t
know, sleepovers just got so popular. I remember being shocked that my 6-year-old was invited
to sleepover at someone’s house. Okay. And if you let them, let’s go with the 9-year-old
and the 10-year old, they sleep over their best friend’s house, and it’s hell to pay
– excuse my language – on Sunday if you’re the parent. Now they’re home with you, and
trying to get that child to do homework or be cooperative, I don’t care, even the best
well-behaved kid is awful on that Sunday, right? I remember thinking, please, no sleepovers.
Whereas, if you think about it, your eleventh grader might have hang out with friends and
been up quite late and they act sort of okay on Sunday. It’s not so bad. They seemed to
… at least those that function relatively well “managed to get by,” in quotes. That’s
the behavioral story that’s tied to that research study. Okay, I talked about this study already, so
I’m going to pass through this and get to here. So this is not my diagram. I actually found
this quite a number of years ago online at this website, scienceblogs.com, in 2006, and
I jazzed it up a little bit. But I think this basically summarizes everything we’ve talked
about already. I think it’s a nice graph to think about what’s going on for the adolescent,
the vicious cycle of the teenager’s sleep. So let’s start at the top. Does this thing
have a pointer? Yeah. If we start at the top … so as we’ve already said, due to both
the circadian clock delays, delay in the circadian timing of sleep as well as all the activities
that adolescents are involved in, they stay up later and later over the adolescent years.
The latest top one, and I’ll show you a little bit of data on that, is text messaging, et
cetera. It’s awful, by the way. We’re just in an awful stage. The cell phone left on
all night long and adolescents answer and text message all night long.>>WORKSHOP PARTICIPANT: I’m living this right
now.>>WOLFSON: Yeah. I mean, basically, really,
we should be removing cell phones from the bedroom. Okay. So it gets later and later.
They need the sleep requirement but their accumulated sleep data over the week. Also,
what’s going on is they’re getting inadequate amount of sleep because they have to get up
so early in the morning because of early school start times. So then, what happens on the
weekends? They sleep in. They go back on their natural schedule and they also are binge sleeping.
So in other words, on the weekend, you’re staying up later, going to bed late Friday
night, later Saturday night, sleeping in Sunday morning. What happens on Sunday night?>>WORKSHOP PARTICIPANT: You can’t go to sleep.>>WOLFSON: You can’t fall asleep, right? It’s
even later than before, and so the cycle starts all over again. Particularly problematic in
school districts where kids have to be in school before I would say 8:30, 8:45 in the
morning. Again, do the math. Okay? And some of you are probably living or experiencing
or working with adolescents where your students are coming to school and they’re starting
school at a time that might be up to two, two-and-a-half hours earlier than what fits
their schedule. Okay. So you reinforce — this gets reinforced.
They’re up even later Sunday night. Some kids may already be using alcohol to fall asleep
or doing something or borrowing or looking for sedatives. Kids who are at risk for substance
abuse, I think that is going on. So they can’t fall asleep Sunday night. Sleep gets restricted.
You start to see all the consequences of this during the week for some kids; academic difficulties,
emotional liability, even risk for depression. And again, I’ve mentioned drowsy driving. And then I think kids are using their own
countermeasure. I don’t think we have enough research to prove that yet, but I think we
have a percentage of adolescents who are using their own countermeasure. In other words,
they are intervening. You’re teaching psych. They’re not doing the best intervention. They
are using their own intervention okay — Dunkin Donuts, et cetera. We’ll talk a little bit
about some of this and then we’re going to have some fun momentarily. I literally, on each of these topics, could
do a lecture and talk to you. And you’ll have to choose where you want to go with this with
your students if you develop a unit on sleep and adolescent sleep in your psych classes
or in other courses that you teach. I mean, there’s a growing, fascinating research on
social class and culture I’ve become very interested in. How many of you teach inner
city or urban districts? So I think you have a whole added issue for kids in those areas,
and a very understudied area. I think I may have given you the study to read. We have data now from Worcester public schools
where we have a very high percentage of children living in the school district out or below
the poverty line. You can see one of the neighborhoods here, Clark University. And these children
are living in environments where they’re sharing bedrooms; possibly there’s an infant in the
same room that a ninth grader is sleeping; where there are greater noise levels, more
televisions; and even in upper middle class families, possibly noisy neighborhoods, so
in addition, possibly families working shift schedules or people coming in and out of the
homes. In published data now, and my study is one among a number, suggesting that these
kids are getting less sleep and have more erratic sleep-wake schedules – not surprising.
I don’t mean to sound naïve about this but finally some data – than kids who are in middle
class and upper middle class families. You put those students in school districts that
start early in the morning and you further, you put them at greater risk. You don’t have
to, again, sort of do the research, even though I’m all about research to make those, draw
those conclusions. Whole area – screens and media growing. I mean, your students will
love … and again, if you email me, there are some fun studies now coming out that you
can talk with your students about. The National Sleep Foundation did a survey
where they over-surveyed high school students and college age or emerging adults to get
a sense of the impact of technology on sleep and what are the most cogent and striking
findings. And if you go to the National Sleep Foundation website, you can get this data.
I’ll be happy to help you find it. But just one stat alone is just so compelling and it
just follows. I think about 19 percent of the 13- to 18-year-olds and the 19- to I think
it was 22-year-olds or some such cutoff, so again high school and college age, self-reported
that at least a couple times a week they were waking up to respond to or send a text message
– 19 percent – and these were thousands of telephone-surveyed individuals. Okay. That
is basically like creating sleep apnea with text messaging – back to your question. Employment, there is some compelling work
that I did quite a number of years ago, and I think there needs to be more work done in
this area. But high school students, there was work done by Laurence Steinberg who’s
a developmental psychologist many years ago. He’s probably cited in some of your textbooks
that you use where we he looked at employment in adolescence. It’s, first of all, far more
likely that upper middle class kids in this … I mean, again, things have changed with
the economy. But for quite a long time, middle and upper middle class high school students
were working who didn’t necessarily have to work for financial reasons, and those working
20 hours a week or more in addition to going to high school were actually at greater risk
for academic difficulties than those not working. People tend to think the opposite. Sometimes
parents think the opposite, oh, it creates great confidence, et cetera. Well, unfortunately, also was sleep. Adolescents
who worked 20 hours or more a week actually have grossly more inadequate and more irregular
sleep-wake schedules than adolescents who don’t work at all or who work under 20 hours.
So the risk factor seems to be the 20 hours or more. So again, some interesting work. And then caffeine, I’ll talk a little bit
about that, and of course high school start times. I love some of the things, some of
the kinds of sort of media things that you can show your students that are so disturbing,
or in this case maybe not disturbing but a suggestion of how concerned people are getting
about these issues. This was from I was on a trip, American Airlines,
their magazine, American Airlines Magazine. And one of the main articles in this issue
of March 2010 was about families who were sending their kids to camps that were going
unplugged; back to the old days, real letter writing, no emails, no websites where you
can see your kids online and so on. So I’ll get this back up — I didn’t end up including
the studies on this topic, but I’m happy to make suggestions. There’s a growing literature
clearly demonstrating, as I said, about the impact of technology. Caffeine, I did want to just say a little
bit about this study that I was involved in just to get you thinking about this as a whole
area to pay attention to. First of all, prevalence: if you compare alcohol and marijuana and tobacco,
those are the sort of latest prevalence data. And yet, if you look at caffeine, adolescents
increased 70 percent in the past 30 years in terms of caffeine use. So when people say,
“Oh, my parents let me have coffee, like I think back, my parents, you know, Sunday mornings
I got to have my cafe au lait with breakfast or whatever.” We’re living in a whole another
world now in terms of caffeine. Yeah?>>WORKSHOP PARTICIPANT: Now that there’s research
to back this up, should there be either nationwide or school-wide or state-wide policy?>>WOLFSON: That’s a great question.>>WORKSHOP PARTICIPANT: As teachers, I know
we see more Red Bull and Starbucks than I have in the last two years – Monster – than
I’ve ever seen . Do the schools need to step it up? Colleges and high schools both can
say we’re going to ban this?>>WOLFSON: You guys should start talking about
it, absolutely. I’m part of a group. We have a policy statement that will be coming out
soon on school start times that will be published in the American Academy of Pediatrics. And
with that, we have an updated adolescent sleep report that’s going to be also published where
we’ve written a caffeine section. We weren’t ready to actually make policy statements yet,
but I think that that’s where we’re heading. As you know, Bill Clinton was very involved
in this pushing the American Beverage Association a couple of years ago. He got involved. And
it was all around obesity, and so there’s now a ban I think, or I don’t know how enforced
it is, but most, I think, schools and other public settings, middle school … right,
middle school, you can’t have sodas or certain types of beverages in your vending machines.
But high schools, because the focus there was on sugar and not caffeine, can have diet
coke in vending machines because they didn’t pay attention to caffeine. Caffeine was not
the issue. But yes, I mean, I think it’s very, very disturbing.
And, I mean, I would encourage those of you who are in the secondary school world to start
talking about it. I mean, Red Bull in particular, I’m going to show you a slide. Red Bull in
particular is a very scary company, in my opinion, in terms of its marketing athletes
basically. And now … it used to be high-risk sports where they would be showing up and
advertising, promoting their products, but now I understand if your students are on the
tennis team, the golf team, it doesn’t matter the type of sport, the Red Bull machines are
showing up in golf settings and tennis and so on. But I can tell you a little bit about
the data too. But yeah?>>WORKSHOP PARTICIPANT: I just think this
is a good opportunity for us as teachers.>>WOLFSON: Absolutely.>>WORKSHOP PARTICIPANT: This would be a great
debate topic. Give them an opportunity to look at some of the numbers in your studies
and take into consideration their own wants and needs. And what keeps coming to mind is
you snooze, you lose, and then taking … that’s the pressure that many of them are living
with. So maybe on one side of it, like, well, yeah, I’m not losing …>>WOLFSON: And from a research perspective,
so the sleep world for so long with adults talked about caffeine as a countermeasure,
believe it or not. Okay. So if you’re talking about pilots, we would say, well, a little
caffeine, if you can’t get on the right schedule, might help, if you can’t get that 30-minute
nap. And there’s been research demonstrating it has the same kind of positive implications.
So for those of us who’d get on an airplane, we’d like to have that pilot. If the pilot
is not on a great schedule to have their Red Bull or to be put on a prescription for modafinil,
which is a stimulant used to treat narcolepsy but off-label use to treat other forms of
sleepiness and fatigue. But we’re talking about a really different scene when we’re
talking about adolescents. So, absolutely. And I’m going to do a different exercise,
but yes, you could do an exercise.>>WORKSHOP PARTICIPANT: I haven’t seen the
5-hour ENERGY in my high school.>>WOLFSON: You haven’t seen what?>>WORKSHOP PARTICIPANT: 5-hour ENERGY. I don’t
know why kids aren’t really hanging on that one because I mean … I don’t know about
anybody else, the other schools, but I just don’t see it as much. They advertise as much
on TV, but I don’t see kids walking around with it.>>WORKSHOP PARTICIPANT: They probably drink
it up in their lockers.>>WOLFSON: I don’t know. Again, I didn’t bring
it. If you Google the history on …>>WORKSHOP PARTICIPANTS: [cross talking]>>WOLFSON: This is a hot topic. All right,
let me take two more questions and then I’d like to move on. Yeah?>>WORKSHOP PARTICIPANT: Are there any studies
of, correlating early school start times with lower academic performance in those first
or second period classes? In other words, those …>>WOLFSON: I’m going to show you some of that
data in just a minute, but not specifically on those; lower academic performance but not
necessarily tied to specific class periods.>>WORKSHOP PARTICIPANT: I’d like to my school
to kind of push this issue. We start at 7:40. Anecdotally, for me, it’s a disaster.>>WOLFSON: Hold off. We’re going to do an
exercise in just a second, okay? I’m going to ask to just hold off questions for just
one more minute. What I just want to show you here just so you know. These are the implications
of caffeine in sleep: reduces slow-wave sleep, increases sleep onset latency and night wakening
– it’s not surprising – decreases sleep proficiency – not surprising – decreases the amount of
sleep, increases morning sleepiness, and obviously a negative impact on sleep quality. And this
has been found in adolescents as well. I’m just going to move on. I’m actually, what
I do want to point out, this is a dataset we have. I just want to show you one finding
of close to 200 high school students. It’s a convenient sample; school district, kind
of working class school district in Central Massachusetts. But what I do want to show you is this. We
broke this sample into three groupings. We broke them down into … again, virtually
all the kids, 96 percent were using some amount of caffeine. But we were able to categorize
the kids as ninth through twelfth grade – and there were no age differences in this study,
no class — no year in school differences – to a mixed use group. So these are kids
who are using caffeine of all different types to what we call a high soda use, so pretty
much their use was in soda and not in other types of beverages. This study by the way
was done prior to the Red Bull craze, just prior, so energy drinks were not the big item.
And a low caffeine user, not a non-user, a low user. And we found really strikingly different behavioral
patterns between these three groups. We found that those who were the mixed use
group tended to use caffeine earlier in the day. They were consuming more caffeine pills.
Again, they were a mixed use group. And they woke up earlier on school days, and they reported
more daytime sleepiness. But it’s the next bullet that’s the most interesting. When you
compared the two high users, mixed use versus soda, really different what we called reasons
for use and expectancies for use, which is how … these are terms that the substance
abuse literature uses. The mixed use kids, males and females, were more likely to use
caffeine, to acknowledge that they were using caffeine, to get through the day, to have
fun and experiment, and, in the red, expected more dependence symptoms and energy enhancement. My colleague who’s a substance use researcher
in adolescents is really struck by these findings, Alison Ludden, in the sense that she is starting
to, as I said earlier this morning, to think that possibly the caffeine in a particular
group of kids, possibly those who are most affected by sleep deprivation as well, as
a high-risk group. It isn’t just that they’re having the Red Bull and when high school is
over that they’re done with it. And there’s now more and more research about this that
there’s high correlation between Red Bull and marijuana use and so on. But that’s not
what we’re … And, I just love this. I was skiing with my
husband, and this was in Canada, and this is not part of a ski lodge. Red Bull has now
positioned itself – I guess they have permission – to stick Red Bull vending … not machines.
In this case, cute little ski hut, right? That’s just a freestanding hut, and there’s
no person there. There are just machines you can go to, to put your coins in right at the
bottom by the chairlift to get your Red Bull. It’s amazing. But this has been around forever. My son goes
to school in Schenectady, New York where Union is, and this was on the board. This is near
the GE plant in Schenectady: “Drink Coca-Cola. It relieves fatigue. Sold for five cents.”
So it’s not as if we haven’t attempted these … marketers haven’t tried this before. So I’m going to actually move on. I’m not
going to go through these slides and get to school start times. So what do we do? What kinds of preventive
interventions can we develop – you’re talking to kids, students at a psychology class – to
make sure, because we know that insufficient sleep and erratic sleep has negative consequences
for mood, possibly for risk for substance abuse, for academic performance issues? I
could have done a whole class also on the latest research on memory, on cognition, and
all the variables that relate to academic performance more than experimental level.
What are we going to do about it? And so you’ve been making comments all morning long about
the question of school start times. I want to say a little bit about that and then we’re
going to have some fun with this, and, again, an exercise that you can replicate with your
students. So I tend to — this is actually not just
psychology terminology but sort of those who were in the transportation industry use the
terminology countermeasures, so not just therapeutic interventions but countermeasures. Or public
health individuals use this term. So we have systematic countermeasures that we need to
be thinking about to increase sleep or get adolescents to have more regular sleep-wake
schedules. The one that’s talked about the most these days, in my opinion, thankfully,
is delaying middle school and high school start times. I’m not sharing data here this
morning, but you should know that times have gotten earlier and earlier since the early
1980s, and there is data to suggest that and a number of theories about it. One has to do with bus schedules. Another
has to do with growth of sort of suburbia and kind of urban sprawl. Another has to do
with … that you would find fascinating as high school teachers, and that’s the push
from public school teachers in the United States back in, again, the late ’70s and into
the 1980s for salary needs. And in some states, they’re not being met, and so teachers are
arguing that they need to have a second job, and so high schools teachers wanting schools
to start earlier so that they could have a second job. There’s been some discussion about
that, but they seemed to be here to stay. That’s the story: school start times. With
the exception of the districts that are working hard to delay school start times, in terms
of the historical data, have gotten earlier and earlier since the 1980s. There are a number
of conversations going on. I’m sorry. Employment hours is an interesting discussion;
drivers education programs. So, all of these – regulation of caffeine as I’m suggesting
– are larger policy-related systematic countermeasures. I don’t want you to forget the bottom part
of this slide. I think it’s a two-pronged multi-tiered approach. And that is to say
we also need to be thinking about preventive intervention programs, education, and what
you all can be doing in high schools or in middle schools, in psychology classes, in
biology classes, and in health classes if you’re in a district that still teaches health.
In other words, sleep has to be included in the curriculum, and not just at a didactic
level but at a personal level. And that’s why I’m very much in favor of you
doing activities or exercises or assignments with your students to get your students to
think about change at the individual level and policy change. We all know that if we
take an interactive approach, we’re more likely to say, whoa, I just collected sleep-wake
diary information on my own sleep-wake patterns. Now I see what’s going on. And one is more
likely to then use that to change behavior. That will be a whole another discussion, but
I’ve been doing some of that with the Worcester public schools. So what do we know about this research on
the actual intervention studies that have been done where districts have systematically
changed school start times? And I’ve sort of put all … there are now quite a number
of studies. You can really do a review paper now on this area, finally. And in fact, a
colleague of mine has just done that, and it will be part of a book chapter, demonstrating
that delaying school start times has a positive impact both in terms of the amount of sleep,
timing of sleep, obviously, and then secondary implications for academic performance, behavior,
and mood, and so on. So, a number of studies have compared school
start times, for example, 7:30 AM versus 8:30 AM. They are largely convenient samples. Most
of them have been self-reported sleep-wake patterns. A few using actigraphy. A number
of the studies have looked at transcript, academic grades, as well as self-reported
grades, self-reported emotional well-being. And the general findings are, first of all,
adolescents do not stay up later and later. In other words, when you delay school start
time, when you go from 7:30 to 8:30, it does not mean that the adolescent then goes to
bed at 1:00 instead of midnight or 11:00. They don’t do that. So what happens is for
the most part, they gain the amount of sleep that you’ve allowed for by shifting what time
they have to be in school. It’s really beautiful. I mean people really, myself included, kind
of said, oh my goodness, with all the things that kids can do, are they just going to stay
up later? Do some kids stay up later? Yes. But on average, it’s 40 to 60 minutes that
you increased the amount of sleep. Clinically speaking, it only is about 15 to 20 minutes
of sleep that can make a difference. So this is much larger than that, regardless of statistical
significance. But not only that, but some studies are showing
– I can’t say there’s a study that shows exactly what hour of the day – improved academic performance.
Our study that we did here in the Worcester public schools, we were not able to show statistical
significance for seventh graders but eighth graders were able to demonstrate improved
academic performance on transcript grades. And also, most of the studies report decreased
tardiness, which we all know kids who are more tardy tend to do less well in school.
In our dataset, four times less tardiness after we delayed school start times. And then also, some of the other secondary
variables in Judith Owens’ study that was done in a private school setting: lower levels
of depressed mood, and, overall, teachers and students being satisfied with delaying
school start times. This is just one of our studies. Okay. So, we’re going to have some fun. So first
of all, I hope we have enough.>>WORKSHOP PARTICIPANT: [Unclear] technically,
we should have finished by 10:00.>>WOLFSON: Oh, geez. I was thinking 10:30.
Oh my god, okay. Well, I’ll just describe what I think you can do with your students,
okay? I’ll just describe. We won’t actually do the whole exercise but you can take it
back with you. This happens to me, I apologize. I guess in my head, I was thinking 10:30.
I don’t know why. That’s so strange. Even though we said 90 minutes, I start looking
at the clock. So first of all, what I’m going to do, and
you can do it with your students, is I hand out a little piece of paper, not blank, which
I turn over, and it has a role. So you pretend that you’re the student. You can just pass
these back. Just someone pass them out. I hope we have enough. But you’ll see there
are different roles. And then what you can also pass out, if someone else can just pass
these out? Everyone should take one of those. So I present to you that, okay, you’ve now
been educated. You’ve done your homework. Either you are a sleep researcher, or you’re
a superintendent of schools, or you’re an assistant superintendent, you’re a principal
of an elementary school, a middle school, a high school, you might be a member of your
school district’s school start time change committee. You’re on this committee, you’re
a rebel-rouser. You’ve agreed to be on this committee. You’re a parent of a kindergartener,
you’re a parent of a third grader, you’re a parent of a tenth grader, you’re a parent
of an early adolescent, a seventh grader, you’re a high school teacher, you’re a middle
school teacher at a school that starts early in the morning, or you’re a middle school
teacher because in the district you live in, a few middle schools already start later,
or you’re an elementary school age teacher, or you might be a hockey coach, a football
coach, a swimming coach. You’re an eighth grader yourself, eleventh grader. You’re a
representative from the National Sleep Foundation who’s coming to give a talk to your school
district. Or you’re a journalist. You’re in there in the media and you would like to talk
about this story throughout your state nationally or just in the school that’s as I call this
project, Sleepy Town U.S.A. So what I tell the students … you can imagine
this. We won’t actually break into groups, but you can sort of go through it and you
imagine what it would be like. What I have the students do is I first have them get into
groups, and I create the groups. Generally, we’ll have sort of a group that … where
do I have this list? Oh yeah, sorry. I break you into three groups. One group is what I
consider sort of the expert group that’s gotten together. It’s the school start time committee
of the school district, and the school start time committee has brought in different experts
who advise them and help them do their homework on the issue of adolescent sleep and whether
or not the district should change school start times. Group number two are school professionals,
so they’re the teachers and the coaches who have their own little committee who is getting
together. They know this school start time committee is going on in the district, but
they’re meeting after school to talk about it; how they feel about it and when they want
to go with this. And then often, some kind of PTA or parent
committee. And I give the students some time to role
play being in those groups for a little while, not long, 5 to 10 minutes or so. And then
I have everybody come back together for a town hall meeting. And the job of the town
hall meeting is for each group … first with the school start time committee presenting
its recommendations. I generally give the recommendations so they know what they’re
moving towards. So in this case, their recommendation is that elementary schools change to a certain
degree, middle schools change, and high schools change. Other times, I’ve done it without
any planned recommendations. And then there’s a discussion, as if it’s
real life. This is how the school districts are doing this often – town hall meeting style
to talk about, are they going to go with the recommendations? What do they want the school
board to do? It’s a great way to get your students to see the, to go from the research
that you’ve been talking about in class to talking about the research themselves from
different perspectives. And the assumption is
that each of these groups has some access
to the information, obviously. And how a different perspective … if a parent
of a second grader comes in to this, if you’re a parent of a second grader and it’s your
oldest child and you haven’t had any adolescents yet, and the recommendation is that elementary
schools is now going to start earlier in the morning in order to accommodate the middle
schools and high schools. Most parents of second graders and the students, the high
school students and college get this right away … are often furious. They don’t want
this for some reason. Or the story of the hockey coach who wants to have kids in practice
early in the morning, or the football coach who wants lit fields and is upset unless the
school district is going to purchase lights to allow the kids to practice starting later
if it means the northeast and it’s going to get dark too early in the fall. The football
coach is adamantly opposed to changing school start times, regardless of what it does for
his or her football players’ academic performance and so on. I am stereotyping a little bit, but just that
the students fall into those role plays immediately. You would make the time to do it, and you
sort of let that evolve. Sometimes they get involved, sometimes they don’t, and it allows
for a real discussion of the relationship between research, theoretical understanding
of these issues that we were talking about all morning, and then real-life implications. And so I know that we don’t have time to do
that exercise. It’s pretty straightforward and you can do it on your own. So I think
we’ll end with that. I guess if you have five minutes to do the Q & A. Does that work for
your schedule?>>WORKSHOP PARTICIPANT: Thank you.