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AD O LESC EN T
SLEEP NEEDS
AND PATTERNS
R e s e a r c h R e p o r t
a n d R e s o u r c e G u i d e
PUBLISHED BY TH E N ATIO N AL SLEEP FO UN DAT I O N
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AD O LESC EN T
SLEEP NEEDS
AND PATTERNS
PUBLISHED BY TH E N ATION AL SLEEP FOUN D AT I O N
w w w. s l e e p f o u n d a t i o n . o r g
R e s e a r c h R e p o r t
a n d R e s o u r c e G u i d e
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Table of Contents
Preface .............................................................................................................................................................i
PART ONE: Research Report ........................................................................................................................1
Introduction .............................................................................................................................................1
Ph ysio logica l Patt ern s ......................................................... ...............................................................2
Beh aviora l an d Psycho social Patte rn s................................................................................................2
Con sequences of Poor Sleep in Adolescent s .........................................................................................3
Wh at Can Be Done ..................................................................................................................................4
Reference s.................................................................................................................................................7
PART TWO: Resource Guide .......................................................................................................................11
Pointers for Parent s ...............................................................................................................................11
Tips for Teen s .........................................................................................................................................13
Becom e a sleep-sm art tren dset ter ....................................................................................................13
High School Start Times .......................................................................................................................14
Sum m ary of Find in gs....................................................... ................................................................1 4
Factors to Con sider ..........................................................................................................................15
References.........................................................................................................................................18
The Zs to A s Act ...................................................................................................................................19
Drowsy Driving Fact Sheet ...................................................................................................................20
Wh o Is Most At Risk?............................................................... ........................................................2 0
Wh at Are Effective Cou n term easures? ............................................................................................21
Minn esota Medical Association Resolution s: Models for Ch ange ...................................................22
Sch oo l Sta rt Times............................................. ................................................................. ..............22
Drowsy Drivin g ......................................................... ................................................................. ......22
American Medical Association House Of Delegates Resolution 418: Sleepy Driving ....................23
Oth er Resources .....................................................................................................................................24
Organizations...................................................................................................................................24
Web Resources..................................................................................................................................26
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PrefaceThe National Institutes of Health (NIH) have identified adolescents
and young adults (ages 12 to 25 years) as a population at high risk for
problem sleepiness based on evidence that the prevalence of problem
sleepiness is high and increasing with particularly serious consequences.
(NIH, 1997) This designation evolved from a Working Group on
Problem Sleepiness convened in 1997 by NIHs National Center on
Sleep Disorders Research and the Office of Prevention, Education, and
Control. The group concluded that steps must be taken to reduce the
risks associated with problem sleepiness.
What are these risks? The most troubling consequences of sleepiness are
injuries and deaths related to lapses in attention and delayed response
times at critical moments, such as while driving. Drowsiness or fatigue
has been identified as a principle cause in at least 100,000 police-
reported traffic crashes each year, killing more than 1,500 Americans
and injuring another 71,000, according to the National Highway
Traffic Safety Administrat ion (NHTSA, 1994). You n g dr ivers age
25 or un der cau se m ore th a n one-ha lf of fall-a sleep cra shes.
The National Sleep Foundations (NSF) Sleep And Teens Task Force
developed this publicat ion to summarize existing research about
sleep-related issues affecting adolescents. We hope that this report
will serve as a valuable and practical resource for parents, educators,
community leaders, adolescents and others in their efforts to make
informed decisions regarding health , safety an d sleep-related issues
within their communities.
A nonprofit, private organization, NSF is a leader in public education
efforts regarding the risks associated with drowsy driving and other
issues related to sleepiness and sleep loss. We welcome your comments
about this document and your suggestions for expanding public aware-
ness and supporting positive changes to protect the safety and well-being
of our nations youth.
For more information, and an online copy of this report please visit NSFs
Web site at www.sleepfoundation.org. The Foundation can also be
reached by e-ma il at nsf@sleepfounda tion.org; phone (202 ) 347 -3471;
or fax (202) 347 -3472. NSFs address is 1522 K Street, NW, Suite 500,
Washington, DC 20 005.
Natio nal Sleep Foun dat ion
Sleep And Teens Task Force
C O - C H A I R S
Mary Carskadon , PhDBrown University
Providence, Rhode Islan d
Thomas Roth, PhD
Henry Ford Sleep Disorders Center
Detroit, Michigan
M E M B E R S
Ruth M. Benca, MD, PhD
University of Wisconsin/Madison
Madison, W isconsin
Ronald E. Dahl, MDUniversity of Pit tsburgh
Medical Center
Pittsburgh, Pennsylvania
William C. Demen t, MD, PhD
Stanford University Sleep
Disorders Center
Palo Alto, California
Mark Mahowald, MD
Hennepin County Medical Center
Minneapolis, Minnesota
Jodi A. Mind ell, PhDSt. Joseph University
Philadelphia, Pennsylvania
Kyla L. Wahlstrom, PhD
University of Minn esota
Minneapolis, Minnesota
Amy R. Wolfson, PhD
College of the Holy Cross
Worcester, Massachusetts
N SF STA F F
Susan D. Sagusti
Program Mana ger
Megan Spokas
Intern
Richard Gelula
Executive Director
2000 N ational Sleep Foundation
i
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AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 1
PA RT O N E
Research Report
In troductionSleep is a basic drive of nature. Sufficient sleep helps us think more clearly, complete complex tasks better
an d m ore consisten tly and en joy everyday life more fully. Altho ugh ma n y questions regardin g the role of
sleep rem ain un an swered, scien tific studies have sho wn th at sleep con tributes significantly to several
importan t cognitive, em otional an d performan ce-related fun ction s.
Sleep is, in essence, food for the brain, and insufficient sleep can be h armful, even life-th reatening.
Wh en h un gry for sleep, th e brain becom es relentless in its quest to satisfy its need and will cause feel-
ings of sleepiness, decreased levels of alertness or con centration , an d, in m an y cases, un an ticipated
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2 A D O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation
sleep. Excessive sleepiness is also associated with reduced short-term memory and learning ability, nega-
tive mood , in consisten t perform ance, poor prod uctivity and loss of some forms of behavioral con trol
(NIH, 1997).
Researchers have identified several changes in sleep patterns, sleep/wake systems and circadian timing
systems associated with puberty. (Carskadon, 1999) These changes contribute to excessive sleepinessth at h as a negative impact on daytime fun ctionin g in adolescents, including increasin g their risk of
injury. (Wolfson an d Carskadon , 1998) Findin gs are similar in North Am erica an d in indu strialized
countries on other continents. (Carskadon, 1999)
Scientists hypothesize that these sleep-related problems are due largely to conflicts between physiologi-
cally-driven sleep needs and patterns, and behavioral and psychosocial factors that influence sleep habits.
Key chan ges in sleep p atterns an d n eeds that are associated with pu berty in clude:
PHYSIO LO GI CAL PAT T E R N S
A d o l esc en t s r e q u i r e a t l e a st a s m u c h s le ep as they did as pre-adolescents (in general,
8.5 to 9.25 h ours each n ight). (Carskadon et al., 1980)
Da yt i m e s l ee p i n e ss i n c r e a s es for som e, to p ath ological levels even whe n an adolescen ts
schedu le provides for op tim al amoun ts of sleep. (Carskadon , Vieri, Acebo, 1993)
A d o l esc en t s sl e ep p a t t e r n s u n d e r g o a p h a s e d e l a y , that is, a tenden cy toward later
times, for both sleeping an d waking. Stud ies show th at th e typical h igh school studen ts natu ral
time to fall asleep is 11:00 pm or later. (Wolfson an d Carskadon , 1998)
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AD O LESCEN T SLEEP N EEDS A N D PAT T E R N S W National Sleep Foundation 3
B E H AVIO RAL AN D PSYCH OSOCIAL PAT T E R N S
M a n y U .S. a d o l e sc en t s d o n o t g e t e n o u g h s le ep , especially during the week. Survey data
show th at average total sleep time du ring the scho ol week decreases from 7 h ours, 42 min utes
in 13 year olds to 7 h ours, 4 min utes in 19 year olds. (Wolfson an d Carskadon, 1998) On ly 15
percent of adolescents reported sleeping 8.5 or m ore hou rs on school nigh ts, an d 26 percent of
studen ts reported typically sleeping 6.5 h ours or less each schoo l night .
A d o l esc en t s h a v e ir r e g u l a r s l ee p p a t t e r n s; in particular, th eir weekend sleep schedu les
are much different than their weekday schedules, to some extent as a direct consequence of weekday
sleep loss. Th ese differences in clude both the quantity an d th e timin g of sleep. On e study of more
th an 3,000 adolescent s sh owed th at th e average increase of weekend over weekday sleep a cross ages
13-19 was one h our an d 50 m inu tes. (Wolfson an d Carskadon , 1998) In 1 8-year-olds, the average
discrepancy was more than two hours. In addition, 91 percent of the surveyed high school students
reported going to sleep after 11:00 pm on weekends, and 40 percent went to bed after 11:00 pm on
school nights.
Irregular sleep sched ules includ ing significan t d iscrepancies between weekdays an d
weekends can contribute to a shift in sleep ph ase (ie, tendency t oward morn ingn ess or
evenin gness), trouble fallin g asleep or awaken in g, an d fragmen ted (po or qua lity) sleep.
(Dahl an d Carskadon , 1995)
Consequences of Poor Sleep in Adolescents
Data on children, teens an d adu lts con firm th at sleep loss and sleep
difficulties can h ave serious det rimen tal effects. Research sp ecifically
on adolescents an d youn g adults is relatively new an d limited, butscient ists believe that m an y effects demon strated in studies and
clin ical observations o f adults are similar in ad olescents. Sleep
researchers, therefore, believe that insufficient sleep in teens and
youn g adults is linked to:
I n c r e a se d r i sk o f u n i n t e n t i o n a l i n j u r i e s a n d d e a t h .
As noted, drowsiness or fatigue has been identified as a principle
cause in at least 100,000 traffic crashes each year. In addition,
about 1 m illion , or on e-sixth , of traffic crash es in th e United States
are believed to be attributable to lapses in t h e drivers atten tion;
sleep loss and fatigue significantly increase the chances of such
lapses occurring. A North Carolin a state study foun d th at drivers
age 25 or youn ger cause m ore th an on e-h alf (55 percen t) of fall-
asleep crashes.
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4 A D O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation
The same sym ptom s of sleepiness th at con tribute to t raffic crash es can also play a role in n on -traffic
injuries, such as those associated with h an dling hazardous equipm ent in th e workplace or in th e
h om e. Furth ermore, adolescents who h ave not received sufficien t sleep and wh o con sum e even
small amou n ts of alcoho l are at greater risk of injury th an th ose who are not lacking sleep because
sleep loss has been shown to h eigh ten th e effects of alcoho l. (Roeh rs et al., 1994)
Lo w g r a d e s a n d p o o r sc h o o l p e r f o r m a n ce . High school students who describe themselves as
h avin g academic problem s and wh o are earning Cs or below in schoo l report getting less sleep, h av-
ing later bedtim es and h aving m ore irregular sleep schedu les th an studen ts reportin g higher grades.
(Note: A causal relation ship h as no t yet been establish ed.) (Wolfson an d Carskadon , 1998)
N eg a t i v e m o o d s (e.g., an ger, sadn ess an d fear), difficulty con trolling em otion s an d beh avior prob-
lems. In one study, female high school students who wen t to sleep on th e weekend two or more h ours
later than their typical weeknight bedt ime reported feeling m ore depressed than tho se who d id no t
stay up late on the weekends. (Wolfson and Carskadon, 1998)
Studies also suggest that sleep loss may be associated with a decreased ability to control, inhibit or
change emotional responses. (Dahl, 1999) Some signs of sleepiness, such as inability to stay focused
on a task, impulsivity, difficulty sitting still, and problems completing tasks, resemble behaviors
com m on also in atten tion deficit hyp eractivity disorder (ADHD) (Dahl, 1999). In addition , a 1995
study of students in transition from junior high to senior high school found that conduct/aggres-
sive behaviors were highly associated with shorter sleep times and later sleep start time. (Wolfson
et al., 1995)
I n c r e a se d l ik e li h o o d o f s t i m u l a n t u se (in cludin g caffeine an d n icotin e), alcoh ol and sim ilar
substances. (Carskadon , 1990)
Teens wh o are h eavily in volved in sch ool an d com m un ity activities, th eir jobs and oth er respon sibilities
appear to be at greater risk for the above effects of sleepiness than those who are less involved in activi-
ties an d wh o either do n ot h old jobs or wh o work fewer h ours. (Carskadon , 1990)
Wh at Can Be Don e
The consequ ences of insufficient sleep am on g adolescents are particularly impo rtant to un derstand
because th ey appear to be closely tied to key element s of hum an developm ent. Achievin g developm ental
goals during adolescence is essential for lifelong success and for what psychologists call social compe-
ten cy. In addition, th e transition from ch ildh ood to adu lthoo d is a critical tim e for seeding the
values an d h abits that will sh ape th eir lives. Th erefore, in tervention to im prove th e sleep pattern s of
adolescents is im portan t.
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Inf luencing Physiolog ical Sleep Pat t erns
Sleep research ers have established th at b asic sleep n eeds within ind ivid-
uals generally remain th e same th rough out t h eir lifetime. Furth ermore,
insufficient sleep accum ulates in to a sleep d ebt th at can ultimately be
relieved on ly through addition al sleep.
Circadian timin g system s are also very resistan t to ch ange. Behavioral
m ethod s, such as con trolled l ight exposure and ch ron oth erapy, can
som etimes h elp shift circadian timin g to more socially approp riate sleep
an d wake times. Because the circadian rh yth m s in teen agers are typical-
ly h igh ly sensitive to erratic sch edules, to effectively adju st th em
requires m akin g gradual, persisten t and co n sisten t chan ges. Adap ting
to a n early sch ool schedule following summ er or oth er vacation peri-
ods d uring wh ich very late sch edules are typically kept, for examp le,
can take several days to several weeks.
It is im portan t to recognize th at excessive sleepiness during th e day an d
oth er sleep prob lems can be an indication o f an un derlyin g biological
sleep d isorder. Accurate d iagno sis of disorders such as n arcolepsy, sleep
apn ea and p eriodic lim b m ovemen t disorder usually requires examin a-
tion by a q ualified sleep specialist and an overnight stay in a sleep labo-
ratory. In m ost cases, sympto m s of sleep disorders can be elim inated o r
minimized through the use of appropriate behavior modifications,
medication or other therapies.
Creat in g Sleep-Fri endl y School s
Scho ol system s can h elp positively influen ce adolescent sleep p atternsin several ways. Suggestion s includ e:
E d u c a t e teachers, school h ealth providers and oth er scho ol
person nel about ado lescent sleep n eeds and patterns, and about the
sign s of sleep loss and oth er sleep or alertn ess difficulties. Teach ers
and sch ool staff shou ld also be inform ed about accomm odations th at
might be n eeded by som e studen ts with ch ron ic sleep disorders.
I n t e g r a t e sleep-related edu cation in curricula so th at studen ts
can learn abou t th e ph ysiology and ben efits of sleep an d th e conse-quen ces of sleep deprivation. Relevant academic subjects include,
for example, biology, health and psychology. In addition, drivers
education courses shou ld cover the prevalence and prevention of
crashes related to drowsy driving.
CHANGING
SLEEP HABITS
Perhaps the most signifi-
cant behavioral change
that adolescents can
make and that their
parents can encourage
them to make is to
establish and maintain a
consistent sleep/wakeschedule. This is a good
practice for people at
all ages, but may be
especially important
for adolescents.
Understanding and
practicing other behav-
iors that are considered
good sleep habits are
also important. These
include getting enough
sleep, avoiding caffeine
and other stimulants late
in the day and alcohol at
night, gaining exposure
to bright light at appro-
priate times to reinforce
the brains circadiantim ing system, relaxing
before going to sleep
and creating an environ-
ment conducive to
quality sleep.
AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 5
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AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 7
Graduated licen sin g regulations to reduce the n um ber of adolescent s driving un supervised at night.
Ch ild labor laws to restrict the n um ber of h ours and t h e time of day that adolescen ts are permitted
to work.
Fun ding to sup port pu blic education an d scient ific research on topics such as the int errelation shipsamo n g sleep loss and injury, learning, an d perform ance, as well as epidem iological data. Relevan t
federal oversight of funded agencies include the National Center for Sleep Disorders Research and
oth er agencies of the Nation al In stitutes of Health, th e Food and Drug Adm inistration , th e
Departmen t of Transportation , the Departm ent o f Education , the Cen ters for Disease Con trol and
Prevention, and military branches.
Initiatives to ed ucate key adults who ha ve frequen t an d regular con tact with a dolescents (eg, caregivers
and auth oritarian s) about sleep, the signs an d h azards of sleepiness, and appropriate interven tion s
for children an d ado lescent s sh owin g signs of sleep difficulties or disorders. Con stituen ts include
parents, teachers, school administrators, school nurses and counselors, coaches, employers, health
providers (family practitioners, adolescen t m edicine specialists, an d th ose who specialize in m en tal
health or learning disabilities) and voluntary group leaders of youth-oriented organizations. In addi-
tion, p olice and emergen cy care personn el sh ould be train ed to recognize problem sleepiness and
distinguish its signs from those associated with drug or alcohol use.
Mak ing New Discoveri es
Sleep research h as established clear relation ships between sleepin ess, health , safety an d p roduct ivity.
However, th e sleep research field in general is relatively youn g, and scient ists still h ave m uch to learn
about th e role of sleep an d th e effects of sleep loss in h um an s. Add ition al stud ies on th e neu robiology,
genetics, epidem iology, and n eurobeh avioral an d fun ctional con sequences of sleepiness are needed.
(NIH, 1997) More studies specifically on the adolescent population are also needed, including interdisci-
plin ary research t o further exam ine sleeps role in adolescent develop m ent , health an d beh avior.
Referen ces
1. Acebo, Wolfson , Carskadon . Relation ship Am on g Self-Reported Sleep Pattern s, Health and Injuries
in Adolescents. Sleep Research Abstract, 1997 .
2. Brown et al. Adolescence, Sleepiness and Driving. Sleep Research 1996, 25: 459.
3. Brownlee, Shan non . Inside the Teen Brain. U.S. News and W orld Report. Augu st 9, 1999, 45-54.
4. Carnegie Foundat ion Council on Adolescent Development , 1996.
5. Carskadon MA, Acebo C, Richardson GS, Tate BA, Seifer R. An approach to studyin g circadian
rhythm s of adolescent h um ans. Journal of Biological Rhythms 1997, 12 (3): 278-289.
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8 AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation
6. Carskadon MA, Harvey K, Duke P, An ders TF, Litt IF, Dem ent W C. Pubertal ch an ges in daytim e
sleepiness. Sleep 1980, 2: 453-460.
7. Carskadon MA, Vieri C, Acebo C. Association between puberty and delayed phase preference.
Sleep 1993, 16: 258-262.
8. Carskado n MA, Wolfson AR, Acebo C, Tzischinsky O, Seifer R. Adolescent sleep pattern s, circadiantimin g, and sleepiness at a tran sition to early scho ol days. Sleep 1998; 21: 871-881.
9. Carskadon MA. Adolescen t sleepiness: Increased risk in a high-risk popu lation. Alcohol, Drugs and
Driving 1990; 5 (4): 317-328.
10. Carskadon MA. Pattern s of sleep and sleepiness in adolescent s. Pediatrician 1990, 17: 5-12.
11. Carskado n MA. Wh en worlds collide: Adolescent n eed for sleep versus societal deman ds. Phi Delta
Kappan 1999; 348-353.
12. Cent er for the Stud y and Preven tion of Violen ce. Youth Violence: A Public Health Co n cern.
Fact Sheet 9. June 1999.
13. Chervin, R. Letter to th e Editor, New England Journal of Medicine. 1999.
14. Dahl RE, Carskadon MA. Sleep an d its disorders in adolescence. Principles and Practices of Sleep
Medicine in the Child . W. B. Saunders Company, 1995: 19-27.
15. Dahl RE. Th e consequen ces of in sufficien t sleep for adolescents: Links between sleep an d em o-
tional regulation . Phi Delta Kappan 1999; 354-359.
16. Dahl RE. The impact of inadequate sleep on childrens daytime cognitive fun ction. Seminars in
Pediat ric Neurology 1996, 3(1): 44-50.
17 . Dem en t W C. The Promise of Sleep . Dell Publishin g, 1999.
18. Kryger MH, Roth T, Demen t W C. Principles and Practice of Sleep Medicine. Ph iladelph ia, PA: W.B.
Saunders Company, 1994.
19. Morrison DN, McGee R, Stan ton WR. Sleep problem s in ad olescence. Journal of the American
Academy of Child a nd Adolescent Psychiatry 1992, 31(1): 94-99.
20. National Highway Traffic Safety Adm inistration, U.S. Departmen t of Transportation . Crash es and
fatalities related to driver drowsin ess/fatigue. Research Notes. 1994.
21. Nat ional Inst itute of Mental Health. This Ch ild Needs Help . 1999.
22. National Institutes of Health, National Cent er on Sleep Disorders Research an d Office of
Prevention, Education, and Control. Working group report on problem sleepiness. Augu st 1997.
23. National Institutes of Health, National Center on Sleep Disorders Research an d Office of
Prevention, Education, and Control. Problem sleepiness in your patient. Septem ber 1997,
NIH Publication No. 97-4073.
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AD O LESCEN T SLEEP N EEDS A N D PAT T E R N S W National Sleep Foundation 9
24. National Institutes of Health, National Cent er on Sleep Disorders Research an d Office of
Prevention, Edu cation , and Con trol. Educating youth about sleep and drowsy driving. September 1998.
25. Nation al In stitutes of Health, National Insti tute of Mental Health. How biological clocks work.
1999, NIH Publication No. 99-4603.
26. National Institutes of Health , Nation al In stitute of Neurological Disorders and Stroke. UnderstandingSleep. 1998, NIH Publication No. 98-3440-c.
27. National Sleep Foundat ion. 1999 Sleep in America Poll Results. April 1999.
28. Pack AI, Pack AM, Rod gma n E, Cucciara A, Dinges DF, Sch wab CW . Cha racteristics of crashes
attributed to th e driver havin g fallen asleep. Accident Analysis and Prevention . 1995, 27 (6).
29. Roeh rs T, Beare D, Zorick F, Roth T. Sleepin ess an d eth ano l effects on sim ulated d riving. Alcohol
Clin Exp Research . 1994, 18 (1).
30. U.S. Departmen t of Health an d Hum an Services, Adm inistration for Ch ildren an d Fam ilies,
Adm inistration on Ch ildren, Youth an d Fam ilies, Family an d Youth Services Bureau. Understanding
youth development: Promoting positive pathways of growth. Jan uary 1997, Contract No. 105-94-2017.
31. Wolfson AR, Tzischin sky O, Brown C, Darley C, Acebo C, Carskadon MA. Sleep, behavior, an d stress
at the transition to senior high school. Sleep Research 1995, 24. (Abstract)
32. Wolfson AR, Carskadon MA. Sleep Schedu les and Daytime Fun ctionin g in Adolescent s. Child
Development 1998, 69: 875-887.
33. Wahlst rom, KL and Freeman CM. School Start Time Study: Report Summary. The Center for Applied
Research and Educational Improvement, College of Education and Human Development,
University of Minn esota. 1997.
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AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 11
PART TWO
Resource Guide
Pointers for Parents
1. Educate yourself about adolescent developm ent, including physical and behavioral chan ges
you can expect (especially those th at relate to sleep needs an d p atterns).
2. Look for sign s of sleep deprivation (insufficient sleep) and sleepiness in your children. Keep in
m ind th at th e signs are n ot always obvious, especially in yo un ger (pre-adolescent ) children .
Signs includ e:
difficulty wakin g in th e mo rnin g,
irritability late in the day,
fallin g asleep spon tan eously during qu iet times of the day,
sleeping for extra long p eriods on th e weeken ds.
Oth er sign s can m imic or exacerbate behaviors com m on ly associated with at tent ion d eficit hyperac-
tivity disorder (ADHD).
3. Enforce and m aintain age-appropriate sleep schedules for all children.
4. Talk with you r children abou t their individual sleep/wake sch edules an d levels of sleepin ess. Assess
how much time they spend in extracurricular and employment activities and how it affects their
sleep patt erns. Work with t h em to ad just th eir schedu les to allow for enou gh sleep, if necessary.
5. Provide a hom e environment conducive to heal thy sleep. Establish a quiet t ime in the evening
wh en th e lights are dimm ed an d loud m usic is n ot perm itted. Do n ot allow use of th e television ,
computer an d teleph one close to bedtime.
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12 AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation
6. Encourage your ch ildren to comp lete a sleep diary for 7 to 14 con secutive (and typical) days. The
diary can provide immediate information on poor sleep habits, and it can be used to measure the
effectiveness of efforts to change. Be sure to share the sleep logs or diaries with any sleep experts
or oth er h ealth p rofessional wh o later assesses your ch ilds sleep or sleepiness. Wh y n ot keep your
own sleep diary as well? (Sleep diaries are available from the National Sleep Foundation or from
you r local sleep center.)
7. If your childs sleep schedule during vacation is n ot synchron ous with upcomin g school or work
dem an ds, h elp him or h er adjust their schedu le for a sm ooth transition. Th is process can take
from several days to several weeks, so plan ahead!
8. If con servative m easures to shift your childs circadian rhythm s are ineffective, or if your child
practices good sleep h abits and still has d ifficulty stayin g awake at times th rough out th e day:
Consult a sleep expert. Excessive daytime sleepiness can be a sign of narcolepsy, sleep apnea,
periodic limb m ovemen t disorder and oth er serious bu t treatable sleep d isorders.
Discuss with teachers and sch ool officials ways to accom m odate your ch ilds needs, if needed.
Excessive daytime sleepiness due to sleep disorders or other medical conditions are covered
un der th e Am ericans with Disabilities Act an d t h e Disabilities Edu cation Act of 1997 (IDEA 97).
9. Be a good role mod el: make sleep a high priority for yourself and your family by practicing good
sleep habits. Listen to your body: if you are often sleepy during the day, go to sleep earlier, take
n aps, or sleep lon ger when possible. Consult a sleep exp ert if n eeded. Above all, dont allow an y
fam ily m emb er to drive when sleep deprived or drowsy.
10. Actively seek posit ive chan ges in your comm un ity by increasing public awareness about sleep an d
th e h armful effects of sleep deprivation an d b y supp orting sleep-smart p olicies. Request th at sleep
education be included in sch ool curricula at all levels and in drivers education courses. En courage
your school district to provide optimal environments for learning, including adopting healthy and
approp riate school start tim es for all stud ents.
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Tips for Teen s
1. Sleep is food for the brain. Lack of sleep can m ake you
look tired an d feel depressed, irritable o r an gry. Even
m ild sleepin ess can h urt your p erform an ce from taking
sch ool exam s to p layin g sports or video gam es. Learnhow m uch sleep you n eed to fun ction at your best
most adolescents need between 8.5 and 9.25 hours of
sleep each n igh t an d strive to get it every nigh t. You
shou ld awaken refresh ed, no t tired.
2. Keep con sistency in mind : establish a regular bedtime an d
waketime schedule, and maintain this schedule during
weeken ds an d sch ool (or work) vacations. Don t stray from
your schedule frequen tly, an d n ever do so for two or more
consecutive nigh ts. If you m ust go o ff schedule, avoid
delaying your bedtime by more than one hour. Awaken
the next day within two hours of your regular schedule,
an d, if you are sleepy du rin g th e day, take an early after-
noon nap.
3. Get into br ight l ight as soon as possible in the m orning,
but avoid it in th e even ing. Th e light h elps to signal to th e
brain when it sh ould wake up an d when it should prepare
to sleep.
4. Understand your circadian rhythm s. Then you can t ry tomaximize your schedule throughout the day according to
your int ernal clock. For examp le, to com pen sate for your
slump (sleepy) times, participate in stimulating activities
or classes th at are in teractive. Try to avoid lectu re classes
an d p oten tially un safe activities, includin g drivin g.
5. After lun ch (or after noon ), stay away from caffeinated
coffee and colas as well as nicotine, which are all stimu-
lants. Also avoid alcohol, which disrupts sleep.
6. Relax before going to bed. Avoid h eavy reading, studying
and compu ter games within on e hou r of going to bed.
Dont fall asleep with the television on flickering light
and stimulating content can inhibit restful sleep.
AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 13
Become a sleep-sm arttrendsetter
Be a bed head, not a
dead head. Understand the
dangers of insufficient sleep
and avoid them! Encourage
your friends to do the same.
Ask others how much sleep
theyve had lately before you
let them drive you somewhere.
Remember: friends dont let
friends drive drowsy.
Brag about your bedt im e.
Tell your friends how good
you feel after getting more
than 8 hours of sleep!
Do you st udy wit h a buddy?
If youre getting together after
school, tell your pal you need
to catch a nap first, or take a
nap break if needed. (Taking a
nap in the evening may make
it harder for you to sleep at
night , however.)
St eer clear of raves and
say no to all-nig ht ers.
Staying up late can cause chaos
in your sleep patterns and your
ability to be alert the next day...
and beyond. Remember, the
best thing you can do to pre-
pare for a test is to get plenty of
sleep. All nighters or late-night
study sessions might seem to
give you more time to cram for
your exam, but they are also
likely to drain your brainpower.
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14 AD O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation
High School Start Tim es
Sum mary of Findi ngs
Does chan gin g sch ool schedu les m ake a positive difference on adolescent sleep patt erns? Does this
approach affect academic achievemen t, beh avior and safety? Th e Cent er for Applied Research an d
Education al Im provem ent (CAREI) at th e Un iversity of Min n esota has stud ied th ese issues am on g bothsuburban an d urban sch ools. (Wahlstrom an d Freeman , 1997) Current d ata reveals th at after daily high
sch ool schedu les are delayed from early m ornin g start times:
Subu rban stud ents report th at, in general, th ey gain an extra hou r of sleep each sch oolday because
they m aintain th e same bedtime and extend th eir sleep in the m orning.
Most teachers observe that m ore studen ts are alert during th e first two periods of the school
sch edule an d fewer studen ts fell asleep at th eir desks. Som e studen ts feel th ey are better able to
com plete more of their ho m ework during sch ool h ours because th ey are m ore alert and efficien t
during the day.
Overall studen t atten dan ce increases and tardiness decreases.
Som e studen ts report eating breakfast m ore frequ ently.
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AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 15
Teachers in suburban sch ools report n oticeable improvem ent s in studen t beh avior, as evidenced by
quieter h allways between classes and less m isbeh avior in t h e lun chroom . Similarly, coun selors from
suburban sch ools describe th e sch ool atm osph ere as calm er, and report th at fewer stud ent s seek
help for stress relief due to academic pressures. Urban teachers, however, observed no general
improvement in student behavior.
Suburban teachers and students did not report any remarkable change or conflict in students
participation in n on academic activities, including work. However, teach ers an d studen ts from t h e
urban schools reported th at fewer stud ent s were in volved in extracurricular an d social activities,
an d th e later sch ool sch edules resulted in con flicts or comp romised earnings for studen ts who
worked after school.
Individual comm un ities can vary greatly in th eir priorities an d values, and ad optin g a policy of later
start tim es in h igh sch ools might n ot be opt imal for every comm un ity or even for every school within
a com mu nity.
Factor s t o ConsiderAdop ting later start times in h igh schools is a com plex process that touch es in some way n early every
aspect of the surrounding community. The list below provides insight into common issues and poten-
tial option s for chan ging high sch ool sch edules.
B el l sc h e d u l es of e le m e n t a r y a n d m i d d l e o r j u n i o r h i g h s ch o o l s in th e district. To a ccom -
modate for the shift in the schedule of school buses, food service and other nonacademic services
provided as part of th e sch ool experience, a chan ge in h igh school bell times often forces a shift in
local schools at oth er levels. For instan ce, som e districts h ave foun d th at switch ing times with th e
elem entary schoo ls is th e least cum bersom e in term s of scho ol system resources (an d is mo re in lin e
with both groups of studen ts sleep pat terns). In oth er districts, lower level schoo ls as well as high
sch ools have sh ifted th eir schedu les.
Tr a n sp o r t a t ion services and related issues. Transpo rtation services m ay be th e sin gle most
com plex, costly and co n sisten tly significant factor am on g scho ol districts, especially if schedule
chan ges result in t h e n eed for additional sch ool buses. Issues related to transportin g studen ts at all
grade levels to an d from school m igh t in volve public scho ol buses, forms of general pu blic trans-
portation (such as buses or subway systems) an d personal tran sportation p rovided by parents an d
high schoo l students.
Oth er con sideration s includ e availability of drivers and parking spaces for school bu s drivers;
chan ge in th e num ber of ho urs that drivers work, which can be influenced by the am oun t of oth er
traffic while en rou te; and t h e effect of the t imin g of schoo l buses on com m uter traffic. The im pact
of th e schoo l bus sch edule on availability of tran sportation for extracurricular activities may also
be imp ortant.
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At h l et i c p r o g r a m s a n d o t h e r ex t r a c u r r i cu l a r a c t i v i t ie s. The im pact on student ath letic
programs appears to be of h igh impo rtance consisten tly with in school districts th at h ave examined
th e plausibility of chan gin g sch ool bell tim es. Ch an gin g sch ool bell times directly in fluen ces the
timin g of athletic programs an d extracurricular activities, and studen ts who participate in ath letic
programs or extracurricular activities arrive hom e later as the schedu le chan ge generates a dom ino
effect. A m ajor concern for districts th at h ave outd oor ath letic programs is the shorten ed periodof daylight after the school day ends. Also, if school hours differ significantly among schools in
the same competitive league, further adjustments or negotiations may be needed to maintain the
same program.
The availability of coaches can become either a problem or a plus with delayed bell times. For example,
if coach ing staff work for a local elem en tary or m iddle schoo l as well as th e high schoo l, the int erre-
lation ship o f the school schedu les is significan t. On th e oth er han d, a later sch edule m ight facilitate
additional involvemen t by wo rkin g parents because th e time wo uld likely interfere less with th eir
professional sch edules. (This th eory could apply also to o th er extracurricular activities.)
U se o f t h e sc h o o l f o r c o m m u n i t y a c t i v it i e s, such as group m embership or adult education
programs, held d uring n on -schoo l h ours.
Th e imp act of bell times on th e accessibility of sch ool facilities for com m un ity grou p m eetings, adu lt
education al or religious programs an d oth er activities can generate great con troversy within th e
community. Some organizations may object to a request for even minimal schedule changes and, in
some cases, revenue potential from leasing facilities or providing other services must be considered.
Also, cleanin g services m ay have lim ited time between th e end of th e scho ol day and th e begin n ing
of evenin g activities.
Sc ho o l f ood s e r v i c e . Factors to be con sidered include wh eth er later start times would requ ire a
chan ge in m eal times or th e addition of breakfast services. Such service chan ges may be furth er
complicated by related issues such as the level of service provided by school cafeterias (onsite versus
offsite food preparation), auxiliary use of kitchen facilities for oth er com m un ity programs (such as
Meals on Wh eels or child care programs) and th e adapt ability of food service workers to tim e
chan ges. (Wah lstrom an d Freeman , 1997)
Em p lo ym en t of adolescents. Based on interviews with employers of high scho ol studen ts
(Wahlstrom an d Freeman , 1997), the n um ber of h ours available for teens to work would n ot be
significantly affected, alth ough some accom m odation s for after-school schedu les m igh t n eed to
be m ade by emp loyers. However, child labor laws that restrict th e nu m ber of h ours and time of
day th at adolescent s are permitted to work n eed to be studied in relation to sch ool ho urs.
Safe ty i s sues related to daylight and darkness. A significant issue in school schedule discussions is
the impact on safety for both students and others in the community. This can be reviewed from
several perspectives and with regard to all scho ol levels. First is the am oun t of dayligh t th rough out
the school year during the t ime th at students are com mu ting to an d from schoo l. Many wh o advo-
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AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 17
cate for older studen ts to begin th eir schoo l days earlier than youn ger stud ent s (e.g., grade school)
base th eir preference on th e belief th at older, m ore self-sufficient children walking to school or
waitin g for sch ool buses in m ornin g darkness is safer than sim ilar comm utes by youn ger studen ts,
for example.
Cr i m i n a l a n d o t h er r i sk y b e h a v io r s. Th e hou rs shortly after scho ol appear to be a critical time
for assessing safety risks among adolescents. Latch-key students, or those who return home from
school to an empty house, are more prone to risky behaviors during this time than their peers who
h ave supervision at h om e. (Carnegie Foun dation , 1996)
National stud ies an d an alysis of data from th e Federal Bureau o f In vestigation reveal th at on sch ool
days, 45 percent of juvenile violen t crim e takes place between 2:00 pm an d 8:00 pm , with th e
sharpest rise occurrin g between 2:00 pm an d 4:00 pm . (Wah lstrom an d Freeman , 1997; CSPV, 1998)
During these times, unsupervised adolescents are more likely to engage in acts of violence, as well
as sex an d recreation al use of alcoho l or drugs. Propon ents of delayed h igh sch ool start times sug-
gest th at th e resultant delayed sch ool closin g times could limit th e amou n t of tim e that ad olescents
are un supervised after schoo l.
I m p a c t on t h e f a m i l y. Research on th e degree to which ch anging school start tim es or m aking
oth er chan ges in t h e sch edules an d beh aviors of adolescents im pacts family mem bers is lim ited and
largely an ecdotal. Th e effects vary widely, depend ing o n family com position , socioecon om ic status,
cultural backgroun d an d values and ot h er factors.
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18 AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation
Issues to con sider when assessing th e poten tial im pact on th e fam ily wh en chan ging sch ool start
times include the contributions of the adolescent to the care of younger siblings or other household
m embers, preparing meals or han dling oth er househo ld chores, tran sportation n eeded an d used by
the adolescent as well as other household members (e.g., sharing the use of an automobile) and the
level of dependen ce on incom e generated by th e teen.
Household members would theoretically benefit indirectly from the positive effects of improved
sleep patterns and beh aviors on th e adolescent, such as improved m oods, behavior and int eractions
with others.
References
Carnegie Foundation Council on Adolescent Development, 1996.
Center for the Study and Prevention of Violence (CSPV). Youth Violence: A Public Health Concern.
Fact Sh eet 9. Jun e 1999.
Fairfax Cou nt y Public Scho ols. Report of the task force to study h igh sch ool open ing times. 1998.
Wahlstrom , KL an d Freem an CM. Sch ool Start Time Stu dy: Final Repo rt Sum m ary. The Cen ter for
Applied Research and Educational Improvement, College of Education and Human Development,
University of Minn esota. 1997.
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AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 19
Th e Zs to As ActA bi ll i nt rod uced i n Cong ress by U.S. Represent at ive Zoe Lof gr en (D-CA) t o encourage
later school st art t im es for secondary student s.
106t h CONGRESS / 1st Session
H.R. 1267
To provide grants to local education al agen cies that agree to begin sch ool for second ary stud ents
after 9:00 in the morning.
IN THE HOUSE OF REPRESENTATIVES
March 24, 1999
Ms. LOFGREN int roduced t h e following bill; which was referred to th e Com m ittee on Education and
th e Workforce.
A BILL
To p rovide gran ts to local educational agen cies th at agree to begin scho ol for second ary studen ts after
9:00 in the m orning.
Be it enacted by the Senate and House of Representatives of the United States of America
in Congress a ssembled,
SECTION 1. SHORT TITLE
This Act m ay be cited a s th e Zs to As Act.
SEC. 2. PROGRAM AUTHORIZATION.
(a) IN GENERAL Th e Secretary of Edu cation is auth orized to p rovide a gran t of n ot m ore
th an $25,000 to each local education al agency th at agrees to begin sch ool for second ary
students after 9:00 in the morning.
(b) ELIGIBILITY To be eligible to receive a grant un der t h is section , a local ed ucat ion al
agency shall subm it an application to th e Secretary providin g assuran ces that
(1) at th e time of th e application , secon dary sch ools served by th e local education al
agency begin sch ool before 9:00 in th e mo rnin g; an d
(2) n ot later th an 2 years after th e date of subm ission of the ap plication, second ary
sch ools served by such agency shall begin classes after 9:00 in th e m ornin g.
(c) USES OF FUNDS A local educat ion al agency t h at receives a grant un der th is Act m ay
use such grant fund s to pay for the adm inistrative and op eratin g costs associated in ch an gin g
th e h ours of operation o f second ary schoo ls served by such agency.
(d) DEFINITIONS For p urp oses o f th is Act
(1) th e term secon dary sch ool h as the same m eanin g given such term in section 141 01(25)
of the Elemen tary and Second ary Education Act of 1965
(20 U.S.C. 8801(25)); and
(2) the term Secretary means the Secretary of Education.
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20 AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation
Drowsy Driving Report
It is difficult to attribute crashes to sleepiness because there is no test to determine its presence as
th ere is for in toxication (i.e., a breath alyzer). In addition , th ere are no standardized criteria for dete r-
m inin g driver sleepiness and t here is little or n o police trainin g in ident ifying drowsin ess crash factors.
Also, to date, six states (Alabam a, Missouri, Arkansas, Delaware, Massachusetts, an d Wiscon sin ) do n ot
have a code for sleepiness on th eir crash rep ort forms.
The U.S. Nation al Highway Traffic Safety Adm inistration (NHTSA) estim ates th at ap prox ima tely
100,000 police-reported crashes annually (about 1.5% of all crashes) involve drowsiness/fatigue as a princi-
pal causal factor. A con servative estim ate of related fatalities is 1,500 an nually or 4% of all traffic crash
fatalities. At least 71,000 people are in jured in fall-asleep crashes each year. NHTSA estimates th ese crashes
represent $12.5 billion in mo n etary losses each year.
Drowsiness/fatigue may play a role in crashes attributed to other causes. About one million crashes
an nu ally one-sixth o f all crashes are th ough t to b e produced by driver ina ttention /lapses. Sleep
deprivation an d fatigue m ake such lapses of attention m ore likely to occur.
In a 19 99 NSF po ll, 62% of all adults surveyed reported driving a car or ot h er vehicle while feeling
drowsy in th e prior year. Twen ty-seven percent reported th at th ey had, at som e time, dozed off
while driving. Twenty-three percent of adults stated that they know someone who experienced a
fall-asleep crash within the past year.
People tend to fall asleep m ore on h igh-speed, lon g, boring, rural highways. New York police
estim ate th at 30% of all fatal crash es alon g th e New York Thruway occurred because th e driver
fell asleep at the wheel.
Who Is Most At Risk?
All drivers who are: Sleep-deprived o r fatigued
Driving lon g distances withou t rest breaks
Driving through the night, the early
afterno on, or at oth er t im es wh en th ey are
normally asleep
YOUN G PEOPLE
Sleep-related crashes are m ost comm on in you n g people, who ten d to stay up late, sleep too little, and
drive at night. In a North Carolina state study, 55% of fall-asleep crashes involved people 25 years old
or younger. 78% were males. The peak age of occurrence was 20.
SHIFT WORKERS
25 m illion Am ericans are rotating sh ift workers. Stud ies suggest th at 20% to 30% of th ose with n on -
traditional work schedules have h ad a fatigue-related d riving m ish ap with in t h e last year. Th e drive
h om e from work after th e n igh t shift is likely to be a p articularly dan gerous on e.
Taking m edication th at increases sleepiness
or drin king alcoho l
Driving alon e
Driving on long, rural, borin g roads
Frequ en t t ravelers, e.g., business travelers
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AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation 21
CO M M ERCIAL DRIVERS
Truck drivers are especially susceptible to fatigue-related crashes. In addition to the high number of
m iles driven each year, man y truckers m ay drive du ring th e nigh t wh en t he b od y is sleepiest. Truckers
m ay also h ave a h igh prevalence of a sleep an d breath ing disorder called sleep ap n ea. Studies suggest truck
driver fatigue m ay be a con tributing factor in at least 30 to 40 p ercent of all heavy truck acciden ts.
PEO PLE WITH UN TREATED SLEEP DISO RDERS
The presence of an untreated sleep disorder increases the risk of crashes. Disorders such as sleep apnea,
n arcolepsy, and p eriodic lim b m ovemen t disorder, all of wh ich frequen tly lead to excessive daytime
sleepiness, afflict an estim ated 30 m illion Am ericans. Most p eople with sleep d isorders remain un diag-
nosed and un treated.
W hat Are Ef f ect ive Count erm easures?
Before motorists embark on their trips, they should:
Get a good n igh ts sleep. Wh ile th is varies from individual to individual, th e average adu lt
requires about 8 h ours of sleep a n igh t; adolescents n eed 8.5 to 9.25 hou rs each n igh t.
Plan to drive long trips with a companion. Passengers can help look for early warning signsof fatigue or switch drivers wh en n eeded. Passengers shou ld stay awake to talk to th e driver.
Schedule regular stops, every 100 miles or 2 hours.
Avoid alcoh ol and m edication s (over-th e-coun ter and prescribed) th at m ay impair performan ce.
Alcohol in teracts with fatigue; in creasin g its effects just like drin king on an emp ty stom ach.
Con sult your ph ysician or a local sleep d isorders cen ter for diagno sis and treatmen t if you
suffer frequen t daytim e sleepiness, have d ifficulty sleeping at n ight often , and /or sn ore
loudly every n igh t.
Once driving, motorists should look for the following warning signs of fatigue:
You can t rem em ber th e last few miles driven.
You drift from your lan e or h it a rum ble strip.
You experience wand erin g or discon n ected tho ugh ts.
You yaw n rep eatedly .
You h ave difficulty focusing or keepin g your eyes open .
You tailgat e or m iss traffic signs.
You h ave trouble keeping your h ead up .
You keep jerking your veh icle back into th e lane.
If you are tired, recognize that you are in danger of falling asleep and cannot predict when a microsleep may occur.
Dont count on the radio, open window or other tricks to keep you awake.
Respond to sym ptom s of fatigue by fin ding a safe place to stop for a break.
Pull off into a safe area away from traffic and take a brief nap (15 to 45 minutes) if tired.
Drin k coffee or an oth er source of caffeine to prom ote sh ort-term alertn ess if n eeded.
(It takes about 30 m inu tes for caffeine to ent er the b loodstream.)
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Minnesota Medical Association Resolutions: Models for Change
The Min n esota Medical Association (MMA) has been a catalyst for policy ch an ges regardin g sch ool start
times and education related to d riving and fatigue. MMA h as demon strated th e impact th at applying
sound policies based on scientific evidence can have on local, statewide, and national levels.
School St art Times
In 1993, t h e Minn esota Psychiatric Society subm itted a resolution ent itled Sleep Deprivation in
Adolescents t o th e Minn esota Medical Association . MMA subsequent ly passed th e resolution , wh ich
provided for an ed ucation al cam paign explaining th e need for more sleep during adolescen ce than
durin g childhoo d, th e biological sh ift to a later sleep patt ern in adolescence, and th e impact of inade-
quate sleep on driving safety and school performance. The MMA will urge local school districts to
elim inate early starting h ours of schoo l for teenagers.
Th is resolution led to th e n ations first sch ool district (Edina, Min n esota) to adop t d elayed schoo l start
times based on scientific evidence of ph ysiological chan ges in sleep n eeds and patterns associated with
pu berty. This landm ark decision op ened th e doors to additional research about sleep in adolescents and
its imp act on their cognitive and oth er fun ction s, and sparked heightened p ublic awaren ess about th is
issue across the United States.
Drow sy Driving
On September 28, 1999, the Minnesota Medical Association adopted two sleep-related resolutions
highlighting the dangers of drowsy driving. Similar language was submitted to the American Medical
Association (AMA) for con sideration by its Hou se of Delegates at th e 1999 In terim Meetin g. AMA
consequently adopted Resolution 418 (I-99) with slight modifications.
RESOLUTIO N 31 4
RESOLVED, that th e Minn esota Medical Association d efine sleepiness behin d th e wheel as a m ajor pub lic
h ealth issue through the d evelopmen t of a public education campaign , and be it further
RESOLVED, th at th e Min n esota Med ical Association delegation to t h e Am erican Med ical Association
(AMA) submit a resolution to the AMA calling on the AMA to define sleepiness behind the wheel as
a m ajor public health issue through the d evelopmen t of a n ation al public education campaign.
RESOLUTION 315
RESOLVED, th at th e Min n esota Medical Association wo rk with in terested o rganization s to p rom ote th e
incorporation of an edu cational compo nen t on th e dan gers of drivin g wh ile sleepy in all drivers educa-tion (for all age groups) in the state of Minnesota, and be it further
RESOLVED, th at th e Minn esota Med ical Association delegation to t h e Am erican Med ical Association
(AMA) submit a resolution to the AMA calling on the AMA to encourage all state medical associations
to prom ote th e incorporation of an education al com pon ent on the dangers of driving wh ile sleepy in
all drivers education (for all age groups) in each state.
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AD O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation 23
Am erican Medical Association Hou se Of Delegates
Resolut ion 418: Sleepy Drivin g
I N T R O D U C E D BY : Minn esota Delegation
R E F E R R E D T O : Reference Com m ittee D Public Health (Willarda Edwa rds, MD, Chair)
The following incorpora tes a mend m ents a s a dopted by th e AMA House of Delega tes, Decemb er 1999.
Source: Preliminary reports of the AMA House of Delegates at its 1999 Interim Meeting. AMA
cau tions th a t such reports should not b e considered fina l an d th a t only the Officia l Proceedings
of th e House of Delega tes reflect officia l policy of th e a ssocia tion .
Wh ereas, Motor veh icle crash es are a leading cause of inju ry and death in th e United States; and
Whereas, The safe operation of a motor vehicle requires alertness as well as quick and accurate
perception, judgment, an d action; and
Wh ereas, An alyses perform ed b y th e Nation al Highway Traffic Safety Adm inistration (NHTSA)
estim ate th at 1%-3% of U.S. h ighway crash es and 4% of fatal mo tor veh icle crash es are caused b y
driver sleepin ess; and
Wh ereas, Surveys indicate th at m any individuals have experien ced excessive sleepiness while drivin g,
while 60% of sleep-related crash es are attributab le to d rivers younger th an 30; and
Whereas, The reasons for sleepiness in drivers include sleep disorders (e.g., obstructive sleep apnea),
sleep d eprivation, an d cu m ulative sleep loss; and
Wh ereas, Physician s have an impo rtant role in preventin g sleep-related in juries and death s by
assessm ent an d follow-up of excessive sleepiness in th eir patients an d d iscussion of possible h ealth an d
safety implications; and
Wh ereas, Ph ysician s sh ould be alert to th e possibility th at patient s may be imp aired by alcoho lism an d
oth er med ical cond itions th at can affect drivin g capabilities; an d
Whereas, Physicians need to understand the range of sleep disorders, including their diagnosis, treatment,
and consequences; and
Whereas, Many drivers, without impact, instinctively open the windows, turn up the radio, and/or
drink caffeine to fight sleepiness while driving; and
Wh ereas, Drivers education courses provide an im portan t opp ortun ity to teach n ew drivers about t h e
dangers of driving while sleeping; and
Wh ereas, Education al campaigns to em ph asize the fact that sleep is a biological im perative and th at
sleepiness is n either a mino r ann oyan ce nor th e sign of a personality defect are recom m end ed to
add ress sleepiness while driving; th erefore be it
RESOLVED, Th at th e Am erican Medical Association define sleepiness beh ind th e wh eel as a major pu blic
h ealth issue an d en courage a n ational pu blic education cam paign by approp riate federal agencies an d
relevant advocacy group s, an d be it furth er
RESOLVED, That the American Medical Association encourage all state medical associations to promote
th e in corporation of an edu cational comp on ent o n t h e dan gers of drivin g while sleepy in all drivers
education classes (for all age groups) in each state.
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24 AD O LESCEN T SLEEP N EEDS AN D PAT T E R N S W National Sleep Foundation
Other Resources
Readers are encouraged to review the references listed in the Research Report and in the Resource Guide, a s
well as th e resources below. Please n ote th at th e following lists are inten ded to serve as a startin g poin t
for addition al information an d d o n ot represent an exhau stive list of available resources.
Organizations
A AA Fo u n d a t i o n f o r T r a f f i c Sa f e t y
1440 New York Avenue, NW
Suite 201
Wash ington , DC 20005-6001
www.aafts.org
Am e r i ca n Ac a d e m y o f Ch i ld &
A d o l esc en t P s y ch i a t r y
3615 W iscon sin Ave., NWWash ington , DC 20016-3007
www.aacap.org
Am e r i ca n Ac a d e m y o f P e d i a t r i c s
141 North west Poin t Boulevard
Elk Grove Village, IL 60007-1098
www.aap.org/family/sleep.htm
A m e r i c a n A ca d e m y o f Sl ee p M e d i c in e
6301 Band el Road
Suite 1 01
Rochester, MN 55901
www.aasm.org
A m e r i c a n As so c i a t i o n o f
Sc h o o l Ad m i n i st r a t o r s
1801 N. Mo ore Street
Arlington , VA 22209
www.aasa.org
A m e r i c a n Sc h o o l H e a l t h A sso c i a t i o n7263 State Route 43
P.O. Box 708
Kent, OH 44240-0013
www.ashaweb.org/
Bo a r d o n Ch i l d r e n Y ou t h ,
a n d F a m i li es
Nation al Academ y of Sciences
Institute of Medicin e
2101 Con stitution Avenu e, HA 156
Washington, DC 20418
www.nation al-academies.org/cbsse/bocyf
Ce n t e r f o r A p p l i e d R ese a r c h a n dEd u c a t io n a l I m p r o v em e n t
College of Education & Human Development
265-2 Peik Hall
159 Pillsbury Drive SE
University of Minn esota
Minn eapolis, MN 55455-0208
http://carei.coled.umn.edu
D ep a r t m e n t o f Ad o l e sc en t a n d
Sc h oo l He a l t h ( DASH)
National Cen ter for Chron ic Disease
Prevention and Health Promotion
Cent ers for Disease Cont rol and Prevention
1600 Clifton Road, NE
Atlan ta, GA 30333
www.cdc.gov/nccdphp/dash
I n s u r a n c e I n s t i t u t e f o r
H i g h w a y Sa f e t y
1005 N. Glebe Road , Suite 8 00
Arlin gton , VA 22201www.iihs.org
www.hwysafety.org
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AD O LESCEN T SLEEP N EED S AN D PAT T E R N S W National Sleep Foundation 25
M i nn e so t a M e d i c a l As soc i a t i on
Suite 300 Broadway Place East
3433 Broadway Street NE
Minn eapolis, MN 55413
www.mnmed.org/
N a t i o n a l A sso c i a t i o n o f S ch o o l
Nur s es , In c .
P.O. Box 1300
Scarborou gh , ME 04070
www.nasn.org
N a t i o n a l Ce n t e r o n Sl e ep
Di so r de r s Res ea r c h
National Heart, Lun g, and Blood In stitute
National In stitutes o f Health
9000 Rockville Pike, Building 31
Bethesda, MD 20892
www.nhlbi.nih.gov/about/ncsdr/index.htm
Na t i o n a l Ce n t e r f o r I n j u r y P r e v en t i o n
a n d C on t r o l
4770 Buford Highway, NE
Atlan ta, GA 30341 -3724
www.cdc.gov/ncipc
Na t i o n a l Ed u c a t i o n A sso c i a t i o n1201 16th Street NW, Suite 521
Wash ington , DC 20036
www.nea.org
Na t i o n a l H ig h w a y T r a f f ic
Sa f e t y A d m i n i st r a t i o n
400 Seventh Street SW
Wash ington , DC 20590
www.nhtsa.dot.gov
N a t i o n a l P a r e n t T e a c h e r A sso c i a t i o n
330 N. Wabash Avenu e
Ch icago, IL 60611
www.pta.org
Na t i o n a l Sc h o o l B o a r d s Fo u n d a t i o n , I n c .
1680 Du ke Street
Alexandria, VA 22314
www.nsbf.org
N a t i o n a l Sl e ep Fo u n d a t i o n1522 K Street, NW
Suite 5 00
Wash ington , DC 20005
www.sleepfoundation.org
P a r e n t s Ag a i n s t T i r ed T r u c k e r s
P.O. Box 209
Lisbon Falls, ME 04252-0209
www.patt.org
Soc i e t y f o r Ado l e s c en t M e d i c i n e
1916 NW Copp er Oaks Circle
Blue Springs, MO 64 015
www.adolescenthealth.org/
St u d e n t s A g a i n s t D e st r u c t i v e D ec i si o n s
101 Depot Road
Chath am, MA 02688
U.S. De p a r t m e n t o f H e a lt h a n d
H u m a n Se r v ic esDivision of Children an d Yout h Policy
200 Indep end ence Avenu e, SW
Wash ington , DC 20201
h ttp://aspe.os.dh h s.gov/h sp/cyph om e.h tm
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Web Resources
See also Website addresses under Organ izations.
Adol e sc e nc e D i r e c t o r y On -L in e
A service of the Center for Adolescent Studies at Indiana University, this site provides information for
profession als, parent s, and teens abo ut a wide ran ge of adolescent issues.
http :/ /www.education .ind iana.edu/cas/adol/adol.htm l
AMA Ado l e sc e n t He a l t h On- Li n e
Sponsored by the American Medical Association, this site includes details about the AMA Guidelines for
Ado lescen t Preven tive Services (GAPS); abstracts of selected recent reports a n d o th er resources.
http://www.ama-assn.org/adolhlth
Ed u c a t i o n R eso u r c e Or g a n i za t i o n s D ir e ct o r y
Published b y th e U.S. Departmen t of Education th is directory is in tend ed to h elp users identify and
contact organization s th at provide in forma tion an d assistan ce on a broad ran ge of education-related to pics.
http://www.ed.gov/Programs/EROD/
Fa m i ly Ed u c a t i o n N et w o r k
Sponsored by a consortium of public sector and private sector relationships including major education-
al an d profession al association s th is on lin e compan y provides education al an d ch ild-developm en t
resources and services for fam ilies, corporate em ployers, schools and comm un ities. Th e Nation al Parent
Teacher Associations exclusive Intern et p artner prom oting family involvemen t, Fam ilyEducation
Network produces familyeducation.com, teachervision.com, myschoolonline.com, and infoplease.com.
www.familyeducation.com
Sl e ep H o m e P a g e s
Fun ded in part by a grant from th e National Institute of Mental Health, th is Website offers a com pre-
h ensive resource of sleep-related information for consum ers, research ers, educators, studen ts an d
clinicians. www.sleephomepages.org
Sl e ep f r o m A t o Z z z
Developed by an international group of adolescents, this site covers a wide range of sleep-related infor-
m ation for teen s and earned a Silver Award in th e 1999 ThinkQu est In ternet Ch allenge, Sports &
Health Category. http://www.thinkquest.org/library/25553.shtml
Yo u t h I n f o
A project of the U.S. Department of Health and Human Services, this site includes a fact sheet profile
of Americas youth; full texts or summaries of various reports, publications, and speeches from govern-
mental and non-governmental sources; grant information and other resources. http:/ /youth.hhs.gov
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Nat ion al Sleep Found ati on
1522 K Street, NW, Suite 500, W ashington , DC 20005
Tel 202.347.3471, Fax 202.347.3472
E-mail n sf @sleepfou n dat ion .org
2000 National Sleep Foundation